Albert

1. NHS Yorkshire and the Humber: Acute Care Albert What might happen now… • An ambulance arrives in 15 minutes and he is taken to his local acute hospital. • Albert waits two days for a CT scan (acute brain imaging) to confirm what kind of stroke it is (sometimes this can be up to 6 days). • In the morning it is confirmed that Albert’s stroke has been caused by a clot but it is too late for thrombolytic (blood-clotting) drugs to be administered. • Albert is referred for rehabilitation care and discharged from hospital two weeks later. He still finds speaking difficult. • Albert continues to see a language therapist at a regular outpatients appointments and has contact with his GP. He also receives social care support to help him and his wife cope at home. • He receives information about life after a stroke developed by the Stroke Association. He finds out that others who have had a stroke have not received this information. • The acute phase of treatment takes up to 4 weeks • Albert is in his late 50s. In the afternoon he begins to feel numb on one side of his body and starts to slur words. His wife is worried so dials 999. N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

2. NHS Yorkshire and the Humber: Acute Care Albert What might happen in the future… • The ambulance is at Albert’s home within 5 minutes. • A stroke specialist is waiting in A&E to check Albert when he arrives at the acute hospital. • The specialist stroke team immediately undertake a CT scan (now available 24/7) which allows Albert to be given blood clot-busting drugs straight away, successfully counteracting the effects of the stroke. • Albert is cared for by a specialist multi-disciplinary team on a dedicated stroke ward. • Albert returns home after three days. Albert and his wife are given full information about stroke and rehabilitation. • Albert’s normal speech recovers quickly and he has minimal disability. • The acute phase of treatment takes 3 days • Albert is in his late 50s. In the afternoon he begins to feel numb on one side of his body and starts to slur words. His wife is worried so dials 999. • . N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

3. Proposed differences between the acute care pathway now and in the future NHS Yorkshire and the Humber: Acute Care • Stroke is recognised as a medical emergency by every part of the NHS so the response time by the ambulance service is quicker • The patient has no choice of hospital but is automatically taken to the best equipped hospital with specialists available 24/7 • Patients have immediate access to a CT scan and blood clotting treatment after diagnosis • The patient is looked after by specialists in stroke care throughout treatment • The patient is cared for on a dedicated stroke unit • The patient is able to go home quicker

4. NHS Yorkshire and the Humber: Children Kieran • It is 7am and Keiran, a 1 year old infant, has a very high temperature. What might happen in now… • His mother is not quite sure what to do or who to call. She decides to telephone the GP surgery where Keiran is registered and ask for advice. • She speaks to a member of staff who arranges an appointment to see the Practice Nurse that afternoon. • The nurse sees Keiran and consults a GP. It is decided that he should go to A&E. • At the hospital, Keiran and his mother wait in A&E to see a specialist. • The specialist refers Keiran to a children’s unit. • He is stays in hospital in the children’s unit for observation and treatment. N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

5. NHS Yorkshire and the Humber: Children Kieran What might happen in the future… • His mother is able to give Keiran basic medication to help control his temperature. Triggers suggest to her that he might be very sick, so she knows to take Keiran to an Urgent Care Centre which is open 24 hours a day 7 days a week. • At the centre, Keiran sees a paediatrician (child health specialist). • Keiran is admitted to a day assessment unit for close observation and cared for by child health specialists. • Keiran’s mother is encouraged to continue to care for her child as the expert carer – she is given information and help to do this. There are also hotel facilities on site. • Keiran has been identified as vulnerable previously so social services do a family assessment. This means that when Keiran and his mother return home, she is more confident in how to care for her child and knows that support systems are in place. • Keiran and his mother receive additional support from a local health visitor, a social worker and visit the Children’s Centre for information when required. • There is a children’s GP at the centre so if there are any further health issues Kieran’s mother can take him there • It is 7am and Keiran, a 1 year old infant, has a high temperature. His mother lives alone, unsupported. N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

