Long Term Conditions Programme in Cheshire and Merseyside

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Long Term Conditions Programme in Cheshire and
Merseyside

• Gary Lucking
• Head of Primary and Chronic Care
• Cheshire and Merseyside SHA

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Cheshire Merseyside SHA

• Covers geographical area of 1,150 square miles
• Population of 2.38 million
• 15 PCTs
• 14 Acute Hospital Trusts
• 3 Specialist Mental Health NHS Trusts
• 1 Ambulance NHS Trust

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High prevalence of LTC

• Amongst worst premature death rates in England
• Liverpool has highest incidence of COPD in
  England
• Many parts of Liverpool have high scores (ie
  poor) on Index of Living Conditions
• Mixed access to primary care because of
  relatively low numbers of GPs, nurses and AHPs
  compared to England
• Low car ownership and low income has contributed
  to culture of accessing healthcare through AED
• Emergency admissions currently rising at over 5
  per annum

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Poor CDM leads to wasteful use of high intensity
resources. 80 of bed days in hospitals are
currently used by emergency beds??????????Of
the eleven leading causes of bed use in the UK,
eight are due to conditions that strengthened
community care would lead to a fall in bed
use???????????
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Evidence based benefits of better management of
LTC

• Pulmonary rehab services for patients with COPD
  26 reduction in readmissions
• Nurse led interventions for managing heart
  failure 62 reduction in readmissions
• Integrated falls services with individually
  prescribed walking and exercise plans 20
  reduction in admissions
• Case Management 83 reduction in AE
  attendances in Knowsley Pilot

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PSA targets

• To improve health outcomes for people with
  long-term conditions by offering a personalised
  care plan for vulnerable people most at-risk and
  to reduce emergency bed days by 5 by 2008 (from
  2003/04 baseline), through improved care in
  primary care and community settings for people
  with long-term conditions.
• Increase to 3000 nationally (224 in CM) number
  of staff in the community matron role providing
  case management in primary and community settings
  for the people with complex long-term conditions
  and high intensity needs
• Increase to 240000 nationally (c18000 in CM) the
  number of Very High Intensity Users (VHIUs) under
  the case management of a Community Matron.

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Top Reasons for NEEIPA

• NOF 97,633 bed days
• Celebral Infarction 78,848 bed days
• COPD 75,062 bed days
• Pneumoniaorganism 66,493 bed days
• Heart Failure 47,204 bed days
• Acute MI 43,045 bed days
• Disorders of urinary system 41,688 bed days
• Senility 30,569 bed days
• Abdominal and pelvic pain 29,999 bed days
• Angina Pectoris 28,316 bed days

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With varying lengths of stay

• NOF 18.4 39.5 days
• Celebral infarction 24.8 49.5 days
• COPD 8.3 12.8 days
• Pneumoniaorganism 10.2 17.8 days
• Heart failure 11.1 17.9 days
• Acute MI 8.5 12.7 days
• Urinary system 6.7 13.0 days

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High risk users in Cheshire and Merseyside

• 11,441 with 2 or more emergency admissions for
  selected ICD 10 codes
• If we assume each length of stay 10 days (on
  average)
• If each of these people only had 2 they would be
  using 228,280 bed days per year

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Challenge

• Stop (and reverse) rise in emergency admissions
• Reduce length of stay
• Target those high users and conditions most
  likely to be admitted
• Develop workforce to deliver this

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Response

• CEO Led Programme Board (7 CEOs others sit on
  this)
• CEO Seconded to lead project full time
• Ovations undertook state of readiness
  assessment for case management
• Emphasis to system that cannot be achieved
  through case management alone
• 2 million identified ring fenced for 05/06 to
  support programme
• Central support and Performance Improvement
  Locally flexible implementation

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KMS
Workforce
Capacity
Engagement
Existing Collaboratives NSF workstreams
Health forecasting
Health and social care
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Progress so far

• Consensus on way forward understanding and
  commitment to wider net than case management
• 50 Case Managers to be in post in next 3 months
• Wealth of learning from IST Programme of support
  for emergency care (6 High Impact Changes in
  Emergency Care and Unplanned Care Direct) on
  admission avoidance
• NHSU Pilot Site for Community Matron education
  and learning
• Learning from Evercare Halton PCT site
• NPDT Programmes in every PCT
• WIPP Self-Care Pilot site
• Data and challenge to support LoS reduction

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Strategic Issues for LTC

• Choice in primary care (expansion of existing
  provision) and Practice Based Commissioning
• LIFT future approval based on greater provision
  of services for people with LTC
• Personal Budgets for healthcare akin to social
  care
• FTs and Vertical Integration
• Improved contractual arrangements between FTs and
  PCTs
• Better primary care demand management