Have you found your Valentine? Ask at the registration desk!

DVD 1: Introduction

Right First Time 24/7 Staff workshop 14 February 2014

Sue Jacques Chief Executive

Purpose for today Discuss our evolving clinical strategy Share work being done NOW to drive it forward Consider what this could mean for you, your service, and the Trust Discuss with the Executive and Senior Clinical Leadership team Make new friends and influence people!

Share your questions, thoughts and ideas…

Have you found your Valentine?

Right first time 24/7 Our evolving clinical and quality strategy

The story so far… 2011: Integrated hospital and community services 2012/13: Discussions with staff and stakeholders around key services as an integrated provider 2013/14: “Getting care right for the emergency patient, especially the frail elderly, must be the priority”

The case for change

“there are patients, usually frail elderly, who are admitted to hospital unnecessarily… because services are not organised to respond to their needs at an early stage.”

“There are days when the 95% target for A&E 4 hour wait is not achieved. Multiple ambulances can be waiting outside A&E to hand over patients.”

“Patients are regularly boarded onto surgical wards. Patients are waiting in A&E for beds to become available for them to be admitted.”

“Many of our rotas at both junior and senior level are supported by locum staff, which impacts on continuity of care and consistency of quality.”

“Recent surveys of medical trainees show that the Trust is not a placement of choice for junior doctors.”

“We are experiencing difficulties in recruiting to nursing vacancies, where we want to make ward managers and team leaders supernumerary and strengthen teams.”

“The Francis report revealed a tolerance of poor standards and risks to patients. We cannot take for granted that similar problems could not happen here.”

In addition, there are issues from : HSMR data Incidents Coroner reports

National financial context £30bn gap

Local context: Better Care Fund 2015/16 D/tonDDESN DurhamTotal Total Fund Contribution £7.2m£22m£17.2m£46.4m Supporting Existing Health Services £3.9m£11.9m£9.2m£25.1m Impact on acute services at CDDFT £3.1m£6.2m£6.3m£15.6m

Local context: Better Care Fund 2015/16 D/tonDDESN DurhamTotal Total Fund Contribution £7.2m£22m£17.2m£46.4m Supporting Existing Health Services £3.9m£11.9m£9.2m£25.1m Impact on acute services at CDDFT £3.1m£6.2m£6.3m£15.6m We are also seeing the impact of new commissioning arrangements, especially on Health and Wellbeing services.

“Our reserves can only be spent once, so it is important that we do so wisely, on investments and capital schemes that will help us achieve our vision.”

“Our reserves can only be spent once, so it is important that we do so wisely, on investments and capital schemes that will help us achieve our vision. “However, pressures on services means reserves for investment are being eroded.”

Right first time 24/7 How do we respond?

Our vision Right person Right place Right time First time 24/7

Our principles Deliver core acute specialties across both acute sites Specialty departments delivering care across two acute sites and beyond Consultant delivered care Patients in homes not hospital, clinicians to patients Care closer to home where safe, effective and efficient Older person at the heart of service delivery, supported in the community

“We need to stop thinking of ourselves as a group of small acute hospitals, merged with community services, and really create a vision of one large progressive integrated provider.” A cultural shift is required:

“Services organised so that consultant review, clinical staff and diagnostic and support services are readily available on a 7-day basis.” A cultural shift is required:

“We need to ensure that steps to keep patients out of hospital and support them in the community are clinically effective and cost efficient at a time when there are pressures on budgets.” A cultural shift is required:

“We need to respond to the challenge to improve service quality and outcome. This will require new models of care that are more efficient than those we currently operate.” A cultural shift is required:

Getting involved Today’s event! One hour roadshows Meetings with the project team Service transformation Clinical reference group…

Executive and clinical leaders Clinical strategy steering group Community care/Care closer to home Unplanned care/Acute and long term conditions Planned care/Surgery and diagnostics Clinical reference group Proposed Workstreams

Executive and clinical leaders Clinical strategy steering group Community care/Care closer to home Unplanned care/Acute and long term conditions Planned care/Surgery and diagnostics Clinical reference group Proposed Workstreams Interested? Why not sign up over coffee?

What do our stakeholders say?

Clinical Programme Board priority areas…  Elderly/frail elderly  Urgent Care  Long Term Conditions  Mental Health and Dementia

“Ambulances need to become places of treatment” “Voluntary sector will build more provision into community services” “More emphasis on independence and self management” “Effective care closer to home will require excellent case management and more carer support” “Disinvestment: There are some hard decisions we need to take together” “We need to learn lessons quickly!” Right First Time Stakeholder Event, 6 February 2014

“Achieve strategic shift (15%) acute activity to outside of hospital via transformational schemes” Right First Time Stakeholder Event, 6 February 2014

acute services

We need credible alternatives to hospital admission

Everybody up!

The 15% challenge

Working with your Valentine: What skills will our workforce need with 15% of work shifting out of an acute setting?

Coffee

DVD2: Front of house

Doing things differently: Unscheduled care – Derek and Stuart Intermediate care – Debbie and Linda Surgery and diagnostics – Janet and Ian

DVD3: Surgical CDU

Discussions questions Care closer to home: intermediate care How do we take advantage of new intermediate care arrangements to keep patients out of hospital and reduce length of stay? What will it mean for our patients and their families? How will it change our acute services? What will it mean for community services? How does this contribute to the 15% challenge?

DVD4: Care co-ordination centre

DVD5: CREST

ALTC: unscheduled care The action plan Work being done in ED ECIST Discussion How can we support the action plan for unscheduled care within our services How can this contribute to 15% challenge

Surgery and diagnostics Focus on surgical specialties and what they are doing to support unscheduled care CDU and the no pyjamas pathway CT pilot – removing unnecessary waits Reference to business case as route in to centres of excellence Discussion Are there other area where we could be removing unnecessary waits Are there other areas where we could assess before we admit How can this help the 15% challenge

Feedback by ACOOs

Lunch

Friends and Family Test “How likely are you to recommend us to your friends and family if they needed similar care or treatment?”

Friends and family test… Would you recommend your friends and family to be treated in your service?

Ask not… what your country can do for you… Ask… what you can do for your country.

Getting better all the time… What can I do to improve my service? What could my team do to improve our service?

Getting better all the time… What can I do to improve my service? – personal pledge for the pledge board What could my team do to improve my service? – take to your team meeting

Introducing the senior team… Questions and answer forum

DVD6: Prevention first

Taking Action in 2014/15 Care groups have been working on their plans We have to submit 2 and 5 year plans over the next few months We need a robust “winter” surge plan 2014/15 is a big year in terms of activity, big year in terms of change 15% challenge What are our breakthroughs for 2014/15?

Tea

Care group “huddles” What are our breakthroughs? What are the priorities for 2 and 5 years What are our priorities for the “winter” surge plan?

Feedback Breakthrough areas from each care group

Next steps Staff workshops and roadshows Working with partners on Better Care Fund proposals Submitting 2 year and 5 year plans Developing a robust winter plan for 2014/15 Meeting required national and local standards (SeQuIHS)