I ntegrated M anagement & Pro active Care for the V ulnerable and E lderly – IMProVE

1. Integrated Management & Proactive Care for the Vulnerable and Elderly – IMProVE Amanda Hume Chief Officer

2. What is the IMProVE Programme? The number of people who are elderly, vulnerable and living with a long-term condition in South Tees is increasing The CCG working closely with social care and other health partners, want to improve the quality of care this group of people receive and to ensure that services remain safe now and are sustainable in the future.

3. To do nothing is not an option! • Health care is constantly changing – 3 main drivers for change • Meeting patients’ changing needs • Improving quality, safety and outcomes • Achieving better value • Evidence supports that there is more to be gained than lost in changing services as more patients will have a better experience and outcome • A whole system approach is required – One service change cannot be changed in isolation to the rest of the system • Patients and their organisations need to critique current provision and inform its redesign to better meet their needs

4. The CCG wants to actively engage with the public in order to better plan and redesign services • To gain views on our vision for the IMProVE programme we held a wide range of engagement activities: • 5 ‘drop-in’ events across different localities • We circulated a questionnaire – 99 responses • We commissioned Carers Together to do a more in-depth survey – almost 350 responses • Our key focus is about commissioning services to meet the needs of our population

5. IMProVE Integrated Management and Proactive Care for the Vulnerable Elderly Key themes emerging from engagement activity September-November 2013 23 Queen Street, Redcar, TS10 1AB tel: 01642 488977 email: carerstogether@btconnect.com web: www.carerstogether.co.uk

6. Engagement activity • Questionnaire - CCG website - Stakeholder organisations - People registered on My NHS - People who attended 5 public events • An in depth survey of patients and carers by Carers Together

7. Profile of survey respondents • 348 respondents from Redcar, Eston, Guisborough, Brotton and Middlesbrough • 16% aged 66 -70 • 48.6% aged over 70 • 36.2% aged over 80 • 43.1% male; 56.9% female • 87% living at home • 58% were carers • 23% were caring for someone with dementia

8. Co-ordination of services • 37.5% of respondents felt that local services were organised very well • 38% of respondents felt that local services were organised fairly well

9. Suggestions for improvements • Better collaboration and co-ordination across health and social care organisations and between services. • More effective and efficient sharing of information • Better communication between providers • Improved liaison with carers • A more holistic view of the family situation

10. Respondent’s views “The different departments do not interact with each other which confuses everyone. No one department seems to have the full up-to-date information”

11. Access to GPs Most respondents felt that their first port of call was their GP and they rely on local doctors.

12. Suggested improvements • Better appointment systems, that are easy to use and understand. • Appointments need to be easier to make. • Shorter waiting times for GP appointments. • GPs need to spend more time visiting patients at home. • Better continuity of care eg being able to see the same GP on a regular basis

13. Respondent’s views “We are very happy with our doctor and the service he provides; he has telephoned when needed and made sure we saw consultants quickly if needed. It is difficult to get an immediate appointment but he’s so popular.”

14. Access to information 67.5% of respondents knew who to contact for advice, guidance or support about their long term condition.

15. Suggestions for improvements • More information/guidance would be helpful (53% of respondents) eg about social care provision, treatment at home and specific conditions eg dementia. • Information needs to be consistent and up-to-date. • Ensure that patients, carers and families understand the information they are given.

16. Respondents’ views “Dad might benefit from someone giving him more information as to the outlook of Mum’s dementia and what to expect.” “After going home physio ceased and I had no idea what I should attempt.” “Carers should be given more information about when a condition worsens.” “Sometimes I don’t understand medical terms and would like it explained in plain English.”

17. Quality of care provided • 3.4% of respondents said they definitely received enough support to manage their condition. • 69.1% of respondents said they have support to manage their condition to some degree.

18. Suggestions for improvements • Shorter waiting times for social care assessments; specialist assessments eg by OTs; installation of equipment. • More support for housebound people. • A better relationship with doctors who understand patients’ conditions. • Longer visits from community nurses.

19. Respondents’ views about what would help “Access to relevant information when doctors and nurses have a collective review and results of test and treatments explained.” “Having the same GP who knows about your condition and not doctors who hardly know you.”

20. Where care should be provided 63.5% of respondents felt that people should receive the majority of their care for a long term condition, in a mixture of home, community and hospital settings, dependent on the person’s condition. 23.4% felt they should receive the majority of their care at home. 11.9% felt they should receive the majority of their care from their GP practice and community nursing staff

21. Suggestions for improvements • More day care for people with dementia. • Assurance of an efficient and reliable network of care. • Regular visits from named carers. • Good communication so that there is continuity of care, co-ordinated by community nursing staff, according to the person’s needs.

