1. St Mary’s patient pathway project Stephan Brusch – Service Development Manager Westminster PCT Mark Sheen - Community Nurse Specialist Kensington and Chelsea Learning Disability Service

2. SETTING THE SCENE High rates of poverty and deprivation centred in specific wards Indices of deprivation (2004) Westminster 39th and K&C 166th out 354 English districts Up to 18 year difference in life expectancy for people living in the wealthiest and poorest wards

3. SETTING THE SCENE cont…. The project involved: St Mary’s NHS Trust Westminster Learning Disability Partnership Kensington and Chelsea Learning Disability Service

4. PAST WORK AND CHALLENGES St Mary’s Disability Group Teaching, video’s, accessible information Limited effectiveness Difficulties in effecting a systems change

5. Opportunity Established link with the Modernisation Board at St Mary’ Body that oversees Transforming St Mary’s

6.  What is Transforming St Mary’s?  A programme of coordinated projects addressing the use of new technology, new roles and new processes  The programme uses a structured approach to project and programme management, and each project reports to the Transforming St Mary’s Board Programme Board

7.  Aim - To improve service efficiency and effectiveness of the trust, for the benefits of staff and patients Objectives – To ensure patients are treated in the right place at the right time by the right staff, to provide safe, high quality care.

8. What are the projects? IT Picture Archiving - electronic capture & storage of X-rays Order Communications - electronic ordering & reporting of diagnostic tests Electronic Discharge Communication - electronic GP discharge letters Choose and Book - direct booking of out patient clinics from GP surgeries Roles St Mary’s 24 / 7 – redesigning roles e.g. Outpatient Clinic Assistants Processes Improving the Patients Journey – streamlining processes and procedures from pre- assessment to discharge

9.  Improving the Patients Journey  Aims To streamline, standardise and improve the processes and procedures of pre-assessment, admission and discharge Objectives To reduce length of stay for patients To increase % of patients who receive pre-operative assessment To increase % of patients who are given an expected date of discharge

10. Why did we get involved?  As part of Improving the Patients Journey (IPJ) project the trust was redesigning the patient journey from pre-assessment to discharge  A proposed pathway was designed.  What impact did this pathway had on vulnerable patients?

11. The St Mary’s project: A defined patient pathway agreed by community and hospital staff.

12. Project Objectives- The Outcomes: Improved patient experience for people with learning disabilities and their carers

13. Project Objectives- The Outcomes: Decrease the number of inappropriate admissions by increasing the number of people who can be treated in the community. Community

14. Project Objectives- The Outcomes: Length of hospital stay in line with the general population

15. Auditing Records: We looked at records of people who stayed at St Mary’s. We wanted to see what worked well and what didn’t work well.

16. Consultation: We arranged a workshop and looked at the following areas: Going into hospital Staying in St Mary’s Leaving St Mary’s and A&E

17. This is what came out of the mapping exercise: Pre-admission Inpatient stay Discharge and A&E

18. Pre-admission Training

19. Pre-admission Ensure people have access to primary care

20. Re-launch communication tool Pre-admission

21. Ensure that St Mary’s can identify people with learning disabilities and their support needs.

22. Inpatient stay Better information when arriving at St Mary’s.

23. Better training and information on consent and best interest. Inpatient stay

24. Better information while staying in hospital. Inpatient stay

25. Better triage in A&E Accident and Emergency

26. Training Accident and Emergency

27. Better communication at discharge. Discharge

28. We included everything in an action plan and set priorities.

29. Next Steps: Transforming St Mary’s Programme Board Partnership Boards St Mary’s Disability Group

30. Reflective Learning Points Gather data and link to national evidence (audit and user involvement). Moving away from focussing on patterns (people’s behaviour) to influencing processes Mainstreaming (transferability to other vulnerable groups, process mapping) Being politically astute (create win-win situation) Be a strategic Health Facilitator