Improving referral pathways between urgent and emergency services in England
|
|
- Marvin Blake
- 8 years ago
- Views:
Transcription
1 Transforming Urgent and Emergency Care Services in England Improving referral pathways between urgent and emergency services in England Advice for Urgent and Emergency Care Networks
2 NHS England INFORMATION READER BOX Directorate Medical Commissioning Operations Patients and Information Nursing Trans. & Corp. Ops. Commissioning Strategy Finance Publications Gateway Reference: Document Purpose Document Name Author Publication Date Target Audience Additional Circulation List Description Guidance Improving referral pathways between urgent and emergency services in England Urgent and Emergency Care Review Programme Team November CCG Clinical Leaders, CCG Accountable Officers, Care Trust CEs, Foundation Trust CEs, NHS England Regional Directors, NHS England Directors of Commissioning Operations, Emergency Care Leads, Directors of Children's Services, NHS Trust CEs, System Resilience Groups; Urgent and Emergency Care Networks CSU Managing Directors, Medical Directors, Directors of Nursing, Local Authority CEs, Directors of Adult SSs, NHS Trust Board Chairs, Directors of Finance, GPs, Special HA CEs This document is designed to help Urgent and Emergency Care (UEC) Networks and System Resilience Groups (SRGs) to improve the flow of patients and information within the urgent and emergency care system by supporting an enhanced and consistent approach to the referral of patients between healthcare professionals and providers. Cross Reference Superseded Docs (if applicable) Action Required Revised planning guidance for 2015/16; Five Year Forward View N/A Best practice Timing / Deadlines (if applicable) Contact Details for further information Document Status N/A england.urgentcarereview@nhs.net 0 0 This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the intranet. 2
3 Document Title: Improving referral pathways between urgent and emergency services in England Subtitle: Advice for Urgent and Emergency Care Networks Version number: FINAL 1 First published: November 2015 Updated: (only if this is applicable) Prepared by: UEC Review Team The National Health Service Commissioning Board was established on 1 October 2012 as an executive non-departmental public body. Since 1 April 2013, the National Health Service Commissioning Board has used the name NHS England for operational purposes. Equality and Health Inequalities Promoting equality and addressing health inequalities are at the heart of NHS England s values. Throughout the development of the policies and processes cited in this document, we have: Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities. Urgent and Emergency Care Networks are reminded to pay due regard to the two duties above when this guidance is implemented locally. Information Governance Safe and efficient patient care requires effective, timely and appropriate transfer of key information that follows the patient through the healthcare system. This is particularly important in the urgent and emergency care system where, by definition, the patient is accessing care from outside of their routine care providers. The informed consent of patients should normally be sought and obtained before accessing or sharing information about them. This informed consent needs to ensure that the patient understand who will access their data and for what purposes. If they are adults and lack the capacity to make these decisions, those decisions should be 3
4 made in their best interests in accordance with the Mental Capacity Act 2005 and its Code of Practice. If they are children aged under 16, those decisions should be made by someone with parental responsibility for them, unless they are Gillick competent and, after applying the Fraser Guidelines it is best interests to respect their decision. If they are children aged 16 or 17, the principles set out in paragraph of the Mental Capacity Act Code of Practice should be followed. The wishes of children (and those with parental responsibility for them) can/should be overridden in their best interests to save them from significant harm; the wishes of adults with capacity cannot be overridden unless overriding their wishes may prevent serious crime Significant abuse or neglect are/may be crimes. All of the above is subject to what might happen in an emergency when people cannot make, or cannot properly be expected to make, decisions. When that is so, all decisions to do with their immediate care and welfare should be made in their best interests in accordance with chapter 5 of the Mental Capacity Act Code of Practice. 4
5 Contents 1 Document summary Transforming urgent and emergency care services in England Purpose Audience Structure How it will be used Clinical governance Introduction Description of the proposed changes Guidance on referrals across the UEC system How this works in practice: HealthPathways The Initial Response Service Paramedic Pathfinder Direct referral to a diabetic specialist nurse team Implementation Principles of enhanced referral Benefits Benefits to the system Benefits to the patient Summary and Conclusion Appendix 1: Case illustrations Case Case Case
6 1 Document summary 1.1 Transforming urgent and emergency care services in England The NHS Five Year Forward View (5YFV) explains the need to redesign urgent and emergency care services in England for people of all ages with physical and mental health problems, and sets out the new models of care needed to do so. The urgent and emergency care review (the review) details how these models of care can be achieved through a fundamental shift in the way urgent and emergency care services are provided to all ages, improving out-of-hospital services so that we deliver more care closer to home and reduce unnecessary hospital attendances and admissions. We need a system that is safe, sustainable and that provides high quality care consistently. The vision of the review is simple: For adults and children with urgent care needs, we should provide a highly responsive service that delivers care as close to home as possible, minimising disruption and inconvenience for patients, carers and families. For those people with more serious or life-threatening emergency care needs, we should ensure they are treated in centres with the right expertise, processes and facilities to maximise the prospects of survival and a good recovery. As part of the review, a number of products are being developed to help create the conditions for new ways of working to take root and when combined, deliver an improved system of urgent and emergency services. The review proposes that five key changes need to take place in order for this to be achieved. These are: Providing better support for people and their families to self-care or care for their dependants. Helping people who need urgent care to get the right advice in the right place, first time. Providing responsive, urgent physical and mental health services outside of hospital every day of the week, so people no longer choose to queue in hospital emergency departments. Ensuring that adults and children with more serious or life threatening emergency needs receive treatment in centres with the right facilities, processes and expertise in order to maximise their chances of survival and a good recovery. Connecting all urgent and emergency care services together so the overall physical and mental health and social care system becomes more than just the sum of its parts. NHS England is collaborating with patients and partners from across the system to develop a suite of guidance documents and tools to promote best practice and 6
