health & social care
local government
2

The Future of Effective NHS Discharge Practices

health & social care

local government

08:45 - 16:30

Tuesday 15 October 2019

The Hatton- etc Venues, Central London

 

This Forum will give participants the opportunity to discuss best practice case studies with key policy leaders and clinicians involved in NHS discharge. Attendees will learn about the future of discharge practices and the incorporation of new data and technological insights, whilst gaining an understanding of how regulation systems can be used to maximise potential benefits and ensure efficient but safe discharge practices. Delegates will learn from innovative case studies from across the UK and practical networking opportunities will ensure that participants gain insight and knowledge about solutions to challenges relating to discharge practices.

Audience

This Forum is designed specifically for the NHS and Local Authorities. Typical job titles will include:

  • Heads of Integrated Discharge Management
  • Discharge Coordinators
  • Long Term Care Leads
  • Heads of Quality and Adult Safeguarding
  • Clinical Operations Directors
  • Directors of Nursing
  • Consultants
  • Integrated Care Leads,
  • Service Improvement and Efficiency Managers
  • Continuous Health Care Leads
  • Community Nurses
  • Senior Nurses and Matrons
  • Emergency Care Leads
  • Patient Flow Coordinators 
  • Integrated Transfer Leads
  • Discharge Project Leads
  • Partnership Delivery Leads
  • Innovation Heads
  • Strategic Planning Officers 
  • Care Home Managers
  • Heads of Adult Social Care
  • Transformation Managers and Patient Champions
Key Speakers Confirmed:
  • Professor Martin Vernon, National Clinical Director for Older People and Person-Centred Integrated Care, NHS England
  • James Walker, Programme Lead, Integration Projects, NHS Digital
  • Jo Beer, Director of Integrated Care & Partnerships, University Hospitals Plymouth NHS Trust
  • Dr Khai Lee Cheah, Consultant Geriatrician, Royal Free London NHS Foundation Trust
  • Tim Horton, Assistant Director (Insight & Analysis), The Health Foundation 
  • Tom Hardie, Improvement Fellow, The Health Foundation 
View the agenda and additional speakers

08:45

Registration, Refreshments and Networking


09:30

Chair's Welcome Address

Michael Wood, NHS Local Growth Advisor, NHS Confederation  (invited)


09:40

Interactive Session: Setting the Scene and Having Your Voice Heard

The day will begin with a 20 minute interactive session, led by the Chair, in which delegates will be able to ask questions, raise their key concerns and inform the Chair of what they would like to discuss during the course of the day.

This will inform debate and direct the conversation throughout the day so that attendees are confident that their most pressing concerns and desired learning objectives will be covered. 


10:00

Morning Keynote: The Future of Effective NHS Discharge

  • Outlining the challenges and opportunities faced in creating effective and safe hospital discharge pathways, including the need to support cross sector collaboration which focuses on time sensitive discharge planning processes
  • Understanding how creating effective primary care networks will help to reduce avoidable A&E attendances and delayed hospital discharge
  • Outlining how the NHS Long Term Plan will look to reduce the risks associated with the Delayed Transfer Of Care (DTOC) by implementing social care teams at the beginning of acute hospital pathways 
  • Discussing future policy avenues which can support national NHS ambitions to deliver tailored and integrated care which makes sense to older people, those with complex needs and their families and carers

Professor Martin Vernon, National Clinical Director for Older People and Person-Centred Integrated Care, NHS England (CONFIRMED)


10:20

Special Keynote: Outlining how Local Government Works in Partnership to Ensure Transfers of Care are Timely, Appropriate and Safe

  • Understanding how the Local Government Association (LGA) is working with the Department of Health and Social Care, the NHS, the Ministry of Housing and Local Governments, local systems and communities to help improve patient flow and transfers of care 
  • Sharing the learning and good practice from councils and NHS partners in encouraging safe and timely hospital discharges to the best place for the person being discharged
  • Highlighting the aims of the support on offer from the LGA, including helping to embed a culture of Home First in to health and care systems 
  • Outlining the work of the LGA’s Care and Health Improvement Programme which provides support to transform health and social care and improve outcomes and quality of life for all 

Fiona Russell, Senior Adviser – Care and Health Improvement Programme, Local Government Association (LGA) (CONFIRMED)


