Healthcare commissioning challenges · 2019. 11. 7. · Healthcare commissioning challenges •...

Partners in improving local health NHS Unclassified - Slide 1

Dr. David Hambleton

Chief Executive , South Tyneside CCG

Healthcare commissioning

challenges


Dr. David Hambleton


Evidence – it’s not all it’s

cracked up to be

Partners in improving local health

Healthcare commissioning challenges

• Sharing learning

• Decommissioning in 2014

– When 3.7 miles is a long way

• Public consultation 2017

– Path to excellence

• Judicial Reviews

NHS Confidential / Protect /

Unclassified - Slide 3


What does the clinical evidence and

best practice say?

‘Transforming urgent and emergency care

services in England’

By Sir Bruce Keogh, national NHS medical

director


What does clinical evidence

and best practice say?• Describes how to improve urgent & emergency care services:

– self-care

– help patients get the right advice/treatment in the right place, first time

– provide a highly responsive urgent care service outside of hospital so people no longer choose to queue in A&E

• Locating walk-in services with A&E is easier for people to get the help they need, all under one roof

• Evidence shows this reduces emergency attendances and demand on urgent care services


How are urgent care services used

in South Tyneside?

• Many patients who go to A&E or call 999 do not

need the high-level specialised care

• For many a different local service is more

appropriate

• Current way local urgent care services are

organised does not help patients understand

where to go


Accident and Emergency

(A&E)

• There were 56,508 patient contacts seen and treated at South Tyneside General Hospital A&E in 2012/13. This cost around £5.3million.

• Of the 56,508, patient contacts, 33,379 attendances, which is 60% of patients, didn’t need any treatment at all and were given verbal or written advice and reassurance.

• 50% of the conditions patients presented with could have been seen by another health service.


Jarrow Walk in Centre

• Walk in Centres introduced to decrease the need for A&E to see patients with minor conditions

• Opened in March 2010: contract due to expire 1 June 2015

• It was originally contracted to see 12,000 patients a year

• A recent survey with users of Jarrow Walk in Centre indicated:

– Only 34% of patients attended the WiC with a ‘minor ailment’

– Almost half of patients (49%) were aged 24 and under

– Only half of those surveyed (51%) had contacted their own GP practice before attending the WiC

– 66% of patients accessed the WiC by car


These represent the number of contacts at the service, not

necessarily the number of people; similar contacts would occur in

future at the urgent care “one stop shop”. Some needs could be

met in Jarrow at the local pharmacy or the GP practice may be a

more appropriate route.


0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

2009/10 2010/11 2011/12 2012/13

Annual Urgent Care Activity

South Tyneside A&E Palmers MIU Jarrow Walk In Centre Bunny Hill PCC


Arranging services in a new way

• Create an urgent care ‘one stop shop’ co-located with A&E at South Tyneside hospital

• A single point of access via one front door, all services under one roof, on one accessible site

• Relocate Jarrow Walk in Centre to new ‘one stop shop’

• Include GP out of hours in the ‘one stop shop’


South

Tyneside

Urgent

Care Hub

Proposed

Model

DRAFT

Acute Hub

Single Front Door

Minor

IllnessEmergency

Minor

Injuries

Community OutreachIntegrated Community Teams

(including Social Care, GP,

Community Nursing Teams)

Out of Hours

Primary Care

Triage/Direction

Children’s Short

Stay

Assessment Unit

Frail Elderly

Assessment

HOSPITAL

Ambulatory

Care

Emergency Care Medicine, Nursing, GP,

Mental Health, Dental, Pharmacy, Social Care


What could possibly go wrong?

15


What could possibly go wrong?

• Save our Walk in Centre campaign group

• OSC

• Local Elected members

• Local MP

16


What will happen to 27,000 people?

‘Build it and they will come’

‘Close it and they will disappear’


Outcome?

• Secretary of state referral

• Independent reconfiguration panel

review

• Judicial review

• Better care for patients

• Learning


Path to Excellence 2017 -

• Stroke

• Maternity

• Paediatrics

21


Path to Excellence 2017 -

22


Stroke care:

the national context for

local service change

Professor Tony Rudd, National Clinical

Director for StrokeSouth Tyneside and Sunderland Joint Health Scrutiny Committee,

21 September, 2017


• Incidence of stroke is falling but because population ageing predicted number of patients needing treatment likely to rise

• Services are improving from prevention to acute treatment and rehabilitation

• Technological and pharmaceutical advances - anticoagulants, thrombectomy. However….

• Stroke is the third biggest killer in England and main cause of severe adult disability

• Care gaps and variation continue to exist

• Significant stroke workforce challenges – now and in the future

National stroke strategy

24


• Transformation and sustainability aims relating to the three care gaps

• Seven day service delivery and priority clinical standards

• Growing population with increasingly complex needs

• Compelling case for greater stroke service centralisation

National stroke strategy and

policy

25


• Critical mass = higher quality care

• Sentinel Stroke National Audit Programme data

• National clinical guidelines

• Stroke service consolidation elsewhere: – London: changing from 32 stroke units to 8 specialist

stroke units achieved a 17% reduction in 30-day mortality and a 7% reduction in patient length of stay.

– Manchester: led to patients staying in hospital two fewer days

The evidence base

26

Figure 3: This graph shows that the longer it takes for a swallow assessment to

be performed for patients after stroke, the higher the risk is of developing

pneumonia

Adjusted incidence of stroke-associated

pneumonia (SAP) for increasing time to speech

and language therapy assessment


Thrombolysis Rates in London

3.5%

12.0%14.0%

18.0% 19.0%

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

0.16

0.18

0.2

% o

f A

dm

issio

ns

Th

rom

bo

lysed

Implementation


Outcome?

• Secretary of state referral

• Independent reconfiguration panel

review

• Judicial review

• Court of appeal hearing

• Better care for patients

Partners in improving local health 30


• Maintaining a relentless focus on why things need to change

• A shared view on the need for change across commissioners and

providers

• A clear, clinical evidence base

• Genuine attempts to be open to external input, views and

assurance

• A strong programme approach from the outset

• Exhaustive efforts on documentation, audit trail, publication and

transparency

• Recognising that there are no shortcuts

P2E lessons learned


Dr. David Hambleton


Evidence – it’s not all it’s

cracked up to be

Healthcare commissioning challenges · 2019. 11. 7. · Healthcare commissioning challenges •...

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