Ilkeston Hospital DTC – Extending the Role of Community Hospitals

1. Ilkeston Hospital DTC – Extending the Role of Community Hospitals Paula Clark - Erewash PCT

2. Starting Point • Traditional community hospital – large & modern • GP beds and GP led medical cover • One existing day case theatre with visiting Consultant teams • New Outpatient Facility • X-ray and ultrasound • Minor injuries unit • 90 beds • Catchment population up to 120,000

3. Committed staff, GPs and local population • Acute local providers with significant developments • Primary care “at the edge” – workload and morale • PCT wanting early wins and identity for itself and its constituents • A few “champions” and track record for innovation – nurses, visiting Consultants and GPs

4. The Environment • Strategic context • Plans for shift of care from secondary to primary care • Concern re growth rates of referrals and non-elective admissions vs capacity and workforce • Primary care access targets vs workforce shortages • PCT context • Desire to provide services close to home for patients • Recognition of need for modernisation

5. The Vision To move away from the traditional community hospital image by creating a modern hospital for the people of Erewash PCT that: • Provides real choice and quality for patients & GPs • Retains investment within the PCT & creates opportunities for income generation • Provides opportunities for staff to enhance their skills and hence improve recruitment and retention • Provides a test bed where new ways of working could be trialed on a small scale

6. First Steps • Where were our pressures? • Financial, Primary Care Access, Social Services • What were we doing well now? Could we do more? • Extended nurse roles, GPwSI, daycase surgery, inpatient care, rehabilitation, palliative care • What would we like to do? • Provide more for patients locally, repatriate investment, fill in service “gaps”, push the boundaries! • What were others doing? • Community Hospitals Association, leading edge PCTs, day case surgery review

7. What Could Be Done Differently? • Changing clinical leads • Changing clinical roles • Changing care management pathways • Changing scope of services

8. The Hurdles • Safety concerns from acute providers • Day case rates • Shifting money • Consultant sign up • Workforce • Capital availability

9. Moving Ahead • Changing Clinical Leads • ENP led minor injuries unit with GPwSI • Extending nurse role on wards • Changing Clinical Roles • ENPs – carpal tunnel injections • Physiotherapy triage • GPwSI – cardiology, dermatology • Changing Care Management Patterns • Repatriation of rehab patients from across Erewash • Changing Scope of Services • Diagnostic and Treatment Centre

10. Ilkeston Hospital DTC • Two day case theatres – up to 4,000 day cases & 1,000 more outpatients (added to 14,000) • Two scoping rooms – urology, hysteroscopy and endoscopy • Echo-cardiography service • 16 day beds

11. Under Construction! • Optometrists with Special Interest • GPwSI – plastic surgery and dermatology day cases • PCT held waiting lists in orthopaedics and ophthalmology from April 1st • Day rehab with Social Services • Radiographer endoscopists • 23 hour beds to extend day surgery • Further income generation for PCT

12. The Lessons • Understand the local strategic context • Build evidence to support your plans – what are your strengths and what has been learned elsewhere • Support the clinical champions and give them the headroom they need • Ensure sign up from all stakeholders • Ensure clinical governance and risk aspects are covered • Understand and agree how funds will shift or what the call will be on growth