7 support commissioners and providers in achieving a fundamental shift towards new ways of working and models of care. These guidance documents are being developed as a suite entitled Transforming Urgent and Emergency Care Services in England and are designed to be read together. The suite comprises the following components: Role and establishment of Urgent and Emergency Care Networks (UECNs), published June Clinical models for ambulance services. Improving referral pathways between urgent and emergency services in England. (This document.) Safer, faster, better: good practice in delivering urgent and emergency care, published August This good practice guide focuses on the safe and effective care of people with urgent and emergency health problems who may seek or need specialist hospital based services. Urgent and emergency care: financial modelling methodology. Other products to support include a Directory of Services (DoS) a tool to include all available services that can be referred to, and Commissioning Standards for Integrated Urgent Care (that includes the NHS 111 contact number), which has been published, as well as its supporting documents, to be published. These will include the Integrated Urgent Care Payment annex; Integrated Urgent Care Contract Alignment Plan; NHS England Integrated Urgent Care (NHS 111 Telephony) National Business Continuity Policy; Procurement Guidance and Integrated Urgent Care Model (Financial Model Tool). 1.2 Purpose This document is designed to help UECNs to improve the flow of patients and information within the urgent and emergency care system by supporting an enhanced and consistent approach to the referral of patients between healthcare professionals and providers. 1.3 Audience This document is intended to be used by UECNs. It provides advice for commissioners on the benefits of enhancing referrals within the urgent and emergency care system, and advice for providers on good practice and how this might be implemented, understanding that this will also be determined by local need. Membership of UECNs is outlined in the Role and Establishment of Urgent and Emergency Care Networks. 1.4 Structure The document begins with an introduction explaining why the move to a more cohesive and integrated approach to the delivery of care is desirable, and how 7
8 different parts of the health service can collaborate to deliver this. It goes on to describe the proposed changes in patient referral across the urgent and emergency care system, and the benefits of implementing these changes. 1.5 How it will be used The 5YFV emphasised the importance of how we will increasingly need to manage health care systems through networks of care; not just by, or through, individual organisations. UECNs are expected to define consistent pathways with equitable access across urgent and emergency care. Commissioners should utilise the principles outlined in this document, tailoring them to meet local need as identified by the networks across England. 1.6 Clinical governance At an operational level, the patient pathways described under each service specification will define clinical accountability according to the patient s needs and their referral pathway. 8
9 2 Introduction The demand for urgent and emergency care has increased significantly over the last decade. Patient attendance at hospital Emergency Departments (EDs) has increased by more than two million, to 16 million annually, and emergency admissions to hospitals have increased by 31%. Attendance at walk-in centres and minor injury units has increased 12% annually, and the number of 999 calls to the ambulance service has increased from 4.9 to 9 million calls per year. As the population is living longer, and has increasingly complex medical needs, this demand is only predicted to increase. The annual cost to the NHS of admissions for conditions that are appropriate for ambulatory care was estimated to be 1.42 billion in 2009/10, and accounted for 15.9% of all emergency admissions to hospital. 1 Many patients who seek emergency input from the NHS111 and ambulance services with ambulatory care sensitive (ACS) conditions would benefit from referral to more appropriate care pathways without admission to hospital. 2 There is emerging evidence that the 999 activity of patients on clinical registers is predictable, and access to data and appropriate and expedient care can reduce conveyance by over 20%. In 2010, in the North West alone, more than 18,000 chronic obstructory pulmonary disease (COPD) patients who accessed urgent and emergency care were admitted to hospitals, of which 11,000 could have been treated in their community via primary and community services. 3 Additionally, mental illness is estimated to be the primary cause of around 5% of ED attendances, and alcohol-misuse a further 10%. 4 It is estimated that there are around 150,000 hospital attendances for self-harm each year. Approximately 90% of these patients have a diagnosable mental health condition. 4 Often, the physical symptoms are treated without managing the underlying mental health problem resulting in future multiple attendances. At present ambulance and other urgent care professionals are not uniformly empowered to refer patients to community or specialist services. Urgent Care Centres (UCCs) frequently do not permit paramedics to refer patients to them on the assumption that the ambulance service does not deal with minor injuries, 3 and hospitals, in turn, may not accept referrals from non-medical healthcare professionals working in UCCs. Paramedics report that an absence of appropriate referral pathways can lead to duplicated and unnecessary activities which consume time and resources, reduce 1 Tian, Y, Dixon A, Gao H. Emergency hospital admissions for ambulatory care-sensitive conditions. Data briefing. Kings Fund Available at 2 Paramedic Pathfinder and Community Care Pathways, North West Ambulance Service NHS Trust. Last accessed 30/7/15. Available at 3 Health Committee. Written evidence from the College of Paramedics (ES 17). May Last accessed 30/7/15. Available at 4 Liaison Psychiatry in the Modern NHS, Centre for Medical Health (2012) Available at: 9
10 efficiency and almost certainly affects patient perceptions of a joined-up NHS. 3 3 Description of the proposed changes 3.1 Guidance on referrals across the UEC system In order to facilitate an improved flow of patients and information within the UEC system, all registered health and social care professionals within physical and mental health (referred to in this document using the general term practitioner ), following telephone consultation or face-to-face contact with a patient, should be empowered, based on protocols developed and agreed locally, to make direct referrals and/or appointments for patients with: The patient s registered general practice or corresponding out of hours (OOH) service; Urgent Care Centres; Emergency Departments in Emergency Centres and in Emergency Centres with Specialist Services; Mental health crisis services and community mental health teams; Specialist clinicians, if the patient is under the active care of that specialist service for the condition which has led to them accessing the urgent and emergency care system. UECNs are encouraged to define the exact referral pathways available to each professional working within their network. The underpinning documentation to support this proposed change is described further in Commissioning Standards Integrated Urgent Care (for NHS 111 services). The diagram below illustrates what a functionally integrated urgent care service including an urgent care clinical hub might look like: 10
11 This integrated care model is also described in more detail in Commissioning Standards - Integrated Urgent Care (for NHS111 services). 4 How this works in practice: 4.1 HealthPathways Developed in 2008 in Canterbury, New Zealand, HealthPathways is described as the most innovative and most effective change to the health and social care system. 5 Essentially, HealthPathways are local agreements on best practice whereby hospital doctors, GPs, nurses and allied health professionals have designed patient pathways and treatment plans in cohesion. These are managed within the community and incorporate guidelines on referrals, available resources for GPs to avoid unnecessary referrals and indicate suitable tests to be conducted before making a referral either in the community or to a hospital. 5 The quest for integrated health and social care - A case study in Canterbury New Zealand. Timmins, N & Ham, C (2013) Available at: 11
