Yvonne McWean Lambeth Primary Care Trust 24th February 2009

Objectives To introduce the Strategic Vision for Intermediate Care To understand the definition of intermediate care To understand the drivers for change To gain an understanding of the local picture To look at the opportunities for a new model of intermediate care To understand can benefit from intermediate care To understand why we need user involvement

Strategic Vision for Intermediate Care Services in Lambeth Developed jointly with LBL ACS Sets out direction and vision for continued development and provision of intermediate care in Lambeth over the next 3 years Local services have developed and while they have progressed in some areas there are still a number of gaps Need to deliver in a more integrated and effective way with the local authority and others

Defining Intermediate Care Intermediate care is a range of needs-led, transitional and integrated services that are intended to maximize health gain and: to prevent unnecessary admission to an acute hospital; to facilitate timely discharges from acute hospital; to reduce the use of avoidable institutional care; and to support optimal independent living.

Other criteria: Other criteria often included are that input: - is time limited, usually lasting no longer than six weeks is provided on the basis of a comprehensive assessment, a structured care plan and goals that involve active therapy, treatment and an opportunity for recovery; involve multi-professional working, within a single assessment framework

National and Local Drivers Wide range of drivers: Nationally – NSF’s, Our health, our care, our say, development of case management models, National Stroke Strategy (early supported discharge), delivery of waiting list targets Locally – Joint OP strategy, management of people with LTCs, Lambeth’s Commissioning Strategy Plan and Healthcare for London – moving more care closer to home, Stroke Modernisation Initiative, LBL Sheltered Housing Review

Current provision Lambeth Community Care and Pulross Intermediate Care Centres – two 20- bedded units providing a range of services Supported Discharge/Rapid Response Team – capacity 50 patients cared for in their own homes Investment of nearly £3 million – PCT funded and provided (2006/07 figures) Over £200k invested in inpatient services for 2007/08 Service utilisation (ref cost 2006/07) Inpatient 69% SD/RRT average number of contacts per day 66 Approx 20% of SD/RRT referrals are declined Costs – 28 day admission varies from £5.7k - £7k depending on costs used SDT – 28 days £1.9k- £3.4K depending on costs and level of care package (pg20)

Local picture - Stats Over 65’s account for 23,540 (8.75% of the population) – compares to 11.8% for London No big increase in overall numbers expected – 25,389 by Average age – 80 years with the over 65’s accounting for 86% of our patients 80% of our referrals come from hospitals Reasons for admission - falls, post-acute illness, post- operative rehab Average length of stay – 27 days 72% of patients are discharged back to their own home from an IC bed

Conclusions No access to services 24/7 Community services are running above capacity – inpatients below Service provision has predominantly concentrated on supporting hospital discharge – (in line with national picture and evidence base) Perception of staff regarding increased acuity of patient condition – especially those admitted to inpatient units ↓ number of people with stroke and heart failure admitted to inpatient units since development of community services – HF nurses, ESD team for stroke Low referral rate from primary care and LAS 40% of people on SDT caseload also in receipt of social care package Many people who would benefit from intermediate care interventions are declined service as they are identified as having no rehabilitation need

Work streams The project board identified key work streams : Community services Bed based services Accessing services Information technology Case finding User involvement

Opportunities for the new model of intermediate care Providing a more community orientated model with rehabilitation closer to and wherever possible in the patients own home A partnership model with joint services from health and social care Providing services for more people Proactive long term condition management A comprehensive and responsive service capable of flexing to meet patient need Person-centred approach Consistency and equity of access Developing extra care housing Utilising assistive technology

Person Centred Nursing care Components of Community Intermediate Care Services Admission avoidance Rehabilitation Re-enablement Therapy services Social care Medical support Rapid response Medicines management GP services Extra-care housing Community mental health service Older people’s services Voluntary service Stroke pathway Equipment Provision Psychological services Assistive technology Long term conditions management Discharge Facilitation Falls pathway Day hospitals Reduce long term care Long term condition management

Who can use intermediate care? Adults Residents of Lambeth People who are medically stable People who demonstrate the potential to benefit from time limited rehabilitation People who require multi-disciplinary intervention

And either: are experiencing an acute health problem (e.g. fall, infection) from which they are expected to recover or greatly benefit from a short period of support to facilitate recovery thereby preventing an unnecessary hospital admission, or require further active rehabilitation to facilitate discharge from hospital following an episode of illness or injury, or have complex problems which would benefit from a co-ordinated rehabilitation package, or require further assessment and a period of recuperation before commencing a rehabilitation programme, or require a period of recovery to enable recuperation from illness or injury before assessment regarding their long term placement needs, or require intervention and support as part of the planned management of a long term condition.

User involvement Understand experiences of previous service users Understand the expectations of future service users Inform future decision making about intermediate care

Exercise – who can benefit from intermediate care A patient who has had a knee replacement? A patient with COPD who has suffered several exacerbations that have reduced their functional independence? A patient who requires only SLT following their stroke? A patient with a complex brain injury who will need specialist long term rehabilitation? A patient who has had a fall and gets easily confused due to their dementia? A patient with an unexplained high fever, fatigue and confusion?

Any Questions?