The Forth Valley
Experience
(a journey across two decades)
Peter Murdoch
1
NHS Forth Valley
•
•
•
•
•
•
•
•
Geography
History- Ancient and Modern
A shared Vision
Working Together
Concrete Future
Some examples
Potential lessons
Discussion
2
Forth Valley
3
Forth Valley
4
Forth Valley
5
Ancient Wars
6
Recent Tensions
7
Shared Values in Strategy for Older
People – since mid 19990s
•
•
•
•
•
•
•
Dignity
Respect
Autonomy
Needs led Service
Evidence based
Quality of Care
Value for money
•
•
•
•
•
•
Access
Equity
Transparency
Partnerships
Public Involvement
Clarity and Objectivity
8
Examples from Falkirk micro-system
• Guidelines for acute admissions from Nursing
Homes
• Transfer of resources
• Dementia- Integrated care pathways
• Resource Panel with joint input
• Dementia Services Development Centre at
Stirling University
9
1997 on – changing politics
•
•
•
•
•
•
•
Abolition of Competition
Joint Futures
Abolition of Trusts
Reorganisation of health boards
“Shifting the Balance”
“Designed to Care”
“Better Health, Better Care”
10
Opportunity for NHS Forth Valley
•
•
•
•
•
New structures
Key stakeholders round table
Urgent need to think again
Safety and sustainability main drivers
Opportunity for clinicians to forge a way
ahead
11
Shared Vision of new NHS Forth Valley
• Improved Health and Healthcare
• Single acute hospital
• Care closer to home- strengthen community
services, ambulatory care
• Driven by patient need, safety, sustainability and
partnerships.
• New ways of working – All change
• Elderly and Dementia friendly
12
Based on need
• 4 point prevalence studies of hospitalised adults
in 2001, 2003, 2005 and 2007
• Diverse prime needs esp. rehabilitation
scattered all over the place
• New focus on “ Right care in Right Place by
Right people Right (first) time
• Streamline Pathways of care
• Clinical Change and Service redesign
13
Working Together
•
•
•
•
Primary and acute care, local authorities
Patient and Public Partnerships
PFI
Clinicians, Management and planners- at
every stage
14
Radical Redesign
•
•
•
•
•
Redesign of Services
Redesign of Hospitals
Whole system approach
Shifting the balance
New Wine in New Bottles
15
Building Blocks
Eof
L
Acute
Complex needs
Acute and Urgent redesign
Long Term Conditions
Development of Symptoms
Whole systems
working project
Well population
Tiered Model of Care
Anticipatory Care
Plans
Shifting the Balance
16
A new Type of Hospital and Models
of Care
17
Proposals for Specialist ward
reconfiguration in 2009
•
•
•
•
•
•
•
•
•
•
•
•
GI Medicine/Surgery
Vascular/Endocrine
Respiratory
Cardiology
Ortho Trauma
Stroke
Rehab
Surgical
Elderly
Mental Health
Paediatrics
Obs & Gyn
18
Practical Examples
•
•
•
•
Delayed Discharges
Long term Conditions
Dementia
Nursing Homes
19
Delayed Discharges
20
Delayed Discharges
21
Long term Conditions- anticipatory care
planning
• For all long term conditions
• Included all stakeholders
• All stages of pyramid from self
management, to crisis management and
Palliative Care
22
Whole System Working- Engaging Primary Care
Eof
L
Acute
Complex needs
Acute and Urgent redesign
Long Term Conditions
Development of Symptoms
Whole systems
working project
Well population
Tiered Model of Care
Anticipatory Care
Plans
Shifting the Balance
23
Dementia
24
Care Homes
25
Readmissions in the system
Standardised bed days for patients with 2+ Emergency Admissions aged 75+ for Clackmannanshire
Council Area, Falkirk Council Area, Stirling Council Area and NHS Scotland per financial year
Bed days standardised rate per 100,000
population
Bed days for m ultiple em ergency adm issions aged 75+
400,000
350,000
300,000
250,000
200,000
150,000
100,000
50,000
0
2003
2004
2005
2006
2007
2008
Financial Year End
Clackmannanshire
Falkirk
Stirling
NHS Scotland
NHS Forth Valley
26
Readmissions in different CHPs
T1: Emergency Readmisions 75+ per 1000 population
50
45
40
35
30
25
20
Mar-05
Mar-06
Mar-07
FV Annual Rate
Mar-08
Clacks CHP
Mar-09
Falk CHP
Mar-10
Mar-11
Stir CHP
27
Hospital admissions by LTC - 1
Number of Hospital Admissions by LTC - Forth Valley
160
140
120
100
80
60
40
20
0
Jan-08
Feb-08
Mar-08
Apr-08
May-08
Jun-08
Angina Pectoris
Jul-08
COPD
Aug-08
Sep-08
Diabetes
Oct-08
Nov-08
Dec-08
Jan-09
Feb-09
Mar-09
Apr-09
Other ischaemic heart disease
28
Hospital admissions by LTC - 2
Number of Hospital Admissions by LTC - Forth Valley
160
140
120
100
80
60
40
20
0
Jan-08
Feb-08
Mar-08
Apr-08
May-08
Jun-08
Jul-08
Acute myocardial infarction
Aug-08
Sep-08
Heart failure
Oct-08
Nov-08
Hypertensive Diseases
Dec-08
Jan-09
Feb-09
Mar-09
Apr-09
Asthma
29
Admissions for LTC by CHPs
Admission Rate per 100,000 population - Forth Valley
180
160
140
120
100
80
60
Jan-08
Feb-08
Mar-08
Apr-08
May-08
Jun-08
Jul-08
Clackmannanshire CHP
Aug-08
Falkirk CHP
Sep-08
Oct-08
Stirling CHP
Nov-08
Dec-08
Jan-09
Feb-09
Mar-09
Apr-09
Forth Valley Total
30
Potential Lessons
•
•
•
•
•
•
•
Shared vision
Assess and re-assess need
Partnership not competition
Engagement and empowerment
Shared outcome measures
Leadership
Focus on quality, experience and value
for money
31
Challenges
•
•
•
•
Continuous improvement and improvement
Refresh stakeholder involvement
Potential perverse consequences
Recession difficult choices- some fixed points eg
PFI hospital
• Consistency of approach- both patient
experience and quality of care
• Pious Platitudes into Practical Progress
32
Discuss Potential levels of Engagement
and Partnership
• National and/ or regional and/or Local ?
• How much whole system or focussed?
• Balance between top-down and bottomup?
• Patients, Public, Politicians, Professionals
and Planners
33
Discuss-Identifying Mutual selfInterest
• Are there issues where a shared approach
between acute and primary care, local
authorities and private sector would be mutually
beneficial?
• What are your priorities for joint planning?
• Have you local examples of success?
• What are potential barriers to take forward?
• How do you engage stakeholders?
34
Discuss- Assessment of Need and
Progress
• Is any information gathered of mutual
benefit across sectors?
• What are/ would be your priorities for
information?
• What place for targets?
• Any perverse unintended consequences?
35
Thanks
• Thanks to countless colleagues in NHS
Forth Valley but especially to Margaret
Campbell, Debbie Lowe, Kath McCormac,
Stuart Cumming, and Jann Davison
36