6. Proposed differences between the acute care pathway now and in the future NHS Yorkshire and the Humber: Children • Every new child in a family will be assessed for risk • All children and families thought to be vulnerable will have a support team working with them • Parents will be more confident in recognising the signs of illness in their children and know how to treat minor illnesses • There will be one point of access for children’s heath care so there is less confusion about points of entry to services • Urgent Care Centres operate alongside A&E departments - where children with less critical conditions can attend 24/7 • Clearer information is available for parents (via TV channel, radio, texts, Children’s Centres) about children’s health • Expertise of parents and children to manage their own care is positively encouraged

7. NHS Yorkshire and the Humber: End of Life Ernie • Ernie is 80 years old. He was diagnosed with stomach cancer eight months ago. Recently his strength has deteriorated and his symptoms have worsened. A friend takes him to see the local GP. What might happen now… • Because there is no social support, the GP recommends that Ernie is admitted to the local acute hospital. • At the hospital, Ernie is checked by junior medical staff in the emergency department. Investigations are carried out (found out later to be unnecessary). • He is given treatment for his symptoms and made more comfortable, but his condition continues to deteriorate. He is transferred to a ward. • Staff recognise that Ernie is dying but it is too late to arrange a package of care at home. • Ernie dies in hospital. • Ernie’s relatives receive support after his death. N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

8. NHS Yorkshire and the Humber: End of Life Ernie • Ernie is 80 years old. He was diagnosed with stomach cancer eight months ago. Recently his strength has deteriorated and his symptoms have worsened. A friend takes him to see the local GP. What might happen in the future… • The GP and Ernie discuss his symptoms in the context of his incurable condition. Ernie decides he wants no further treatment. • An End of Life Care Package is developed taking into account all of Ernie’s needs. Ernie tells his GP that he would prefer to die at home. • A key contact worker is identified to coordinate Ernie’s care. • Ernie is visited and supported by appropriate health and social care professionals at home. • Ernie dies at home supported by a carer and his family. • Ernie’s family are assessed for their needs for bereavement care and it is provided N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

9. Proposed differences between the end of life pathway now and in the future NHS Yorkshire and the Humber: End of Life • There is recognition that the patient is nearing death and open discussion about end of life options • The patient is able to decide whether to continue or discontinue active treatment • The patient is able to choose the kind of support they want and where they would like to die • The patient’s holistic needs are assessed and an End of Life Care Plan developed • A key contact person is identified who coordinates the appropriate care • Carers and family members are offered support when looking after the patient at home and are assessed for their needs into bereavement.

10. NHS East Midlands: Long Term Conditions John • John is in his 60s. He has been feeling constantly thirsty and passing a lot of urine. What might happen now… • He visits his GP who suspects diabetes and refers him for blood tests. • John is diagnosed with Type 2 diabetes. • John sees a diabetes-trained Practice Nurse who sets up appointments for foot care, retinal screening plus an appointment with a dietician. • He receives educational information and advice for self management of the condition. He is told about Diabetes UK as a resource. • John doesn’t attend his appointment with the foot specialist and develops advanced foot complications • He has to be admitted to hospital and treated by a consultant N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

11. NHS East Midlands: Long Term Conditions John What might happen in the future… Similar to now, but… • John has a routine screening test in his local pharmacy. Results indicate problems with his blood sugar levels so he visits his GP. • Type 2 diabetes is confirmed and an individual care plan set up. • John’s yearly care plan covers lifestyle, diet, eyes, psychological well-being and foot care. • He undertakes a structured education programme to learn more about his condition and how to look after himself. • He is given the number of a diabetes support helpline in case he needs advice. This is available 24 hours a day 7 days a week. • He is given support at work to carry on his usual tasks. • John is in his 60s. He has been feeling constantly thirsty and passing a lot of urine. N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

12. Proposed differences between the acute care pathway now and in the future NHS Yorkshire and the Humber: Long Term Conditions • Earlier diagnosis made possible by access to screening in other settings • Targeted screening done by GP practices • Better written information for patients and their families • Individual care plans agreed and held by patient • Care records shared between professionals electronically • More support for self management - 24/7 helpline available

