1. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Challenges in POA Mrs Jane Jackson SRN MPhil MCGI Consultant Nurse Honorary Fellow University of Hertfordshire jane.jackson@whht.nhs.uk

2. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Early beginnings – but were they patient centred? 1930’s Consultant led service only for complex surgery

3. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust How has POA developed? Day Surgery 1993 - POA for all patients Worldwide delivery of care / sharing of knowledge and experience From Nurse led to Patient Led care possibly as a Nurse run service

4. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Shaping of the POA service Healthcare professionals Delivery of service, audit, patient survey e-mail and Internet and networking exchange of POA procedures / delivery of care www.pre-op.org Demands for efficiency, lean thinking, lean working Advances in Day Surgery

5. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Life expectancy at age 65 yrs. Life expectancy Source: Office for National Statistics; Government Actuary’s Department Life expectancy at age 65, United Kingdom

6. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust The most common causes of death in England and Wales Age-standardised mortality rates for selected broad disease groups, England & Wales

7. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Department of Health / CNO Health of the Nation – 1998; The NHS Plan 2000; Creating a patient led NHS Delivering the NHS Improvement Plan 2005; Healthcare Associated Infections 2006 - reduction in the rates of MRSA / C.Diff; 18-week patient pathway 2006; Patient Choice 2007; Healthy weight, healthy lives 2008.

8. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Clinical practice NICE clinical guidelines European working times directive For nursing staff, Advanced practice Modernising nursing careers

9. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust 18 week pathway 85% compliant in England and Wales by March 2008 90+% compliant by Dec 2008 Key words Patient led care Clock starts – referral Clock stops - treatment

10. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust POA at decision to treat Referral +/- investigations CATS /OPDdtt POA ffsW/L not ffs

11. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Challenges of 18 week delivery through one stop POA Re-organisation of the OPD / POA / admission process Involves changes for all the surgical division – Consultant, secretary, POA, records. Primary and Secondary care cohesion Key – clarity for patient of the 18 week process

12. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Benefits of 18 week Short journey for patient Lean thinking and lean working “…the patient receives the right care, at the right time and of the right quality without unnecessary delays.” Delivering the 18 week patient pathway DOH 2007 Effective use of resources - notes Appropriate referrals

13. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Patient led care through Inter professional teamwork

14. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Annual Conference – “A Risky Business” 6th November 2008 6th November 2008at Royal Court Hotel, Coventry Registration:£190 (members of the POA) £225 (non-members) For further details including registration forms, please visit www.pre- op.org or contact meetings@pre-op.org

15. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Pre Operative Assessment 2008 Providing a service for the user Effective assessment Location – convenient to the patient

16. West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust A practical guide to developing and running effective pre assessment Legal aspects Career developments Team leadership IT support Audit Predicting and explaining risk of surgery Developing a POA – face to face and telephone How to set up POA The role of POA in meeting the 18-week pathway