Module B Performance Requirements Specification, Quality and Productivity

Fernwood Community Unit Service Specification v.1.1 26Feb 15

MODULE B – PERFORMANCE REQUIREMENTS – SPECIFICATION, QUALITY AND PRODUCTIVITY

SECTION 1 – SPECIFICATION

Care Pathway/Service / SFHT Fernwood Community Unit Service
Commissioner Lead / NHS Newark & Sherwood CCG
Provider Lead / Sherwood Forest Hospitals NHS Foundation Trust
Period / 1stApril 2015 -
Applicability of Module E (Acute Services Requirements)

Purpose

1.1Introduction
This document sets out the service specification for the SFHT Fernwood Community Unit (FCU). It outlines the services the identified provider organisation will be required to deliver. The specification isdesigned to ensure the rehabilitation needs of service users are effectively met and monitored. It describes the services required of the Service Provider [Sherwood Forest Hospitals NHS Foundation Trust] and makes reference to the role of other parties likely to be involved in the operation of the Service, including:

Therapists
Referrers e.g. Integrated Care Teams
Social workers
Voluntary Services
CNCS
OOH Services

FCU is a 12 bedded rehabilitation ward located at Newark Hospital. It opened on the 4th February 2013. The unit provides single sex bays (2 x 3 beds) and private rooms (6) for anyone aged 18 or above who requires a short period of rehabilitation (up to 3 weeks - in exceptional circumstances this can be extended by the duty admissions coordinator or the MDT). It provides both step up from home and step down from hospital rehabilitation.
The acronym “FCU” will be used to describebeds commissioned by the Newark & Sherwood CCG in SFHTthat is supported with therapy inputs, aimed at maximising the person’s independence / capacity to undertake activities of daily living.
1.2Aims

Deliver rehabilitation services to people who would otherwise face unnecessarily prolonged hospital stays or inappropriate admission to acute inpatient care, long term residential care, or continuing NHS inpatient care
Assist and enable the person to achieve and maintain an optimum level of health and independence at home or in another community setting.
Enable a full assessment of the person's needs and future care requirements to be carried out in a non-acute environment where the focus is on promoting independence and a return home.
Deliver time-limited rehabilitation packages
Incorporate cross-professional working, with a single assessment framework, single professional records and shared protocols.

1.3Evidence Base

Sherwood Forest Hospitals NHS Foundation Trust Newark Hospital Fernwood Community Unit Review, March 2014, Elizabeth Cowley
NHS Mandate, April 2013 – March 2015
The NHS Outcomes Framework. DH London
Health and Social Care Act 2012
Carer (Equal Opportunity) Act 2004
Nottinghamshire End of Life Care Pathway for all diagnosis
King's Fund's Guidance, Enhancing the Healing Environment for People with Dementia

Scope & Service Delivery

2.1Service Description
The FCU provides inpatient intermediate healthcare.
The FCU is required to:
a)Deliver a service that:

Actively promotes the independence of all those referred and enables individuals to achieve and maintain an optimum level of health and independence
Ensures that service users are cared for in an appropriate setting, with respect to personal privacy, dignity, choice and independence, and are provided with opportunities for rehabilitation and recovery wherever possible
Provides an holistic care experience which addresses the physical, psychological, cultural and social needs of service users, their family and informal carers
Facilitates the prompt step down from acute care and step up admissions from the community
Provides the opportunity for service users to become medically and psychologically stable following an acute episode

b)Provide a rehabilitation environment with nursing and therapy support available 24 hours per day, 7 days per week. Qualified occupational therapist and physiotherapist will both be available Monday to Friday; 52 weeks a year with therapy cover available Saturday and Sunday.
c)Provide/identify 1 bed for people who are dependent upon hoisting and have rehabilitation goals.
d)Start upon the person’s admission and complete within 24 hours of their admissionan effective, person-centred multi-disciplinary care plan(s) that provides enabling care and support to assist people who are recovering from an acute episode or period of ill health to regain their confidence, motivation and ability to undertake activities of daily living, and deliver this plan. This can be provided by a therapy on-call service at the weekend 9am – 5pm.
e)Following the completion of the multi-disciplinarycare plan(s) for the person, deliver this plan in accordance with its requirements on a 7 day a week basis.
f)To support the person to independently manage their own medication.
g)The multi-disciplinary care plan(s) are evaluated at a daily (Monday to Friday) MDT and progress towards discharge evaluated.
h)Provide a physical environment that allows for the assessment of the person’s needs for on-going care and therapy and also supports other Community Teams’ involvement, including:

Suitable space in which to hold multi-disciplinary team meetings
Adequate and suitable therapy space for the Therapist(s) to deliver the service
Provision of WIFI or a hard-wired 3m network compatible internet connection and telephone line

and secure space for the operation of a printer and/or fax machine

Provision of adequate and suitable space in which to store therapy equipment
Adequate and suitable space in which to use equipment, including access to stairs and a

kitchen environment with microwave and other kitchen equipment, and suitable bathroom facilities e.g. domestic bath, shower.