13. NHS Yorkshire and the Humber: Planned care • Sally is in her 50s and has been bleeding when she goes to the toilet. She visits her GP. What might happen now… • Sally’s GP refers her for an urgent specialist appointment. This is booked straight away at the surgery by the GP • Sally has an outpatients appointment two weeks later and is seen by a specialist who books her in for an urgent colonoscopy. • Sally is diagnosed with bowel cancer. • Sally is referred for care by a Multi-Disciplinary Team. • Surgery is undertaken in hospital within two weeks. • She is given information about bowel cancer and what to expect after major surgery. • Sally has several follow-up appointments in the weeks following surgery at the hospital to check her progress. Sally N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

14. NHS Yorkshire and the Humber: Planned care • Sally is in her 50s and has been bleeding when she goes to the toilet. She visits her GP. What might happen in the future… • The GP books Sally an urgent colonoscopy in a local diagnostic centre for three days’ time. • A nurse at the GP practice tells Sally about the diagnostic unit and how to prepare for her appointment. • Sally sees a specialist nurse who explains the colonoscopy procedure and why Sally has been referred. • Bowel cancer is diagnosed at the unit. Sally receives support from a member of Bowel Cancer Multi-Disciplinary Team during and after the confirmation of the diagnosis. • Sally is given supportive literature and a nurse helpline number at the clinic to tell her about her condition. • The diagnosis is communicated to Sally’s GP. • Surgery takes place in hospital a week later. • Sally’s follow up appointments take place in a community setting close to her home. Sally N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

15. Proposed differences between the pathway now and in the future NHS Yorkshire and the Humber: Planned Care • Time from initial GP appointment to diagnosis is quicker • Time from diagnosis to treatment is quicker - two weeks instead of four to five weeks • A multi-disciplinary team gives the patient support both during and after diagnosis • A nurse helpline number is given to the patient • Follow up appointments are closer to the patient’s home

16. NHS Yorkshire and the Humber: Maternity and Newborn Care Jane • Jane is 32 and pregnant with her first child. She visits her GP and an appointment is made for her to see a midwife. What might happen now… • The midwife tells Jane the benefits of breastfeeding and asks her how she is planning on feeding her child when it is born. Jane says she would like to try breast feeding. Her choice is recorded. • Jane gives birth to a health baby on a labour ward. • Skin to skin contact and an attempt to breast feed is made within an hour of the birth • Jane finds the experience of breast feeding difficult as the child is not feeding properly • There are not enough members of staff to advise Jane and the information she does receive is conflicting. In the end she gives up breast feeding and resorts to bottle feeding. • Because she has given up trying breast feeding she can return home sooner. N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

17. NHS Yorkshire and the Humber: Maternity and Newborn Care Jane • Jane is 32 and pregnant with her first child. She visits her GP and an appointment is made for her to see a midwife. What might happen in the future… • The benefits of breastfeeding are explored with the midwife and Jane is asked to consider it for further discussion. Jane decides to try breast feeding • When Jane is 8 months pregnant she attends an antenatal appointment with her midwife. They complete an antenatal breast feeding check list. There is further discussion about benefits • After the birth, when Jane finds breast feeding difficult on the labour ward trained staff are able to help her. All staff are trained to do so. • A peer support worker (a trained volunteer) sees Jane and is able to offer reassurance and information about breastfeeding. • After initial difficulties, Jane manages to successfully breast feed her baby. • Mother and child return home. • Jane is still breast feeding six weeks after birth. The personal peer support worker who visited her on the labour ward now visits her at home to see how she is getting on. • Breast feeding continues for six months. N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

18. Proposed differences between the pathway now and in the future NHS Yorkshire and the Humber: Maternity and Newborn Care • Future parents are educated about the benefits of feeding their baby breast milk in the first few weeks of life • The midwife discusses the benefits of breast feeding with the mother before birth over a period of time. There are no closed questions. • Staff give consistent feeding advice • All staff are trained to support breastfeeding for 24 hours after birth • A peer support worker visits the family at their home to give support

