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New models of care

Medical Admissions

We were asked by the Acute (Hospital) Trust in a large city to engage stakeholders in their re-design of the referral process for specialist medical assessment, investigation and treatment.  Different processes had evolved in different parts of the city, leading to some confusion.  By working with a group that brought together primary care, the Accident & Emergency department and inpatient secondary care, we identified that the ideal set of responses depend on how long the patient is likely to need to stay at the hospital, which ranges from

• ·         No stay needed if GP has immediate access to telephone advice / diagnostics / outpatient referral

• ·         Less than 3 hours – patients who need a clinical opinion +/- simple diagnostic tests

• ·         3-12 hours – patients who need brief stabilisation or more time-consuming diagnostics

• ·         12-48 hours – patients who need a longer period of stabilisation or diagnostics

• ·         Inpatient care of over 48 hours

We then involved a wider group of over 100 people who explored what would be needed to make it possible to route each of these groups of patients to the appropriate part of the hospital.  The list, which identified issues like the rapid availability of diagnostics and specialist opinion, and the undertaking of frequent clinical review of patients needing only brief stays in hospital, became an action plan for the trust.  The task remains to find appropriate names for the ‘3-12 hour’ and ’12-48 hour’ wards.

Developing Community Services

The Community Services Development Group wanted a new kind of planning process which would be inclusive, and less driven by the needs of individual organisations. They selected care of older people as the topic. We worked with them to design a series of local meetings to draw on the personal knowledge of frontline staff and residents about how services work now. The planners fed back their impressions.

‘As the story about this elderly couple unravelled I began to see out-of-hours in a new light. It brought home to me just how nine-to-five our services are and what some of the unintended consequences can be’.(LA manager)

‘One of the most powerful impacts was ‘to see’ the importance of transport. If we could think of it as part of the healthcare system rather than a set of wheels to get people from A to B we might start to plan in quite different ways.’ (NHS planner)

The next stage was to work with the planners to uncover the guiding principles behind the real life stories and use these to shape the plan. Two months later they returned with a draft plan and all 90 participants from the localities worked together over two days to check that the guiding principles were ones they recognised and to take the plan a stage further into action.

‘In all we have a set of 17 proposals for change each of which can be related to one or more of the guiding principles.(NHS planner)

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