GENERAL HOSPITAL

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PAST HEALTH CARE SYSTEM
Slide 1
PATIENT
GENERAL HOSPITAL
Residential home
home
AE gatekeeper
Nursing home
Ambulance 999
Cottage hospital
Mental health
Rest of Acute Trust Services
GP
consultants
critical care
Medical Centre
outpatients
surgery
? Under whos care
Wards / bed
Diagnostics
Community nursing services
discharge
rehabilitation
sub teams
Local Authority
Social Services Rehabilitation Team
pharmacy
Voluntary Sector
opticians
Home care packages
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THE PAST
Slide 2

• Scoop and run ambulances
• Admit to assess need and treatment
• Large uncontrolled demand which is unscheduled
  and urgent
• Inappropriate use of AE patients with alcohol,
  drug and mental health issues which cannot be
  dealt within the hospital environment
• Overcrowded, understaffed, under-resourced
  casualty departments
• Trolleys
• Sickest patients seen by most junior doctors
• Patchy primary care
• FRAGMENTATION

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The Future Vision 2008 HEALTH CARE SYSTEM
Slide 3
Ambulance Trust
General Hospital
AE
999
ECP
No AE
NHS Direct
Complex surgery
Super GP Surgeries
Community Hospital
Urgent Care Unit
Urgent Care Centres
PATIENT HOME
Minor Surgery
W I C
ESS
EMS
Diagnostic Tests
Acute Alcohol Team
MIC
Outpatient Clinics
PCC
Rapid Response Team
ECP
Well Being Clinics
Acute Substance Abuse Team
I S T C
Long Term Conditions Clinics
Local Authority
Low Vision Services
Rehabilitation Team
Voluntary Sector
pharmacy
opticians
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KEY TO FUTURE VISION OF HEALTH AND SOCIAL CARE
SYSTEM 2008
Slide 4

• WIC Walk in Centres
• MIC Minor Injuries Centres
• ESS Emergency Social Services Team
• EMS Emergency Mental Health Team
• ECP Emergency Care Practitioner
• ISTC Independent Sector Treatment Centres
• PCC Primary Care Centre

Patient self referral
Practitioner referral
Dashed box indicates service sits in community
and is co-located with other services in one
site. This depends on model adopted by PCT
Increase in the type and access to urgent care
services in the community Principle is to assess
need before admission. Treat in the field nearer
to home. Reflecting the closure in AE
Departments. More choice, easier to access, more
convenient, improved quality of care, faster
care. Services are centred around the patient.
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THE SERVICE IN 2008
Slide 5

• PATIENT FOCUSED
• Community centred
• Care close to home where possible
• Simple access
• Seamless pathways
• High quality
• CONTROLLED DEMAND, planned surgery and admission
  to Independent Treatment Centres or Super
  Sugeries
• Offers choice
• Encouraging all health partners to work together
  in a system-wide approach to developing urgent
  care services

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The Future Vision 2008 Introduction of New
Models of Service Delivery
Slide 6

• New Health Surgeries
• Increased investment into GP Practices giving
  rise to new
• Health Centres, Polyclinics, Super Surgeries,
  or Primary
• Care Centres.
• 125 such centres to open by December 2006,
  outside general hospitals, by 2008 the total will
  be 750 units
• Offering a wide range of services under one roof.
  The services provided will reflect the needs of
  the locality. This should be achieved through the
  PCTs understanding the needs of their population
  through research evidence and consultation with
  service users about want they want.

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Slide 7

• GPs with specialist interests and Consultants
  e.g. ophthalmology,
• community nurse, district nurses, midwifery,
  dentistry,
• physiotherapy, pharmacy, optometry,
  podiatry.
• Management of long term conditions such as
  Diabetes, Heart
• Disease, Elderly Care, Asthma, Well being
  clinics, Outpatient
• Clinics and wide range of diagnostic tests.
• To facilitate this budget control has been
  transferred from national
• control to local level.
• 5 of the NHS budget has been transferred from
  the Acute Trust
• (general hospital) to the PCTs. This means
  PCTs and GP hold the
• purse strings to commission or provide
  services, they deem
• appropriate.

