1. Welcome to the new acute and community County Durham and Darlington NHS Foundation Trust Clinical strategy FT member events April 2011

2. The new Foundation Trust… …an acute and community Foundation Trust for County Durham and Darlington …more integrated, better co-ordinated care for patients …helping the health and social care system work together more effectively …opportunities for staff working in new and different ways

4. Trust governance Public governors Staff governors Governing Council Stakeholder governors Foundation Trust Board

5. Clinical vision – an opportunity “to shift the centre of gravity from hospital to community and develop fully integrated care pathways”.

6. Clinical vision Premier provider of healthcare in County Durham and Darlington including: –Prevention and enablement –Community Services –Planned and emergency hospital care Major provider of women’s and children’s services in the North East Reputation for excellent specialist services National profile as a pathfinder for new ways of offering health services in hospital, home and community

7. Clinical strategy – our aims The best health outcomes for patients An excellent patient experience High quality, low cost services for commissioners

8. Clinical strategy – key areas Long term conditions Care of older people Women and children Acute medicine and emergency care Surgery End of life care

9. Case study – long term conditions

11. Long term conditions Quick win: Facilitated discharge, good referral guidelines for disease progression, pathway for minor acute events, access to specialist support 0900-1700 via bleep and phone line (being set up now), Priority issue: Patient education, equity of care, community clinics across the county, decrease LOS in surgical patients (CQUIN), IT - common LTC pathway and paperless clinics with instant transfer of data across primary and secondary care Synergy benefits: –Outcomes and experience: reduced admissions through better accessibility to specialist staff, better screening and management –Workforce: development opportunities working across the pathway utilising district and community nurses and integrating them with hospital specialist nurses –Efficiency: Community rather than hospital follow ups; Nurse rather than Consultant follow ups. Working along with other workstreams - old age/ emergency and end of life care pathways to be put in place

12. Older people Quick win: Dementia – training of all staff who are in contact with older people through e-learning etc Priority issue: single point of access to range of services Synergy benefits: –Outcomes and experience: Early prevention /screening, future care planning –Workforce: better use of specialist skills through dedicated specialist direct assessment /admission unit –Efficiency: better use of community hospitals

13. End of Life Quick win: Use of DH ‘surprise question’ as a trigger into advanced care planning in the last year of life Priority issues: Shared, real time access to information via IT systems; single point of access in the form of a coordination centre Synergy benefits: –Outcomes and experience: patients more likely to access preferred option/place of care at the end of life –Workforce: developing skills to facilitate patient choice of preferred place of care at the end of life –Efficiency: reduce number of avoidable admissions to acute care at the end of life

14. Acute medicine emergency care Quick win: integration of protocols between UCC and A&E Priorities: joined up approach with all stakeholders including NEAS, social care Synergy benefits: –Outcomes and experience: reduced waits by quicker access to appropriate level of care –Workforce: access to senior experienced clinician opinion at earliest opportunity in the pathway –Comprehensive directory of supporting services in community and acute settings –Efficiency: reduced admissions from ED and urgent care

15. Women’s and children’s Quick win: Antenatal assessment for vulnerable families Priority issues: Middle grade cover in paediatrics and maternity, training of advanced paediatric nurse practitioners, consultant numbers in paediatrics Synergy benefits: –Outcomes and experience: Community care pathways for women with low risk pregnancies –Workforce: Alignment of community midwives with integrated children’s teams –Efficiency: integrated Health Visitors and school nursing children’s teams with social care

16. Surgery Quick win: Redesigning pre-operative pathway; changes to urology pathway Priority issues: Addressing pressures in vascular surgery Synergy benefits: –Outcomes and experience: more accessible service for patients, reducing unnecessary hospital visits ( pre-operative pathway), delivery of care closer to home (Urology pathway). –Workforce: changes to skill mix to meet pathway requirements, staff have the skills to deliver care in the appropriate setting for the patients –Efficiency: Reducing emergency admissions to hospital. Offering other services to manage surgical emergency activity, to deliver a better service for patients.

17. Clinical strategy - discussion What services could be offered in the community that are currently offered in hospital? Delivering services in hospital –Advantages –Disadvantages Delivering services in the community –Advantages –Disadvantages

18. We are developing a new clinical strategy for the new organisation Take part in the discussion at www.cddft.nhs.uk/about- us/clinical-strategy.aspx

19. Any questions?