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Commissioning alternatives to hospital. Dr Seth Rankin Rob Persey. Structure. Introduction to the Community Ward in Wandsworth. Platform for other admission diversion schemes. Not just health and social care – everybody’s responsibility!. What is a Community Ward?.

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Commissioning alternatives to hospital

Commissioning alternatives to hospital

Dr Seth Rankin

Rob Persey


Structure
Structure

  • Introduction to the Community Ward in Wandsworth.

  • Platform for other admission diversion schemes.

  • Not just health and social care – everybody’s responsibility!


What is a community ward
What is a Community Ward?

  • A new way to structure Community Service.

  • Multidisciplinary Platform

    for providing integrated health & social care in the community.

  • Towards developing a comprehensive service designed to deliver acute & chronic healthcare at home.


An analogy
An Analogy…

Hospitals

Acute & Chronic Patients

A&E, MAU, Inpatient, etc

MDT Ward Rounds

Bedside & Paper

Nurses

Doctors

Social Workers

Pharmacists

MDT input…

Community Wards

Acute & Chronic Patients

Home-based

MDT ‘Ward Rounds’

Paper-based

Nurses– CMs, ANPs, DNs

Doctors– GPcw, Geriatricians

Social Workers

Pharmacist

MDT input – Mental Health, Palliative Care, Specialist Nurses, Addiction Services, Age UK, Carers


Why have a community ward
Why have a Community Ward?

Improve patient’s experience and increase capacity for home-based healthcare

Reduce unnecessary admissions.

Assist integration, productivity & responsiveness of community services.

Platform for Integration of Social and Health Services.

Care often not equitable across an area.

To prevent admissions and facilitate discharge we need to provide a safe place for patients to go.


The basics
The Basics:

  • Daily ‘activity rounds’ with core team

  • Weekly MDT ward rounds with ‘everyone’

  • Joint visits (GPcw, CM & SW) for ‘chronic’ patients

  • ANP or GPcw visits for ‘acute’ patients

  • In-reach into hospitals to facilitate early discharge

  • Patient information entered directly into GP’s computer (EMIS) via remote connection


MDT

‘Rounds’

Key elements

GPcw

Geriatricians

Community Matrons

ANP

Integrated IT

(EMIS, iClip, Framework i)

Pharmacist

Ward Clerk

(Core Team)

Social Worker

• DNs • ICT • Specialist Nurses

• Mental Health • Dementia Addiction • AgeUK • Palliative

...and more


Patient Pathways:

Community Ward

Secondary

Care

(IP or OP)

Ward Clerk

  • Acute Intervention

  • ANP

  • GPcw

Primary

Care

Social

Services

SPoC

Secondary

Care

  • Chronic Management

  • Community Matron

  • GPcw

  • Social Worker

Ambulance

Service

Predictive Modelling

Voluntary Services

GP


Lessons learned
Lessons Learned:

  • Patients prefer to be at home.

  • Massive duplication of services in the community.

  • MDT meetings & integration help address this.

  • Integrating with Social Services is enabled by MDT meetings.

  • GPs can be useful.

  • ‘Ward Clerk’ role is vital.

  • IT integration can be cobbled together.

  • None of this is easy.


Challenges
Challenges:

  • Ongoing Funding linked to Evidence of Effectiveness.

  • Transition from Pilot to Establishment.

  • Staffing levels difficult to maintain – CMs & GPs.

  • Line Management Structure & Systems.

  • Project/Change Management resources.

  • IT integration – technical difficulties & lack of will.

  • Predictive Modelling.

  • Rooms & Estates Issues.

  • Internal ‘marketing’ – hearts & minds of existing staff.

  • External ‘marketing’ - GPs, Secondary Care, Social Services, Ambulance, OOH providers, voluntary sector.


Exploring other admission diversion schemes
Exploring other admission diversion schemes

  • Developing an integrated assessment and response service (IARS):

    • Improve transition for patients between hospital and community services

    • Reduce acute hospital activity, including unnecessary admissions

    • Maximise independent living to support people ‘to do’ rather than ‘be done to’

    • Reduce and delay admissions into residential/nursing care

    • Develop dementia friendly services


Iars what s in scope list not exhaustive
IARS – what’s in scope? (list not exhaustive!)

  • Community Ward as platform for other interventions:

    • Reablement and Intermediate Care

    • Telecare and telehealth services

    • Equipment

    • Integrated Falls Service

    • Community Therapies

    • Out of Hours service

    • Specialist Day Services


3 workshop questions
3 workshop questions ?!?! …

  • Practically how do we implement this on the frontline – can it work as a platform for integrated health and social care delivery?

  • Will we ever realistically see a reduction in hospital admissions?

  • (How) can we facilitate the transfer of resources from the acute to the community sector?


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