Programme for Health Service Improvement

Improving Services in Central & Eastern Cardiff

Service Option Appraisal Workshop

15th November

CARDIFF AND VALE NHS TRUSTYMDDIRIEDOLAETH GIG CAERDYDD A’R FRO

Agenda12.30hrs Welcome and Introductions

What are we here to do today? Rebalancing Services: PHSI

Katie Norton PHSI Programme Director

Turning to Central and Eastern Cardiff: The critical issues What happened yesterday

Mike Walsh - Project Director Dr Simon Walford - Facilitator

Workshop Format

Tom Bayston

13.00hrs Objectives and Benefit Criteria

Tom Bayston / Bruce Whitear

13.15hrs Presentation of Service Options

Dr Simon Walford/ Dr Mark Drayton

13.45hrs Group Session: Ranking of Benefit Criteria

Dr Simon Walford / Tom Bayston

14.15hrs Coffee

14.30hrs Group Session: Weighting of Benefit Criteria

Dr Simon Walford / Tom Bayston

15.00hrs Group Session: Scoring of Service Options

Dr Simon Walford / Tom Bayston

15.45hrs Feedback of Results and Discussion

Dr Simon Walford

16.30hrs Summary and Close

Katie Norton / Mike Walsh

Purpose of Today

To work together to: Conduct an appraisal of the service

option defined during yesterdays workshop

This work will appraise the options against the investment objectives for the project

Programme for Health Service Improvement

CommunityBased

Services

HospitalServices

Key Principles

A shift of focus from illness to health Improve quality, safety and outcomes Right care, right time, right place, right

professional Focus on services and patient experience Maximise resources to achieve excellence

Working together as a health community

Developing Primary and Community Based Services

Patients will have access to: High quality primary care practices

working within defined localities Strengthened community based services

supporting people with long term conditions e.g. diabetes and heart disease

Meeting needs of children and young people Supporting frail elderly

So…Today…

Patient Focus

Ambition

Innovation

Opportunities for Change

From NHS Institute for Innovation and

Improvement

Patient risk

Referral

Condition/Cohort

GP interest

Lifecycle Position

Invasiveness

Given current conditions, should this service be performed

closer to the community

Is there adequateDEMAND?

Can theTECHNOLOGY

required support shift?

Can STAFFING &

SKILLS requirements support shift?

What are the SAFETY

considerations?

What OPERATIONAL

Issues should be considered?

Patient choice

Facilities

Separation of tasks

Equipment

Lifecycle Position

Training/CertificationAvailabilitySupport Staff

Access

Patient risk

Referral

Condition/Cohort

GP interest

Lifecycle Position

Invasiveness

Given current conditions, should this service be performed

closer to the community

Is there adequateDEMAND?

Can theTECHNOLOGY

required support shift?

Can STAFFING &

SKILLS requirements support shift?

What are the SAFETY

considerations?

What OPERATIONAL

Issues should be considered?

Patient choice

Facilities

Separation of tasks

Equipment

Lifecycle Position

Training/CertificationAvailabilitySupport Staff

Access

Supporting Clinical Pathways

Diagnostics involved in the Clinical Pathway

Bloods

Swabs

LaproscopyPelvic Inflam. Disease

BloodsVarious endoscopy

ECGX-rayPerf Ulcer

BloodsECGX-rayHypertension

Bloods

BG

ECGX-rayDiabetes

BGECGX-rayAsthma

Bloods

BG

Ox. SaturationECGX-rayHeart Failure

BloodsECGX-rayAngina

Blood gases (BG)

O2 Saturation spirometry

X-rayCOPD

PathEndoscopyRespiratoryCardiologyImaging

Diagnostics involved in the Clinical Pathway

Bloods

Swabs

LaproscopyPelvic Inflam. Disease

BloodsVarious endoscopy

ECGX-rayPerf Ulcer

BloodsECGX-rayHypertension

Bloods

BG

ECGX-rayDiabetes

BGECGX-rayAsthma

Bloods

BG

Ox. SaturationECGX-rayHeart Failure

BloodsECGX-rayAngina

Blood gases (BG)

O2 Saturation spirometry

X-rayCOPD

PathEndoscopyRespiratoryCardiologyImaging

X-Ray, ECG, Oxygen Saturation and Bloods are on pathways that represent 60% of the total number of spells for 19 of the most common

conditions appropriate for management out of hospital

Potential for Shift

435444

555545SpirometryOxygen saturation

Respiratory

444443Monitors

445334Echocardiogram

555455ElectrocardiogramsCardiology

445443Retinopathy

443344DEXA

443344Ultrasound

452243Mammography

442244x-rayImaging

554445Newborn screening

453345Tympanometry

453345Pure Tone Audiogram

Audiology

OverallOperationsSafetyStaff/SkillsTechnologyDemandDiagnosticFamily

435444

555545SpirometryOxygen saturation

Respiratory

444443Monitors

445334Echocardiogram

555455ElectrocardiogramsCardiology

445443Retinopathy

443344DEXA

443344Ultrasound

452243Mammography

442244x-rayImaging

554445Newborn screening

453345Tympanometry

453345Pure Tone Audiogram

Audiology

OverallOperationsSafetyStaff/SkillsTechnologyDemandDiagnosticFamily

These 13 tests were assessed as the most likely to be feasibly shifted and most health communities should be able to achieve shift in these areas

