Welcome to
the new acute and community
County Durham and Darlington
NHS Foundation Trust
Clinical strategy
FT member events
April 2011
The new Foundation Trust…
• …an acute and community Foundation
Trust for County Durham and Darlington
• …more integrated, better co-ordinated
care for patients
• …helping the health and social care
system work together more effectively
• …opportunities for staff working in new
and different ways
Trust governance
Staff
governors
Public
governors
Governing
Council
Foundation
Trust Board
Stakeholder
governors
Clinical vision – an opportunity
“to shift the centre of gravity
from hospital to community and
develop fully integrated care
pathways”.
Clinical vision
• Premier provider of healthcare in County Durham and
Darlington including:
– Prevention and enablement
– Community Services
– Planned and emergency hospital care
• Major provider of women’s and children’s services in the
North East
• Reputation for excellent specialist services
• National profile as a pathfinder for new ways of offering
health services in hospital, home and community
Clinical strategy – our aims
• The best health outcomes for patients
• An excellent patient experience
• High quality, low cost services for
commissioners
Clinical strategy – key areas
Long term conditions
Care of older people
Women and children
Acute medicine and emergency care
Surgery
End of life care
Case study – long term conditions
Case study – long term conditions
Long term conditions
• Quick win: Facilitated discharge, good referral guidelines for
disease progression, pathway for minor acute events, access to
specialist support 0900-1700 via bleep and phone line (being
set up now),
• Priority issue: Patient education, equity of care, community
clinics across the county, decrease LOS in surgical patients
(CQUIN), IT - common LTC pathway and paperless clinics with
instant transfer of data across primary and secondary care
•
Synergy benefits:
– Outcomes and experience: reduced admissions through better
accessibility to specialist staff, better screening and management
– Workforce: development opportunities working across the pathway
utilising district and community nurses and integrating them with
hospital specialist nurses
– Efficiency: Community rather than hospital follow ups; Nurse rather
than Consultant follow ups. Working along with other workstreams
- old age/ emergency and end of life care pathways to be put in
place
Older people
• Quick win: Dementia – training of all staff who are in
contact with older people through e-learning etc
• Priority issue: single point of access to range of
services
• Synergy benefits:
– Outcomes and experience: Early prevention /screening,
future care planning
– Workforce: better use of specialist skills through dedicated
specialist direct assessment /admission unit
– Efficiency: better use of community hospitals
End of Life
• Quick win: Use of DH ‘surprise question’ as a trigger
into advanced care planning in the last year of life
• Priority issues: Shared, real time access to information
via IT systems; single point of access in the form of a
coordination centre
• Synergy benefits:
– Outcomes and experience: patients more likely to
access preferred option/place of care at the end of life
– Workforce: developing skills to facilitate patient choice
of preferred place of care at the end of life
– Efficiency: reduce number of avoidable admissions to
acute care at the end of life
Acute medicine emergency care
• Quick win: integration of protocols between UCC and A&E
• Priorities: joined up approach with all stakeholders including
NEAS, social care
• Synergy benefits:
– Outcomes and experience: reduced waits by quicker access to
appropriate level of care
– Workforce: access to senior experienced clinician opinion at
earliest opportunity in the pathway
– Comprehensive directory of supporting services in community and
acute settings
– Efficiency: reduced admissions from ED and urgent care
Women’s and children’s
• Quick win: Antenatal assessment for vulnerable
families
• Priority issues: Middle grade cover in paediatrics
and maternity, training of advanced paediatric nurse
practitioners, consultant numbers in paediatrics
• Synergy benefits:
– Outcomes and experience: Community care pathways for
women with low risk pregnancies
– Workforce: Alignment of community midwives with integrated
children’s teams
– Efficiency: integrated Health Visitors and school nursing
children’s teams with social care
Surgery
• Quick win: Redesigning pre-operative pathway; changes to
urology pathway
• Priority issues: Addressing pressures in vascular surgery
• Synergy benefits:
– Outcomes and experience: more accessible service for patients,
reducing unnecessary hospital visits ( pre-operative pathway), delivery of
care closer to home (Urology pathway).
– Workforce: changes to skill mix to meet pathway requirements, staff
have the skills to deliver care in the appropriate setting for the
patients
– Efficiency: Reducing emergency admissions to hospital. Offering
other services to manage surgical emergency activity, to deliver a
better service for patients.
Clinical strategy - discussion
•
•
What services could be offered in the
community that are currently offered in
hospital?
Delivering services in hospital
– Advantages
– Disadvantages
•
Delivering services in the community
– Advantages
– Disadvantages
We are developing a new clinical
strategy for the new organisation
Take part in the discussion at
www.cddft.nhs.uk/aboutus/clinical-strategy.aspx
Any questions?