10:40

Questions and Answers Session


11:00

Refreshments and Networking


11:20

Case Study: Sharing Data to Support Safe and Efficient Patient Discharge

  • Discussing how Poole Hospital implemented a Rapid Access and Consultant Evaluation unit (RACE) to improve discharge practices and prevent unnecessary overnight stays 
  • Exploring how Poole Hospital developed an Ambulatory Emergency Care (AEC) pathway to perform assessments and arrange treatment quickly 
  • Outlining the results of implementing this scheme, in which 51% of patients seen in AEC would otherwise have required admission
  • Sharing the lessons learnt from this programme, including how to integrate community and social care partners

Dr Naomi Fox, Consultant Geriatrician, Poole Hospital NHS Foundation Trust (CONFIRMED)


11:40

Case Study: Using Technology to Manage System Stresses Through Safe and Efficient Patient Flow

  • Sharing how taking an integrated, technological-based approach saw Derriford Hospital reduce delayed transfers of care from 7% of beds in 2017 to 2% in 2018
  • Exploring how the creation of a new central command centre combined tactical management oversight and hospital discharge teams to implement improved discharge pathways by strengthening inter-department working and improving data flows to key sources
  • Discussing the role of improved data flows to make informed decisions and direct resources to where they could make the most difference regarding discharge, achieved through using data insights from the command centre to react to specific requirements as they arise
  • Outlining how NHS healthcare professionals can best seek to research and implement best-practice ideas from both inter-UK and international examples to improve discharge processes, such as adapting the command centre approach from an American model researched by the Trust 

Jo Beer, Director of Integrated Care & Partnerships, University Hospitals Plymouth NHS Trust (CONFIRMED)


12:00

Questions and Answers Session


12:20

Structured Task and Discussion

  • This session will allow delegates to discuss challenges faced and to share experiences of improving discharge processes
  • Keynote and case study speakers will be on hand to listen, provide feedback and insight into some of the challenges faced to promote idea generation on effective discharge practices
  • Key insights and discussion points can be shared on the Sli.do app for later reference and discussion in networking sessions alongside forming a basis for questions and answers sessions 
  • All discussion points will be shared, collated and sent out to delegates after the event


12:40

Lunch and Networking


13:40

Special Keynote: Exploring How Improving Digital Services can Help Improve Patient Discharge Procedures

  • Outlining how NHS digital are working with Electronic Patient Record and Trust Integration Engine suppliers to provide structured discharge summaries to GP IT system suppliers using Fast Healthcare Interoperability Resources (FHIR)
  • Understanding how NHS Digital are looking to transform Transfer of Care for In-Patient discharge, Emergency Care discharge, Mental Health discharge and Outpatient Clinics
  • Discussing the importance of sharing information across the health and social care sector, especially in relation to discharge procedures and how it will improve patient care
  • Highlighting how hospitals can encourage the use of professional record standards to ensure consistency across the health sector and improve patient discharge

James Walker, Programme Lead, Integration Projects, NHS Digital (CONFIRMED)


14:00

Panel Session: Creating A Integrated Multi-Agency Discharge Pathway To Support Patient Recovery

  • Outlining the integrated ‘Home Safe Sooner’ initiative and how the co-partnership work of the NHS Trust, Local Authority and the Five Lamps Charity has contributed to a significantly smoother, safer and quicker discharge process in North Tees and Hartlepool
  • Discussing how each member of the initiative plays a role at different stages of discharge, from the Trust treating the patient and organising at home care, the Local Authority finding and providing social care and the Five Lamps Charity organising travel and everyday help at home
  • Highlighting the creation of an integrated discharge and frailty team to provide comprehensive and coordinated care, ensuring that post-hospital measures are put in place to support patients recovery, supporting efficient discharge practices 
  • Discussing the importance of creating a positive, communicative relationship between frontline staff and management to best create solutions to discharge problems

Jill Foreman, Senior Clinical Professional, North Tees and Hartlepool NHS Foundation Trust (CONFIRMED)

Victoria Ingham, ART/MDS Team Manager, Stockton-on-Tees Borough Council (CONFIRMED)

Claire Evans, Senior Social Worker, Stockton-on-Tees Borough Council (CONFIRMED)


14:20

Questions and Answers Session


14:40

Refreshments and Networking


15:00

Case Study: Working in Partnership to Reduce Hospital Admissions and Improve Quality of Life