The Present…

Physio

SocialWorker

Domiciliary Care

OT

Family

Diabet-ologist

Practice Nurse

CPN

Cardiol-ogist

GP

DistrictNurse

Podiatrist

RespiteCare

VoluntaryTransport

Physio

SocialWorker

Domiciliary Care

OT

Family

Diabet-ologist

Practice Nurse

CPN

Cardiol-ogist

GP

DistrictNurse

Podiatrist

RespiteCare

VoluntaryTransport

The Future…

Physio SocialWorker

Domiciliary Care

OT

Family

Diabet-ologist

Practice Nurse

CPN

Cardiol-ogist

GP

DistrictNurse

Podiatrist

VoluntaryTransport

RespiteCare

Physio SocialWorker

Domiciliary Care

OT

Family

Diabet-ologist

Practice Nurse

CPN

Cardiol-ogist

GP

DistrictNurse

Podiatrist

VoluntaryTransport

RespiteCare

So What?

Resource Shift

Workforce Shift

Patient Expectation

Shift

OrganisationShift

CULTURAL SHIFT

Primary Healthcare Service & Estates Implementation Plan

Background, vision & purpose of the plan

The Model of Service Delivery

Local Service Delivery in Central and Eastern Cardiff

Background to the Plan

2004 – LHB completed Primary Care Estates Strategy. High level strategy based on ‘hub and spoke’ model

2005 – LHB completes consultation on services for Central and East Cardiff – includes CRI as first ‘hub’ in Cardiff

2006 – Cardiff & Vale of Glamorgan launch Programme for Health Service Improvement

Summer 2006 – Locality-based workshops for GPs and community services to develop proposals

Vision & Purpose of the Plan:Services

‘Designed for Life’ / Cardiff & Vale of Glamorgan ‘Programme for Health Service Improvement’

Primary and community healthcare services at the heart of the delivery of 21st Century healthcare, meeting patients’ needs in their local community and supporting them to maintain and improve their health

So build on current primary and community services to provide: Stronger, more responsive primary care Local provision of community services delivered in

or close to people’s homes

The Model of Service Delivery

Services will be organised at 3 levels: Primary Care Facilities – supporting the expansion

and renewal of primary care. Focus on GPs but encouraging co-location of other primary care contractors

Community Health Resource Centres – supporting the expansion and renewal of primary care. Providing GP services with co-location of targeted community services for a wider area

Locality Health & Treatment Centres – providing services on a locality basis and supporting the decentralisation of acute services into the community. Serve as a base for existing community services, integration with local authority and voluntary sector, and potential for GP re-location

The Model of Service Delivery

UHW / Llandough

West

North

Central & East

GP

GP

GP

GP

CHRC

CHRC

CHRC

LHTC

Cardiff

Central & Eastern Cardiff:Local Needs

Includes some of the City’s most deprived communities

Inner city wards contain high numbers of homeless, asylum seekers, ethnic minorities and students

High population growth and severe lack of GP capacity

Poor physical state of GP premises/health centres/clinics

Central & Eastern Cardiff:Phase 1 Proposals

Develop Locality Health and Treatment Centre at CRI

New Community Health Resource Centres: New Butetown Health Centre as part of Loudoun Sq

redevelopment New combined premises for Drs Jones & partners/Dr

Gerson & Partners in Llanrumney/Rumney New Llanedeyrn Surgery as part of Maelfa Shopping

Centre re-development

New practice premises for 7 GP Practices

Public Consultation Implications

Transfer of services from Splott Health Centre to LHTC

Transfer of community services from Grangetown HC to re-developed Butetown CHRC

Transfer of services from Trowbridge Health Centre to CHRC in Llanrumney/Rumney

Transfer of Services from Roath clinic to LHTC Transfer of non mental health services from

Pentwyn HC to new Llanedeyrn CHRC

Option Appraisal Process

PreferredOption

All options must be treated

the same

The preferred

option is a judgement

-based decision

Non-Financial Benefits

Risks Value for MoneyAffordability

Short-ListedOptions

Long List of Options

Objectives Constraints

Benefits Criteria

Case for Change

Future Activity Facility

Req’mts

Strategic Context

PreferredOption

All options must be treated

the same

The preferred

option is a judgement

-based decision

Benefits Risks Value for MoneyAffordability

Short-ListedOptions

Long List of Options

Objectives Constraints

Benefits / SuccessCriteria

Case for Change

Future Activity Facility

Req’mts

Strategic Context Case for

ChangeCase for Change

Future ActivityFuture Activity Facility

Req’mtsFacility Req’mts

TODAY’S

EVENT

Improving Services in Central & Eastern Cardiff:Objectives

To improve and increase the access to, range and quality of care provided out of hospital in response to the local needs of people living in Central and Eastern Cardiff to improve health and reduce inequalities

To promote multi-disciplinary and multi-agency team working that delivers high quality, integrated patient/client centred care.

