Acute Care

What did we say in Healthy Ambitions?*

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The Acute Care pathway group recognised that acute care is not consistently provided to the best possible standards in Yorkshire and the Humber. The group identified the need to offer patients better access, especially out of hours and to reduce some of the pressure arising from rising A&E attendances.

They therefore recommended:

  • A wider range of services to avoid having to go to A&E (pharmacies, extended primary care, urgent care centres)
  • Better support to look after yourself
  • A single telephone number for local urgent care and out of hours care
  • New models of care for stroke; heart attack; trauma and for older people.
  • Guidance for ambulance services to take people immediately to the best location
  • Experienced staff making decisions at the door of all A&E departments.

Who is taking this work forward?

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PCTs across Y&H have worked with the SHA to agree which of the recommendations of the Acute Care pathway should be taken forward locally and which might need action at regional level. This is summarised in fig.2 on the next page.

*Full details can be found at: www.healthyambitions.co.uk/acute_episode.html.

When is it happening?

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The actions to be taken forward in the first year of implementation for the Acute Care pathway are shown in fig.3.

Local delivery

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PCTs have prioritised the recommendations in Healthy Ambitions in light of the needs of their local community and the current position of their services.

Working with their local partners and providers they have all set out the action that they will take to start to turn the recommendations in Healthy Ambitions into reality in the five year strategic plans. These plans are the main vehicle for the delivery of the recommendations in this pathway.

An example of the action being taken by NHS Kirklees is shown in fig.4.

How could you help?

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Everyone with an interest in improving health and healthcare can play a part in taking forward the recommendations in the acute episode chapter of Healthy Ambitions. In fig.5 we have set out some of the suggestions from staff about how people could help implement the recommendations.

As an NHS publication – this section has just focussed on the roles that NHS Staff could play – but we very much recognise that our partners have a big contribution to make if we are to deliver the recommendations of the acute episode chapter in Healthy Ambitions. We know that local authorities have a big part to play – e.g. in integrating services for older people designed to prevent acute hospital admissions, developing joint working between ambulance and police and in promoting awareness of the need for prompt action e.g. in patients experiencing stroke symptoms.

Who will make sure that this work happens?

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There are a number of key leadership roles in the delivery of this pathway:

Locally

Each PCT is responsible for working with local providers and partners to ensure the delivery of recommendations in line with their local priorities and their own strategic plans.

Collaboratively and Regionally

Delivery will be overseen by a Pathway Delivery Board – as described in the chapter on governance arrangements.

For Acute Care the chair will be Jane Lewington Cheif Executive at North East Lincs CTP who will act as a sponsor within the wider chief executives forum and assist the clinical lead and SHA Director lead to promote implementation of the pathway.

The clinical lead is David Dawson, former Medical Director at Mid-Yorkshire Hospitals Trust, who will oversee progress against the acute care pathway recommendations, act as a champion for the recommendations, advise on delivery processes and encourage regional colleagues to continue to focus and give priority to the acute care recommendations.

A number of regional directors will take responsibility for key areas of the acute pathway.

Chris Welsh, SHA Medical Director, will ensure that regional reviews of critical care and vascular surgery take place during 2009/10, with appropriate clinical involvement, and appropriate governance arrangements – in discussion with the Specialised Commissioning Group where appropriate (i.e. vascular). He will oversee the development of new models of care for primary angioplasty and major trauma services during 2009/10.

Annette Laban, SHA Director of Performance and Delivery will oversee the development of a single telephone number for urgent care as part of an integrated triage and signposting system.

Rosamond Roughton, SHA Director of Strategy and System Reform, will oversee the implementation of the stroke pathway set out in Healthy Ambitions

How will we measure success?

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We have developed a “Healthy Ambitions Dashboard” based on a small number of key indicators which taken together can be used to start to measure the success of the Healthy Ambitions programme as a whole. This is underpinned by trajectories which each PCT will set to reflect their local priorities and circumstances. It will show the measurable improvements they are making in each pathway area. This will supplement the “vital signs” indicators and trajectories which support delivery of the targets set out in the NHS Operating Framework and the selection of outcome measures which PCTs have included in their strategic plans. In many cases these measures are one and the same. All of these measures will feature in PCTs annual operating plans to be agreed with the SHA and be the basis for the SHA’s performance management regime.

Recognising that the pathway recommendations are many and various we intend to start by tracking progress against the key pathway pledge, which for the acute care pathway is to save 600 premature deaths every year with better stroke care.

We know that this doesn’t tackle all the priorities in this chapter. Primary care access, healthcare associated infection rates and stroke outcomes will be tracked through existing routes. Myocardial infarction best practice and NICE standards for reducing stroke morbidity and mortality is a CQUIN measure.

The key indicators we will therefore track in the “Healthy Ambitions Dashboard” will be:

  • Stroke mortality per 100,000 population
  • Stroke and TIA admissions and readmissions per 100,000 population
  • Percentage of TIA with high risk of stroke who are treated within 24 hours
  • Percentage of patients receiving thrombolysis within 60mins of ambulance call.

Work has been undertaken to establish baselines for the pledge and by the end of March ’09 trajectories for improvement will have been agreed between the SHA and PCTs and will be reflected in annual operational plans.* We intend to publish progress against individual trajectories.

*More details can be found in the chapter on performance metrics