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  • Issue

    Northumberland is a large and geographically diverse county.  Its population is equally diverse, with significant socio-economic and health disparities.  Health and social care across the county was often disjointed, resulting in:

    • Ageing population with increasing expectations wanting quick access, often turning up at the wrong services, e.g. inappropriate Emergency Department (ED) presentation;
    • Inappropriate hospital referrals;
    • Unnecessary hospital admissions, causing delays for those most in need;
    • Insufficient budget to meet demand;
    • Shortage of health and care professionals;
    • Delayed discharge because no where to place patients post medical intervention;
    • Disjointed care between healthcare (NHS) and social care (local government); and
    • High proportion of hospital end of life care.

    Solution

    Northumbria designed and implemented a system of integrated care that delivered the right service for the right patient in the right location by the right staff with the right resources.  The integrated care model includes, not exhaustively:

    • Delivering a seamless, patient centric experience across all care settings;
    • Multidisciplinary teams planning and working seamlessly across health and social care;
    • Providing the right type, location, standard and equipping of facility – over 100 of them including 3 general hospitals, 3 specialist hospitals and 3 community hospitals;
    • Technology to safely manage the patient across and between all care interfaces including a unified patient record accessed by the multidisciplinary team;
    • Collaborative planning for elective procedures, with proactive diagnostics;
    • Providing a rapid response to community based solutions to prevent hospitalisation;
    • Proactive hospital discharge management ;
    • Primary care at scale;
    • Tailored education and training for all staff;
    • Culture of continual care monitoring and improvement with end-to-end assurance;
    • Workforce planning including values based recruitment, and introducing practical innovations e.g. Advanced Nurse Practitioners, working at junior doctor level to free up doctors’ time for things that only doctors can do;
    • Cultural change and increased focus on strong leadership and governance with business unit teams replacing traditional hierarchy structure; and
    • Patient experience focus, including collecting and publicly sharing real-time and right-time data at consultant, department, facility and system level to drive improved performance.

    Outcomes

    • Rated Outstanding by the Care Quality Commission – the highest possible rating by the UK care regulator;
    • Significant reduction of avoidable admissions, ED presentations, delayed discharges;
    • Improved safety and quality;
    • Increased patient and satisfaction;
    • Increased staff satisfaction and retention;
    • Improved patient access;
    • Reduced mortality and morbidity;
    • Reduced sepsis and infection;
    • Reduced palliative hospital deaths for patients who preferred to die at home; and
    • Reduced costs.

    Kick start your project today

    Talk to our team on +44(0)1670 620 214 or visit our contact page

    Looking for advice?

    Talk to one of the team today, you can send us an email or call us on +44 (0) 1670 620214