BETTER HEALTH AND CARE FOR
SUNDERLAND
Ian Holliday
Head of Reform and Joint Commissioning
NHS Sunderland Clinical Commissioning Group (CCG)
AIM: BETTER HEALTH AND CARE FOR SUNDERLAND
Key Objective: To transform out of hospital care to achieve better
outcomes for people and the whole system.
OBJECTIVES FOR PEOPLE
OBJECTIVES FOR WHOLE SYSTEM
• Person Centred co-ordinated care
• Less people being admitted as Emergency
to hospital where clinically appropriate
• Less delayed transfers of care
• More people dying in preferred place
• Giving information once
• People living longer and with better
quality of life with long term conditions
• People supported to recover from
episodes of ill-health and following injury
• Higher levels of patient and family
satisfaction
• Resilient communities
• Integrated commissioning
• Integrated Provision and Lead Provider
• Wrapped around Practices –TEAMS and
mdt decision making
• Moving investment from acute to
community/primary
• Shared patient information
• Staff wanting to work in Sunderland
• Better Value from reducing resources
SUNDERLAND THE PLACE
Map showing population density of Sunderland
Population characteristics
•
•
•
Sunderland North
Washington
Galleries Health
Centre
Supply Characteristics:
Sunderland
West
Sunderland East
Coalfield
High
Low
283,000 people in Sunderland
A population increase of 8,100 (3%) forecast over
next 20 years
– 37% increase amongst those aged 65-84
– 105% increase amongst those aged 85+
Life expectancy in Sunderland is 78 for males and 82
for females (approx. 2% lower than the England
average)
Population
Density
•
•
•
•
•
•
•
CCG Co terminus with the LA
1 main acute trust
1 community services provider ( provided by
neighbouring acute trust across 3 CCGs)
Large MH trust covering 13 CCGs
51 Member Practices organised in 5 Localities
660m budget for health and social care; 180 on acute
of which 55 m non elective; 152m in BCF re OOH care
Organisations whose focus is Sunderland need to
save over 15Om by 18/19
Source: ONS Statistics, Sunderland CCG Prospectus and Business Plan
3
The population cost pyramid indicates that the top 3% of
patients drive 50% of cost in Sunderland
Population cost segmentation, secondary care, community and mental health spend, 20131
Population
segments
Cost
breakdown
High Cost
Over £5,000 per year
3%
50%
9 .7k
£106m
Moderate Cost
£1,000 to £5,000 per year
12%
36%
Low Cost
Under £1,000 per year
84%
34k
239k2
Source: Sunderland CCG secondary, community care and mental health data, Oliver Wyman analysis
1 – 2013 for secondary care and MH, March 2013 to Feb 2014 for community care
2 – 127k registered patients with no secondary, community or mental health interactions
£77m
14%
£29m
Spend per
head:
£10.9k
£2.2k
£0.1k
4
Average Frail Elder without Cancer or Specialist Dementia care
(2,000 patients in segment – 73% of Frail Elders)
Frail Elders have diverse needs and use all care settings heavily
Service utilisation
Details
Name
Age
65+, 2+ co-morbidities
no Cancer or Specialist
Dementia
79 (avg.)
Health
Top
Comorbidities
Top Risk Factors
• COPD (49%)
• Myocardial Infarction
(39%)
• Diabetes (38%)
• Hypertension (70%)
• Addictions (14%)
• Obesity (4%)
20131 Utilisation
20131 Spend
>10
£500
Primary2
Appointments
Inpatient
Spells
3
£7,300
Outpatient
Episodes
9
£900
A&E
Attendances
2
£300
Mental Health
Clusters
0
£200
Community
Visits
55
£2,000
Social
Visits
Total
Expected high user of social care
87
£11,200
Reasons for admission (Top Primary Diagnosis CCS Codes)
• 87 – Retinal detachments; defects; vascular occlusion; and retinopathy (7%)
• 122 – Pneumonia (except that caused by tuberculosis or sexually transmitted
disease) (6%)
• 127 – Chronic obstructive pulmonary disease and bronchiectasis (5%)
• 159 – Urinary tract infections (5%)
• 108 – Congestive heart failure; nonhypertensive (3%)
Source: Sunderland CCG secondary, community care and mental health data, Oliver Wyman analysis
1 – 2013 for secondary care and MH, March 2013 to Feb 2014 for community care
2 – Estimates based upon previous work
WHAT NEEDS TO BE DIFFERENT?
CASE FOR CHANGE – Accelerated Solutions Event
George now
George’s improved journey
George is 78 years old and has lived within Hendon Care Home for
the last two years. Prior to moving to the Care Home, George lived
alone in Southwick following the death of his wife. George has two
children: a daughter, Julie, who lives in Houghton with her two
children and a son who moved to Nottingham with his work.
Three years ago, George suffered his first stroke and following
treatment on the acute stroke ward at Sunderland Royal Hospital and
support to return home from the Community Stroke Rehabilitation
Team, George managed to continue to live in his own home for a
further 9 months, with support from Home Care staff.
During the 9 months, George became frightened to go out alone, which
meant he didn’t meet up with his friends as often as he did. George is
an avid Sunderland Football supporter and was a season ticket holder
until he had his stroke. If George wasn’t watching football, he also
enjoyed playing bowls for his local bowls club; this was George’s way
of keeping himself ‘fit and active’.
Unfortunately, George experienced a second stroke, which left him
with significant disabilities. George is unable to move parts of his
body, suffers from double incontinence, has difficulty in swallowing
and often chokes and becomes agitated quite quickly due to the effects of
his stroke. Despite the best efforts of everyone concerned with George’s
care and treatment, George moved into Hendon Nursing Care Home.
In the care home George was assessed by the link nurse who also
arranged for the community geriatrician to see him. Some of his
medications were changed and they have involved Physiotherapy to
see if his mobility can be increased. The Dietician has also been
consulted as George has been losing weight despite eating relatively
well.
George has had a number of UTIs, resulting in
admissions to hospital for treatment. He is
expressing anxiety about having to go into hospital and
just wants to stay at home. George has been well cared
for within the Care Home; with his daughter and
grandchildren visiting as often as possible. He has made
new friends, however often gets frustrated with some of
his fellow residents, especially those who have dementia
symptoms; spending more and more time on his own
in his room.
Recovery at Home
In Summary
• The challenge in Sunderland, both financial
and demographic, is significant
• No change is not an option – we must do
things differently
• All stakeholders are now working together to
deliver this ambitious agenda