1. A Clinical Commissioning & Primary Care Perspective Dr Dawn Moody GPwSI Geriatric Medicine & Clinical Associate for the Care of Frail Older People Jo Williams Head of Commissioning for Unplanned Care North Staffordshire CCG

2. Key Principles Older people should have access to NHS services which are: - patient centred - needs based - equitable - free at point of delivery

3. Commissioning Objectives Integrated patient-centred journeys which: – recognise scope & complexity of need – proactive when possible, reactive when necessary – maximise continuity of care – minimise sudden or unplanned transitions of care – we would accept for ourselves or our loved ones

4. Challenges in Commissioning for Older People Commissioning commitment & resources Evidence base for commissioning Effective collaboration

5. Challenges in Commissioning for Older People Commissioning commitment & resources Evidence base for commissioning Effective collaboration

6. Response to ‘Failing the Frail’: North Staffs Nursing Home project Systematically assess residents’ healthcare needs Review existing service specifications, contracts & delivery Analyse gap between healthcare needs and current provision Develop enhanced specifications to better meet needs Monitor service delivery against agreed quality standards and clinical outcomes

8. Unscheduled admissions of North Staffs Nursing Home residents Admissions 593 admissions during 2011 Total cost = £1,439,426 Bed occupancy 4160 occupied bed days per year Mean length of stay = 7.0 days Discharges 72 deceased 521 discharged home

9. ‘Good news stories’ Only 2.9% of admissions for heart failure Excellent community heart failure service Heart failure 0.7% admissions, LOS 1.2 days Prompt assessment and discharge Head injuries Only 1.3% admissions coded for malignancy Only 3/593 patients died within 48hrs of admission Palliative care

10. Possible opportunities for service improvement 7.4% of costs linked to codes for aspiration Implies need for increased community SALT provision Speech & Language therapy provision Long LOS for CVA and # NOF Is access to rehabilitation adequate? Rehabilitation Long LOS for renal disease, CVA, # NOF Would case management shorten LOS? Virtual Ward

11. Challenges in Commissioning for Older People Commissioning commitment & resources Evidence base for commissioning Effective collaboration

12. Effective Collaboration Commissioners Providers Private Primary & Community care Social ServicesSecondary careCity CouncilCounty CouncilNS CCGPartners:

13. Thank You Dawn.Moody@northstaffs.nhs.uk