Grampian 2005/06 Action Plan

Grampian Action Plan

Grampian 2005/06 Action Plan

Grampian Delayed Discharge Action Plan 2006 - 2008

Introduction

Grampian's Winter Plan for 2006/08 builds on the success of our previous plans and the experience gained over a number of years. This Plan will set out the actions which will be taken over the next two years to reduce the delayed discharges in the acute sector to zero and have no patients waiting longer than 6 weeks by April 2008.

The measures put into place in recent years have been successful in significantly reducing delayed discharges from a high of 365 in 2002 to 154 in April 2006. This has been achieved while major redesign of services for older people was taking place by closing longstay beds and re-investing the resource in community services. The redesign of services has not yet been completed and will continue over the period covered by this Plan.

The successful lowering of the delayed discharge figure has been achieved by continued excellent working relationships between the NHS, the 3 Local Authorities and the independent sector and the hard work of staff who are fully committed to prevent delays in discharging patients from hospitals where possible. The Grampian Partnership face significant challenges in continuing to reduce the number of patients awaiting discharge. We need to address issues related to the supply and quality of nursing home provision, the recruitment and retention of staff alongside continued integration of the health and social care workforce. Similarly NHS Grampian and the three local authorities are continuing to be engaged in the wider redesign and reconfiguration of services required to maintain the highest quality of services within available resources in the context of the many forces and drivers for change on the health and social care system. This includes the review of existing long-stay and community hospital provision and local authority care homes alongside the major reorganisation of acute services provision. Within NHS Grampian this fundamental redesign of services is set out in the Change and Innovation Plan which is in turn an integral part of our Grampian Health Plan. It is clearly crucial to fully involve both staff and the public in this process in order to achieve successful outcomes.

Against this background, the Grampian Partnership considered the achievement of the April 2006 target for reductions in delayed discharge to be very significant and further reducing these during 2006/08 will continue to be very challenging while redesign work is progressing.

The Partnership has agreed the following local targets:

Over 6 weeks

Short Stay Acute

April 2007

Grampian 37

(City 22, Shire 10,

Moray 5)

Grampian 10

(City 5, Shire 5)

April 2008

None

It has been recognised for a long time that dealing with the various pressures in both health and social care systems requires a whole system approach and year round planning. The Grampian Winter Planning Group and the Older People Strategy Implementation Group merged to form the Integrated Care Group. Integrated Care is one of a number of Change Projects under the auspices of NHS Grampian's Change and Innovation Plan. Planned Care and Unscheduled Care are other examples of projects included in this Plan together with other cross cutting projects. The Integrated Care Group is leading in the fundamental redesign of health and social care services across Grampian including the planning of services to reduce delayed discharges. This Group oversees Grampian's Winter Plan for 2006/08.

We know that the measures we have taken over the years have been successful in reducing the number of delayed discharges. Having monitored and evaluated a range of projects in terms of their effectiveness in reducing delayed discharges, it has been agreed to integrate these within mainstream services in order that the progress we have made so far can be sustained. The projects in question have been described in detail in previous plans and in our latest progress report. They have been summarised in Table I.

Recently a number of new projects have been developed and funded.

· Funding has been allocated to appoint a Falls Co-ordinator. Falls are among the most common and serious problems facing older people, often leading to loss of independence and a reliance on care at an earlier stage than would ordinarily be necessary. Most fractures are a direct consequence of a fall and account for substantial morbidity and mortality. Falls are a major cause of disability and admission to institutional care. Although there is much good work going on in falls prevention in areas of Grampian, it is not as well co-ordinated as it should be and there is no standardised approach. The Falls Co-ordinator would develop a Grampian-wide strategy on falls prevention with the aim of reducing the incidence of falls through a planned programme of risk assessment, health promotion and treatment interventions within health, social, private and voluntary settings. The work will be completed by September 2006.

· Elderly Care Development Nurse - This post was established earlier last year with a remit to identify patients in non-elderly specialist areas and providing specialist nursing support for all staff. The nurse will visit patients identified on the weekly Delayed Discharge list to ensure that all relevant referrals have been made. Excellent liaison has been established with medical, AHPs, social work staff and the Admission & Discharge Team.