22. Respondents’ views “I feel strongly that people are better cared for in their own home rather than going into hospital as many become disorientated when out of their own surroundings – as long as carers are given time to do the job when calling on patients living alone.” “ Everyone has different needs. The main thing should be continuity of care with someone that can be contacted when a problem arises, whether in hospital or at home.” “Colin’s GP and mine are very good at co-ordinating our care. Colin’s GP has spoken to other agencies and nurses about his care.”

23. Care closer to home • There was some support (23.4%) for more care being provided at home or in the community. • Some respondents felt that providing care at home could aid recovery, prolong independence and keep hospital beds free for people who are seriously ill.

24. Suggestions for improvement • Ensure an efficient and reliable network of care. • Provide contact numbers for and regular visits from named workers. • Improve local transport. • Better communication and co-ordinated care. • More support from GPs and nurses.

25. Respondents’ views “My husband, who is 90 years old, is my main carer. Without my own transport, access to services is difficult or nearly impossible.” “Social services can do more joined up thinking in organising care at home.” “Communication and contact with the GP when discharged from hospital and support at home for as long as needed are important”

26. Quality of community provision Quality, ease of access and extent of community based services were important to respondents.

27. Suggestions for improvements • More frequent and longer home visits from health professionals and home care staff. • Swifter assessment of needs, access to services and equipment, especially following discharge from hospital. • More practical support at home. • More respite care provision. • More on-call support at weekends/evenings. • More support for unpaid carers.

28. Respondents’ views “I think social services could visit people more and help them, depending on what’s wrong with them and also tell them what special groups can help them.” “Joined up working between doctors, nurses and social services is needed.”

29. Hospital beds • 50% of respondents felt that there are not enough hospital beds. • Some respondents would prefer to have too many beds, rather than too few. • 50% of respondents supported the idea of closing community beds and providing more care in the community, which would aid recovery and promote independence.

30. Suggestions for improvements • Better community heath and social care services. • Ensure that hospital beds are available when needed. • Have adequate budget and resources eg staff, to develop and improve community services.

31. Respondents’ views “The concerns are that beds are not readily available. The worry is that some people are definitely better looked after in hospital. But people with good support at home do better.” “There should be enough beds still available for anyone who needs hospital care, at all times.” “Care outside of hospital is ideal for some, but a growing elderly population means beds will still be needed.”

32. Other issues • Physiotherapy and Occupational therapy: reduce time taken for assessment and access. • Dementia services: better information for patients and carers and more services • Community hospitals: valued for their proximity to home, relative and friends • Travel: cost and lack of public transport • Investment: greater investment in health and social care services needed. • Care homes: good, local care homes and staff training needed. • Care and Support: reliance on elderly carers • Carers/family: need to keep carers/family informed about health conditions and how to deal with them • Listen to patients and include carers, wherever appropriate.

33. Why do we need to change? Julie Stevens Commissioning & Delivery Manager South Tees Clinical Commissioning Group

34. Major progress has been made in improving the performance of the NHS in the past decade

35. Waiting times for treatment in hospital have fallen dramatically and generally remain stable

36. Hospital-acquired infection rates like MRSA have fallen dramatically

37. The NHS continues to be highly valued by the public Source: Ipsos Mori 2013

38. The NHS continues to perform well on most indicators when compared to other countries

39. However, the current health and social care delivery system has failed to keep pace with the needs of an ageing population, the changing burden of disease, and rising patient and public expectations

40. Fundamental change is needed It is time to ‘think differently’

41. 1. Variations in quality and outcomes of care

42. ‘The UK has the second highest rate of premature deaths for which effective clinical interventions exist in 16 high-income nations.’ Source: Nolte and McKee 2011

43. In Tees life expectancy is lower than the England average. There are inequalities across South of Tees with regard to life expectancy, access to services and deprivation. • Life expectancy is 14.8 years lower for men and 11.3 years lower for women in the most deprived areas of Middlesbrough than in the least deprived areas. In South Tees

45. There are wide variations in performance and gaps in the quality of care of general practice.

46. 2. Funding Pressures Current spending projections in the NHS suggest significant financial pressures on services for the next 20 years

48. 3. Delivery Systems not fit for the future

49. A significant proportion of patients occupying beds do not need to be in hospital on clinical grounds Source: Goddard et al 2000; Audit Commission 2003

50. In South Tees • An Independent Survey across South Tees carried out around 18 months’ ago showed that: • 49% of patients in a community bed did not need to be in there and could have been appropriately supported by other services • ?50% of patients in an acute bed did not need to be there