Access to 7-day ServicesMeeting the local challenge: one size

does not fit all

4th March 2015

Better Care Bristol

What did Bristol do?

• Fact finding audit on what services needed to be available to reduce emergency admissions

• Saturday morning ‘front door audit’ to assess what was needed (attached)

What happened next…

Acute – Access to 7 Day Service • More frequent use of criteria led discharge at

weekends • Work with partners to extend the Liaison

Psychiatry coverage• Work with partners to extend support to complex

discharges• Further development of Diagnostics services at

weekends• Care Home Selection• Integrated Discharge Hub

Community – Access to 7 Day Service

• Community discharge facilitation and admission avoidance are 7-days with scaled down hours –ongoing review of what is needed and the impact

• REACT – Rapid Emergency Assessment Care Team (based in ED & OPAU)

• Community Discharge Coordination Centre –Discharge to assess, reablement, rehabilitation pathway

Mental Health – Ahead of the game?

• 24/7 offering a single point of access, crisis line, response to ED and community/ home visits.

• April 2015 extending assessment and recovery service to provide 8-8 7-day/ week coverage.

Primary Care - Access to 7 Day Services

• BrisDoc Professional Line 24/7

• GP Support Unit at the front door is 7 days

• Weekend GP review

You don’t always get what you want

• What is required? • Piloting social care working weekends in NBT during winter on a

short term basis. Positive effect in terms of keeping on top of S2s, progressing some weekend discharges and avoiding a Monday catch up syndrome.

• Could there be a greater focus on admission avoidance at weekends?

• Keen to move to permanent 7 day working but need to work with HR to change working arrangements and contracts

• Need the system wide approach – consideration of other services, e.g. Brokerage, providers being contactable and able to start packages, non-hospital community bed availability

499480

427

357236

200188169199

5306

836

851

648

698

701

549570

Emergency Admissions 65 + UHB bytimeband

00 to 01

01 to 02

02 to 03

03 to 04

04 to 05

05 to 06

06 to 07

07 to 08

08 to 09

Inhours

17 to 18

18 to 19

19 to 20

20 to 21

21 to 22

22 to 23

23 to 0029.9% between 17:00 and 22:00

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

Saturday Sunday Monday Tuesday Wednesday Thursday Friday

OOH Emergency Admissions per day 65+

Ref no Scheme

1 Deteriorating Patient - Early & Preventative Interventions

2 Admissions Avoidance – Community

3 Admissions Avoidance - Front Door

4 Integrated Rehabilitation & Reablement

5 Frail and Complex, Falls Prevention, including Community Geriatricians and Long Term Conditions

6 Joint Commission Information and Advice Services

7 Long term care options for people with mental illness and learning disabilities (section 117 after care)

8 Extra Care Housing

9 Carers Breaks

7

7

Solutions

• Needs to be system wide• Need to consider smoothing out over 7 days• More generalists to cross-cover• Single point of access• Care coordinator that can help patients through

the system• Wider use and acceptance of technology