· The Joint Equipment Project to develop shared procurement and management of equipment, was established during 2004/05 and a project manager was appointed. This post will continue to develop. An equipment IT system has been purchased to assist with tracking and monitoring the use of equipment across Grampian with funding provided by all the partners. The system will be used by health and local authorities, and other organisations are interested in using the system, for instance the ambulance service. A Grampian Steering Group and local action groups have been established with representatives from all organisations. A stage I Efficient Government Fund bid of £1.1 million was submitted to the Scottish Executive for funding to allow the project to develop effectively in line with Audit Scotland's recommendations. This has been successful and a full business case is now being prepared for stage II.

· An extra £55k has been made available to the Scottish Ambulance Service to facilitate patient transfers during week-ends. This has proved very useful in reducing delays and earlier discharge.

· An increase in funding for the support of people with dementia/mental ill health in the community. The funding has been instrumental in reducing delayed discharges especially for those who have been delayed in hospital for a considerable time.

· Medicine Management Training for home carers. This initiative is based on implementation of guidelines providing a safe framework within which social work carers may assist patients/clients with the management of their medication. It acknowledges that care workers undertake a range of medicine related tasks and provides appropriate training and systems to support safe practice and promote optimum treatment outcomes.

Progress to reduce delayed discharges even further now depends on more radical measures and requires a whole system approach. The Integrated Care Group will continue to take this important piece of work forward which includes consideration of the following issues:

· Demographic changes - the expected increase in the number of older people, especially the over 85 age group, is substantial

· The growth in the level of admission/emergency admissions to acute hospitals

· The lack of vacancies in Care Homes especially in and around Aberdeen. EMI places specifically are in short supply. It will take time to commission and supply increased capacity and get the right balance of provision

· Difficulties in recruitment and retention of staff across all sectors but especially home carers in an atmosphere of low unemployment.

In order to meet the above challenges, fundamental redesign of services is required and a number of actions have been agreed by the Integrated Care Group.

· In line with our Older People Strategy "Ageing with Confidence" further reductions in the number of longstay beds in Aberdeen are planned, re-investing the resource released in community services. The planning for this project is well underway and it has been agreed to provide bridging finance from winter planning/delayed discharge funds to pump prime effective community services and meet short-term double running costs. The phased reduction of hospital beds will take place over a number of years and needs to be matched with increases in care home provision, sheltered/very sheltered housing, step down facilities and other community services. Bridging funding of £120k has been set aside in 2006/07 to develop community services to facilitate bed reductions for this project.

· A reconfiguration of community hospital beds in the North of Aberdeenshire, re-investing the money released in a variety of flexible and responsive community services, to meet the needs of older people in their own homes and in other settings. Three hospitals in the area are involved in the re-design. In addition, Aberdeenshire Council are reviewing their Care Homes, providing an excellent opportunity to integrate the planning and implementation of services for the area as part of the Joint Future arrangements. The Integrated Care Group has agreed to provide bridging funds of £90k for 2006/07. This will be used to provide the required extra nursing, AHPs, Care Management and Home care staff as well as Community Geriatrician input, extra equipment and medical supplies. It is anticipated that the reconfiguration will be achieved over a 3 year period.

· A replacement for the AMAU will be built on the Foresterhill site and will be integrated with A & E, GMED and NHS 24 as the Emergency Care Centre. This is expected to be ready by 2009. To improve the physical environment of the current AMAU, it will be moved on an interim basis within ARI.

· In Moray both wards in Spynie Hospital have closed. The money released has been used to increase domicilary and nursing care, enhance rehabilitation potential of patients by providing additional physio and OT, an increase in care management and the purchase of extra care home places.

· A store assistant has been appointed for the Joint Equipment store in Elgin and funding for the permanent post of Cross Agency Project Officer secured.

· In discussion with the independent sector, increasing the number of care home beds in Aberdeen City in line with anticipated bed closures. EMI provision is inadequate in some areas which is a major factor in delayed discharges and this too is being pursued with care home providers.

· The Grampian Partnership, working closely with campaign and community groups, developed a specification for a service for older people on the site of the former convalescent facility at Tor-na-Dee. A design brief was developed and following a competitive tendering process, a preferred bidder (Southern Cross) appointed. This innovative project will provide a mix of nursing home, housing and community facilities on the Tor-na-Dee site. However, there have been unavoidable delays and the project is now not expected to be operational until 2008/09.

