Integrated Out-of-Hospital Services Progress Under Radar

Lynn WoodsCEO

Adastra Software Ltd, Ashford, Kent

OoH = Out of Hospital

Service Providers = Operational Hubs

Introducing the Operational Hub

• There are too many service silos• We need integrated services, interoperable

systems• Information pathways must be made inseparable

from the Patient Journey• The more that is functionally integrated the

less needs communicating across boundaries!

• ….so what is the operational hub and what is its reach?

Operational Hub

NHS DirectGP Surgery

Ambulance Control

Hospital

Patient referrals

Downgraded emergencies

Care plans and essential patient

information

Diverted Accident & Emergency

Presentations

National Spine(PSIS)

Upgraded emergencies

Contact reports

Priming Information and outcomes

Admissions & Referrals

Spine Communication Spine Communication

Spine Communication Spine Communication

GP Summary Record access and PDS look-up

The Policy Backdrop

• There’s no coherent provider development policy

• That’s why hubs are “under radar”• GP Co-operatives did the pioneering• But now we have a commissioning free-for-all• Short-termism, commissioning fault-lines,

investment starvation, obsession with stats over facts, induced competitive tensions etc etc

• Therefore development paralysis• Progress despite the strategy, not because of it

Despite all that…..

inside the Operational Hub “Shell”

An Adastra Model of Integrated Urgent and Out-of-Hospital Care in England

The Operational Hub

Mental Health Team

Out of Hours Primary Care

Centre 1

24hr PCC (Handling GP

Surgery Overload)

OoH Primary Care Centre 2

OoH Primary Care Centre 3

60 wider locality Hubs

Avge 800,000 population

Call Centre & Operational Control RoomConvergence of Single Points of Access

Consistent clinical assessment and prioritisationCo-ordination and tasking of point-of-care resources

Casework distributaryConcentration of Quality and Governance focus

Minor Injuries Unit

Social Servs

Palliative Care District

Nursing

Emerg Dentist

Long Term Care

Out of Hours GPs

Real-time event management – in car computers and hand-

helds

A&E primary care filter

Telehealth/ Long Term Conditions

Intermediate Care

Admissions Avoidance Schemes

Polyclinics

Patient Transport

GP Referrals Management

NHS Direct

Ambulance Service

General Practice

Neighbouringhub services

Hospital

Forensic Medicine

...and the interception or re-routing of primary

care traffic presenting to A&E & 999

Integrated Community-facing Services within the hub umbrella

PBC commissioned

services

National Data Management Resources

Real time data for secondary uses

Capacity Management systemsPandemic response planning

Bioterrorism surveillanceInfectious illness screening

Added Value Services

Conventional urgent and OoH care caseload...

Bi-directional interoperation with other NHS domains

Inappropriate (Category C) 999 callers

In Hours urgent visiting

...extending to support of in-hours

operations...

Support of Prisons &

Military Units

Walk in Centres

E-dischargeCo-ordination

...leading on to the delivery of out-of-

hospital workstreams

System Direction?

We must support…– Complex operational flows– Multiple services and disciplines– Cross-boundary information flow– Embedded expert capability (eg CDSS, Map of M)– Local processes of the user’s definition– USPs?

• User definable case flows • Dispersal and segregation• Operational and clinical functionality• Integral and real-time mobile data

Catch us at the breaks for more info