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• New Community Hospitals
• Will offer patients wide range of access to
  health and social care which will be co-located
  on the same site. They will complement the
  specialist general hospital, providing speedy
  access to key medical tests, day case and
  outpatient surgery. They will be integrated with
  Social Service Departments.
• providing care closer to home in six specialities
  ear, nose and throat,
  trauma and orthopaedics, dermatology, urology, 
  gynaecology and general surgery.
• 700 million into new buildings through NHS LIFT,
  by the end of 2005, 54 new buildings were opened
  and in 2006, a new LIFT building is expected to
  open every week.
• Purpose-built facilities, where GP services are
  on the same site as pharmacies and social
  services, The centres are more convenient for
  patients, particularly older patients and those
  with long-term conditions, as they offer more
  care closer to home.
• some models of community hospitals will provide
  Urgent Care Units

Slide 8
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Examples of Community Hospital Developments
Slide 9
Reference to CISP, 2006 Developing Community
Hospitals Models of ownership 1 pdf, gives
cases of community developments of
hospitals. Recommended referencing to the Funding
Team as it explains how voluntary organisations
can fund services from the NHS.
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Slide 10

• Services which may be provided in Community
  Hospitals
• Long term conditions Clinics
• a resource Base for management of LTC with
  Specialist GP interest and Consultants for
  chronic disease management in the community.
• Older people
• Multidisciplinary Assessment Centre, for falls /
  mobility and complex needs. Integrating
  intermediate, social, urgent care and mental
  health.
• step- up / down intermediate care
• In / out patient clinics for comprehensive
  assessment for long term packages of care.
• Children and Young Peoples Centres
• Focusing on the Family and preventive health.
  Based on integrated and co-ordinated care across
  wide selection of agencies. Plan is for 3,500
  Childrens Centres by 2010.

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• Service which may be provided in Community
  Hospitals
• Self Care and Self Management
• The following facilities will be provided to
  enable self care of own health
• Education Rooms for Action on Personal Health
• terminals for personalised support packages for
  lifestyle changes,
• rooms to meet with health trainers and personal
  advisors
• gym equipment, yoga, dance, drama and music
  facilities
• kitchen facilities for cooking and learning new
  skills
• Facilities fpr Self Assessment
• enabling an individual to complete own health
  check
• enable to check own blood testing, borrow, learn
  and use self testing equipment.
• Facilities for Information Encompassing
• provision of both general and local information
• enabling individuals to obtain help and learn
  how to access it and how to personalise it.
• Sign posting

Slide 11
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Service which may be provided in Community
Hospitals Mental Health Facilities The
principles of Self care and self management
extends to Mental Health Services. Priorities
focus on the development of community Well-being
Resource Centres providing services and access to
agencies in community locations e.g. Employment
Advisers increased uptake of Direct Payments
and advance directives, will enable service users
to receive services in more local facilities
more culturally specific services, contact points
and information services and better use of
community facilities to provide information
signposting on mental health and mental health
services. Our health, our care, our community
investing in the future of community hospitals
and services, 2006) p 40
Slide 12
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Slide 13
Super surgeries The NHS Plan (2000) describes a
vision of the new GP surgery as, many of the
GPs will be working in teams from modern
multi-purpose premises along side nurses,
pharmacists, dentists, therapists, midwives and
social care staff. Nurses will have new
opportunities and some GPs will tend to
specialises in treating different conditions. An
increasing number of consultants will take
outpatient sessions in local primary care
centres. PCTs are being encouraged to set up
one-stop health centres which bring services,
such as GP. Health visitors, dentists, pharmacy,
a cardiology clinic, x ray facilities, optometry
services, Sure Start and healthy living café
under one roof. Work on about 50 centres is
underway. (The NHS in the UK 2006/07)
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An acute hospital admission is a failure of the
Health System.
Slide 14

• The real challenge to the NHS is how to manage
  chronic disease better

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Slide 15
URGENT CARE is all unscheduled, urgent and
emergency care, i.e. anything which is not a
programmed activity
Current Admissions - 70 elderly, Majority with
long term conditions of which 50 are
unnecessary.

