Posted by: ayrshirehealth | November 26, 2014

More than the building by @cameronasharkey

Building for Better Care – more than the building

University Hospital CrosshouseFor those of us lucky enough to come to work every day at either University Hospital Ayr (UHA) or University Hospital Crosshouse (UHC), it is difficult not to notice the steel skeletons beginning to emerge from behind the barriers surrounding the building sites in front of these hospitals. screen-capture-18

For many these might represent no more than an added obstacle to negotiate in their search for an elusive parking space.

For me they represent a daily, and looming, reminder of NHS Ayrshire and Arran’s commitment to the transformation of urgent care.

New Models of Care

The Building for Better Care (BfBC) will deliver a new Combined Assessment Unit (CAU) at Crosshouse and a new Emergency Department and CAU at Ayr as part of a £27 million commitment to make this transformation a reality. Impressive though these new, state of the art clinical areas will be, they are only the most tangible – not most important – part of the change required. The development of a New Model of Care is already underway to ensure that the benefits of these new builds can be fully realised and the service we deliver continue to meet the demands which we expect the coming years to bring.

The underpinning ethos of this New Model of Care is that patients will only be admitted to a specialty bed as a result of a deliberate decision being made by a senior clinician to begin treatment, rather than being admitted so that we can then work out what to do with them- decide to admit not admit to decide.

First of their kind

The CAUs – the first of their kind in Scotland – will consist of a number of single-room beds (41 at UHC and 34 at UHA) as well as ambulatory care bays and assessment chairs. Patients will arrive at the CAU either as a result of a referral from their GP or after having self-presented at A&E and will benefit from early access to senior decision makers, early access to diagnostics and imaging and input from a skilled multi-disciplinary team. screen-capture-12Within 48 hours, the patient will either be admitted to an inpatient bed under the care of the relevant specialist team or will be discharged home. In essence, the vision is to shift the focus from the back door wards to the new front door enabling patients to be cared for, without delay, in the most appropriate setting for them.

screen-capture-13We should not underestimate the scale and the nature of change which as at hand, nor can we ignore the driver behind that change. It is clear that continuing to deliver care in the manner in which we have done will leave us unable to match the demand of a population living longer with more illnesses. Attempting to effect this change at a time of financial plenitude would be challenging enough; under the current circumstances it represents an undertaking of significant ambition.

Repeating the mantra

While we can repeat the mantra that ‘we’re not creating new activity, but simply moving it from the back to the front of the hospital’, it is obvious that we are fundamentally altering the nature of the activity which is being undertaken. screen-capture-19The change required is not one which is limited to the services which will be delivered within the new buildings. It impacts on the care being delivered in the primary care sector, the community, on speciality wards in the acute hospital and on the services run by colleagues in the Scottish Ambulance Service and in the Social Work departments of the Health and Social Care Partnerships.

Each of these areas has a vital role to play in the success of the Building for Better Care programme and each will experience their own improvements when this success is realised.

Solution focused

Ideas for redesign, improvements and enhancements to the care being offered have been plentiful and promise significantly better experiences and outcomes for patients. MoneyHowever, the funding to implement these initiatives is scarce to non-existent and people have been challenged to produce solutions as to how they’ll best support the patient journey through the new Units within their current level of resource.

The response to this challenge has been one characterised by innovation, vision and hard work.

Opening dates

The CAU at Crosshouse is scheduled to open at the end of March 2016, with the CAU at Ayr opening a year later. It would be naive to think that by this time we would be in a position to implement a Model of Care which will enable us to reap the full benefits of these new units. NHSaaaInstead, the opening of the new buildings will offer the chance to implement a way of working which is significantly different from what has gone before and is a step on the way to achieving the shared gold standard vision.

What we can be in no doubt about is that opening the new building without making this change is an option which will result in the failure to meet the needs of the patients.

We should be mindful that in articulating the necessary limits in respect of the available resource to deliver the improvements required, we do not limit the ambition, enthusiasm and commitment which has been so evident in the work which has so far taken place.

This week’s blog was by @CameronASharkey (Cameron Sharkey) Management Lead – Building for Better Care, NHS Ayrshire & Arran.

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