Programme for Health Services Improvement Primary and Community Services Workshop February 2008

Programme for Health Services Improvement Community Based Services Hospital Services

Key principles A shift of focus from illness to health Improve quality, safety and outcomes Right care, right time, right place, right professional Focus on services and patient experience Maximise resources to achieve excellence Working together as a health (and social care) community

Community Services Framework … More services in the community Better use of primary care contracts Develop preventive approach Manage resource shift Achieve improved integration “policy and planning must reflect presumption that services will be community based, unless pressing reasons dictate a different model..” “ Trusts and other service providers must not expect to continue to provide the same pattern of services as in the past”

Our Starting Point…. Current disparate services are not set up to provide optimal care Current pathways are confusing for patients and professionals Need to get “upstream” and focus on prevention and proactive management Need to promote greater personal responsibility for health and wellbeing

Rebalancing….. Long Term Conditions Rehabilitation / Long Term Care Unscheduled Care

Developing Primary and Community Based Services Patients will have access to: High quality primary care practices working within defined localities Strengthened community based services supporting people with long term conditions e.g. diabetes and heart disease Meeting needs of children and young people Supporting frail elderly

Cardiff Localities – Emerging Map 91,693 (18 practices) 93,902 (12 practices) 82,640 (13 practices) 81,700 (11 practices) Health Resource & Treatment Centres New Community Health Centres

Vale Localities – Emerging Map Western Vale 26,678 (3 practices East Vale 38,003 (7 practices) Central Vale 54,974 (7 practices)

Examples of Locality Services Rehabilitation and reablement teams Day case surgery (local anaesthetic) Specialist rehabilitation Outpatient Clinics Diagnostics Patient education and support Community nursing teams Minor emergency services Day therapy services Child health clinics Community mental health teams Therapy services Locality Resource Centre Co-ordinating “out of hospital” services for local communities Local Authority Services Voluntary Sector Services Asylum Seekers Services Sexual health services

Getting it Right – Landscape NOT deckchairs Physio Social Worker Domiciliary Care OT Family Diabet-ologist Practice Nurse CPN Cardiol- ogist GP District Nurse Podiatrist Respite Care Voluntary Transport PhysioSocial Worker Domiciliary Care OT Family Diabet-ologist Practice Nurse CPN Cardiol- ogist GP District Nurse Podiatrist Voluntary Transport Respite Care

Opportunities for change Patient risk Referral Condition/Cohort GP interest Lifecycle Position Invasiveness Given current conditions, should this service be performed closer to the community Is there adequate DEMAND? Can the TECHNOLOGY required support shift? Can STAFFING & SKILLS requirements support shift? What are the SAFETY considerations? What OPERATIONAL Issues should be considered? Patient choice Facilities Separation of tasks Equipment Lifecycle Position Training/CertificationAvailabilitySupport Staff Access From NHS Institute for Innovation and Improvement

Eg. Diagnostics - Supporting Clinical Pathways Diagnostics involved in the Clinical Pathway ImagingCardiologyRespiratoryEndoscopyPath COPDX-rayO2 Saturation spirometry Blood gases (BG) AnginaX-rayECGBloods Heart FailureX-rayECGOx. SaturationBloods BG AsthmaX-rayECGBG DiabetesX-rayECGBloods BG HypertensionX-rayECGBloods Perf UlcerX-rayECGVarious endoscopy Bloods Pelvic Inflam. Disease LaproscopyBloods Swabs X-Ray, ECG, Oxygen Saturation and Bloods are on pathways that represent 60% of the total number of spells for 19 of the most common conditions appropriate for management out of hospital

Potential for shift…. FamilyDiagnosticDemandTechnologyStaff/SkillsSafetyOperationsOverall AudiologyPure Tone Audiogram Tympanometry Newborn screening Imagingx-ray Mammography Ultrasound DEXA Retinopathy CardiologyElectrocardiograms Echocardiogram Monitors RespiratorySpirometry Oxygen saturation These 13 tests were assessed as the most likely to be feasibly shifted and most health communities should be able to achieve shift in these areas

So What? Resource Shift Workforce Shift Patient Expectation Shift Organisation Shift CULTURAL SHIFT

So What – the Deliverable… “To ensure that the [PHSI] consultation proposals set out our plans for enhanced primary and community based services which are clear, with particular reference to: - The models of care to support the improved delivery and integration to meet local needs - The location and services to be provided in each locality (including options for Resource Centres and Enhanced Community Health Centres) across Cardiff and the Vale and the implications of these plans (noting Central and East Cardiff already consulted upon)

The now….

The Future – Resource & Treatment Centres & High Quality Estate

Locality Model