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Putting the Framework into the IRF

Putting the Framework into the IRF. Adrian Baker IRF workshop - Stirling 9 th June 2010. Overview. Context Current System: (It’s stuffed) Patient flows & costs Unscheduled Care Where people die Does it matter –Demographics (it’s getting worse)

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Putting the Framework into the IRF

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  1. Putting the Framework into the IRF Adrian Baker IRF workshop - Stirling 9th June 2010

  2. Overview • Context • Current System: (It’s stuffed) • Patient flows & costs • Unscheduled Care • Where people die • Does it matter –Demographics (it’s getting worse) • How to improve patient care and reduce costs • The Vision • Next steps

  3. Current system: Practice direct Impact

  4. 2008/09 Practice Direct Impact (£203.4m)

  5. The 44% in Mid CHP

  6. Occupied bed days >74

  7. Highland Elective vs Emergency

  8. Cost of DD’s per year for Highland • Delayed discharge patients • Number of patients 64 • Total Occupied Bed Days 3279 • Total cost @ £200 a day £656,000 • Conservative Annual cost £5M

  9. Mental Health • Ultra Long Stay patients (>12 months) • Number = 24 • Total OBD’s = 116 years • Total Cost = £8.4M • Cost of Both- DD’s and MH= £17,600 / day • Weekly = £123,200 • Annual = £6.4M

  10. Home Care Pan Highland

  11. Home Care & Proportionality • Total Home Care wte’s in Highland Council = 370 • Total Population served = 220,000 • Home carers / head of population = 1.68 • Nairn current provision = 12.3 wte • Proportionate allocation of resource = 25.2 • Allows 24/7 home care, prevents and delays institutionalisation.

  12. What is in a death? • Practice A 25% of patients die in hospital • Community Nursing • GP’s • Marie Curie Nursing • Voluntary sector • Culture • Alerts, DNAR, Information sharing • Practice B 80% of patients die in hospital

  13. Where people die

  14. Polypharmacy – Martin Wilson

  15. 5 years and 20 years >75 pop 2009 - 27,000 2016 – 35,000 2031 – 59,000

  16. The Future

  17. 2005/06 & 2006/07: 3 Admissions in Raigmore 44 Bed Days in Raigmore 1 Admission & 1 Transfer to Nairn 39 Bed Days in Nairn 6 Months 2007/08: 1 Admission to Raigmore 1 Bed Day in Raigmore 78 Yr Old Married Male Smoker withHypertension, CHD, Diabetes, Heart Failure & Stroke Living at HomeBefore After

  18. Extraction

  19. Extraction 13 March 2008 05:02 1349 NAIRNADMS.csv13 March 2008 05:02 2121 NAIRNDISC.csv13 March 2008 05:02 5020 NAIRNINPS.csv

  20. First steps towards IRF?

  21. First steps towards IRF?

  22. Vision • Equity of service and funding for patients • Integration with Social Services • Comprehensive Primary Care local services to ensure local response • Clinically and socially appropriate response especially Mental Health • Ability to provide • rapid home care, • community bed • secondary hospital admission

  23. Carers & Voluntary AHP’s / Pharmacy Nursing GP’s Community Hospitals Secondary / Tertiary Care 99 ? OR 999

  24. Next stepsIRF in Highland • Locality Budget • Explicit detail of variation and analysis • Making 44% matter to GP’s and Teams • Integration of services to provide seamless care for patients. • Contracting and movement of resource with patient activity

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