Commissioning alternatives to hospital Dr Seth Rankin Rob Persey

Structure Introduction to the Community Ward in Wandsworth. Platform for other admission diversion schemes. Not just health and social care – everybody’s responsibility!

What is a Community Ward? A new way to structure Community Service. Multidisciplinary Platform for providing integrated health & social care in the community. Towards developing a comprehensive service designed to deliver acute & chronic healthcare at home.

An Analogy… Hospitals Acute & Chronic Patients A&E, MAU, Inpatient, etc MDT Ward Rounds Bedside & Paper Nurses Doctors Social Workers Pharmacists MDT input… Hospitals Acute & Chronic Patients A&E, MAU, Inpatient, etc MDT Ward Rounds Bedside & Paper Nurses Doctors Social Workers Pharmacists MDT input… Community Wards Acute & Chronic Patients Home-based MDT ‘Ward Rounds’ Paper-based Nurses – CMs, ANPs, DNs Doctors – GPcw, Geriatricians Social Workers Pharmacist MDT input – Mental Health, Palliative Care, Specialist Nurses, Addiction Services, Age UK, Carers Community Wards Acute & Chronic Patients Home-based MDT ‘Ward Rounds’ Paper-based Nurses – CMs, ANPs, DNs Doctors – GPcw, Geriatricians Social Workers Pharmacist MDT input – Mental Health, Palliative Care, Specialist Nurses, Addiction Services, Age UK, Carers

Why have a Community Ward? Improve patient’s experience and increase capacity for home-based healthcare Reduce unnecessary admissions. Assist integration, productivity & responsiveness of community services. Platform for Integration of Social and Health Services. Care often not equitable across an area. To prevent admissions and facilitate discharge we need to provide a safe place for patients to go.

The Basics: Daily ‘activity rounds’ with core team Weekly MDT ward rounds with ‘everyone’ Joint visits (GPcw, CM & SW) for ‘chronic’ patients ANP or GPcw visits for ‘acute’ patients In-reach into hospitals to facilitate early discharge Patient information entered directly into GP’s computer (EMIS) via remote connection

Key elements MDT ‘Rounds’ Integrated IT (EMIS, iClip, Framework i) GPcw Social Worker Pharmac ist ANP Community Matrons DNs ICT Specialist Nurses Mental Health Dementia Addiction AgeUK Palliative...and more Geriatricians

Ward Clerk Predictive Modelling Secondary Care (IP or OP) GP SPoC Secondary Care Voluntary Services Primary Care Ambulance Service Ambulance Service Social Services Chronic Management Community Matron GPcw Social Worker Chronic Management Community Matron GPcw Social Worker Community Ward Acute Intervention ANP GPcw Acute Intervention ANP GPcw Patient Pathways:

Lessons Learned: Patients prefer to be at home. Massive duplication of services in the community. MDT meetings & integration help address this. Integrating with Social Services is enabled by MDT meetings. GPs can be useful. ‘Ward Clerk’ role is vital. IT integration can be cobbled together. None of this is easy.

Challenges: Ongoing Funding linked to Evidence of Effectiveness. Transition from Pilot to Establishment. Staffing levels difficult to maintain – CMs & GPs. Line Management Structure & Systems. Project/Change Management resources. IT integration – technical difficulties & lack of will. Predictive Modelling. Rooms & Estates Issues. Internal ‘marketing’ – hearts & minds of existing staff. External ‘marketing’ - GPs, Secondary Care, Social Services, Ambulance, OOH providers, voluntary sector.

Exploring other admission diversion schemes Developing an integrated assessment and response service (IARS): –Improve transition for patients between hospital and community services –Reduce acute hospital activity, including unnecessary admissions –Maximise independent living to support people ‘to do’ rather than ‘be done to’ –Reduce and delay admissions into residential/nursing care –Develop dementia friendly services

IARS – what’s in scope? (list not exhaustive!) Community Ward as platform for other interventions: –Reablement and Intermediate Care –Telecare and telehealth services –Equipment –Integrated Falls Service –Community Therapies –Out of Hours service –Specialist Day Services

3 workshop questions ?!?! … Practically how do we implement this on the frontline – can it work as a platform for integrated health and social care delivery? Will we ever realistically see a reduction in hospital admissions? (How) can we facilitate the transfer of resources from the acute to the community sector?