Mental health acute flow improvement tool

Mental health acute flow improvement tool
NHS Improvement 21 March 2019

• An intuitive data visualisation tool that gives providers of NHS mental health services and their stakeholders extensive information on flow through the adult acute inpatient pathway

The challenge and potential of whole system flow

The challenge and potential of whole system flow: Improving flow across whole health and care systems
Health Foundation Advancing, Quality Alliance (AQuA) December 2016

• This report introduces methods that local health and social care leaders can use to improve whole system flow and describes steps policymakers and regulators can take to create an environment conducive to change at this scale.

Building bridges, breaking barriers: Integrated care for older people

Building bridges, breaking barriers: Integrated care for older people
CQC 13 July 2016

• This report looks at how well care for older people is integrated across health and social care, as well as the impact on older people who use services and their families and carers.
• Recommendations:
• Health and social care leaders should develop and agree a shared understanding and definition of what integrated care means for the population in their local area, and then work towards delivering this shared aim.
• NHS England and Association of Directors of Adult Social Services should lead on developing an agreed methodology and data set for identifying people at risk of admission to secondary care or deterioration.
• Older people should be meaningfully involved in making informed decisions about their care needs and care planning – in particular about the outcomes that are important to them – based on the existing national and local guidance.
• Commissioners and providers in an area should ensure that information and support for older people and their families or carers is available, and this sets out connections between services, and how the people's accessibility needs will be met.
• The National Quality Board, in partnership with the National Information Board, develop and share a set of validated data metrics and outcomes measures for integrated care with person-centred outcomes at the heart of decision making about service provision and based on a consistent, shared view and definition of integration.

High Impact Change Model

High Impact Change Model
ADDAS, NHS England, LGA, DH 1 December 2015

• This model provides practical options to support local health and care systems particularly around patient flow and discharge and to assess how effectively current systems are working. It also encourages areas to consider new interventions to be introduced throughout the year.
• The tool identifies eight high impact changes:
• early discharge planning
• systems to monitor patient flow
• multi-disciplinary/multi-agency discharge teams, including the voluntary and community sector
• home first/discharge to assess
• seven-day services
• trusted assessors
• focus on choice
• enhancing health in care homes

Burstow Commission: DTOC - causes and how to address them

Right Place, Right Time: Better Transfers of Care: A Call to Action

Commission chaired by Rt Hon Paul Burstow
NHS Providers, 11 November 2015

• The Commission report collates evidence and good practice in transfers of care in all provider settings – across acute, community, mental health and ambulance services - and offers practical approaches to tackle the causes of delayed transfers of care.
• Causes of delayed transfer of care include:
• complex challenges within the patient journey from health settings back into the community or social care.  
• workforce capacity and skills mix
• flow within and between organisations 
• Specific messages for a number of national organisations with a wide range of recommendations are presented. These include a call to the Department of Health for further guidance to speed up the process of Continuing Healthcare assessments, including these assessments in arrangements for assess to discharge.
• The report also includes a wide ranging "Call to Action" for Providers, CCGs,  Local Councils and HWBs. 
• "In the end this report boils down to three calls to action. These calls to action are addressed to every part of the health and care system. First, start with the person (the patient or service user). They are your common cause. Second, ask yourself how do we help this person get back to where they want to be? Third, agree what the data tells you. A shared understanding of the numbers can help with tracking down the root causes."p3

See the monthly statistics on Delayed Transfers of Care here. 

Improving length of stay: what can hospitals do?

Improving length of stay: what can hospitals do?
Nuffield Trust, September 2015

• Drawing evidence from the literature together with insights from a number of senior clinicians, managers and case studies, this report explores what approaches to reducing length of stay have been (and could be) effective, providing a set of measures for improving length of stay that are within the control of the hospital itself.
• Key points:
• Focus on flow
• Get the basics right
• ‘Bundle’ approaches together
• Maintain a rapid pace for decision-making and patient progress 
• Ensure active support for discharge seven days a week
• Large-scale top-down change is often not required

Extract:

• "There has been extensive use of audit tools such as the Medical Care Assessment Protocol (MCAP) by the Oak Group and Greater Manchester Commissioning Support Unit looking at the potential for patients to be cared for in alternative settings. Monitor and the Nuffield Trust have been given access to these data, which typically show that 20 to 25 per cent of admissions and 50 per cent of bed days do not ‘qualify’ for the use of an acute bed and could be treated at a different, usually lower, level of care to meet medical needs."(Oak Group, 2014). (p4)

Part of the Nuffield progamme of work on Exploring approaches to reducing length of stay

Improving patient flow - evidence from Monitor

Improving patient flow: evidence to help local decision-makers
Monitor 3 September 2015

• Findings from three Monitor publications offering evidence that may help local NHS decision-makers evaluate options for improving patient flows through local health and care systems.
• Includes: 
• Understanding urgent and emergency care performance
• Schemes to deliver care closer to home (to be published)
• Improving productivity in elective care  (to be published)
• Other options for improving patient flow - including case studies from Nuffield Trust around reducing length of stay.

https://www.gov.uk/government/publications/improving-patient-flow-evidence-to-help-local-decision-makers

Why did patients wait longer in A&E?

A&E delays: why did patients wait longer last winter?
Monitor 3 September 2015

• Analysis of the sudden 4.7 percentage point decline in A&E performance against the four-hour target in Q3 2014/15. 
• The report tests 10 hypotheses and concludes that the most important national cause was hospitals’ inability to accommodate the increase in admissions from A&E departments generated by the increase in A&E attendances because hospitals were running at very high occupancy rates of 90% or above. 
• Data indicates 27% more delayed transfers of care out of acute hospitals.
• The other half of the decline is likely to be explained by local drivers of A&E performance. 
• Documents include main report, findings at a glance, conclusions from 10 tested hypotheses, econometric analysis and next steps.
• The Next steps suggested are: 
• Improving patient flow in the rest of the hospital 
• Getting a better understanding of the impact of social and community care 
• Supporting the mid-long term sustainability of A&E departments 
• Supporting efforts to tackle local issues including the establishment of an Emergency Care Improvement Programme (ECIP) to help the most challenged urgent care systems, with a focus on patient flow.