• The 20 of Patients who need 80 of the Care
• Older People
• Decreased Functional Ability
• Mobility, sight loss, daily living skills
• Revolving Door Admissions
• COPD Heart Failure
• End of Life
• Psychological Social Support
• Packages of care tailored to the individual

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Slide 16

• Urgent care Services
• Our health, our care, our community investing
  in the future of community hospitals and
  services, 2006) p 40 states,
• Community Hospitals have a future major role in
  Urgent and Unscheduled care.
• It anticipates an increase in this type of
  provision which will be set out in future
  government Urgent Care Strategy.
• Minor injury units (MIU) and NHS Walk in Centres
  (WIVs) are providing much urgent / unscheduled
  care in the community.
• A network of Urgent Care Centres are planned
  which will be nurse led and co-located with out
  of hours GPs, emergency social services team and
  emergency mental health teams, ambulance base
  with Emergency Care Practitioners (ECP)
• Central will be Diagnostic Facilities, X-Rays for
  example will prevent unnecessary attendances to
  acute general hospitals.
• Urgent Care Centre will additionally act ( in
  some models of practice) as a resource for
  management of chronic disease.

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Slide 17

• The Urgent Care Strategy
• The new focal point for integrated unscheduled/
  urgent care
• URGENT CARE PLUS
• The link to Long Term Conditions (LTC)
• Base for community matrons
• LTC diagnostics
• LTC review clinics

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our health, our care, our community
investigating in the future of community
hospitals and services (DOH, 2006)
Slide 18

• A new generation of community hospitals and
  services
• The White paper defines what a community
  hospitals and services are as covering the
  following
• The broad range of services that are sited in
  defined local
• communities with small populations rising to
  about
• 100,000
• Any clinical or social care functions that can
  be provided safely
• and appropriately away from large specialist
  centres and those
• services and functions that benefit from close
  links to other local
• services, for example intermediate care
  services aimed at enabling an
• older person to regain independence in their
  own home .
• Will not undertake complex surgery requiring
  general anaesthetic nor
• provide fully fledged accident and emergency.
• It means that some larger hospitals will
  concentrate on specialist
• services and some will merge or close

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Individual and Community Oriented Preventative
Action for Health
Slide 19
Individually oriented preventative action
Health Hazards
Environmental hazards
Community oriented preventative action
poor education
poor food nutrition
unemployment
poor housing
poverty
Intersectoral action for Health. WHO. 1986
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Delivering Choosing Health (DOH 2004)
Slide 20

• Key messages
• Making healthy choices easy choices
• Interventions for the disadvantaged
• Health policy to inform and support
• Principles
• Informed choice
• Personalisation supporting people to make
  healthy choices, especially deprived groups and
  communities
• Working together through effective
• Choosing Health priorities
• Reducing health inequalities
• Reducing smoking, obesity, alcohol consumption,
• Tacking hypertension, poor dietary intakes, lack
  of exercise,
• Improving mental health and well being

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Slide 21
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Slide 22
Level 3
Patients with highly complex needs and
co-morbidities
Case management
Disease management equally shared care
Level 2
High risk patients
Level 1
Largely self care
70-80 population
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Future Health Care Trends an overview

• There are many powerful forces for change in our
  populations health and the way we deliver health
  care.
• The population is ageing. The balance between
  young and old is shifting. Life expectancy is
  increasing, as premature mortality rates fall.
  The average family size of 1.77 (2004) sits below
  the replacement level of 2.1. The number of
  single person and single parent households is
  growing. The number over 60 are expected to grow
  by nearly a third by 2021, while the numbers of
  young people under 16 will fall. The ethnic
  population is also ageing. However, there is
  significant uncertainty about the net impact of
  the ageing population on health care demand.