12 Canterbury has more than 480 pathways which are routinely reviewed every year and regularly audited. Referrals are directed through an Electronic Shared Management System which is used to request tests as an outpatient, to make community assessments and to request specialist advice. An Acute Demand Management System (ADMS) has been implemented which provides general practice with a support structure for patients who may need medical support but otherwise do not need to be referred to a hospital. It also offers support for the hospital to refer patients from the emergency department to more appropriate settings, thereby benefiting patients who require tests or observation but do not require admission to hospital. As a result patients can be managed close to home where it is safe and appropriate to do so. How the ADMS works in practice an example A specific programme for COPD was introduced after analysis showed that once patients reached the emergency department they had very high admission rates. Patients are given care plans and something as simple as a fridge magnet which has their normal oxygen saturation and exercise tolerance on it. This allows the ambulance service to know what is normal for the patient, so that supported by telephone access to a respiratory physician paramedics can decide whether the patient needs to go to the emergency department or can be managed in the community by the GP or by acute demand management. In the winter of 2012, Canterbury estimates that some 40 per cent of COPD patients who would previously have been taken to the emergency department were diverted to other forms of care. 6 Other innovative changes include an Electronic Shared Care Record View (escrv), a 24 hour General Practice service where GPs responsible for out of hours care work alongside a nurse triage system, and a number of centers that have extended opening hours. A falls management system has been implemented, as has a pharmacy-linked medication management system which conducts a review of patients prescribed multiple drugs. Results Canterbury demonstrates low rates for acute medical admissions compared to other health boards in New Zealand. Its average length of stay is low, and its acute readmission rate is also low. These innovations have led to a demonstrably reduced demand on hospital resources and a flattening and reduction of the demand curve across health and social care, due to improved integration between hospital, primary care and community services. Overall this has resulted in better and more integrated care for patients, resulting in the right care in the right place at the right time. 4.2 The Initial Response Service 12
13 Northumberland Tyne and Wear NHS Foundation Trust have implemented an assessment response team providing a single entry point for patients with mental health issues via a 24/7 telephone line. The service provides advice for patients on their current presentation and allows referral into other services so that patients can access the right care for their needs, without the need to default to Accident and Emergency Departments. The service also provides advice to General Practice on presenting patients, so GPs feel better supported in managing patients with mental health issues. 6 Nurses triage through telephone consultation. This results in a clinical decision, identifying the most appropriate intervention for the individual which could be: Referral to rapid response for face to face triage; home visits undertaken within one hour; Referral to GP services to manage presenting symptoms; Referral to existing Crisis Resolution and Home Treatment Teams for crisis management; Simply providing telephone advice on managing the current situation. Staff meet daily to discuss patient referrals, which enables the large proportion of referrals that are not urgent or in mental health crisis to be booked into the most appropriate outpatient service or proceed with an agreed management plan. Results Following implementation of the assessment response team, the Trust report: 100% of service users surveyed reported satisfaction with the response and would recommend the service to a friend; A reduction in the number of urgent calls to the ambulance service, improved response times from the Crisis Team and a reduction in four-hour breaches; Reduced avoidable harm due to reduced referrals bouncing around the system; 100 per cent of GPs said their calls were answered quickly and the team met their needs. 4.3 Paramedic Pathfinder The North West Ambulance Service (NWAS) implemented Paramedic Pathfinder in Based on the Manchester Triage System, Pathfinder is a consistent and clinically safe triage system to enable accurate face-toface assessment of individual patient needs on scene, identifying the most appropriate care pathway for that patient. This initiative has been adopted by several UK Ambulance Trusts and has enabled NWAS to increase safe care closer to home by over 10% in 3 years. 7 Pathfinder will generate one of four key outcomes which stream and direct patients based on their care needs, including: 6 The Initial Response Service, Northumberland Tyne and Wear NHS Foundation Trust. Available at: 7 Paramedic pathfinder and community care pathways. Available at and 13
14 Emergency department; Urgent care centre; Community or primary care pathways; Self-care. Community Care Pathways (CCPs) are one of the clinical outcomes linked to the Paramedic Pathfinder. Each individual care plan will enable ambulance paramedics to access the most effective referral and treatment option for known patients. The community care plans are prepared by the patient s case worker or lead clinician and are an effective alternative pathway of care for patients with long term conditions that enables paramedics to identify when referral to expert community teams may be a better option for the patient. GP Referral Scheme in Paramedic Pathfinder In 32 of the 33 Clinical Commissioning Groups (CCGs) across the North West, ambulance crews have access to a GP via a GP Referral Scheme, with patient consent, to establish if the patient is safe to be left at home, requires a GP visit or should be transported to the ED. Over the past 12 months this has greatly increased the proportion of patients successfully managed using a See and Treat model of care. The GPs have been funded by the local CCG, as an ED avoidance scheme. The results show that in little over a year, almost 30,000 ED attendances have been avoided, with financial savings noted in both ED attendances and acute admission costs. 4.4 Direct referral to a diabetic specialist nurse team A direct referral pathway for acute hypoglycaemic events, where patients are referred directly to a diabetic specialist nurse (DSN) by the ambulance service, has been trialled in West Yorkshire. 8 Patients with acute hypoglycaemia for whom an ambulance has been called are assessed and treated on scene by the ambulance service, rather than being transported to an ED or UCC. Patients are referred directly by ambulance staff to the DSN team, who contact the patient via telephone within 7 days. Results The DSNs arranged for 76% of referred patients to be reviewed in clinic; all were provided with patient education regarding hypoglycaemia and over half had their medications altered. Following contact and review by the DSN team: 8 Walker A, James C, Bannister M, Jobes E. Evaluation of a diabetes referral pathway for the management of hypoglycaemia following emergency contact with the ambulance service to a diabetes specialist nurse team. Emerg Med J 2006;23:
