Commissioning alternatives to hospital

1
Commissioning alternatives to hospital

• Dr Seth Rankin
• Rob Persey

2
Structure

• Introduction to the Community Ward in Wandsworth.
  
• Platform for other admission diversion schemes.
• Not just health and social care everybodys
  responsibility!

3
What is a Community Ward?

• A new way to structure Community Service.
• Multidisciplinary Platform
• for providing integrated health social care in
  the community.
• Towards developing a comprehensive service
  designed to deliver acute chronic healthcare at
  home.

4
An Analogy

• Hospitals
• Acute Chronic Patients
• AE, MAU, Inpatient, etc
• MDT Ward Rounds
• Bedside Paper
• Nurses
• Doctors
• Social Workers
• Pharmacists
• MDT input

• Community Wards
• Acute Chronic Patients
• Home-based
• MDT Ward Rounds
• Paper-based
• Nurses CMs, ANPs, DNs
• Doctors GPcw, Geriatricians
• Social Workers
• Pharmacist
• MDT input Mental Health, Palliative Care,
  Specialist Nurses, Addiction
  Services, Age UK, Carers

5
Why have a Community Ward?

• Improve patients experience and increase
  capacity for home-based healthcare
• Reduce unnecessary admissions.
• Assist integration, productivity responsiveness
  of community services.
• Platform for Integration of Social and Health
  Services.
• Care often not equitable across an area.
• To prevent admissions and facilitate discharge we
  need to provide a safe place for patients to go.

6
The Basics

• Daily activity rounds with core team
• Weekly MDT ward rounds with everyone
• Joint visits (GPcw, CM SW) for chronic
  patients
• ANP or GPcw visits for acute patients
• In-reach into hospitals to facilitate early
  discharge
• Patient information entered directly into GPs
  computer (EMIS) via remote connection

7
Key elements
8
Patient Pathways
Community Ward
Secondary Care (IP or OP)
Ward Clerk

• Acute Intervention
• ANP
• GPcw

SPoC

• Chronic Management
• Community Matron
• GPcw
• Social Worker

Predictive Modelling
GP
9
Lessons Learned

• Patients prefer to be at home.
• Massive duplication of services in the community.
• MDT meetings integration help address this.
• Integrating with Social Services is enabled by
  MDT meetings.
• GPs can be useful.
• Ward Clerk role is vital.
• IT integration can be cobbled together.
• None of this is easy.

10
Challenges

• Ongoing Funding linked to Evidence of
  Effectiveness.
• Transition from Pilot to Establishment.
• Staffing levels difficult to maintain CMs
  GPs.
• Line Management Structure Systems.
• Project/Change Management resources.
• IT integration technical difficulties lack of
  will.
• Predictive Modelling.
• Rooms Estates Issues.
• Internal marketing hearts minds of existing
  staff.
• External marketing - GPs, Secondary Care,
  Social Services, Ambulance, OOH providers,
  voluntary sector.

11
Exploring other admission diversion schemes

• Developing an integrated assessment and response
  service (IARS)
• Improve transition for patients between hospital
  and community services
• Reduce acute hospital activity, including
  unnecessary admissions
• Maximise independent living to support people to
  do rather than be done to
• Reduce and delay admissions into
  residential/nursing care
• Develop dementia friendly services

12
IARS whats in scope? (list not exhaustive!)

• Community Ward as platform for other
  interventions
• Reablement and Intermediate Care
• Telecare and telehealth services
• Equipment
• Integrated Falls Service
• Community Therapies
• Out of Hours service
• Specialist Day Services

13
3 workshop questions ?!?!

• Practically how do we implement this on the
  frontline can it work as a platform for
  integrated health and social care delivery?
• Will we ever realistically see a reduction in
  hospital admissions?
• (How) can we facilitate the transfer of resources
  from the acute to the community sector?