New Ways To Tackle Capacity Issues At Addenbrookes And Peterborough City Hospital

trolley_dash08:07 Thursday 18th April 2013
Bigger Breakfast Show
BBC Radio Cambridgeshire

[P]AUL STAINTON: The Patients Association has criticised a new initiative which uses financial incentives to cut down on bed blocking at one of Cambridgeshire’s biggest hospitals. Wards at Addenbrookes are being offered money if they manage to discharge two patients by 10am every day. Last month there was an average of 76 delayed transfers of care, with an average of 277 delayed days. Now whilst the new policy may help to ease the pressure on beds, and guard against so many cancelled operations and appointments, is it always in the best interests of the patients, especially given the strain on care in the community? Well Catherine Murphy is Chief Execuive of the Patients Association. Earlier she told me why the Association was vehemently against the idea. (TAPE)
CATHERINE MURPHY: Financial incentives should not be included when discharging patients. No patients should be discharged from hospital until they are clinically well enough to go. And also, they have to make sure that there is support for them ready in the community. And very often the support might come from social care or district nursing. And this may not be available. (LIVE)
PAUL STAINTON: Meanwhile here in Cambridgeshire a new scheme is being tried out to treat elderly patients in their home, a specialist care unit or nursing home, instead of sending them to hospital. The Firm is being piloted in Peterborough to try to avoid unnecessary bed blocking. Ian Turner, the Chairman of the Registered Nursing Home Association, has welcomed moves like this, as long as it’s the right treatment in the right place. (TAPE)
IAN TURNER: It’s making sure that the services that we provide are appropriate for the groups that we’re actually addressing. People being in an acute bed in some cases is absolutely right. They need to be there. That’s where the investigation’s done and the diagnosis is done. In other cases we know that an awful lot of beds are occupied by people that could be looked after in a more appropriate way, in a more appropriate setting. And it’s making sure that we keep that word appropriate at the top of the agenda (LIVE)
PAUL STAINTON: Well Dr Rhiannon Nally is the lead GP of The Firm. She’s here now. Morning.
DR NALLY: Good morning.
PAUL STAINTON: Just explain what it is and what it does.
DR NALLY: Well The Firm is a pilot project running in Peterborough. It stands for For Immediate Review and Management. And what it means is that we are taking sick elderly people, either from the hospital or from primary care, and we are looking after them in the community setting, when they are more unwell than is normal practice in the community. So in other words, when elderly people perhaps go off their legs, or they become confused, or they fall, a lot of these kind of cases would have normally resulted in hospital admission. And we’re looking at a new way of delivering care, where we bring hospital services to really patients either in their own home, or if they can’t manage in their own home, we’re sometimes placing them in interim care beds in nursing homes. And of course we’re using our Community Care Centre, intermediate care centre in the city to take patients in for a few days, and look after them, and then discharge them into the community.
PAUL STAINTON: Have I got this right? People injure themselves at home or out in the community. Instead of going to hospital, you bring who to look after them? Who will look after them straight away?
DR NALLY: We’re a group of two and a half GPs. We have one care of the elderly consultant that works on our team. We have an adult social worker. And we have a Community Matron who’s a very highly experienced nurse. And so we are a multi-disciplinary team. We have close links with Occupational Therapy, with Physiotherapy and with Mental Health. So we’re kind of like a total package really, and we can operate in the community in a very similar way to the multi-disciplinary approach that happens in a hospital.
PAUL STAINTON: Ok. So that’s one way of doing it. That’s one way of unblocking some beds in hospitals. Another way is what Addenbrookes are doing, incentivising wards with cash incentives to get rid of two patients every morning. Is that right, Dr Keith McNeil, Chief Executive of Addenbrookes. That’s about right, isn’t it?
DR MCNEIL: Good morning. No it’s not .. we’re not incentivising people to get rid of patients at all. What we’re doing is we’re putting in some incentives for people to discharge plan more effectively, so that we’ve got capacity to flow our patients more efficiently.
PAUL STAINTON: So you’re not incentivising people to empty beds. You’re not offering them £1000 if they discharge two patients by 10am every day. If they do that for a week they get £1000 don’t they? If they do it for a month the ward gets £5000.
DR MCNEIL: That’s correct.
PAUL STAINTON: So you are incentivising them to empty beds.
DR MCNEIL: We are incentivising them to do their discharge planning pre-emptively, so that when patients are ready to go, they can be moved efficiently and quickly from those beds, so that other patients who need those beds can be moved into them.
PAUL STAINTON: What safeguards are in place here?
DR MCNEIL: Well the safeguards are that we have number one an unrelenting and unremitting focus on safety and quality. And all of the clinicians, all of my clinical colleagues know that patient safety comes first. So patients who are .. might be involved in this initiative would only be those who are clinically ready to be discharged, and the incentive is to get all of the staff involved, that’s quite a complex mix of professionals and other people, it’s to get that mix right in a pre-emptive way, rather than leaving it to the last minute.
PAUL STAINTON: Are you not though pitting wards against each other in a race for cash? Surely if there’s temptation there, that’s dangerous, isn’t it?
DR MCNEIL: No it’s not dangerous. We did this back in Australia and it worked very effectively. We get far more out of incentivising behaviour than we do out of penalising it. And in fact having that friendly rivalry between the wards is in fact very effective in getting people to change the way they do their business. In fact there’s another incentive in this that you probably haven’t heard of, that if any ward is able to achieve this consistently for an entire month, they get me forr a whole day to go and work on that ward to do whatever they want me to do.
PAUL STAINTON: Oh right. Ok. That’s not a bad incentive I suppose, is it? There’s a reason you’re doing all of this of course, because cancelled appointments, operations within the hospital on red alert, you’ve got to do something. Is this not just a desperate measure though?
DR MCNEIL: Well look, you’re right. We do have to do something, and patient flow and freeing up capacity is critical to the safety of all of the patients that we see, not only those that are waiting for care in the emergency room, the ones who are waiting in ambulances, but as you say those who are waiting for operations, both elective life-saving, those with cancer, etcetera. So we have a resource that is limited in terms of bed capacity, and we have to make sure we use that as effectively as possible. You referred before to delayed transfers of care. In fact we have anywhere between 70, 80, 90 of those in the hospital on any one day. And in fact that’s testimony to the fact that we don’t push people who aren’t ready out into the community. Those people are actually waiting for care outside of the hospital.(?) And we keep those people there ’till it is safe in fact to discharge them. But it is critical for the whole system, for patients in general practice, surgery, on ambulance stretchers, in the emergency room waiting for operations, for us to get our flows right.
PAUL STAINTON: Yes. And you’ve got to be confident that the care is there in the community, which in some cases it isn’t.
DR MCNEIL: Absolutely. That’s absolutely right. And the mini-home, or the scheme that you were just talking about, is one of the ways that we’re also looking to address the capacity issues.
PAUL STAINTON: Yes. And very quickly, on the subject of A&E, Monitor fined you didn’t they earlier £104,000. How is the situation going on your cancer treatment targets as well?
DR MCNEIL: Cancer treatment targets are going well. In fact we hit those targets earlier than we had anticipated. The surgery targets are also going well, despite the pressure. And in fact despite the unrelenting pressure that’s been on the emergency room, we’re doing very well. We just missed that target of 95% last month. I think we had 94.01% I think. So given the pressures we did extremely well.
PAUL STAINTON: Keith, thank you for coming on this morning. Dr Keith McNeil, Chief Executive of Addenbrookes. His comments there on using incentives to avoid bed blocking at Addenbrookes Hospital.