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Enablers of the new model This is an ambitious, complex model which requires robust supporting mechanisms and tools to be in place in order to realise its potential and become sustainable. The partnership has embedded the following key enablers: Hospital visibility and accountability: really embedding the basics through well-defined roles, responsibilities and accountabilities across the hospital pathway, and providing front- line staff and leaders with live visibility of data to drive the right behaviour and evidence-based decision-making. Pull model: commencing the discharge process as soon as someone is admitted to hospital, led by the local integrated team which has deep knowledge of and connections with services in the community and is able to actively pull residents out of hospital. Workforce and leadership : integration at all levels across the three main organisations, with a single leadership structure to help hundreds of staff work collectively in the new model. Digital and data: building a single intermediate care record system with shared access to holistic care plans for patients and enabling effective resource planning. Creating a suite of dashboards providing live visibility of activity across the urgent care pathway to enable evidence-based decisions, both at a patient level by frontline staff, as well as at a system level by executive leadership. The new model has been designed, trialled and iterated, with involvement from across the health and care system, including PCNs and the ambulance trust, in the design of interfaces with the local integrated team, ensuring a more streamlined service for residents.
OUTCOMES
The Improving Lives programme has seen many positive outcomes, from the creation of a locally integrated model that effectively supports residents, the introduction of a pull model which allows patients who are being discharged from hospital to have their care plan before they’re medically optimised, and improvements to the visibility of the services within the system. Most importantly, the experience of the residents in Coventry has improved significantly with a personalised approach to health and care supporting them in achieving the best outcomes. As of January 2025, the programme is having the following impact on outcomes across the UEC pathway in Coventry: 18% reduction in older adult admissions to base wards with people being better supported by primary care or the urgent community services 20% reduction in P0 patient length of stay 50% reduction in the number of people moving to a long-term bedded setting Reduced demand for short-term bedded care from 85 beds to 39 beds, with this group having more independent outcomes in their own homes Successfully moved 158 members of staff from eight different services into one new organisation Built a care record that hosts a case load of 700+ people and connects community, adult social care, and acute data This performance translates to ~ £17m annual financial benefit for Coventry.
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