Transcript Document

NHS Operating Framework/Out of
Hospital Strategy/Integrated Care
Pilot
Presentation to Health and Well &
Being Board ; Dr Mohini Parmar
Chair Ealing Clinical Commissioning
Group
NHS Outcomes Framework
• Domain 1
Preventing people from dying
prematurely;
• Domain 2
Enhancing quality of life for
people with long-term conditions;
• Domain 3
Helping people to recover from
episodes of ill health or following injury;
• Domain 4
Ensuring that people have a
positive experience of care; and
• Domain 5
Treating and caring for people in
a safe environment; and protecting them from
avoidable harm.
Contents and Agenda
NHS Operating Framework;
• Everyone Counts; Planning For Patients 2013/4; CCG’s Proposed Local Priorities
• Plan on a Page
• Planning requirements
Out Of Hospital Strategy ;
• Development of networks
• Update on OOH delivery
• Update on OOH Strategy; Diabetes
• Update on OOH Strategy; Other Developments
• Mental Health Services
• Mental Health Services; Dementia update
Integrated Care Pilot
• Progress to Date
• Feedback and Views
• Next Steps
Every One Counts; Planning For
Patients 2013/4
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Requirement for CCGs increasingly to develop local priorities through their input
into Joint Health and Well Being strategies
National Commissioning Board (NCB) asked CCGs to identify 3 local priorities
against which it will make progress during 2013/4
These priorities will be taken into account when determining if the CCG should be
rewarded through a Quality Premium
Ealing CCG propose (subject to views of H&WB Board following indicators):
– Priority 1; Diabetes :( numbers with a completed care plan)
– Priority 2; Alcohol: % of people aged 15-75 registered with an Ealing GP who
receive alcohol screening 4%
– Priority 3; Heart Disease: Indicator either reduction in CVD mortality or
Increase in number of Health Checks
By April; CCG will publish its prospectus that provides further details on its delivery
of Every One Counts
Plan on a Page
EALING SUMMARY PLAN ON-A-PAGE 2013-14
Child Health
CVD
Best Value for Money
Right Services in the Right Place at the Right Time
Increased productivity & value
Reduced duplication & waste
Better Health
High Quality, Cost
effective services
closer to patients
No £ growth e xpe cte d
Qua l i ty Sta nda rds ,
Sa HF
Improving Quality of Primary Care
Patient Education
Se conda ry Ca re Qua l i ty
Sta nda rds
High Quality Service
Sha pi ng a He a l thi e r
Future
Providing the right care, at the right time in the right place for the population of Ealing
Growi ng El de rl y
Popul a ti on
Exce s s Ca nce r, CVD a nd
Re s pi ra tory de a ths
Partnership Working
Moving from Unplanned to Planned
Cul tura l de pe nde nce
on & hi gh us e of
hos pi ta l s
Services Closer to Home
Patient, Public and Carer Engagement
Quality Assurance
Member Practice engagement
Health Networks Out of Hospital Strategy
Poor l i fe s tyl e s
Increasing Life expectancy
I ncre a s i ng ma l e a nd fe ma l e l i fe e xpe cta ncy a nd
re duci ng the ga p wi th Engl a nd
Re duce CVD morta l i ty
Re duce re s pi ra tory morta l i ty
Re duce ca nce r morta l i ty
Re duce a l cohol re l a te d a dmi s s i ons
Respiratory
Cancer
Diabetes
Alcohol
Shift Unplanned towards Planned Care
Furthe r be ddi ng i n of ca re -coordi na ti on a nd
ma na ge me nt
Whol e s ys te m re de s i gn a nd i mpl e me nta ti on of
unpl a nne d ca re s e rvi ce s a cros s Ea l i ng
I ncre a s e the pe rce nta ge of s e rvi ce s de l i ve re d i n
a communi ty s e tti ng
Re ducti on i n unpl a nne d a nd e me rge ncy
