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Meeting 5: Tiered Models of Care

The fifth Stakeholder Reference Group (SRG) for the Moving Forward Together (MFT) Programme took place on Tuesday the 13th of February. The Group of 16 patient, service user and carer representatives (details at the end) heard a presentation by Dr David Stewart, Lead Medical Director for Acute Services in NHS Greater Glasgow and Clyde and engaged in discussion about tiered models of care.

David explained that the tiered model was about how care might be structured across different settings to meet the future needs of the whole population of Greater Glasgow and Clyde with some services being also delivered to people from across the West of Scotland. Overall the Programme, taking direction from national policy and plans, would aim to deliver more care at or closer to people’s homes and promoting independence and self management.

He spoke about the extensive engagement with specialist clinical groups asking them to think of new ways to deliver services to meet future demand. The discussions used a tiered model based on an increasing level of complexity and severity of illness where highly specialised treatment in care would be in fewer or even just one site – sometimes serving the population beyond Greater Glasgow and Clyde.

David described in more detail how the tiers might be structured and provided examples stating that these were early high level drafts needing revised for wider public use. However, the tiered approach had been embraced by the clinical and multidisciplinary teams and was also being used to model primary, community and social care services. Using this approach helps identify the infrastructure required to deliver coordinated care across the different settings with much better integration.

He said the feedback from the clinical engagement has seen all the specialities identifying elements of their service that can be moved from hospital to community with roles such as specialist nursing and allied health professionals providing expert care traditionally delivered by doctors. This would allow expertise to be focused where it’s needed most and free up time for highly specialist staff, such as consultants to see more complex patients.

The Group members all agreed that the rationale for planning in this way made sense but also asked questions and led discussion on number of themes. They thought that having more services closer to home that promote independence was positive, but that in complex cases people either need to be empowered to coordinate their own care or someone should be assigned to do this. They said that the long held perception that hospitals are the best place to be as that’s where the specialists are will need to be challenged along with the belief that you need to see a doctor for expert advice.

There was talk about how the different systems can already be confusing for people and that better, easy to understand descriptions of the pathways are required. These should be described by the specialist staff and illustrated using patient journey’s and experience to explain what happens, by who and where. This could help reduce the burden in places like Accident and Emergency and mean that the newer Ambulatory Care Hospitals are better utilised.

There was discussion about the costs and how allocation of monies will work across hospital, community health and social care to do deliver the new ways of working with Health and Social Care Partnerships deciding local priorities and spend. Also that to deliver the new ways of working will require a change in workforce that might take some years to deliver and how priorities would be set for implementation and in which areas.

The group also discussed that being involved and hearing about how the Programme was aiming to improve the delivery of health and social care had been very positive; however the focus needs to always be on providing a seamless, person centred journey and that the mindset and culture of those who use and those who deliver services needs to change.