Our CCG serves a population with significant health challenges, both in terms of poor health and high levels of health inequality. People living within Darlington are more likely to die sooner than those living in other parts of the country.
We have looked at local health needs and current health service provision and listened to what patients and clinicians have told us.
This has helped us to identify a number of challenges:
- We need to manage the increased demand on healthcare resulting from a growing and ageing population, with high levels of cancers, cardiovascular disease, stroke, dementia and long-term conditions such as diabetes and chronic obstructive airways disease (COPD). Cardiovascular disease and cancers already account for the majority of early deaths in Darlington
- We need to do more to improve the overall quality of care and reduce unwarranted clinical variation in healthcare, in order to get the best health outcomes and overall patient experience for everyone
- We need to deliver more services in the community and closer to home
- We need to ensure that health services are safe, meet patient needs and are consistently delivered
- We must ensure that we get the best return on investment from our funding
11 GP practices serve the Darlington population of 106,000. Our GP practices will be brought together into groups of 3 or 4 practices called ‘community hubs’ so they can share their skills to match the needs of Darlington residents.
Community hubs allow patients to benefit from the knowledge and expertise of local GPs and other practitioners within their hub, and reduce the need for unnecessary attendance at hospital.
GP practices will still run as they do now, but sometimes you may be asked to attend another GP practice to receive your care.
Care Co-ordination Centre
The public have told us accessing services is confusing when they are unwell.
In future, the Care Co-ordination Centre we are planning, will provide a single point of access for the public, allowing people to attend and be seen by the most appropriate health services.
The centre will have an overview of all health services and teams working across Darlington, including professional teams working in hospitals and the community. This will ensure patients are seen appropriately whether that is being assessed in hospital or staying at home with effective community support.
Discharge Management Team
Patients can often stay in hospital longer than is necessary. We are working closely with health and social care colleagues to improve support for patients leaving hospital, so they can be discharged quickly when it is medically safe to do so.
Ideally patients will be discharged to their own home or for a short while in a rehabilitation bed within the local community, as research tells us patients recover quicker at home.
We’re developing care plans that can be completed with patients (or their carers) with long term or complex health needs.
Care plans will ensure their views, priorities and preferences are recorded. This will include how the patient wishes to be cared for should their circumstances change.
The care plan will be shared with, and visible to, health and social care staff who are caring for the patient. This will reduce the need to repeat conversations and record details with several professionals.
The development of the Great North Care Record will allow all health care organisations in the North East to view and input into the electronic patient record. This will significantly improve the quality and safety of care provided.
Technology will be used to help health care professionals when accessing patients over a vast geographical area, bringing clinical assessment close to where patients live, reducing the need to travel.
Using technology across websites and smart phone apps will also improve patients’ ability to self-care and support patients managing their condition at home.
Community and Voluntary Support
Darlington has a strong and vibrant voluntary sector, providing a wide range of services which can often complement services provided in GP practices.
We want to build and encourage the development of the voluntary sector so they can support patients care in the community, ensuring health and social care services are used well.
Care Homes and Community Hospitals
Health and social care services provided by the NHS and the local authority have a joint responsibility for the quality of care provided in nursing homes, even though they are run by independent companies.
Over the past 2 – 3 years we have been working to support nursing homes in Darlington through community nursing services and GP practices. As a result of this work there has been more consistent care provided and improvements in planning patients care, reducing unnecessary admission to A&E or hospital wards.
Darlington does not have a community hospital.
Often patients in Darlington Memorial Hospital can be discharged to Richardson Hospital – a community hospital based in Barnard Castle – however this creates problems for patient visitors as it can add extra time and cost to visitors journeys.
Recently a nursing home in Darlington has provided an additional 9 beds for this purpose which has been a great success and enabled people to regain their independence and get to their own homes quicker.
Urgent Care and Accident & Emergency
There are a number of places people can seek prompt treatment in Darlington.
Urgent care services are there to deal with problems requiring prompt medical attention but are not live threatening. These can often be managed by staff based in GP practices.
However, should you require urgent care when your GP practice is closed, there is an urgent care centre available at Dr Piper House in Darlington 8am – 6pm, and at Darlington Memorial Hospital 6pm – 8am.
It is the CCGs intention to base the Urgent Care Centre at Darlington Memorial Hospital 24 hours a day, this will allow staff to assess patients and decide whether they need to be seen by urgent care or in A&E. Staff within urgent care will be able to arrange blood tests, X-rays and scans if this is felt to be necessary and seek specialist opinion if required.
The urgent care service can already access patients’ full GP medical record, which A&E cannot, though this will be available widely through the Great North Care Record.
The Accident and Emergency department (A&E) is also available for anyone to be seen 24 hours a day.
A&Es are designed to deal with trauma accidents and life threatening emergency. However, they often treat patients who should be seen in a primary care setting, such as their GP practice, urgent care or minor injury unit.
As there are patients who use A&E as their only form of medical care – rather than discourage people seeking medical help, we intend to increase the availability of routine services (such as having the urgent care centre based at Darlington Memorial Hospital A&E). So that when patients attend they can be seen by the appropriate service.
The Better Health Programme has determined that we cannot continue to deliver the same number of specialist A&E sites across County Durham, Darlington and the Tees Valley due to a lack of available consultants to provide services safely 24 hours a day, 7 days a week.
At present we do not know if A&E at Darlington Memorial Hospital will be designated as a specialist A&E site, should this not be the case, it would not affect other services set to be provided from the site 24 hours a day, 7 days a week such as an urgent care centre and Minor Injuries Unit.