15 88% of patients reported in a post-treatment survey that their understanding of hypoglycaemia had improved; 73% of patients felt more able to self-manage any future hypoglycaemic episodes. Overall patient satisfaction with the care pathway and the care they had received was high. 5 Implementation Successful implementation of this guidance should be supported by the local development of direct community and acute specialist referral pathways to enable safe and effective onward care to be reliably achieved as an alternative to ED presentation and emergency hospital admission. Appropriate clinical and information governance arrangements will need to be established, and it is suggested that governance and responsibility rests with the referring practitioner until the referral has been accepted by the receiving practitioner, at which point governance and responsibility transfers. Successful implementation is also dependent on the development of a trusting, reciprocal arrangement between composite parts of the UEC system. Practitioners will need to be able to trust the referrals from other health and social care professionals without the need to re-triage. To facilitate a process of continuous quality improvement, and to provide education for those who refer, an enhanced feedback loop should be established. This will provide the practitioners who receive referrals with access to a method of feeding back to a named practitioner in the referring service. To achieve this, a senior member of clinical staff with clinical governance responsibilities should be nominated in each referring service (e.g. ambulance trust, NHS 111 provider, etc.) to act as an accessible point of contact for collating and responding to this feedback, and introducing any education and system changes that are required in response to the feedback received. In some instances a trusted assessor model may be implemented that, by pathway, provides senior clinical expertise and authority to support practitioners operating within that care pathway and also offers expert clinical assurance for practitioners, patients and relatives. This will help to build confidence in the enhanced referral pathway, and ensure it can be subject to regular audit and review. 5.1 Principles of enhanced referral Nothing in this guideline is intended to replace the primacy of general practice in coordinating care and referral to specialist services. 15
16 The referring practitioner must assess the patient either over the phone or in person prior to initiating any onward referral. Patients can only be referred to hospital specialists when they are under the active care of that specialist team for the condition that has led them to contact the urgent and emergency care system. The timing of any referral should be proportionate to clinical urgency. In many cases the utilisation of the expertise within an urgent care clinical hub may help to assess and prioritise referrals, thereby preventing system overload. 6 Benefits 6.1 Benefits to the system The benefits to the system of adopting an enhanced and consistent approach to the referral of patients include: Enabling health and social care professionals to enact previously agreed care plans, by removing potential referral barriers in the system. This reduces pressure on EDs and acute hospital beds by offering access to alternative services and pathways of care. It also reduces the use of ED as a default service or safety net when other services prove inaccessible. Management of patients within community care settings enables emergency resources to be more available and responsive to life threatening emergencies. Enabling patients with presenting mental health issues to be seen by mental health services at an earlier point, which can significantly improve chances of recovery. Financial savings may be significant, and a direct result of a reduction in ED attendance and emergency admissions, particularly for patients with care plans. Examples of this can be seen in Kirklees and Warrington where admissions for patients with a current care plan are 50% lower than pre-care plan 9. Up to 40% reduction in conveyance to the ED as a result of paramedic pathfinder. 60% reduction in 999 calls for those patients with an active care plan. Avoiding duplication of effort ; for example when the patient is assessed by multiple services before reaching a point of definitive care. NHS England will be releasing in the later part of the year an Urgent and Emergency Care Review financial modelling methodology document this document will provide further guidance for localities on how they can model and understand the potential financial implications of improving referral pathways. 6.2 Benefits to the patient The benefits to the patient include: Avoiding unnecessary and inappropriate delays to the appropriate care; Avoiding duplication of assessment and additional steps in the urgent care
17 pathway that add no value to the patient; The patient can be guided towards the most appropriate care destination directly, by overcoming unnecessary referral restrictions and integrating elements of the urgent and emergency care system; Where the patient requires follow-up with a specialist service to which they are already known, this can be arranged directly in a timely way; Access to community care for patients who require it, such as district nursing care, community physiotherapy or review by a falls team. 7 Summary and Conclusion This guideline describes the principles underpinning a system of enhanced referral and improved patient pathways achieved by removing unnecessary blockages and reducing duplication in the urgent and emergency care system. Clear and consistent feedback mechanisms are required to support this recommended service development and ensure a process of continuous quality improvement supported by education and audit. 17
18 8 Appendix 1: Case illustrations Case 1 ST is a nine year old child who has brittle asthma. He has previously been hospitalised on a number of occasions due to his severe and recurrent attacks. ST has regular review appointments at his local hospital in a specialist paediatric asthma clinic. It is Monday morning, and ST s mother has observed deterioration in his condition, which has worsened further over the weekend. She dials 111 and is connected to a children s nurse, working in an urgent care clinical hub. The nurse is able to assess ST s condition over the telephone and assess the acuity of his attack. The nurse and ST s mother agree that he does not need immediate hospital admission, but further specialist input is required. The nurse is able to refer ST directly to the inpatient specialist team, who arrange to see ST at the hospital outpatient clinic that afternoon. ST is seen within four hours of the 111 call by a consultant paediatric respiratory physician who prescribes a high dose of oral steroids and modifications to ST s inhalers that rapidly improve his breathing. ST s condition settles, and he is able to return to school the next day, avoiding a hospital admission. Case 2 JN is an 80 year old lady who lives in sheltered accommodation; she uses her emergency call bell after falling at home. When the paramedics arrive they find her on the floor, shaky and upset, with some bruising to her right shoulder. The paramedics help JN to her feet, and are able to assess the need for hospitalisation based on the injuries sustained and agree that clinically, admission to hospital is not required. The paramedics treat JNs physical injuries in her home, avoiding the need for transfer to hospital. The paramedics note that JN is taking medication to lower her blood pressure, and with her consent refer her to her GP for follow up. The referral includes a request for a review of her current medication The paramedics recognise JN s anxiety regarding her fall, and that she is at risk of further falls. With JN s consent they refer her to the local falls team who arrange to visit JN at home in two days time. The community falls team develop a personalised treatment plan with JN, which includes an exercise programme and advice on how to complete everyday tasks more safely. JN reports that her confidence has increased, and that her independence is improved as a result. JN has avoided a hospital visit and her risk of further falls; injury and hospital admission are substantially reduced as a result of these referrals. 18