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• The workforce is changing and ageing. The
  national and international competition for
  skilled staff will grow. The workforce is
  demanding a better work/life balance.
• Current lifestyles present major risks to the
  future health of the population. Obesity,
  sedentary lifestyles, sexually transmitted
  disease, and alcohol consumption are growing,
  especially amongst the young. This is driving
  increased incidence in diabetes, osteoarthritis,
  heart disease and kidney disease. Over a quarter
  of the population still smoke. This creates a
  significant burden of respiratory disease and
  cancer.
• Health inequalities continue to present a
  challenge. People from lower socio-economic
  groups are much more likely to adopt risk taking
  lifestyles and yet are frequently handicapped in
  accessing health services and taking on board
  positive health messages - 40 of those from
  social classes DE have poor literacy skills.

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• The disease profile is changing. Previously fatal
  acute conditions such as cancer and heart disease
  can now be treated. Ageing related and chronic
  diseases, such as diabetes, respiratory illness,
  renal disease and arthritis, are becoming much
  more significant. More people are living with
  long term illness, and with multiple conditions.
• Medical advance can improve health outcomes, but
  will create budgetary pressures. Significant
  advances in medicine and surgery are anticipated,
  supported by the increasing insight offered by
  genetics. The capacity to treat is increasing,
  especially the older frail. This magnifies the
  potential demand of an ageing population.
• The expectations of society are changing. Rising
  education and income levels are helping to drive
  higher public expectations of health and health
  care services. The future old are expected to be
  much more demanding than their current
  counterparts.

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• Advances in information technologies enable
  improved models of care. The capacity to share
  clinical information and expertise between
  professionals and patients offer many
  opportunities for patients to take a positive and
  active role in their care and improve the
  quality of patient care and outcomes.
• These forces bring threats and opportunities to
  the health of the population and health care
  services. The impact on health care demand and
  our capacity to meet that demand is very
  difficult to foretell.
• There is significant debate about the impact of
  an ageing population. The incidence of chronic
  disease grows markedly in those over 60, but
  there is also evidence that the old of today are
  fitter than the old twenty years ago, postponing
  the onset of chronic disease. As chronic
  conditions are diagnosed earlier, treatment is
  likely to be more effective. One of the greatest
  uncertainties is that of the impact of current
  lifestyles on the population over the next two
  decades. Will the young of tomorrow have even
  greater levels of obesity, sexually transmitted
  disease and drug misuse than the young of today,
  and will the old be sicker and more dependent? A
  lot will depend on societys attitude and
  response to risk taking behaviours. We have the
  opportunity to live longer and healthier lives
  than ever. Will society grasp that opportunity,
  or will we see health inequalities increase as
  some do and some dont, or perhaps cant.

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Large growth in the number of older people what
will be the impact on total health care costs?
Per capita costs are greater for older people

• Starting from 2006, the post-war baby boom will
  boost the year-on-year growth rates in the
  elderly populations, with growth rates peaking in
  2012.
• The number of people over 65 is expected to grow
  by
• 527,000 - 2010
• 1,619,000 2015
• 2,390,000 - 2020

Hospital and community health service expenditure
by age of recipient ( per head, 2002/03)
Source DH
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An increased capacity to treat and reduced age
discrimination are raising intervention rates in
older people
Demographics and Medical Demand ( increase,
1990-2000)
(1)

• Coronary Artery Bypass Grafts
• Source DH, ONS

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New technologies offer a means to bridging the
care gap
New technologies enable a different relationship
with older service users

• Social Care is developing a number of new care
  models
• Extra care housing
• Homeshare
• Adult placement
• Technology-enabled services
• Connected care centres

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The Planning FrameworkIt outlines four
objectives for the future NHS
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Our health, our care, our say

• People want to keep themselves well, and take
  control of their own health. They wanted more
  help through
• Better information
• Advice
• Support