44.9% 32.3% Limiting i i long term. Help with self care

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1 Dr Bharath Lakkappa Clinical Director Community Rehabilitation and Elderly care NHFT Dr Champa Balalle Consultant Psychiatrist Old Age Liaison / CECS NHFT

2 New service for over 75 yrs Additional and restructured t resources Improve elderly l care services in Northamptonshire t hi Quality Efficiencyi Productivityd it 2

3 Address the acute service pressure Emergency g y hospital admission i Excess bed days Provide high h quality service in most appropriate p care setting, usually at home or in the community 3

4 2001 UK national census 4

5 Health and disability yp problems in >65 yrs NCC joint strategic t needs assessment 2009 executive summary 44.9% 32.3% 3% Limiting i i long term Help with self care conditions 35.2% Help with domestic task 5

6 The age group is forecast to increase by 36.8% in 2015 While the 75 and over age group is forecast to increase by 16.9% in 2015 Over 65 with dementia is forecast to increase by 20% in pp org, NCC joint strategic needs assessment 2009 executive summary 6

7 2/3 of beds are filled by the old 39% of health care spending is on the old 49% of social care expenditure is on the old => the old are core NHS business => GPs, hospital doctors and everyone should be able to deal with issues about the old => >iti is impossible ibl as well as groundless for all old people p to be managed by geriatricians/psycho-geriatricians cho g Community Geriatrics, Prof John Gladman University of Nottingham, Nottingham University Hospitals NHS Trust 7

8 >75 yrs - over 47,000 people 26% - at tlease 1hsp admission i last year Increasing lengths of stay in >75 age group 8

9 >70 yr non-elective admission- i outcome 12 months after discharge Gen Medical Service Tertiary care hospital pts discharged d with new discharged d at baseline ADL dsab disability function cto 41.3% died 17.8% died 28.6% alive; not 15.2% alive; but with recovered to baseline worse than baseline function function 30.1% at BL function 67% at BL function JAmGeriatrSoc.2008;56(12):

10 66% via A+E, 34 % after GP assessment Patients t given neither medication &/or fluids intravenously ta ousy -50% at KGH Could admission have been prevented if the following were available? Better ICT services 40% Step Up beds 29-40% Urgent OPA 16-22% Patient-carer/EMAS t had involved GP before 22-33% 10

11 MAU intermediate edaecaep t care pilot CGA and ICT input in A&E, MAU Increased referrals to ICT & reduced readmission Psycho-geriatric input vital for early discharge Hazelwood Pilot Spinneyfield Specialist Care Centre step down beds Medical cover & greater social service input Reduced readmission and length of stay (37-26 days) 11

12 CECS- Truly integrated service for over 75 age group GP A&E MAU CGA- Geriatricians i i CMA- Psycho-geriatricians i i Care homes ICT Community Geriatricians Home SERVE START SOCIAL CARE SCC 12

13 >75 yrs Patients t in Community, A&E and MAU Referral through h Intermediate care team ICT Determines need for CECS consultant Geriatric review - CGA Comprehensive Mental assessment of relevant patients t by Consultant t Psycho-geriatrician i i Consultant t Walkthrough h A&E and MAU with ICT to help with early identification of suitable patients t ICT covers the whole county 13

14 Social Care (NCC) - Greater involvement In acute hospitals through h discharge teams Increased care manager input into community hospitals and scc Greater access to SERVE( ( careinthe community) and START( ( short term rehabilitation i team) in A&E 14

15 Patients t tracked and reviewed for 72 hrs if admitted d Majority of discharges are to patients t own home with ICT CECS beds in SCC Social care referral ( or Joint working ) if needs are mainly social 15

16 Direct Hospital Avoidance from community referrals A&E, MAU hospital Admission i avoidance numbers Savings from estimated t bed days 16

17 505 prevented admissions i county wide (59 above plan) Equates to 1182 saved EBDs, 713 over plan 101 patients t through h SCC CECS beds Average length of stay in scc beds -7d days 17

18 Falls under the scheme of governance for QIPPS performance management and monitoring i in Northamptonshire t hi Urgent care delivery group reporting to Northamptonshire Integrated Care Partnership p( (NICP) NICP reports to QIPPS board 18

19 Thank you 19