Ability to arrange the environment to replicate the layout of the person’s home e.g. bed at same

height, bed access from the same side, not using bed rails, etc.
i)Provide a physical environment that is supportive of people with dementia in line with the King's Fund's Guidance on Enhancing the Healing Environment for People with Dementia, and which is designed to:

Ease decision making
Reduce agitation and distress

Encourage independence and social interaction

Promote safety
Enable activities of daily living.

j)Be accountable for and must ensure that all stored equipment including therapy equipment

Is risk assessed as being appropriate for its agreed purpose
Continuously meets health and safety requirements as it is removed from and returned to storage
Is regularly maintained and cleaned
Is returned to the store when it is no longer needed by a person, e.g. on discharge

k)Communicate with other members of the MDT and other stakeholders as required, including providing all necessary information to other care providers e.g. social services, PRISM & Integrated Care Teams, Intermediate Care at home, voluntary services, CNCS, person’s GP on the person’s needs and condition to assist in facilitating discharges.
l)Contact the Social Services immediately if there is any significant change in the person’s condition where a care package is on hold.
m)Notify the Community Care Teams & person’s GP as soon as possible if a person’s circumstances change, such as their medical condition, social issues or other changes that may impact on their discharge date or destination.
n)Decision to discharge will be with agreement of the GP/Community Care Team.
o)Upon discharge provide a discharge summary to include any changes to medication and the person’s current medical & functional status to the relevant Community Care Teams and a discharge summary on SystmOne where possible.
p)Provide a service that is compliant with the Essential Standards of Quality and Safety.

Referral, Access and Acceptance Criteria

3.1Geographic coverage/boundaries:
The service will be delivered within the boundaries of the NHS Newark and Sherwood Clinical Commissioning Group, to the adult population, registered with a Newark and Sherwood GP practice.
The service will operate within Newark and Sherwood locality with population of 129,558.
3.2Location(s) of Service Delivery:
The Fernwood Community Unit is situated at Newark Hospital and can be accessed through the Main Entrance located to the front of the building. The Fernwood Community Unit is clearly sign posted from the Hospital main corridor. There are 6 single occupancy bedrooms and two 3 bedded bays.
3.3Days/Hours of operation

Sherwood Forest Hospitals step down persons can be discharged to Fernwood 7 days a week with a TTO supply and newly written drug card.
Non SFH step down persons can be repatriated 7 days a week 08:00 – 16:00 and will arrive with a TTO supply of medication. The Pharmacy Technician will then transcribe on to a drugs card.
Step up persons can be admitted 24 hours a day with a FP10 to accompany persons so that current medications can be transcribed by Pharmacy staff or Out of Hours G.P.

3.4Referral criteria & sources

Medically stable for primary care management with no further intended acute secondary care requirements for this episode of care
Diagnosis and an outline care plan with parameters for discharge (referring clinician to stipulate the indicative discharge date)
18 years and over
Person is aware of and in agreement with admission / transfer having understood the reason
Ability to engage with a rehabilitation programme or appropriate management plan
Dementia persons with management/care plan.

3.5Referral route
3.5.1Step Down:

Repatriation from acute or sub-acute bed via discussion with designated duty admissions coordinator.

