Cardiff and the Vale Healthcare Community Programme for Health Services Improvement Clinical Services Redesign Workshop 8 th Sep 06

Service re-design is a ongoing process, not a one-off event  Quality  Clinical outcomes  Patients’ perspective  Responsive and accessible services  Efficiency and resource utilisation  Affordability and value-for-money  Limited physical resources & 1º care capacity  HR and clinical staffing  Performance management  Performance targets and benchmarking  Access targets (Project 2009 / 4-hr trolley wait) Why health communities need to re-design services

Set up a model which  Reflects existing (in base form)  Projects forward (demography, Project 2009 etc)  Allows changes to model of care (MoC)  Service (AA, IC etc)  Clinical groupings and philosophy  Location ( sites, departments etc) Stage 1 involves  Set up user interface  First-cut data analysis  Preliminary conclusions Objectives of study

Model (1)

Model (2)

Set up a model which enables us to  Project increased demand  Rebalance between hospital and non-hospital settings  Anticipate “working smarter”  More efficiently  Better focus on goals and targets  Better focus on outcomes Working smarter applies to both hospital and non-hospital services Model

Hospital Care Pathway

Set up a model which enables us to analyse activity by  Commissioner  Hospital  Age band (children 75)  Type of admission and discharge  Time spent in hospital (IP vs. DC and LoS bands)  Type of clinical activity (various) Analysis : Hospital activity

Analyse clinical activity by  Broad category (adult acute, paediatric, maternity, mental health  Medical / Surgical  Specialty  HRG chapter (the “ology”)  HRG sub-chapter (stroke, AMI etc)  HRG (detailed condition)  Other groupings (e.g. cancer)  Underlying condition (e.g. diabetes)  Other coding systems (ICD, OPCS) Analysis : Type of Clinical Activity

 Inpatient vs. Day case vs. Day hospital  Length of stay band  0-1 days  2-3 days  4-7 days  8-14 days  14+ days  Longer lengths of stay  >14 days  >21 days  >28 days  >42 days Analysis : Time spent in hospital

Analysis : Hospital activity Go to detailed analysis by LoS Go to detailed analysis by HRG Go to detailed analysis for longer LoS

Activity : Preliminary Analysis

Activity : Profile and Changes

Model : User interface Remodel activity to reflect  Admissions avoidance  Acute sector efficiency  Better models for recovery and rehabilitation By taking activity in any category and moving all or part to another  Change location  Change style or model of care  Change time spent Measure volume and performance changes / improvements  Against current  Against benchmarks  Against planned targets

Model : User interface

The tip of the iceberg ?  How many people are being cared for outside hospital?  What are the resource implications now and in the future?

The tip of the iceberg ?  What do we know about them?  How can we assess their needs now and in the future?