19 Case 3 KR is a 47 year old man with schizophrenia who moved to new accommodation several months ago. He was unable to find a practice that would register him and lost contact with his community psychiatric nurse (CPN), and was unable to access his antipsychotic medication. Since then he has become progressively more withdrawn, and has been seen by his new neighbours to be muttering to himself. KR calls NHS111 with a sore throat, which he feels has been caused by poisons that his neighbours are concealing in his food. His call is transferred to a mental health nurse, who establishes KR s mental capacity and with his consent is able to access his electronic summary care record and confirm his history of schizophrenia and usual medication list. The nurse also establishes that KR has not been to a GP for a prescription of his medication for some time, and has lost contact with specialist mental health services. The nurse provides advice to KR regarding his presenting minor illness, and with his consent is able to refer him directly to the local mental health crisis home treatment team. He is seen by the crisis team that afternoon, and is restarted on his medication, which has been dispensed by his GP pharmacy. The crisis home treatment team see him daily for 2 weeks, help him register with a practice and allocate a new accountable care coordinator. This CPN arranges to review him regularly, and his symptoms improve over the next few weeks. The prompt involvement of mental health services through a direct referral pathway means that KR s mental health issues are addressed swiftly, and this prevents him from deteriorating to a point where an acute mental hospital admission is required. 19
Transforming urgent and emergency care services in England
Transforming urgent and emergency care services in England Clinical models for ambulance services 1 NHS England INFORMATION READER BOX Directorate Medical Commissioning Operations Patients and Information
More informationAVOIDING UNPLANNED ADMISSIONS ENHANCED SERVICE: PROACTIVE CASE FINDING AND CARE REVIEW FOR VULNERABLE PEOPLE GUIDANCE AND AUDIT REQUIREMENTS
April 2014 AVOIDING UNPLANNED ADMISSIONS ENHANCED SERVICE: PROACTIVE CASE FINDING AND CARE REVIEW FOR VULNERABLE PEOPLE GUIDANCE AND AUDIT REQUIREMENTS A programme of action for general practice and clinical
More informationTime to Act Urgent Care and A&E: the patient perspective
Time to Act Urgent Care and A&E: the patient perspective May 2015 Executive Summary The NHS aims to put patients at the centre of everything that it does. Indeed, the NHS Constitution provides rights to
More informationNational Clinical Programmes
National Clinical Programmes Section 3 Background information on the National Clinical Programmes Mission, Vision and Objectives July 2011 V0. 6_ 4 th July, 2011 1 National Clinical Programmes: Mission
More informationImproving Emergency Care in England
Improving Emergency Care in England REPORT BY THE COMPTROLLER AND AUDITOR GENERAL HC 1075 Session 2003-2004: 13 October 2004 LONDON: The Stationery Office 11.25 Ordered by the House of Commons to be printed
More informationBig Chat 4. Strategy into action. NHS Southport and Formby CCG
Big Chat 4 Strategy into action NHS Southport and Formby CCG Royal Clifton Hotel, Southport, 19 November 2014 Contents What is the Big Chat? 3 About Big Chat 4 4 How the event worked 4 Presentations 5
More informationRedesigning Urgent and Emergency Care Services. the new offer
Urgent and Emergency Care Developing the vision for London Keith Willett Director of Acute Care Redesigning Urgent and Emergency Care Services. the new offer www.england.nhs.uk www.england.nhs.uk What
More informationBriefingPaper. Towards faster treatment: reducing attendance and waits at emergency departments ACCESS TO HEALTH CARE OCTOBER 2005
ACCESS TO HEALTH CARE OCTOBER 2005 BriefingPaper Towards faster treatment: reducing attendance and waits at emergency departments Key messages based on a literature review which investigated the organisational
More informationIntensive Rehabilitation Service & Community Treatment Team
Intensive Rehabilitation Service & Community Treatment Team Caroline O Donnell Integrated Care Director North East London Foundation Trust Carol White Deputy Integrated Care Director North East London
More informationCommunity health care services Alternatives to acute admission & Facilitated discharge options. Directory
Community health care services Alternatives to acute admission & Facilitated discharge options Directory Introduction The purpose of this directory is to provide primary and secondary health and social
More informationFaversham Network Meeting your community s health and social care needs
Faversham Network Meeting your community s health and social care needs Your CCG The CCG is the practices and the practices are the CCG. There is no separate CCG to the member practices. - Dame Barbara
More informationThe Scottish Ambulance Service Improving Care, Reducing Costs. Working together for better patient care
The Scottish Ambulance Service Improving Care, Reducing Costs Working together for better patient care Key points The Scottish Ambulance Service is seeing more people, faster, and offering better quality
More informationConnection with other policy areas and (How does it fit/support wider early years work and partnerships)
Illness such as gastroenteritis and upper respiratory tract infections, along with injuries caused by accidents in the home, are the leading causes of attendances at Accident & Emergency and hospitalisation
More informationEveryone counts Ambitions for GCCG for 7 key outcome measures
Everyone counts s for GCCG for 7 key outcome measures Outcome ambition Outcome framework measure Baseline 2014/15 Potential years of life lost to 1. Securing additional years of conditions amenable to
More informationKeeping patients safe when they transfer between care providers getting the medicines right
PART 1 Keeping patients safe when they transfer between care providers getting the medicines right Good practice guidance for healthcare professions July 2011 Endorsed by: Foreword Taking a medicine is
More informationPatient Access Policy
Patient Access Policy NON-CLINICAL POLICY ACE 522 Version Number: 2 Policy Owner: Lead Director: Assistant Director of Operations Director of Operations Date Approved: Approved By: Management Executive
More informationINVESTIGATION The care and treatment of Ms FG
INVESTIGATION Our aim We aim to ensure that care, treatment and support are lawful and respect the rights and promote the welfare of individuals with mental illness, learning disability and related conditions.
More informationNHS 111. Commissioning Standards. June 2014. Page 1 of 28
NHS 111 Commissioning Standards June 2014 Page 1 of 28 NHS England INFORMATION READER BOX Directorate Medical Operations Patients and Information Nursing Policy Commissioning Development Finance Human
More informationAn introduction to the NHS England National Patient Safety Alerting System January 2014
An introduction to the NHS England National Patient Safety Alerting System January 2014 1 NHS England INFORMATION READER BOX Directorate Medical Operations Patients and Information Nursing Policy Commissioning
More informationLeeds Palliative Care Ambulance Transport Working Group Date - Version 10.2 Update
Yorkshire Ambulance Service NHS Trust LEEDS PALLIATIVE CARE AMBULANCE OPERATIONAL POLICY Author: Leeds Palliative Care Transport Working Group Date: November 2013 Version: Version 10 1 Introduction 1.1
More informationNot just a matter of time A review of urgent and emergency care services in England
Inspecting Informing Improving Not just a matter of time A review of urgent and emergency care services in England Service review September 2008 Commission for Healthcare Audit and Inspection This document
More informationMeasuring quality along care pathways
Measuring quality along care pathways Sarah Jonas, Clinical Fellow, The King s Fund Veena Raleigh, Senior Fellow, The King s Fund Catherine Foot, Senior Fellow, The King s Fund James Mountford, Director
More informationFinancial Strategy 5 year strategy 2015/16 2019/20
Item 4.3 Paper 15 Financial Strategy 5 year strategy 2015/16 2019/20 NHS Guildford and Waverley Clinical Commissioning Group Medium Term Financial Strategy / Finance and Performance Committee May 2015
More informationA Framework of Quality Assurance for Responsible Officers and Revalidation
A Framework of Quality Assurance for Responsible Officers and Revalidation Supporting responsible officers and designated bodies in providing assurance that they are discharging their statutory responsibilities.