· A workshop on delayed discharges was recently held, facilitated by the Joint Improvement Team, to discuss the new targets and what could be done to achieve these. An Action Plan has been developed and each local area is preparing local actions to reduce delayed discharges in their area.

· The development of detailed joint workforce planning to tackle recruitment and retention problems is continuing

· The Integrated Care Group has tasked Price Waterhouse Cooper with the independent evaluation of all our projects to establish their effectiveness in reducing delayed discharges and providing value for money. This will enable informed decisions to be made about future funding of these projects. A number of projects were evaluated during 2005/06 and a programme for 2006/07 will be discussed and agreed

· The Partnership is currently looking at possible ways to fund the rolling out of the Community Geriatrician Projects across Grampian.

· The three Local Authorities have commissioned research/needs assessment re future requirement for housing for older people and for people with disabilities. Representatives from Housing have become more involved with the Integrated Care Group.

· Work is underway to have a broader look at inter hospital moves so that more patients can be cared for in community hospitals when appropriate, freeing up more acute beds.

Partnership working has been well established in Grampian and all partners are committed to reducing delayed discharges to a minimum by a fundamental redesign of the whole system, reducing longstay beds and increasing services in the community. The Integrated Care Group meets monthly to monitor progress and discuss and solve any problems. It is clearly important to constantly monitor and assess performance given finite resources and to ensure that challenging targets are met.

A summary of the actions/projects for 2006/07 is provided on the next page. (See Table I) Note however, that this is still a draft and further discussion about new projects and amendments to current ones is to take place over the next few months. All three local areas are working on local Action Plans as a result of the Grampian Workshop on Delayed Discharges held in May and once completed will further inform our Winter Plan for 2006/08.

For the Integrated Care Group

Rieta Vilar

June 2006

Grampian Wide Initiatives

Initiative	Cost £000	Lead person	Benefit/impact/data/key risks	Expected Outcome
Admission & Discharge Team	160	Mrs Janice Gorman	Co-ordinated and early discharge planning has greatly improved the discharge process and benefited patients and staff Data is collected daily in all hospitals in Grampian and is shared widely on a weekly basis Key risk: Shortage of care home places especially in Aberdeen and for EMI patients	No delayed discharges in the Acute Sector
Early supported discharge for COPD	200	Dr P Strachan	An initiative to enable COPD patients to be cared for at home rather than hospital Benefit: reduced hospital admissions	Prevention of unnecessary hospital admission
Alternatives to EMI admission	90	Mr A Walker	Reducing delayed discharges especially those patients delayed in hospital for over 12 months. Prevent avoidable admission by providing additional support in the community Training for staff in Care Homes to enable them to cope with patients and reduce admissions to hospital Key risk: recruitment of staff	Reduction in number of patients in longterm hospital care Prevention of unnecessary hospital admission
Elderly Rehabilitation Facility in Woodend Hospital	184	Mrs C Ledingham	Provides intensive therapy to enable patients to return to their home Key risk: people unable to move on	Reduction in delayed discharges in the acute sector. Enabling people to return home instead of waiting for a vacancy in a Care Home thus reducing delayed discharges
Flu immunisation and publicity campaign	25	Dr Diana Webster	Immunisation of older people and those at risk as well as staff in health and social care settings Data collected during immunisation period and shared with Integrated Care Group Key risk: staff coming forward for immunisation	Prevention of hospital admission Less staff absence during winter
IV antibiotic services	38	Mr A Chisholm	Prevention of hospital admission	Prevention of hospital admission
Joint Equipment Project Manager	24	Mrs H Hardisty	A project to develop shared procurement and management of equipment Benefit: quicker delivery of equipment to patients resulting in earlier discharge from hospital. Cost savings Key risk: initial cost of the project (IT equipment etc) before savings can be realised	Reduction in delayed discharges of patients waiting for equipment
Joint Equipment Store IT system maintenance	10	Mrs H Hardisty	As above	As above
Administrator	17	Mr D Sullivan	Supporting CHPs with collecting data for capacity planning,	Balance of hospital beds/care home places/sheltered and very sheltered housing provision and other community based services
GP input into AMAU	15	Dr J Black	GPs supporting Medical Assessment	Reduction in delayed discharges Prevention of inappropriate hospital admission
Ambulance Service	55	Mr R Page	Enabling patients to be discharged from hospital out-of-hours.	Reduction of delayed discharges Shorter stays in hospital
Elderly Care Development Nurse	29	Mrs C Ledingham	Enhancing the care of elderly patients in non-elderly specialist areas by providing advice, support and expertise. Identifying and visiting patients on the weekly delayed discharge list to ensure all relevant referrals have been made. Key risk: availability of resources to make the post a permanent one.	Quicker assessments resulting in shorter hospital stays and less likelihood of becoming a delayed discharge. .
Falls Co-ordinator	17	Ms Jenny Ingram	Post established for 1 year to develop and co-ordinate strategies for reducing falls in older people. Reducing falls and reducing the risk of fractures will reduce hospital admissions. Such patients are often at risk of becoming a delayed discharge. Key risk: a one year post might not be sufficient time to complete the task.	Prevention of hospital admission Reduction in delayed discharges
Medicine Management	15	Prof George Downie	Training of social work carers in medicine management This has been successfully piloted and is being rolled out across Grampian.	Prevention of hospital admission
Total	879

