INTERMEDIATE CARE CONFERENCE 31ST MAY 2004

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INTERMEDIATE CARE CONFERENCE31ST MAY 2004

• Improving the health and well being of older
  people in Wigan Borough - a multi- disciplinary
  approach to redesigning services

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CONTENTS

• 1. About Wigan
• 2. About the Innovation Forum of Excellent
  Councils - Wigans involvement
• 3. Intermediate Care in Wigan

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WIGAN

• Higher than average levels of
• Smoking
• Diabetes
• Obesity
• Low physical activity
• Poor diet
• Higher incidence of COPD/related admissions -
  1086 compared to expected 629
• Life expectancy 1.33 / 1.34 years less than
  England and Wales average
• Contd.

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WIGAN

• 13 of the 29 electoral wards are within 20 of
  most deprived in England
• 4 are within 10
• 37 more emergency hospital episodes than average
  in 2000
• 22 more elective
• despite having low proportions of people 65
  (39.9 compared to 15.7 nationally)

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WIGAN

• Excellent Council - strong leadership
• 3 star hospital
• 1st wave foundation trust
• 2 star SSD
• Wigan performs well assisting older people to
  live at home (Joint Review 2004)
• In spite of low FSS figure
• Very low levels delayed discharges
• Good history of joint working
• Simple health economy - co-terminus Met.
  Council/ PCT/Acute Hospital

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INNOVATION FORUM

• 10 Excellent Councils
• Health of Older People
• Whole system commissioning from a single point to
  reduce hospital bed days
• Better use of resources
• Improve care pathways
• Freedom and flexibilities
• National and local evaluation

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PROJECT LEADS GROUP
DOH
Kent
Policy Lead
Cheshire
ODPM
Freedom
Cornwall
IDeA

Flexibility
Dorset
LGA
Hampshire
NAT PACT
Hertfordshire
LSE
Shared Learning
Nuffield
Kingston

• Support of-
• Stephen Ladyman
• George Alberti
• Ian Philp

Westminster
West Sussex
Wigan
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HEADLINE TARGET
20 reduction in unscheduled acute hospital bed
days occupied by people over 75 years old, living
in partner PCT areas, over the three years
2004-2007
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OUTCOMES SOUGHT

• Older people will live more healthy and
  independent lives, with greater choice of
  services, more means of support and increased
  community participation
• Care and treatment of older people will be
  arranged more holistically and seamlessly, with
  fewer service gaps, interface delays and
  administrative burdens
• Much needed capacity will be released in acute
  services to improve services and choice of people
  who really need acute treatment in hospital

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HOW APPROACHING THIS IN WIGAN?

• Commitment of 3 Chief Executives
• Executive Steering Group
• Single point of commissioning
• Co-ordination of other groups
• Steering Group
• Wide representation
• Dedicated project lead

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A Whole Systems Approach to Health and
Well-Being for Older People
Acute Hospital
Intensive Management
Intermediate Care
Specialist Outreach
Continuum of Support Older People
Assisted Support
Management of Chronic Disease Support of Frail
Elderly
Preventative Services
Self Care Support
Community Strategy Environment Information
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WIGAN PROJECT MANAGEMENT PLAN

• Improves pathways within the acute setting and
  upon discharge
• Expands intermediate care to prevent avoidable
  admission and facilitates early, safe discharge
• Develops traditionally hospital based services
  within the community (primary care) setting
• Integrates health and social care management
  within a primary care setting giving particular
  emphasis to proactive chronic disease management,
  the promotion of self-care and enablement
• Contd....

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WIGAN PROJECT MANAGEMENT PLAN

• Develops a multi-agency prevention strategy which
  promotes independence and empowerment
• Focuses on universal environmental factors which
  impact upon well-being, e.g. environment, housing
  property and community safety

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INTEGRATION

• Shared vision and strategy
• Primary, Intermediate and Secondary Care
• Council and NHS
• Hospital Discharge Care Pathways/Bed Management/
  Care Management
• Macro and micro commissioning
• Joint eligibility criteria
• Single Assessment/Shared Records
• Whole system Performance Management
• Not just Older People

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INVOLVING OLDER PEOPLE

• Existing structures
• Citizens panel
• Patient forum
• Audit of previous consultation
• What matters?
• Local conference
• Reference group

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INTERMEDIATE CARE IN WIGAN

• Well established Intermediate Care Services
• But
• Avoidable admissions
• Unnecessary tests
• Loss of dependency
• Reactive to bed pressures rather than planned
  care pathways
• Transfers between sites - reactive
• Issues around clinical ownership

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OVERALL APPROACH

• Single vision
• Whole system financial priorities
• Increase investment in self care support in the
  community
• Integrated teams
• High risk group specialist support
• Wider group multiple pathology
• Invest in community-based alternatives
• Risk management
• Longer term reduce need for intermediate care by
  avoiding exacerbation/crisis
• Shorter term whole system approach shared
  priorities

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CURRENT FOCUS

• Simplified pathway
• Intermediate Care in its widest sense
• Over 28 days stays
• Impact of reduction in acute beds
• Readmissions
• Admissions from nursing homes
• Impact of new financial flows

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INVESTMENT PRIORITIES

• Developing the single point of access to a 24/7
  service
• Expand the capacity of Rapid Response at home
  with 24-hour access
• Specifically to expand services in response to
  the development of the new 48 assessment unit
  from June, and the 4 hour target
• Ensure maximise utilisation of the Single Point
  of Access
• Fully integrated single assessment process within
  Intermediate Care (single client record)
• Contd..

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INVESTMENT PRIORITIES

• Expand clinical input/diagnostic services out of
  hospital setting
• Expand capacity of intermediate care services in
  the wider sense, e.g. those needing recovery
  time to facilitate a dignified and care managed
  end of life

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FOCUS - COPD

• Avoidable admissions
• Anxiety
• Treatment compliance
• Care pathway
• Secondary - primary
• Health and Social Care Support
• Flexible roles
• Evercare approach - intensive support to high
  risk group

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• If we get it right for Older People we get it
  right for everyone