More informationGuidance on NHS patients who wish to pay for additional private care
Guidance on NHS patients who wish to pay for additional private care DH INFORMATION READER BOX Policy HR / Workforce Management Planning / Clinical Document Purpose Gateway Reference Title Author Publication
More informationA&E Recovery & Improvement Plan
Engagement and Patient Experience Committee (A Sub-Committee of NHS Southwark CCG Governing Body) ENCLOSURE B A&E Recovery & Improvement Plan DATE OF MEETING: September 2013 CCG DIRECTOR RESPONSIBLE: Tamsin
More informationGuide for general practice staff on reporting patient safety incidents to the National Reporting and Learning System
Guide for general practice staff on reporting patient safety incidents to the National Reporting and Learning System NHS England INFORMATION READER BOX Directorate Medical Commissioning Operations Patients
More informationconsultant link Too many unnecessary referrals and hospital admissions?
consultant link Too many unnecessary referrals and hospital admissions? Working with networks of local hospital consultants we provide GPs with fast, efficient and high quality advice and guidance GP Care
More informationHSE Transformation Programme. to enable people live healthier and more fulfilled lives. Easy Access-public confidence- staff pride
HSE Transformation Programme. to enable people live healthier and more fulfilled lives Easy Access-public confidence- staff pride The Health Service Executive 4.1 Chronic Illness Framework July 2008 1
More informationClinical Solutions - A Case Study on the Future of Cancer
Clinical Solutions Midpoint Alencon Link Basingstoke RG21 7PP United Kingdom 12 November 2007 Main +44 (0) 1256 337300 Fax +44 (0) 1256 337399 Email info@csdss.com View www.csdss.com `Better Health, Better
More informationInsulin Pump Therapy for Type 1 Diabetes
Insulin Pump Therapy for Type 1 Diabetes Aim(s) and objective(s) This guideline has been developed to describe which patients with Type 1 Diabetes should be referred for assessment for insulin pump therapy
More informationPrinciples and expectations for good adult rehabilitation. Rehabilitation is everyone s business: Rehabilitation Reablement Recovery
Wessex Strategic Clinical Networks Rehabilitation Reablement Recovery Rehabilitation is everyone s business: Principles and expectations for good adult rehabilitation 2 Principles and expectations for
More informationCASE STUDY. Sunderland dermatology and minor surgery service
CASE STUDY Sunderland dermatology and minor surgery service October 2014 Specialists in out-ofhospital settings As part of the drive to keep patients out of hospital and better integrate services across
More informationbriefing An involving service Ambulance responses in urban and rural areas Background Key points November 2011 Issue 226
briefing November 2011 Issue 226 An involving service Ambulance responses Key points Patients, rightly, expect a high level of service, wherever they live. Trusts need to address the public s expectation
More informationMental Health Crisis Care: Shropshire Summary Report
Mental Health Crisis Care: Shropshire Summary Report Date of local area inspection: 26 and 27 January 2015 Date of publication: June 2015 This inspection was carried out under section 48 of the Health
More informationFuture National Clinical Priorities for Ambulance Services in England
Background Future National Clinical Priorities for Ambulance Services in England National Ambulance Service Medical Directors (NASMeD) April 2014 Ambulance services have delivered significant improvements
More informationSeeing ambulance services in a different light
factsheet June 2010 Seeing ambulance services in a different light More than a patient transport service Key points NHS ambulance services face some of the most demanding performance targets in the world.
More informationSouth East Coast Ambulance Service NHS Foundation Trust
South East Coast Ambulance Service NHS Foundation Trust Emergency and Urgent Care in Kent and Medway for Kent HOSC What does SECAmb do? South East Coast Ambulance Service NHS Foundation Trust is an innovative,
More informationNHS England Equality Information Patient and Public Focus First published January 2014 Updated May 2014 Publication Gateway Reference Number: 01704
NHS England Equality Information Patient and Public Focus First published January 2014 Updated May 2014 Publication Gateway Reference Number: 01704 NHS England INFORMATION READER BOX Directorate Medical
More informationPlanning and delivering service changes for patients
Planning and delivering service changes for patients 1 NHS England INFORMATION READER BOX Directorate Medical Operations Patients and Information Nursing Policy Commissioning Development Finance Human
More informationDelivering Appropriate Emergency Care Services - Protocol Development and Design
Delivering Appropriate Emergency Care Services - Protocol Development and Design Sherrill Evans, Karen Evans, Peter Huxley, Helen Snooks, Ian Russell et al Mental Health Research Team, College of Human
More informationThe CCG Assurance Framework: 2014/15 Operational Guidance. Delivery Dashboard Technical Appendix DRAFT
The CCG Assurance Framework: 2014/15 Operational Guidance Delivery Dashboard Technical Appendix DRAFT 1 NHS England INFORMATION READER BOX Directorate Medical Operations Patients and Information Nursing
More informationEpilepsy Scotland Consultation Response. Scottish Ambulance Service Our Future Strategy Discussion with Partners. Submitted September 2009
Epilepsy Scotland Consultation Response Scottish Ambulance Service Our Future Strategy Discussion with Partners Submitted September 2009 Section 1: Accessing the right help in an emergency How can we work
More informationAustralian Safety and Quality Framework for Health Care
Activities for the HEALTHCARE TEAM Australian Safety and Quality Framework for Health Care Putting the Framework into action: Getting started Contents Principle: Consumer centred Areas for action: 1.2
More informationSHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST EXECUTIVE SUMMARY COUNCIL OF GOVERNORS 2 ND DECEMBER 2014
SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST C EXECUTIVE SUMMARY COUNCIL OF GOVERNORS 2 ND DECEMBER 2014 Subject: Supporting Director: Author: Status 1 NHS England Five Year Forward View A Summary
More informationAmbulance Community Care Plan. An information guide
TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Ambulance Community Care Plan An information guide Ambulance Community Care Plan The Pennine Acute Hospital Trust is working in partnership
More informationINTEGRATED CARE INFO SUMMARY INTEGRATED CARE STRATEGY 2014 2017
INTEGRATED CARE INTEGRATED CARE STRATEGY 2014 2017 Integrated care involves the provision of seamless, effective and efficient care that responds to all of a person s health needs, across physical and
More informationNHS England Operating Model for NHS Continuing Healthcare
NHS England Operating Model for NHS Continuing Healthcare 20 NHS England INFORMATION READER BOX Directorate Medical Commissioning Operations Patients and Information Nursing Trans. & Corp. Ops. Commissioning
More informationAppendix 1 Business Case to Support the Relocation of Mental Health Inpatient Services in Manchester (Clinical Foreword and Executive Summary)
