Update from Cheryl Hardisty, Programme Director
Following the generally successful management of winter pressures last year, and an improvement in performance we continue to build on this work by developing the next stage of our resilience planning with the development of a predictive trigger tool which will allow for a more proactive approach in order to respond to the demands of the service earlier and which can used across the year. This will be trialled at University Hospitals of North Midlands NHS Trust (UHNM) in July and the tool will also be trialled at County Hospital in Stafford and Burton’s Queens Hospital in time for winter 2019/20. Additional measures will be incorporated into the tool which will show the numbers of patients who are experiencing delayed transfers of care from the acute hospital to a community setting, the number of over-75s seen within four hours in A&E and the numbers of over-75s discharged to their home. In addition, the new clinical triage at the ‘front door’ of acute hospitals will further improve the four-hour target. Together these will provide further detail on the overall quality of the service received by patients.
Following a successful pilot in February, which showed that 75% of referrals to existing community services could remain at home for their care, rather than be conveyed to A&E, a further care co-ordination test of change is planned for July. This initiative, led by Midlands Partnership NHS Foundation Trust (MPFT) will determine the proportion of patients coming through NHS111 who could be directly booked and treated by community services - potentially in their own homes - rather than the patient attending their local A&E or their GP practice. MPFT and NHS111 will work closely together to offer alternative, simplified pathways of care already in place, supporting patients to remain in their own homes.
We are well underway with testing the procurement specification for the integrated urgent and emergency care system. The specification will be submitting to the membership boards through July and August with the final specification going to the CCG Governing Bodies in August.
We are preparing for the launch of the Red Bag Scheme in August. This is a national initiative which supports the transfer of patients from care/residential homes to hospital and facilitates their return in a timely manner. The scheme, which will initially be launched across UHNM, with University Hospitals of Derby and Burton NHS Foundation Trust’s Queen’s Hospital in Burton to follow, will see each care/residential home taking ownership of red bags which, on transfer of the patient to the acute trust, will contain their belongings required for an inpatient stay and subsequent discharge. A patient’s own medications can also be accommodated in the bags along with up-to-date transfer documents which will record the their current status and care needs.
The patient will return to the care/residential home with the bag and a transfer document from the acute trust summarising the care received. There will also be a commitment from each care/residential home to visit and review the patient in hospital, 48 hours after admission. The use of the bags and supporting documents and procedures has nationally been shown to reduce lengths of stay in hospital for care/residential home residents.
Patient flow across the complex discharge pathway has seen significant improvements when compared to this time last year. Traditionally, the bank holiday periods can be extremely challenging; this year there were three bank holidays in quick succession due to the lateness of Easter, which increased the risk of surges in demand and a potential increase in delays to discharge. However, the number of patients in acute beds who were medically fit for discharge and ‘green to go’ were significantly lower at this point compared to the same point in 2018.
The discharge to assess model (which enables patients to be assessed for continuing care outside of the acute hospitals) is now in its second year and maturing, with a significant increase in hours delivered by the Home First community service and a reduction in the length of stay for patients across all discharge to assess community beds when compared to the previous year, facilitating improved flow across the system.
A large amount of joint working is taking place across system partners to identify areas of focus; this includes the development of joint plans, pathways, clinical reviews, audits to identify ‘quick wins’ and longer-term actions that will make a positive difference to patients. We are also fortunate to have been supported by a national expert on urgent care, Dr Ian Sturgess, who has been visiting all discharge to assess home and bed-based services and the acute hospital sites, and is providing bespoke feedback and advice, which is having a positive impact on provision.