1 The Forth Valley Experience (a journey across two decades) Peter Murdoch

2 NHS Forth Valley Geography History- Ancient and Modern A shared Vision Working Together Concrete Future Some examples Potential lessons Discussion

3 Forth Valley

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6 Ancient Wars

7 Recent Tensions

8 Shared Values in Strategy for Older People – since mid 19990s Dignity Respect Autonomy Needs led Service Evidence based Quality of Care Value for money Access Equity Transparency Partnerships Public Involvement Clarity and Objectivity

9 Examples from Falkirk micro-system Guidelines for acute admissions from Nursing Homes Transfer of resources Dementia- Integrated care pathways Resource Panel with joint input Dementia Services Development Centre at Stirling University

on – changing politics Abolition of Competition Joint Futures Abolition of Trusts Reorganisation of health boards “Shifting the Balance” “Designed to Care” “Better Health, Better Care”

11 Opportunity for NHS Forth Valley New structures Key stakeholders round table Urgent need to think again Safety and sustainability main drivers Opportunity for clinicians to forge a way ahead

12 Shared Vision of new NHS Forth Valley Improved Health and Healthcare Single acute hospital Care closer to home- strengthen community services, ambulatory care Driven by patient need, safety, sustainability and partnerships. New ways of working – All change Elderly and Dementia friendly

13 Based on need 4 point prevalence studies of hospitalised adults in 2001, 2003, 2005 and 2007 Diverse prime needs esp. rehabilitation scattered all over the place New focus on “ Right care in Right Place by Right people Right (first) time Streamline Pathways of care Clinical Change and Service redesign

14 Working Together Primary and acute care, local authorities Patient and Public Partnerships PFI Clinicians, Management and planners- at every stage

15 Radical Redesign Redesign of Services Redesign of Hospitals Whole system approach Shifting the balance New Wine in New Bottles

16 Building Blocks Whole systems working project Acute and Urgent redesign Eof L Acute Long Term Conditions Well population Development of Symptoms Complex needs Anticipatory Care Plans Tiered Model of Care Shifting the Balance

17 A new Type of Hospital and Models of Care

18 Proposals for Specialist ward reconfiguration in 2009 GI Medicine/Surgery Vascular/Endocrine Respiratory Cardiology Ortho Trauma Stroke Rehab Surgical Elderly Mental Health Paediatrics Obs & Gyn

19 Practical Examples Delayed Discharges Long term Conditions Dementia Nursing Homes

20 Delayed Discharges

21 Delayed Discharges

22 Long term Conditions- anticipatory care planning For all long term conditions Included all stakeholders All stages of pyramid from self management, to crisis management and Palliative Care

23 Whole System Working- Engaging Primary Care Whole systems working project Acute and Urgent redesign Eof L Acute Long Term Conditions Well population Development of Symptoms Complex needs Anticipatory Care Plans Tiered Model of Care Shifting the Balance

24 Dementia

25 Care Homes

26 Readmissions in the system Standardised bed days for patients with 2+ Emergency Admissions aged 75+ for Clackmannanshire Council Area, Falkirk Council Area, Stirling Council Area and NHS Scotland per financial year

27 Readmissions in different CHPs

28 Hospital admissions by LTC - 1

29 Hospital admissions by LTC - 2

30 Admissions for LTC by CHPs

31 Potential Lessons Shared vision Assess and re-assess need Partnership not competition Engagement and empowerment Shared outcome measures Leadership Focus on quality, experience and value for money

32 Challenges Continuous improvement and improvement Refresh stakeholder involvement Potential perverse consequences Recession difficult choices- some fixed points eg PFI hospital Consistency of approach- both patient experience and quality of care Pious Platitudes into Practical Progress

33 Discuss Potential levels of Engagement and Partnership National and/ or regional and/or Local ? How much whole system or focussed? Balance between top-down and bottom- up? Patients, Public, Politicians, Professionals and Planners

34 Discuss-Identifying Mutual self- Interest Are there issues where a shared approach between acute and primary care, local authorities and private sector would be mutually beneficial? What are your priorities for joint planning? Have you local examples of success? What are potential barriers to take forward? How do you engage stakeholders?

35 Discuss- Assessment of Need and Progress Is any information gathered of mutual benefit across sectors? What are/ would be your priorities for information? What place for targets? Any perverse unintended consequences?

36 Thanks Thanks to countless colleagues in NHS Forth Valley but especially to Margaret Campbell, Debbie Lowe, Kath McCormac, Stuart Cumming, and Jann Davison