Examples of what type of conditions Urgent care Centre’s and Minor Injuries Units are designed to see and treat:
› sprains and strains
› broken bones
› wound infections
› minor burns and scalds
› minor head injuries
› insect and animal bites
› minor eye injuries
› injuries to the back, shoulder and chest
› infections and rashes
› stomach aches
› vomiting and diarrhoea
› cuts and lacerations
› emergency contraception and advice
› hay fever
Urgent care / A&E Assessment
To support urgent care, entry assessment will allow patients who require more care or investigation to be seen appropriately and not in a shorter appointment that is suitable for most patients.
To make sure patients are seen as quickly as possible, assessments will be separated into children, adults, elderly and mental health. This will allow quicker assessment to get the patient treated whilst avoiding hospital admission (where possible).
These assessments will be supported by senior hospital doctors who will work with urgent care staff to make sure patients receive the most appropriate care.
Healthcare Outside of Darlington
Across County Durham and Teesside there are 3 hospital foundation trusts which provide services from 8 hospital sites.
County Durham and Darlington NHS Foundation Trust:
› University Hospital of North Durham
› Bishop Auckland Hospital
› Darlington Memorial Hospital
North Tees and Hartlepool NHS Foundation Trust:
› University Hospital of Hartlepool
› University Hospital of North Tees
South Tees NHS Foundation Trust:
› James Cook University Hospital
› Redcar Primary Care Hospital
› Friarage Hospital, Northallerton
James Cook University Hospital in Middlesbrough is designated as 1 of 2 North East major trauma sites dealing with patients who have sustained severe injuries and require specialist care. Even though this means patients have to travel further for specialist care, for conditions including stroke, heart attack and major trauma, deaths and disabilities have reduced by up to 20%.
The Better Health Programme is looking to decide where some hospital services will be provided from to provide the best outcomes for patients. This could result in patients having to travel out of Darlington for some treatment, but it could also mean patients having to travel into Darlington for treatment.
The Better Health Programme will not make any decisions until they have proposed options which will be the subject of formal, public consultation with residents in Durham, Darlington and Teesside.
Short Stay Children’s Urgent Assessment Unit
In recent years, there has been an increasing attendance of children to Accident and Emergency departments for a variety of reasons and as a result there has been a significant increase in admissions to the in-patient children’s wards.
The increase is not because children are necessarily any sicker but as a way of coping with the increased attendances at A&E. This is demonstrated by the shortening length of stay and many children admitted to the ward, are there less than 24 hours.
In the early stages of childhood illness, it can be difficult to differentiate between minor conditions and more serious ones without further observation and sometimes further assessment.
A majority of current admissions to children’s wards are for simple and common illnesses which do not require the skills of a specialised in-patient children’s ward.
In recent years, Short Stay Children’s Assessment Units have been introduced successfully in other parts of the country where children can be observed, investigated if necessary and treated safely in in a local child-focused environment. These units work very closely with Urgent Care Centre’s and GPs but they also have readily available access to consultants without the need for children to be kept on a specialist inpatient ward.
These units are often open 12 hours a day, a majority of cases will be observed and discharged within this time period, however for the minority of cases where there is a requirement for further care beyond this point, these patients would then be transferred into an in-patient children’s ward.
Medical conditions that can be managed in a short stay unit include fever, diarrhoea and vomiting, abdominal pain, minor head injuries, mild breathing difficulties, fits (seizures), accidental poisonings with a view to early discharge as soon as it’s appropriate to do so.
Frail & Elderly Assessment Units
As we get older and frailer, it doesn’t take much to knock us sideways with even simple medical conditions that can easily affect our ability to cope living at home.
Often the elderly can end up inappropriately in Accident and Emergency departments and then being admitted into a hospital bed – not because they’re seriously ill – but because the combination of their simple medical problem and social situation can make it unsafe for to be sent home while their condition is treated.
Admissions into medical wards can often worse an elderly person’s independence and confidence, which can result in a loss of muscle strength which in turn can increase the risk of falling. Admissions can also worsen a patients mental condition if they suffer from dementia, so keeping elderly patients out of hospital unless absolutely necessary is really important.
Sometimes it can be unclear what medical problems are causing an elderly patient to be unwell, and investigations are required to establish what the problem is but as things are currently, this can take several days to take place.
Frail Elderly Rapid Assessment Units are specifically designed to perform rapid investigations to determine the cause of the problem and then decide whether it can be dealt with in the community with support from community nursing and social care, or whether the condition does in fact require the facilities of a specialist in-patient medical ward.
These units are staffed and supported by healthcare professionals who specialise in managing problems of the elderly and are available to give support and advice to GPs and community nurses in managing elderly patients in the community.
Urgent Mental Health Assessment
At present people who are experiencing a crisis in their Mental Health access help from GP surgeries, Urgent Care Centres, Accident and Emergency and Police services.
Accident and Emergency is also often used as a main provider of medical care for patients who have a combination of mental health, alcohol and drug problems and who are less likely to access normal GP services. As a result, these patients tend not to access preventative services on offer and are at a greater risk of dying prematurely.
At present the Mental Health Crisis team are based at West Park Hospital. In future, it is hoped that we can locate the Crisis team at Darlington Memorial Hospital, to provide a more appropriate location alongside the Urgent Care centre, where patients can be encourage to attend assessments and appropriate support.
In the future we would also like to provide some GP services alongside Urgent Care at Darlington Memorial Hospital, to ensure those who are unlikely to visit normal services can have access to services that will support them and reduce their risk of harm or illness in the future.