Designing and implementing new models of care across a health system

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TN facilitated a series of workshops with health system partners to co-ordinate the design and implementation of alternative pathways.

Objectives

Improving quality and access to emergency and urgent care within Norfolk & Waveney STP.
System-wide engagement and commitment to address ambulance handover delays at A&E.
Reducing ambulance conveyances to A&E by:
- Increasing usage of existing alternative pathways, especially community, elderly care, and mental health.
- Designing and implementing new pathways for patients who can be treated more appropriately in community.

Bringing together the right people: To facilitate a fast pace of change this included Executives and directors from Acute, Community & Mental Health, and Ambulance trusts, NHSI, NHSE, and ECIST. Teams discussed what “working as a system” really meant and identified ways to facilitate joint working e.g.:
- Increasing usage of existing alternative pathways especially community, elderly care, and mental health.
- Designing and implementing new pathways for patients who can be treated more appropriately in community.
Establishing new pathways: Identified and mapped out potential pathways, agreeing initiatives that can be implemented immediately to improve patient outcomes, patient experience, and performance for the system. Then prioritised four pathways based on impact, feasibility, and leadership.
Increasing utilisation of existing pathways: Reviewing current practice and discussing optimisation opportunities for current pathways. Learned from user stories and understood what prevents us from using alternative pathways more frequently.

36% reduction in ambulance handover delays at A&E
Established new pathways e.g., paramedics to refer patients directly to mental health charities, epilepsy & respiratory pathways (chronic conditions), direct admission-to-assessment wards at NNUH hospital, and a PV bleeds pathway.
Established six community beds for patients who did not need an acute hospital admission, and a mental health interim night hub.