Aberdeen City Initiatives

Initiative	Cost £000	Lead	Benefit/impact/data/key risk	Expected Outcome
Additional cost of nursing homes	512	Mrs J Gorman	Increased well being of older people Key risk: shortage of care home places	Reduced delayed discharges in hospital and earlier discharge.
Croft House Rehabilitation facility	120	Mrs H Stadames	After intensive therapy the majority of patients are able to return to their own home instead of a needing a care home place The project has been evaluated, data is collected and the project is regularly monitored Key risk: availability of appropriate staff	Reduced delayed discharges in hospital and earlier discharge
Rapid Response Team	341	Mrs H Kelman	Prevention of inappropriate admission to hospital Earlier and safe discharge from hospital for patients with ongoing rehabilitation needs. Data on numbers, outcomes etc collected on an ongoing basis Key risk: availability of appropriate staff	Prevention of unnecessary hospital admission Reduction in length of stay
Smithfield Court Project	362	Mrs H Stadames	Patients supported for a period in a sheltered housing complex increasing their independence, confidence and motivation. Data on numbers, outcomes etc collected on an ongoing basis Key risk: availability of appropriate staff	Earlier discharge from hospital Reduction in delayed discharges Prevention of hospital admission
City Hospital Rehabilitation beds	42	Sister R Nixon	Slow stream rehabilitation provided to enable older people to return home. Data on numbers, outcomes etc collected on an ongoing basis Key risk: availability of appropriate staff	Reduced delayed discharges in the acute sector
Additional OT, AHP and community nursing initiatives	448	Mrs H Hardisty Mrs J Gorman	Prevention of avoidable admissions to hospital by increasing community support Key risk: availability of appropriate staff	Reduction in delayed discharges Prevention of unnecessary hospital admission
Equipment	150	Mrs H Hardisty	Timely discharge from hospital Patients able to return home with required equipment in place	Reduction in delayed discharges Quicker discharge from hospital Less carer stress
Community Geriatrician	30	Mrs H Kelman	This is a pilot and has recently been evaluated. Data collected on an ongoing basis. Key risk: increased workload for geriatricians. Cost if pilots are to be expanded across Grampian	Preventing inappropriate admission to hospital
High cost care package for permanently disabled person now living in the community	104	Mrs H Hardisty	Better quality of life for patient Key risk: high cost and sustainability of the care package	Reduction in delayed discharge
Redesign of services for older people in the City	120	Mrs J Fletcher Mrs H Hardisty	Project to redesign services for older people by changing the balance of care Key risk: availability of appropriate staff and bridging funds to finance the project	Reduction in inappropriate admission to hospital and earlier discharge by increasing the capacity of community services.
Total cost of initiatives in Aberdeen	2229