Appendix 1 Business Case to Support the Relocation of Mental Health Inpatient Services in Manchester (Clinical Foreword and Executive Summary) Together we are better Foreword by the Director of Nursing
More informationPrime Minister s Challenge Fund (PMCF): Improving Access to General Practice. Innovation Showcase Series Using Technology to Improve Access
Prime Minister s Challenge Fund (PMCF): Improving Access to General Practice Innovation Showcase Series Using Technology to Improve Access February 2015: Showcase Two About PMCF In October 2013, the Prime
More informationSupporting the development of ambulance services as out-of-hospital providers
Supporting the development of ambulance services as out-of-hospital providers Richard Hunt CBE Chair, London Ambulance Service NHS Trust Representing the Association of Ambulance Chief Executives (AACE)
More informationImproving Urgent and Emergency care through better use of pharmacists. Introduction. Recommendations. Shaping pharmacy for the future
Improving Urgent and Emergency care through better use of pharmacists The Royal Pharmaceutical Society (RPS) believes that pharmacists are an underutilised resource in the delivery of better urgent and
More informationAbout public outpatient services
About public outpatient services Frequently asked questions What are outpatient services? Victoria s public hospitals provide services to patients needing specialist medical, paediatric, obstetric or surgical
More informationProgress on the System Sustainability Programme. Submitted to: NHS West Norfolk CCG Governing Body, 31 July 2014
Agenda Item: 9.1 Subject: Presented by: Progress on the System Sustainability Programme Dr Sue Crossman, Chief Officer Submitted to: NHS West Norfolk CCG Governing Body, 31 July 2014 Purpose of Paper:
More informationClinical Hubs and UCS
Clinical Hubs and UCS Clinical Hub Staff Development Traditionally Clinical Hub staff join the Trust as call handlers and progress to dispatcher roles. Recent changes to Hub structure brought about by
More informationIntermediate care and reablement
Factsheet 76 May 2015 About this factsheet This factsheet explains intermediate care, a term that includes reablement. It consists of a range of integrated services that can be offered on a short term
More informationReview of compliance. Mid Staffordshire NHS Foundation Trust Stafford Hospital. West Midlands. Region:
Review of compliance Mid Staffordshire NHS Foundation Trust Stafford Hospital Region: Location address: Type of service: Regulated activities provided: Type of review: West Midlands Mid Staffordshire NHS
More informationReducing underage alcohol harm in Accident and Emergency settings
Reducing underage alcohol harm in Accident and Emergency settings The current scale of underage alcohol-related harm requires a consistent national response 36 under-18s were admitted to hospital in England
More informationEmergency admissions to hospital: managing the demand
Report by the Comptroller and Auditor General Department of Health Emergency admissions to hospital: managing the demand HC 739 SESSION 2013-14 31 OCTOBER 2013 Our vision is to help the nation spend wisely.
More informationMedical Billing and Capacity Planning in the UK
Operational resilience and capacity planning for 2014/15 NHS England INFORMATION READER BOX Directorate Medical Commissioning Operations Patients and Information Nursing Policy Commissioning Development
More informationEffective Approaches in Urgent and Emergency Care. Priorities within Acute Hospitals
Effective Approaches in Urgent and Emergency Care Paper 1 Priorities within Acute Hospitals When people are taken to hospital as an emergency, they want prompt, safe and effective treatment that alleviates
More informationilinks Informatics Transformation Strategy
ilinks Informatics Transformation Strategy 2014-2017 1 Contents Introduction Background Vision Objectives Outcomes & Benefits Guiding Principles Delivering the Strategy Governance 3 5 6 7 8 9 11 11 Approach
More informationCoventry and Warwickshire Repatriation Programme
NHS Arden Commissioning Support Unit Coventry and Warwickshire Repatriation Programme Large-scale service redesign and innovation to benefit patients Arden Commissioning Support Unit worked with Coventry
More informationThe challenge. What we did. Highlights. Designing and delivering scalable telemonitoring and telecare through partnership.
Telehealthcare Designing and delivering scalable telemonitoring and telecare through partnership The challenge Northern Ireland has a population of approximately 1.8 million people. Around two thirds of
More informationDelivering Local Health Care
Delivering Local Health Care Accelerating the pace of change Delivering Local Integrated Care Accelerating the Pace of Change WG 17711 Digital ISBN 978 1 0496 0 Crown copyright 2013 2 Contents Joint foreword
More informationTaking Healthcare to the Patient. Transforming NHS Ambulance Services
Taking Healthcare to the Patient Transforming NHS Ambulance Services Acknowledgements Photos on pages 15, 48 courtesy of Essex Ambulance Service NHS Trust Cover, 10, 12, 18, 24, 34, 40 courtesy of London
More informationThis document is a mixture of statutory guidance and non-statutory advice.
Supporting pupils at school with medical conditions Statutory guidance for governing bodies of maintained schools and proprietors of academies in England February 2014 Contents Summary 3 About this guidance
More informationBorderline personality disorder
Understanding NICE guidance Information for people who use NHS services Borderline personality disorder NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases
More informationTransforming urgent and. England on line length; please delete. you have chosen one. 20pt
Transforming urgent and emergency Insert heading care depending services in England on line length; please delete Urgent other and cover Emergency options Care once Review you have chosen one. 20pt End
More informationNHS CONTINUING HEALTHCARE Redress Guidance NHS Continuing Healthcare Refreshed Redress Guidance
NHS CONTINUING HEALTHCARE Redress Guidance NHS Continuing Healthcare Refreshed Redress Guidance NHS England INFORMATION READER BOX Directorate Medical Commissioning Operations Patients and Information
More informationHow To Manage A Hospital Emergency
ENHANCED SERVICE SPECIFICATION RISK PROFILING AND CARE MANAGEMENT SCHEME Introduction 1. This enhanced service has been designed by the NHS Commissioning Board (NHS CB) to reward GP practices 1 for the
More informationAdvanced Nurse Practitioner Specialist. Palliative
JOB DESCRIPTION ellenor Advanced Nurse Practitioner Specialist Palliative Care Responsible to Accountable to: Head of Adult Community Services Director of Patient Care General ellenor is a specialist palliative
More informationPatient Choice Strategy
Patient Choice Strategy Page 1 of 14 Contents Page 1 Background 4 2 Putting Patients and the Public at the Heart of Health and 5 Healthcare in West Lancashire 3 Where are we now and where do we need to
More informationEYE HEALTH CENTRE Castleton Way, Eye, Suffolk IP23 7DD Telephone: 01379 870689 Fax: 01379 871182
SURGERY TIMES EYE HEALTH CENTRE Castleton Way, Eye, Suffolk IP23 7DD Telephone: 01379 870689 Fax: 01379 871182 Mornings: Monday to Friday By appointment 08.30 11.00 Monday to Friday Telephone Consultations
More informationIMPROVING DENTAL CARE AND ORAL HEALTH A CALL TO ACTION. February 2014 Gateway reference: 01173