a dmi s s i ons for Ambul a tory Se ns i ti ve Condi ti ons
Re ducti on i n e me rge ncy re a dmi s s i ons wi thi n 30
da ys
Re ducti on i n de l a ys i n hos pi ta l di s cha rge
Urgent and
Unscheduled Care
Reducing variation in primary care
I mprove e a rl y di a gnos i s a nd i nte rve nti on
Re duce va ri a ti on i n hos pi ta l re fe rra l pa tte rns
a cros s Ea l i ng GPs
Planned Care
Improving recovery
by i ncre a s i ng the ra nge of a nd the re by a cce s s to
re ha bi l i ta ti on s e rvi ce
Rehabilitation
Enhanced Mental Health Services
I ncre a s e the provi s i on of communi ty s e rvi ce s
tha t a re re s pons i ve to ne e d 24/7 for a dul ts a nd
chi l dre n
Re duce e me rge ncy a nd cri s i s a dmi s s i ons to
me nta l he a l th s e rvi ce s
Mental Health
Improve care at the end of life
I ncre a e s e i n proporti on of de a ths a t pre fe rre d
pl a ce
I mprove d pri ma ry ca re knowl e dge a nd
ma na ge me nt of e nd of l i fe s ymptoms
End of Life Care
Ma te rni ty Se rvi ce s - re vi e w a nd i mpl e me nta ti on of be s t
pra cti ce
Gyna e col ogy - pa thwa y re vi e w a nd re commi s s i on
Sa fe gua rdi ng Chi l dre n - be d i n ne w orga ni s a ti on s tructure a nd
work joi ntl y wi th LA
Communi ty Chi l dre n's Nurs i ng Se rvi ce - e xte nd the s cope a nd
ra nge of s e rvi ce s provi de d
I mpl e me nt Di a be ti e s Be s t Pra cti ce Ta ri ff
I mpl e me nta ti on of He a l thy Chi l d Progra mme
I mpl e me nt Ea l i ng's Chi l d Acci de nt Pre ve nti on Stra te gy
I mpl e me nt He a l thy We i ght Stra te gy
I mpl e me nt Sport a nd Phys i ca l Acti vi ty Stra te gy
Ca rdi ol ogy - re vi e w a nd re commi s s i ong communi ty ca rdi ol ogy
pa thwa y
Anti coa gul a ti on - rol l out ne w communi ty ba s e d s e rvi ce
I ncre a s e upta ke of CVD he a l th che cks i n pri ma ry ca re
COPD - be d down the ne w Pul mona ry Re ha bi l i ta ti on Se rvi ce
As thma - re vi e w a nd s tre ngthe n a s htma ma na ge me nt i n the
communi ty for a dul ts a nd chi l dre n
I mprove a cce s s to di a gnos ti cs a nd wa i ti ng ti me s
I mprove a cce s s to ca nce r s cre e ni ng
Ful l y be d i n the I nte gra te d Ca re Pi l ot
Ful l y rol l out Communi ty Di a be ti c Mode l of Ca re
I ntroduce a l cohol a wa re ne s s i nto He a l th Che cks
i nte gra te a l cohol s e rvi ce i nto ne twork hubs
Rol l out I de nti fi ca ti on a nd Bri e f Advi ce (I BA) a cros s pri ma ry
ca re s ta ff
Ta rge te d i nte rve nti ons for i ndi vi dua l s wi th a hi gh ra te of
a l cohol re l a te d hos pi ta l a dmi s s i ons
Rol l -out a nd i mpl e me na ti on of 111 Progra mme
Re vi e w cri te ri a for pa ti e nts a tte ndi ng The Urge nt Ca re Ce ntre
a nd A&E a t Ea l i ng Hos pi ta l Trus t
Re vi e w a nd re comi s s i on urge nt ca re pa thwa y a t Ea l i ng
Hos pi ta l Trus t
Eva l ua te a nd s ca l e up Ea l i ng I CE (pre ve nti on of a dmi s s i on
s e rvi ce )
Tra i ngul a te ca re pa thwa y work to e ns ure be tte r ma na ge me nt
of l ong te rm condi ti ons wi thi n pri ma ry a nd communi ty ca re
a nd fa ci l i ta te a re ducti on i n a vi oda bl e UCC a nd A&E
a tte nda nce s condi ti ons (I CP, COPD, di a be te s , a s thma )
Re vi e w curre nt a rra nge me nts for s upporte d di s cha rge commi s s i on a ra nge of s e rvi ce s to e ns ure ti me l y di s cha rge
from hos pi ta l a nd re duce e xce s s be d da ys
Mobi l i s e ne wl y commi s s i one d Ca re Home Se rvi ce for Nurs i ng
Home re s i de nts
Ful l y be d i n the Re fe rra l Fa ci l i ta ti on Se rvi ce - cons i de r
e xte ns i on to me nta l he a l th re fe rra l s