To create an environment that has the flexibility to respond to changing needs and opportunities for service improvement to deliver sustainable modern patient care

To provide accommodation suitable for the delivery of safe 21st Century health and social care which meets the needs of the local community and ensures compliance with all mandatory accommodation standards.

To improve service efficiency through reduced duplication of services and improved use of limited resources.

Objective 1

Objective Stakeholder Group

Benefit Summary Benefit Criteria

To improve and increase the access to, range and quality of care provided out of hospital in response to the local needs of people living in Central and Eastern Cardiff to improve health and reduce inequalities

Patients, Carers and Public

Improved level of support available to maintain people within their own homes Improved health outcomesReduced health inequalities, in particularly to vulnerable groupsIncreased range of services available outside of the hospital settingReduced travelling and waiting time for servicesEnvironment that facilitates the implementation of service redesign and refocusing of the care pathway

Improvements in health, social care and wellbeing

Multi-Agency Staff

Improved use of staff skill mix Increased physical capacity to provide out of hospital services

Objective 2Objective Stakeholder

GroupBenefit Summary

Benefit Criteria

To promote multi-disciplinary and multi-agency team working that delivers high quality, integrated patient/client centred care.

Patients Increased range of services provided on a one-stop basis Enhanced continuity of careSimplified access arrangement for patients who traditionally find the NHS difficult to navigate

Improved integration of services for patients

Trust Staff Reduced duplication of assessment of health and social care needs.Improved working relations and integration of teams within health and between health and social careImproved opportunities for innovation and research - Introduction of new models of care reflecting best practice in service delivery

Objective 3

Objective Stakeholder Group

Benefit Summary Benefit Criteria

To create an environment that has the flexibility to respond to changing needs and opportunities for service improvement to deliver sustainable modern patient care

Patients Flexibility to allow changes in line with changes in health care standardsAppropriate clinical environment to support patient self-care

Delivery of relevant local services

Trust Staff Increased integrated office / assessment and treatment accommodationImproved opportunities to implement integrated service modelsPromotes opportunity to support cultural changeFlexibility to allow changes of services to be managed within existing accommodation as strategies develop

Objective 4Objective Stakeholder

GroupBenefit Summary

Benefit Criteria

To provide accommodation suitable for the delivery of safe 21st Century health and social care which meets the needs of the local community and ensures compliance with all mandatory accommodation standards.

Patients Care delivered in fit for purpose accommodation supporting the delivery of modern healthcare High quality environment for treatment; improved privacy and dignity; appropriate settings appropriate to relevant client groups.Compliance with Disability Access standardsServices for children provided within accommodation designed for this purpose

Improved safety of and confidence in local services

Trust Staff Safe and appropriate settings for modern health care deliveryImproved staff recruitment and retention due to improved working environment Closure / release of existing estateCompliance with Health Building Notes, Fire, Health & Safety, Disability Discrimination Act and Health Inspectorate Wales standards.

Objective 5Objective Stakeholder

GroupBenefit Summary

Benefit Criteria

To improve service efficiency through reduced duplication of services and improved use of limited resources.

Patients Improved management of long term conditions/chronic disease/mental health needs in a community setting Supporting admission avoidance and reducing delayed transfers of careReduction to the Inpatient length of stay for certain Chronic Disease ConditionsReduction in number of follow-up appointments for key medical conditions

Improved efficiency and effectiveness in the use of resources.

Trust Staff Co-location allows more efficient effective service delivery through co-ordinated services.More effective non-clinical support and backroom functionsStrategic, fit for purpose, co-ordinated development of services to remove and prevent duplication.

Options for Assessment

For all options except the do nothing, it is assumed that there will be:

Car parking considered and public transport links developed.

Access to appropriate step up and step down facilities.

Option 1 – Do Nothing

This option would only involve maintenance of the current services provided: the Cardiff Royal Infirmary (CRI) would be maintained to a standard to allow the safe provision of existing services. GP practices would not relocate to the CRI site.

Option 2 – Do Minimum

This option meet the minimum requirements of the previous public consultation. The assumption is that under this option the building will be open 9 – 5 Monday to Friday (other than GP out of hours services).

Backlog maintenance of the CRI will be addressed, retaining the current footprint of the building. 3 GP practices will move onto the site and the described services would transfer or expansion.

Option 3 – Integrated Health, Social Care and Wellbeing Service

This option will include all the services and facilities described in Option 2. There is an assumption that the building will be open for extended hours, and will be refurbished with the footprint designed to achieve optimum clinical synergy of the services provided. The Centre would include a range of supporting facilities such as a café, play area, group education facilities.

The integrated model would provide a range of integrated services to support complex needs assessment and treatment of local residents as described.

Option 4 – Integrated Health, Social Care and Wellbeing Service with Increased Devolution of Hospital Services

This option would include all the services and facilities described for Option 3 and include additional transfers of hospital based services into the community as described.

Ranking of Benefit Criteria

1. Improvements in health and wellbeing 2. Improved integration of services for

patients 3. Delivery of relevant local services 4. Improved safety of and confidence in

local services 5. Improved efficiency and effectiveness

in the use of resources.