1 IMPROVING DENTAL CARE AND ORAL HEALTH A CALL TO ACTION February 2014 Gateway reference: 01173 2 Background NHS dental services are provided in primary care and community settings, and in hospitals for
More informationGuidance for NHS commissioners on equality and health inequalities legal duties
Guidance for NHS commissioners on equality and health inequalities legal duties NHS England INFORMATION READER BOX Directorate Medical Commissioning Operations Patients and Information Nursing Trans. &
More informationSummary Strategic Plan 2014-2019
Summary Strategic Plan 2014-2019 NTWFT Summary Strategic Plan 2014-2019 1 Contents Page No. Introduction 3 The Trust 3 Market Assessment 3 The Key Factors Influencing this Strategy 4 The impact of a do
More informationAbout the organisations taking part
About the organisations taking part The Care Quality Commission is the independent regulator of health and adult social care in England. We make sure health and social care services provide people with
More informationBreakfast symposium: From hospital to home - the focus on the patient
Breakfast symposium: From hospital to home - the focus on the patient Nadya Hamedi DARZI Fellow UCLPartners and Barts Health NHS Trust in collaboration with North Central London Local Pharmaceutical Committee
More informationNHS outcomes framework and CCG outcomes indicators: Data availability table
NHS outcomes framework and CCG outcomes indicators: Data availability table December 2012 NHS OF objectives Preventing people from dying prematurely DOMAIN 1: preventing people from dying prematurely Potential
More informationReference: NHS England B04/P/a
Clinical Commissioning Policy: Haematopoietic Stem Cell Transplantation (HSCT) (All Ages): Revised Reference: NHS England B04/P/a 1 NHS England Clinical Commissioning Policy: Haematopoietic Stem Cell Transplantation
More informationAustralian Safety and Quality Framework for Health Care
Activities for MANAGERS Australian Safety and Quality Framework for Health Care Putting the Framework into action: Getting started Contents Principle: Consumer centred Area for action: 1.1 Develop methods
More informationRehabilitation Network Strategy 2014 2017. Final Version 30 th June 2014
Rehabilitation Network Strategy 2014 2017 Final Version 30 th June 2014 Contents Foreword 3 Introduction Our Strategy 4 Overview of the Cheshire and Merseyside Rehabilitation Network 6 Analysis of our
More informationYour local specialist mental health services
Your local specialist mental health services Primary Care Liaison Service B&NES Primary Care Mental Health Liaison service is a short-term support service to help people with mental health difficulties
More informationNational Framework for NHS Continuing Healthcare and NHS-funded Nursing Care
National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care November 2012 (Revised) Incorporating: NHS Continuing Healthcare Practice Guidance NHS Continuing Healthcare Frequently Asked
More informationPolicy Document Control Page. Title: Protocol for Mental Health Inpatient Service Users who require care in the Pennine Acute Hospital
Policy Document Control Page Title: Protocol for Mental Health Inpatient Service Users who require care in the Pennine Acute Hospital Version: 5 Reference Number: CL25 Supersedes Supersedes: Protocol for
More informationPatient Access. UCLH policy
Patient Access UCLH policy Version 3.2 Version Date June 2014 Version Approved By EB Policy Approval Sub-Group Publication Date July 2013 Author Kevin Nicholson Review By Date June 2016 Responsible Director
More informationNATIONAL INFORMATION BOARD WORK STREAM 1.1 ROADMAP
NATIONAL INFORMATION BOARD Personalised Health and Care 2020 WORK STREAM 1.1 ROADMAP Enable me to make the right health and care choices Providing patients and the public with digital access to health
More informationSpecialised Services Circular
Specialised Services Circular Issue date: 26 March 2014 ID Category: Status: Public & Press: SSC1417 Request for action N/A Primary Care responsibilities in relation to the prescribing and monitoring of
More informationRachel Binks Nurse Consultant Digital & Acute Care Airedale NHS Foundation Trust
Rachel Binks Nurse Consultant Digital & Acute Care Airedale NHS Foundation Trust Telehealth, e health, digital health.. Telecare Telemonitoring Teleconsultation Tele care Tele monitoring Tele coaching
More informationChanging health and care in West Cheshire The West Cheshire Way
Changing health and care in West Cheshire The West Cheshire Way Why does the NHS need to change? The NHS is a hugely important service to patients and is highly regarded by the public. It does however
More informationSUBJECT: NHS Lanarkshire Winter Plan 2009/20010
Meeting of Lanarkshire NHS Board Lanarkshire NHS Board 14 Beckford Street Hamilton ML3 0TA Telephone 01698 281313 Fax 01698 423134 www.nhslanarkshire.co.uk SUBJECT: NHS Lanarkshire Winter Plan 2009/20010
More informationSPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE
SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT OF ALCOHOL MISUSE Date: March 2015 1 1. Introduction Alcohol misuse is a major public health problem in Camden with high rates of hospital
More informationHealth and Safety Policy
Health and Safety Policy Status: Final Next Review Date: Apr 2014 Page 1 of 16 NHS England Health and Safety: Policy & Corporate Procedures Health and Safety Policy Policy & Corporate Procedures Issue
More informationSpecifically, the group is asked to agree (with any caveats it would like to introduce) and endorse:
Joining Up Your Information project (JUYI Gloucestershire s Shared Care Record) Proposed Model for Patient Consent to Share Data in Gloucestershire 10 th March 2015 Executive Summary This paper is to request
More informationSimon Community Northern Ireland welcomes the opportunity to respond to the Alcohol and Drug Commissioning Framework for Northern Ireland 2013-2016
Simon Community Northern Ireland welcomes the opportunity to respond to the Alcohol and Drug Commissioning Framework for Northern Ireland 2013-2016 About the Simon Community Simon Community Northern Ireland
More informationAnnex 5 Performance management framework
Annex 5 Performance management framework The Dumfries and Galloway Integration Joint Board (IJB) will be responsible for planning the functions given to it and for making sure it delivers them using the
More informationPublications Gateway Ref No. 04365. Patient Online: MAKING THE MOST OF ONLINE APPOINTMENTS AND REPEAT PRESCRIPTIONS
Publications Gateway Ref No. 04365 Patient Online: MOST OF ONLINE AND REPEAT Equality and Health Inequalities Statement Promoting equality and addressing health inequalities are at the heart of NHS England
More informationNHS Scotland Wheelchair Modernisation Delivery Group
SCOTTISH GOVERNMENT HEALTH AND SOCIAL CARE DIRECTORATES THE QUALITY UNIT HEALTHCARE PLANNING DIVISION NHS Scotland Wheelchair Modernisation Delivery Group WHEELCHAIR & SEATING SERVICES QUALITY IMPROVEMENT
More informationCosting statement: Depression: the treatment and management of depression in adults. (update) and
Costing statement: Depression: the treatment and management of depression in adults (update) and Depression in adults with a chronic physical health problem: treatment and management Summary It has not
More information