Aberdeenshire Initiatives

Initiative	Cost £000	Lead	Benefit/impact/data/key risk	Expected outcome
Increase and sustain nursing home places	508	Mr D Boynton	Better quality of life for patients Key risk: availability of care home places in some areas of Aberdeenshire and lack of EMI provision	Reduction in delayed discharge and prevention of avoidable admission to hospital
Community Geriatrician	30	Mr S Dustan	This is a pilot and has recently been evaluated. Data collected on an ongoing basis Key risk: increased workload for geriatricians. Cost if pilots are to be expanded across Grampian	Prevention of inappropriate admission to hospital
Additional out-of-hours Home Care, OT, Community nursing, AHP input and equipment for Banff & Buchan	257	Mr S Dustan	Increase in community support Key risk: availability of appropriate staff	Reduction in delayed discharge Reduction in inappropriate admission to hospital
Additional out-of-hours Home Care, community nursing and AHPs for Central Aberdeenshire	205	Mr M Ogg	Increase in community support Key risk: availability of appropriate staff	Reduction in delayed discharge from hospital Reduction in inappropriate admission to hospital
Additional OT, AHPs and equipment in Deeside	79	Mrs W Johnston	Increase in community support Key risk: availability of appropriate staff	Reduction in delayed discharge from hospital Reduction in inappropriate admission to hospital
Additional OT, AHP and equipment in Kincardine	84	Mrs F Francey	Increase in community support Key risk: availability of appropriate staff	Reduction in delayed discharge from hospital Reduction in inappropriate admission to hospital
Redesign of services for older people in North Aberdeenshire	90	Mr S Dustan	Project to redesign services for older people in the North East part of Aberdeenshire - changing the balance of care from institutional care to care at home. Project Team will provide regular up-dates on the project Key risk: availability of appropriate staff and bridging funds to finance the project	Reduction in inappropriate admission to hospital and earlier discharge.
Total cost of initiatives in Aberdeenshire	1,253

Moray Initiatives

Initiative	Cost £000	Lead	Benefit/impact/data/key risk	Expected outcome
Additional equipment for the community	25	Mrs C McClusky	Extra funding for equipment for use in the community	Timely discharge from hospital and avoidance of inappropriate admission
Rapid Response and Rehabilitation	285	Mrs I Graham	Support in the community to provide a rapid response when required and an increase in rehabilitation in the community Key risk: availability of appropriate staff	Avoidance of inappropriate admission to hospital and early discharge freeing up acute beds
Hospital Liaison Nurse	28	Mrs F Grant	Identifying patients for discharge to community hospitals and/or home. Reduction in length of stay and delays.	Reduction in delayed discharges
Transport	3	Mrs F Grant	Ability to discharge out of hours from acute Benefit: availability of acute beds.	Reduction in delayed discharge due to transport problems out-of-hours
Nursing/Social Care Team and flexible care	49	Mrs I Graham Mrs J Tidey	Ability for earlier discharge into the Community and avoiding unnecessary hospital admissions Key risk: availability of care staff, budget issues	Reduction in delayed discharges Prevention of avoidable admissions.
Joint Equipment store assistant	16	Mrs I Graham	Part of the development of a joint equipment service for Moray Benefits: quicker delivery of equipment to patients resulting in earlier discharge from hospital. Benefit: a more efficient service for patients and possible cost savings over time.	Reduction in delays from hospital
Community Geriatrician	60	Mrs F Grant	Preventing inappropriate admissions to hospital Key risk: Workload of geriatrician	Prevention of admission to hospital
Sustain and increase nursing home places	292	Mrs J Tidey	Increased well being of older people Key risk: shortage of available places especially for EMI, Budget issues	Reduction in delayed discharges
Cross Agency Project Officer	32	Mrs J Tidey	Reduction in delayed discharges / shorter hospital stays
Redesign of Spynie Hospital	529	Mr A Fowlie	Closure of Spynie Hospital and re-investing the resources released in community services in the Elgin and Lossiemouth area	Reduction in delayed discharges
Total cost of initiatives in Moray	1,319

Total for Grampian

£ 5,680

Balance of funding

To be agreed

£ 114

Funding Sources 2006/07

Delayed Discharge Local Joint Action Plans

	£ M
NHS funded share of SE money	2,633
Local authority funded share	1,312
NHS Grampian Revenue Funding	1,288
Idem (Moray)	0,561
Total	5,794

Page updated: Monday, October 02, 2006

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