1. 1 Integration to avoid hospital admission: ITHAcA Sarah Purdy on behalf of the HIT

2. What is a HIT? Health Integration Team modus operandi of Bristol Health Partners Should:  improve outcomes across the patient pathway  create an integrated whole health system approach  promote research  disseminate innovation and evidence  align with education/training 2

3. 3 ITHAcA Aims to reduce avoidable hospital admissions across BNSSG  increase enablement of patients and carers  reduce complexity in urgent care system  develop capacity to use data and evaluate changes  optimise productivity and efficiency of existing and new interventions Includes all BHP partners plus BCC and collaborators

4. 4 Address priorities for BHP NHS outcomes framework – reducing emergency admissions adults and children Highest bed days for LTCs in South West Admissions for COPD 25% above average Rising population over 65 years of age - pressure on social and health care Acute services redesign and integration priority for NHS partners “Admissions should be appropriate, focused and effective”

5. 5 Challenges in urgent care: diagnosis simplify systems in and OOH match demand and capacity expert early assessment reduce LOS in bedded settings address needs of high risk populations

6. 6 Urgent care potential work streams Prevent Simplify Create Reliability Minimise time in bedded settings Cultural enablers Alternatives Enablers Front Load See and Sort Flow Enablers Urgent care centres – location and spec NHS111 & Directory of services – avoid multiple SPAs End of Life Care planning Directory of Emergency Ambulatory Care/Hot Clinics (Professional SPA link) Urgent category transport (same day, 1 hour) Connecting Care – integrate information Mental Health Liaison Advice & Guidance Match demand and capacity 7 days a week Public comms – GP 24/7 Evidence-base – Health Improvement Teams/Partnership integration Early senior review at first point of contact Benefits measurement – balanced scorecard approach Address financial disincentives through tariff changes and/or budget integration Preventative Escalation Protocol for ambulance management of HCP calls with referrers Invest in discharge enablers Other Healthy Futures project/programme Key 1 st June priority - top 1 st June priority - next Existing work streams Focus on reducing LOS – pull from front door, pull from back Operating Principles

7. 7 Evidence based strategy targeting four areas 1. Using data to inform commissioning Model patient flows – system dynamics Risk profile severity at presentation Increase understanding of triggers for admission using qualitative methods and case studies Evaluate new interventions – start with NHS 111 2. Childhood asthma Model patient flows Inform development of interventions

8. 8 Evidence based strategy targeting four areas 3. Dementia and intercurrent illness Ensure appropriateness of admission and discharge Increase understanding of burden on carers with aim of increased support at home and reduced long term care placement Develop living environments to sustain people with dementia who wish to live in the community 4. COPD Optimise productivity and efficiency of existing interventions Introduce and evaluate new evidence based approaches

9. 9 Improving and integrating COPD care Model flow Severity at presentation Map services Improve utilisation of smoking cessation Increase pulmonary rehab uptake Evaluate BTS care bundles at NBT Acute admission prevention strategy Short term 1-3 years Exemplar for other conditions

10. 10 Other components of a COPD acute admission prevention strategy Medium term (3-6 years)Longer term (5-10 years) Intensive education in self management with follow up Increase expertise amongst community staff Develop and pilot new interventions Earlier diagnosis Specialist led care for all admissions New models of specialist/GP working

11. 11 ITHAcA strengths Strong existing links between senior individuals in all partner organisations around the problems to be addressed + underpins existing mechanisms Expertise in research, clinical, social care and organisational development Links to: existing PPI groups other proposed HITs Pilot work to develop initial project funded and potential programme manager in post

12. 12 ITHAcA challenges and opportunities Potentially huge agenda but a priority NHS reconfigurations and reforms Need for whole system changes and buy in Robust evaluation has resource implications NIHR HS&D Research Programme calls: New models of care for LTCs EOI Jan 2013 Sustaining impetus – HIT longevity an opportunity