Re te nde r pri ma ry ca re out of hours s e rvi ce
Re vi e w a nd i mpl e me nt ne w a rra nge me nts for di re ct a cce s s
di a gnos ti cs
Se t up a nd de l i ve r a nd e duca ti ona l progra mme for pri ma ry
ca re
Re vi e w a nd cons i de r re commi s s i oni ng the fol l owi ng pl a nne d
ca re pa thwa ys - De rma tol ogy, Optha mol ogy, Ga s tro, E.N.T a nd
Urol ogy
I mpl e me nta ti on of pre s cri bi ng i ni ti a ti ve s
Exte nd the s cope of ca pa ci ty of the communi ty MSK Se rvi ce by
commi s s i oni ng a n I nte rfa ce Cl i ni c a nd a ddi ti ona l phys i o
ca pa ci ty
Commi s s i on a ne w e nha nce d fa l l s s e rvi ce for pa ti e nts a t ri s k
of fa l l s or fra gi l i ty fra cture s
1. Work wi th WLMHT to i mpl e me nt NWL Me nta l he a l th Stra te gy
i ncl udi ng s hi fti ng s e tti ngs of ca re . 2. I mpl e me nt a cti on pl a n
a s a gre e d by Ea l i ng De me nti a Boa rd.
I mpl e me nt re comme nda ti ons form the End of Li fe Se rvi ce
Re vi e w wi th the Ea l i ng Communi ty Se rvi ce s
Be d i n ne wl y commi s s i one d Ma cmi l l a n GP a nd s upporte d
di s cha rge s e rvi ce
Community Empowerment
Maternity &
Women's Health
Crosscutting Themes
Use of Technology
Professional Education
Health Promotion &
Prevention
De pra va ti on, Ethni ci ty
& wi de r de te rmi na nts
of he a l th
A better start in Life
I ncre a s i ng bre a s tfe e di ng i ni ti a ti on
Re duci ng i nfa nt, ne ona ta l morta l i ty a nd s ti l l
bi rth ra te s
Re duci ng s moki ng i n pre gna ncy
Re duci ng chi l d obe s i ty a t ye a r 6
Re duce a voi da bl e chi l dhood i njuri e s
I ncre a s e chi l dhood i mmuni s a ti ons
Commissioning Developments
Workforce Development
Programmes
Partnership Working
Outcome Aspiration
Ma te rni ty & Ea rl y Ye a rs
Primary Care Strategy
Strategies and
Vehicle for Change
Wellbeing and Prevention
Vision
Context
NHS Outcomes Framework
Domain One;
Preventing People dying
Prematurely
• Actions To Date
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Domain Two;
• Enhancing Quality of
Life For people with
Long Term Conditions
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Focus on improving cancer screening rates
especially for breast, bowel and cervical
cytology
Learning disability ; Promote uptake of Health
checks
People with Severe and Enduring Mental health;
Use current contracting round to promote focus
on physical health e.g. smoking cessation
Dementia Board leading on improvements ( se
later slide)
Integrated Care Plot; Focus currently on
diabetes but will be extended
Focus on ambulatory sensitive conditions e.g.
management of DVTs in ANE as part of redesign
work of emergency pathway
NHS Outcomes Framework
Domain 3
• Helping People to Recover From
Episodes of Ill Health or Following
Injury
Domain 4;
• Ensuring that People have positive
Experience of Care
Actions
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Domain 5;
• Treating and caring for People in
a Sage Environment , and
protecting them from avoidable
harm
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Transfer of IAPT service into WLMHT (subject to
agreement), Recruitment to vacant posts
Use of PROMs
Work with Children Community Nursing Team to
reduce A&E and emergency admissions from
asthma
Implement Friends and Family Test starting in A&E
and inpatients and then maternity
ICP; focus on patient education and involve with
care planning
CCG plans to develop improvements to access
Use 2013/4 contracting round to embed
improvements in management of VTEs
Use of Safety Thermometer
Focus on reducing health Acquired Infections e.g.