19. NHS Yorkshire and the Humber: Mental Health Mark • Mark is 17. His thinking has become confused and muddled. He occasionally believes that someone is ‘after’ him leading him to feel distressed. What might happen now… • Mark sees his GP with one of his parents after experiencing his symptoms for a year. The GP is unsure of the diagnosis and offers some general advice. • The GP is reluctant to diagnose Mark with mental health problems because of the stigma associated with it. • Four months later Mark and his parent return to the GP concerned about Mark’s increasingly odd behaviour and high stress levels. • The GP refers Mark to an Early Intervention Team which has recently been established. • Four months later, the Early Intervention Team (EIT) assess Mark and offer support. • Mark is unable to complete his college education N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

20. NHS Yorkshire and the Humber: Mental Health Mark • Mark is 17. His thinking has become confused and muddled. He occasionally believes that someone is ‘after’ him leading to feel distressed. What might happen in the future… • Mark is aware that something is wrong and goes to see a College Tutor after experiencing symptoms for a couple of months. • The tutor recommends that Marks sees his GP. • Mark’s GP immediately refers him to a local Mental Health Team • The next day, a mental health worker - linked to Mark’s GP practice - checks Mark and offers support to both Mark and his parents. The mental health worker refers Mark immediately to a specialist Early Intervention Team and sends them an up-to-date report detailing the checks she has already carried out. • Two days later the specialist EIT team continue assessment and begin treatment and support. • Meanwhile, Mark’s mental health worker remains in contact with Mark and his family supporting them through the system. She also feeds back information to Mark’s GP. • Mark continues treatment for 3 years with the specialist team. He completes college. N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

21. Proposed differences between the pathway now and in the future NHS Yorkshire and the Humber: Mental Health • Improved knowledge about mental health and well being within society and by NHS staff reduces stigma • Access to mental health services is easier and better understood by NHS staff and GP practices • A local mental health worker completes the initial assessment and refers immediately to a specialist team for best treatment • The local mental health worker acts as a key worker and helps the person and their family through the system • There is good communication between the GP practice and mental health worker

22. NHS Yorkshire and the Humber: Staying healthy Sarah • Sarah is overweight and feels out of breath easily. She would like to lose weight but feels she needs some extra support. What might happen now… • Sarah decides to sign up to a diet club that meets every week. • She attends for three months but finds it difficult to stick to the plan that she is given as she feels hungry most of the time. • Sarah has not managed to lose much weight on her own and is starting to feel depressed about her situation, so visits her GP. • Her GP refers her to the Dietetics Department at an acute hospital for some advice. • Sarah has an appointment at the hospital two months later with a dietician. She finds the information she is given useful and makes some changes to her diet following the meeting. • Sarah is able to lose some weight over the following year. N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

23. NHS Yorkshire and the Humber: Staying healthy Sarah • Sarah is overweight and feels out of breath easily. She would like to lose weight but feels she needs some extra support. What might happen in the future… • At a GP appointment for something else the GP recommends that Sarah loses some weight • A trained worker gives her advice about ways to lose weight and offers treatment and support. Sarah chooses what will suit her best. • Sarah decides to go to a local weight management service. She enrols on a long-term programme that covers both food and activity levels and sets Sarah specific goals. She also sees a behaviour change worker who advises her on breaking her habits about overeating. • Sarah receives regular support and advice from her local weight management service. • She stays on the programme until she has achieved a healthy weight loss and is exercising regularly. N.B. The names and images used in this scenario are completely fictitious and are for discussion purposes only

24. Proposed differences between the pathway now and in the future NHS Yorkshire and the Humber: Staying Healthy • Weight management is recognised as a distinct health problem needing support • Comprehensive screening and identification of obesity occurs throughout the NHS • A range of options for weight management are developed in local areas e.g. weight management services, exercise prescriptions and surgery • Behaviour change model is used (based on smoking cessation service) • Ongoing information and support on weight management • Wide range of NHS staff trained in helping people to lose weight and stay healthy