1. Whos in the beds: surveying and the aftermath Dr Paul Forte Balance of Care Group and Centre for Health Planning & Management, Keele University, UK

2. Typical questions We want to improve the flow of patients through acute beds –what alternative care processes are there? –which types of patients are these suitable for? –what are implications for the types of resources required such as staff and beds/ places? –when might we achieve this by? –who pays?

3. Data required Referral route into the hospital and health/ social care system Reasons for admission; diagnosis; risk factors affecting discharge Alternatives to acute admission - and to continued presence in acute beds Discharge arrangements and factors delaying this process

4. Pre-survey Finding out the true extent of local whole systems working Gaining acceptance of the methodology Identifying extent of the survey Recruitment and training of surveyors Addressing issues of patient and information confidentiality

5. Who are the patients?

6. Alternatives to acute admission on day of the survey

7. Alternatives to acute care on day of survey

8. Post-survey Database input, initial analyses, surveyor interpretation workshops Four weeks later: data from local information systems to gain longitudinal perspective (length of stay, discharge destinations) Capacity analyses with local workshops and presentations on the implications of the results and potential forward strategies

9. Future care trends More active rehabilitation in the community: hospitals, care homes, clients own homes Blurring of boundary between health and social care environments More flexibility and devolution of tasks within and between care professions More active upstream management –chronic disease management –risk management of frail elderly in the community –health promotion

10. Capacity cascade

11. Potential consequences Intermediate Care services have tended to focus attention on patients who can be rehabilitated quickly Community-based services could broaden scope to slow stream rehab patients More creativity both in locations for care and in the care processes themselves comes with better knowledge about patients

12. Community care workforce implications – by dependency

13. By staff grade and location

14. Enabling environments for new directions Organisational issues: –partnership working, joint appointments Information issues: –common definitions, data sharing Engaging clinicians: –harnessing clinical drive –facilitating clinical engagement

15. Reflections Getting beyond local blame cultures and cynicism Making whole-systems more than a buzz-word Difficulties of following through – takes time for local health and social care economies to absorb and act upon messages Targeted follow-up work on specific issues using survey data as a starting point – populating the Balance of Care model