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Long term conditions

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Department of Health
Department of Health
Gesundheit & MedizinBusiness
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Jude Smith Respiratory Nurse Consultant & Long Term Condition Lead 24 th March 2011 Transforming Community Services LONG TERM CONDITIONS personalised  responsive  effective  innovative
Background ,[object Object],[object Object],personalised  responsive  effective  innovative
What is a Long-Term Condition Hub? ,[object Object],[object Object],[object Object],[object Object]
Current Situation personalised  responsive  effective  innovative Administration ,[object Object],[object Object],[object Object],[object Object],GPs Hospitals Patients Community Teams Consultants Social/ Voluntary Care LTC Clinicians / Community Matrons
Future Plan personalised  responsive  effective  innovative LTC Hub ,[object Object],[object Object],Triage GPs Hospitals Patients Community Teams Consultants Social/ Voluntary Care LTC Clinicians / Community Matrons
Key Features (current thinking) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],personalised  responsive  effective  innovative
Key Benefits ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],personalised  responsive  effective  innovative
Steps we took ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],personalised  responsive  effective  innovative
Screen, Diagnose Optimize Care Case manage Acute response Care co-ordination Specialist interventions End Of Life General Practice Community Teams Secondary Care Social Care ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],COPD HF Diabetes Neuro Complex Elderly EOL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],= MDT Review
Implementation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Implementation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Implementation- KPI’s ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Communication ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Staff rota   NWD NWD NWD X   NWD NWD X     Heart Failure NWD   NWD H   NWD   NWD   X NWD Heart Failure     HA X UNI   AL AL AL AL AL Heart Failure   X   X X   X   X X X Heart Failure   NWD NWD   H   NWD NWD X SL   Heart Failure NWD     NWD NWD NWD NWD NWD NWD   X Heart Failure   X X     HA X X X X X Heart Failure           H           Diabetes             HA         Diabetes NWD NWD       NWD NWD H     NWD Diabetes H                 HA   Diabetes   NWD H       NWD       HA Diabetes     X         HA   X   COPD AL NWD NWD NWD     NWD NWD NWD     COPD X X X X AL AL H X X X AL COPD   H X   X X X X HA X X COPD   X X X X   X   H     CM       X HA           H CM HA     X           H AL CM
Clinician capacity plan
The Launch
The Launch
The Launch
Where we are now ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Future? ,[object Object],[object Object],[object Object]

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Long term conditions

  • 1. Jude Smith Respiratory Nurse Consultant & Long Term Condition Lead 24 th March 2011 Transforming Community Services LONG TERM CONDITIONS personalised  responsive  effective  innovative
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  • 14. Staff rota   NWD NWD NWD X   NWD NWD X     Heart Failure NWD   NWD H   NWD   NWD   X NWD Heart Failure     HA X UNI   AL AL AL AL AL Heart Failure   X   X X   X   X X X Heart Failure   NWD NWD   H   NWD NWD X SL   Heart Failure NWD     NWD NWD NWD NWD NWD NWD   X Heart Failure   X X     HA X X X X X Heart Failure           H           Diabetes             HA         Diabetes NWD NWD       NWD NWD H     NWD Diabetes H                 HA   Diabetes   NWD H       NWD       HA Diabetes     X         HA   X   COPD AL NWD NWD NWD     NWD NWD NWD     COPD X X X X AL AL H X X X AL COPD   H X   X X X X HA X X COPD   X X X X   X   H     CM       X HA           H CM HA     X           H AL CM
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