3.5.2Step Up:

MIU- via discussion with GP or delegate
Ambulatory clinic following discussion with designated duty admissions coordinator and GP informed
GP - on discussion with designated duty admissions coordinator

Band 6 Senior Clinicians with appropriate clinical assessment skills with the acknowledgement of the GP/OOH on discussion with designated duty admissions coordinator
3.6Exclusion criteria
The service will not be appropriate for the following groups:
a)People who are not resident within Newark & Sherwood CCG boundaries
b)People with acute medical needs requiring secondary care
c)If planned date of discharge is within 48 hours, person cannot be stepped down to the FCU
d)Step down to the FCU cannot take place if it does not demonstrate a measurable benefit to the person
e)Step down to the FCU cannot take place if the person does not have clear therapy or management goals
f)People who do not have the capacity to return home
g)People whose need for rehabilitation and re-enablement can be managed in their own home
h)People with capacity that refuse the Service. However, for people for whom there is an on-going concern, e.g. relating to safeguarding, capacity or risk, the Service must follow the Nottinghamshire Safeguarding Adults Procedure.
i)People who cannot be safely managed within a rehabilitation environment
j)People who are at latter stages of end of life pathway where there is no rehabilitation / re-enablement potential.
k)People whose informal carers are unable to manage them being back at home even with a comprehensive package of support because of their own health needs.
l)People who require a temporary care home placement as a result of carer breakdown e.g. carer being admitted to hospital, or a period of respite to avert carer breakdown.
3.7Response time & detail and prioritisation

For urgent step up admissions, a decision for accepting or declining admission should be made in line with the admission criteria during the referral phone call to the duty admissions coordinator.

Urgent step up admissions should take priority for bed allocation.

For non-urgent step up/step down admissions, a decision for accepting or declining admission should be made within an hour of the referral phone call to the duty admissions coordinator.

3.8Documentation
Fully implement SystmOne across the FCU to ensure integration with the GPs and Community Services to reduce duplication of documentation and assessments and enable sharing of clinical documentation.

Staffing

The Service Provider shall ensure:
a)The provision of regular supervision of, and on-going training for, all staff as required under the
National Minimum Training Standards for Healthcare Support Workers and Adult Social Care Workers in England, Nursing & Midwifery Council and the Health & Care Professions Council.
b)All staff are undertaking mandatory training.
c)That all staff are working in line with policies and procedures.
The Service Provider shall provide as a minimum:
a)A designated duty admissions coordinator is identified to coordinate admissions into the FCU and ensure that admissions can occur 24 hours per day, 7 days per week.
b)There is appropriate skill mix available on every shift, 52 weeks a year. This includes therapy input 7 days per week.

Medical Cover

5.1Readmission

Readmissions to the FCU as per admission criteria
Readmissions/admission to secondary care - any person requiring secondary care acute intervention.

5.2Medical Cover
Robust GP cover is provided in hours by the five following surgeries:

Barnbygate
Lombard Street
Balderton
Sutton on Trent
Fountain

Out of hours the staff contact the out of hours (OOH) GP service and any emergency medical requirements trigger a 999 call to EMAS.
5.3Temporary Registration
Any person not already registered with one of the listed 5 practices is temporarily registered with one for the duration of their stay.

Discharge Criteria and Planning

Decision to discharge will be with agreement of the GP/Community Care Team.
Notify the Community Care Teams & person’s GP as soon as possible if a person’s circumstances change, such as their medical condition, social issues or other changes that may impact on their discharge date or destination.
Upon discharge provide a discharge summary to include any changes to medication and the person’s current medical & functional status to the relevant Community Care Teams and a discharge summary on SystmOne.

Medicines Management

7.1The safe receipt, storage and custody of medicines on the ward are the responsibility of every Registered Nurse.
7.2All medicines received on the ward must be immediately placed within the appropriate locked cupboard.
7.3All persons should be assessed as to their ability to self-administer medication and if deemed competent should be supported to self-administer medication.
7.4Each bedside locker is provided with an integral lockable drawer for the storage of persons’ medicines. The drawer must be kept locked at all times. Persons who have been assessed as suitable for Self Administration of Medicines may hold a key to the drawer, in accordance with the appropriate policies.

Prevention, Self-Care and Patient and Carer Information

Provide an information leaflet for persons and relatives, ensuring it emphasises the re-enablement focus and is consistently provided prior to transfer/admission to the FCU.
Promotes self-management including referring onto appropriate services e.g. PRISM Plus, FLO Telehealth services.
Acts as a resource for signposting to self-help/patient support groups.

Transport

The referrer / referral handling team will be responsible for arranging the person’s transport to the FCU.
The FCU will be responsible for arranging transport for people discharged from these beds.
The FCU will be responsible for making arrangements for people to attend hospital and other essential appointments with an escort as required.

Baseline Performance Targets – Quality, Performance & Productivity

See Appendix 1

Currency and Prices

11.1Currency and Price
Issued separately as part of the Sherwood Forest Hospitals NHS Foundation Trust main Contract.

Appendices

Appendix 1

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