  • Discussing the importance of the One Croydon Alliance in reducing avoidable hospital admissions, an innovate partnership between local NHS services, Croydon Council and Age UK Croydon
  • Examining how this alliance was able to help avoid over 100 hospital admissions over the winter of 2017/2018 by providing coordinated care for long-term conditions that could lead to hospitalisation if left unattended
  • Outlining how this alliance has implemented multi-agency ‘huddle’ meetings to coordinate care between GPs, community nurses, pharmacist, social workers, and Age UK to provide care and support for patients across the borough
  • Highlighting how the work of One Croydon Alliance has resulted in a 20% reduction in the length of hospital stays, making efficiency savings of £12 million a year

Laura Jenner, Programme Manager, One Croydon (CONFIRMED)


15:20

Case Study: Exploring Practical Approaches to Patient Discharge Procedures Through the Same Day Emergency Care Programme

  • Highlighting how the Same Day Emergency Care will improve patient care for elderly patients to reduce unnecessary hospital stays 
  • Discussing the Royal Free Care Homes Outreach Programme which aims to improve the patient care for older people through proactive care planning 
  • Outlining the success of this programme in reducing emergency hospital stays for care home residents and how this was enhanced by training the workforce in care homes 
  • Exploring how Royal Free London NHS Foundation Trust has implemented a Triage Rapid Elderly Assessment Team (TREAT) to help assess, diagnose and treat patients without hospital admittance

Dr Khai Lee Cheah, Consultant Geriatrician, Royal Free London NHS Foundation Trust (CONFIRMED)


15:40

Closing Keynote: Outlining the Importance of the Discharge to Assess Model in Combatting Delayed Transfer of Care

  • Understanding how the discharge to assess model can help hospitals to evaluate a patient’s needs within their own home in order to reduce unnecessary waiting for treatment that is available outside of hospitals
  • Outlining how The Health Foundation has evaluated the Discharge to Assess Model in three different locations across England to gather valuable insights into the success of this programme
  • Sharing key insights from these evaluations and how these can be disseminated to frontline staff in other hospitals to help them implement their own D2A pathways

Tim Horton, Assistant Director (Insight & Analysis), The Health Foundation (CONFIRMED)

Tom Hardie, Improvement Fellow, The Health Foundation (CONFIRMED)


16:00

Questions and Answers Session


16:20

Chair's Summary and Close

*programme subject to change


Despite significant improvement since 2015, latest figures from NHS England indicate that there were 135,700 total delayed discharge days across the NHS in January 2019, of which 86,800 were in acute care. Discharge without adequate social care support has led to Citizens Advice estimating that a fifth of a GP’s time is spent on problems with non-medical causes.

Delayed discharge is especially important in the case of elderly patients suffer from unnecessarily extended stays, delays of over 10 days leading to the equivalent of 10 years of muscle ageing for those most at risk. With an ageing population likely to increasingly rely on NHS services, safe and efficient discharge processes must be established and maintained to reduce potential future risk for the NHS.  It was announced in August 2019 that 20 hospitals from across the UK will receive £850 million in funding to upgrade facilities and equipment, as part of a larger £1.8 billion funding pledge made by Prime Minister Boris Johnson. 

In an attempt to improve discharge pathways, NHS England developed the ‘Discharge To Access’ model, seeking to improve coordination and communication between overlapping service providers. The National Institute for Clinical Excellence (NICE) has published guidelines on discharge processes, whilst the introduction of Care Quality Commission (CQC) discharge inspections has provided an impetus for regular staff training, coordinated care networks and greater patient-led care decisions. The provision of the Better Care Fund (BCF) was designed to join up health and social care programmes, so that local partners can work in tandem to access funds to promote efficient transfers of care, shifting resources away from hospital services and towards community-orientated care. Finally, the Government has provided increased funding to support adult social care, with a £2billion increase in 2017 and a further £240 million in October 2018 supporting the goal of the 2019 NHS Long-Term Plan to further reduce delayed transfers of care (DTOC).

Yet, the Home To the Unknown report by the Red Cross has argued that these initiatives have not gone far enough, and that too many people are discharged without a full assessment of their situation at home. They have called for a fuller assessment using physical, social, psychological, practical and financial factors and for increasingly joined-up care between local government and health care to ensure better support for patients as they require it. 

If the NHS is to cope with a rise in demand amongst patients requiring short, intensive hospital care with appropriate discharge processes to support recovery, it will need to continue to improve discharge pathways to free up valuable resources and ensure that patients receive the comprehensive care they require. Improving pathways, collaborating better with social care services and reviewing internal procedures will be crucial to ensuring the NHS overcomes challenges involved in discharge. 

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