1. NHSI - Criteria Led Discharge Case study: Oxleas NHS Foundation Trust
Dr Derek Tracy, Consultant Psychiatrist & Clinical Director
Oxleas NHS Foundation Trust, London
Senior Lecturer, King’s College London

2. Overview of presentation
Background: the landscape in mental health
Recent work: rationalised admissions, facilitated discharges
Current work, future plans: better commissioning & data-sets

3. Background 1948, NHS founding, 50% of beds were mental health
From over 250,000 then….

5. An enormous need to rationalise our inpatient services:
3% of our patients
50% of our budget
Increased scrutiny of:
Rationale for admission
Duration of stay for those in hospital
Delays in discharge
Move away from:
Medic-led decision making
Discharge-when-well to discharge-when-well-enough

6. Recent work: being strategic about discharge

8. On the way out as soon as you’re in
Before/at admission: - Reason for admission - Outcomes from admission - Predicted LOS for these - Clear diagnoses & medicines - Factors likely to delay discharge
Initial ward assessment: - MDT Team agrees LOS & plan - 1˚ nurse ‘how can we get you home’ - Housing: probs identified - Who is at home who can help? - What will help them get home?
During admission, info: - ‘what to do to get well when home’ - Any medicines/changes - Date of OPC & review - Physio/AHP inputs as IP/OP - ‘how to keep your spirits up ‘ - websites for peer support

9. Current work, future plans
Reducing admission rates: targeting ‘problem groups’
Crisis cafes: late opening, non-medicalised environments, reducing ‘crisis admissions’
Day Treatment Services specifically helping crisis planning
Work with the police & their High Intensity Network
Reducing duration of admission: better data sets
A chronic, critical problem in MH – what to measure?
We’ve digitised clinical and psychosocial outcomes into EPRs
Monitor individuals, units/teams, strategically map services

13. NHS Benchmarking data, 2016, from acute Trusts

14. National Audit Office: “Representative care journey of older person”

15. Strategic integration with social care+ =

16. Questions? derek.tracy@nhs.net With thanks to Geraldine Strathdee