RightCare - Wessex AHSN

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RightCareDr Bruce Pollington - Delivery Partner10th May 2018

RightCare scenario:The variation between standardand optimal pathwaysJanet’s story: FrailtyAugust 2016

Janet’s story: Journey 1 Janet is 84 - a retired teacher living with her 85 year-old husband ArthurOn a Friday evening, Janet falls. Arthur calls 999. Janet is taken to A&EShe is given a hip x-ray. There is no fracture but blood and urine tests show UTI anddehydration, so she is admitted to an acute medical wardThe next day (Saturday) she is moved to a general medical wardAfter the weekend, Janet is assessed as having postural hypotensionIn 2014/15 there were 2,154 serious falls (per 100k population) in the average CCGDue to a lack of available beds in the community, Janet is moved to a winter escalationward in the hospital. She falls again in the ward. As a result she is no longer fit forrehabilitation and requires a care packageThis is put in place almost three weeks after admittance and she is finally discharged.10 days in a hospital bed leads to the equivalent of 10 years of ageing in themuscles for people over 80Seven months later, Janet falls again and, after discharge from hospital, goes into a carehome. After rapid deterioration and another fall, she returns to acute care and after 10days on the intensive care ward, she passes away aged 85.This version of Janet’s journey costs 35k at 2015/16 prices

Janet’s story: Journey 2 Janet’s journey begins four years earlier when, aged 80, she and Arthur are visited bythe Fire Service. As well as helping with fire prevention, they conduct a gait speed teston Janet and Arthur and deem Janet to show early signs of frailty. They provide herwith the Practical Guide to Healthy Ageing and put her in contact with a local charitythat runs exercise classes for the over 80s which Janet enjoys.Five years on she remains well and engaged in the local community but is beginningto feel frail. She visits her GP who diagnoses moderate frailty and refers the systemwide multi-disciplinary team to her. The team assess her needs, make her home‘frailty-friendly’, optimise her medication and engage her in the local Memory Service.This culminates in a jointly agreed personalised frailty and dementia care plan.Two years later, aged 87, Janet falls. The out of hours GP visits, armed with her careplan and aware of her personal preferences. Via discussion with Janet, Arthur and –by phone – the on-call case management team leader, they agree how to manage thesituation, without recourse to A&E or a hospital bed. Instead the new CommunityGeriatric Rapid Access Clinic is used.A year later, Janet falls again and this time does have a hospital stay but returns homequickly, with a support package. 11 months on, aged 89, Janet passes away.Journey 1 cost 35kJourney 2 cares for Janet much better and costs only 19k

Financial informationAnalysis by Cost CategoryStandardOptimalPrevention and Public Health 0 2,239Detection 0 20Primary Care Management 176 59Urgent and Emergency Care 699 233Non-elective Admissions 28,838 0Intermediate Care 2,735 4,979Community Care 2,766 11,856Miscellaneous 60 0Grand total 35,274 19,386This is the cost to the local health economy rather than the commissioner (which would be tariffbased)

Financial informationAnalysis by ProviderStandardOptimalFire Service - Safe & well visits 0 60Community teams 0 9033rd Sector 0 4,400Primary Care 176 370Ambulance Service 699 233Rapid access assessment unit 0 314Acute 28,830 0Acute frailty unit 0 1,200Ambulatory Care unit 0 157Community Hospital 0 2,993Mental Health Provider 0 272Social Services 2,842 8,483Care Home 2,727 0Grand total 35,27419,386This is the cost to the local health economy rather than the commissioner (which would be tariffbased)

NHS RightCare Intelligence:Frailty updateFrailty Focus Packs – outline and preview

Falls & Fragility Fractures ts/pathways/8

Development of Frailty focus pack & Afrailty pathway Focus packs present data from a range of datasets to enable adeep dive into the condition area for a Local health economy. Will predominantly focus on 65 dataset indicators Does not aim to replicate every indicator that may be potentiallyrelevant where these are in other focus packs Currently working to align with work on RightCare’s FrailtyPathway and the Geriatric Medicine workstream of NHSImprovement’s Getting It Right First Time (GIRFT) programme9

Dementia estimated prevalence 65 10

Dementia diagnosis rate 65 11

Take up of flu vaccine12

Influenza NEL admission - Broadlycorrelates13

Rate of injuries due to falls 65 14

Spend on NEL admissions fordisorientation (R410)15

Spend on NEL admissions for collapse 75 16

Aspiration pneumonia NEL17

Offered rehab following D/C from hospital18

Still at home 91 days after D/C into rehab19

NHS RightCare intelligence for frailty stakeholdersFollowing initial engagement with NHS England’s NCD for Older People (MartinVernon) and Associate NCD for Older People (Dawn Moody), participants inupcoming engagement events for NHS RightCare’s intelligence developmentwork for frailty will also include representatives from: NHS Improvement’s Getting It Right First Time programme - GeriatricMedicine workstream Public Health England National Institute for Health and Care Excellence Association of Directors of Adult Social Services Chartered Society of Physiotherapy Royal College of Speech & Language Therapists Age UK Subject matter experts in Pharmacy in the care of older people.20

iFor more information and support about how touse the NHS RightCare approach to get best valuefor your population, go to www.rightcare.nhs.ukor email us at rightcare@nhs.netPiers GlenNHS RightCare Delivery Partner8 bpollington@nhs.net 07710 152763NHS RightCare is a programme of NHS England

Currently working to align with work on RightCare'sFrailty Pathway and the Geriatric Medicine workstream of NHS Improvement's Getting It Right First Time (GIRFT) programme . NHS RightCare is a programme of NHS England Piers Glen NHS RightCare Delivery Partner 8 bpollington@nhs.net 07710 152763. Title: PowerPoint Presentation

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