MRSA
Everyone Counts; Technical
requirements
CCG has to complete a template covering :
• Self certification of commitment to delivery of the rights and pledges
of the NHS Constitution, Mandate and Clostridium difficile objective
• Self certification of assurance that provider cost improvement plans
are deliverable without impacting on the quality and safety of patient
care
• Trajectory for dementia diagnosis rates and Improving Access to
Psychological Therapies (IAPT) - proportion of people entering
treatment
• Trajectories for locally selected priorities; Suggested diabetes,
alcohol screening and CVD in Ealing
• Activity trajectories for 4 key measures – elective admissions for
operations non-elective admissions, first outpatient attendances,
A&E attendances
• Financial information, including a brief overview of financial position,
underlying assumptions and associated risks.
Out Of Hospital Strategy
• Focus for CCG to deliver its aspiration of ‘ Right Care, Right Time, Right
Place’
• Builds on a number of developments that took place in 2011/12 and
2012/3 as well as new schemes
• Aim for both physical and mental health care to be delivered in the lowest
intensity settings that are consistent with high quality care, as close to
home as possible
• Work to date will increasingly be scaled up once CCG Clinical leads and
member practices are confident in the quality and safety of service
delivery
• Investment and Delivery is being closely monitored to be able to
demonstrate to member practices, patients and the public that out of
hospital services are ready to support changes to inpatient services.
Development Of Clinical Networks
• Organisation of practices into 7 networks across Ealing, supported by
Clinical CCG Board members and Multi-Disciplinary Group (MDG)Chairs
• Used as basis to start to deliver out of hospital services. So far anticoagulation and paediatric phlebotomy services are network based
• Appointed a Head of Localities who is due to start in early April
• Exchange of ideas from practices to share expertise at a practice level and
start to cross refer e.g. for minor surgery, etc. can be developed as basis
for a number of services. CCG is working to agree with local networks,
service priorities for network delivery = equitable access for patients not
currently possible for services that are provided by Local Enhanced
Schemes
• Building block for Integrated Care Pilots and multi-disciplinary working
opportunity for different agencies e.g. health, social care to meet together.
Update on Out of Hospital Delivery
CCG has previously reported on a number of new services being delivered in
the community;
• Integrated Care in Ealing or ICE; delivery of intermediate care. So far 1660
patients have been seen since the 1st April 2012. We will review this in
April 2013 before further developments are agreed
• Anti-coagulation Services; Services are provided in all 7 of the networks.
To date 223 patients have moved from hospital to primary care
management since October 2012
• Pulmonary Rehabilitation; Service provided by Ealing ICO . Has been in
place since November 2013. To date 134 referrals and 95 have started the
rolling training programme
• Community Ophthalmology Service; To date X patients have been seen in
our 2 community clinics.
Number of anticaogulation patients managed in the community
2150
2100
2050
2000
1950
Introduction of the new
anticoagulation
pathway in October
2012
1900
1850
1800
1750
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Update on OOH Delivery; Diabetes
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Model based on one stop shops with Multi-disciplinary Teams working
together ; To date 3 locations ( GUV, Featherstone Rd Clinic and community
clinic at Ealing Hospital site) in place with plans developing to roll out to other
locations in Ealing
Nurse Consultant to lead Diabetic Specialist Nurses (DSN) will start at
beginning of April and will support the DSNs as well as providing input into the
training of practice nurses etc.
Working with the ICO the CCG plans to recruit 3 new DSNs as well as appoint a
specialist Community Based Diabetologist to support service delivery;
increased support from other services such as dietetics and podiatry as part of
diabetes delivery model
Agreed model also involves commissioning Education support and Training for
diabetic patients , ensuring more patients are able to work as expert patient
partners
Work with ICO to implement ‘ Best Practice Tariff ‘ For young diabetic patients;
new package of care for children and adolescents to deliver consistent care
with support to schools etc.
Update on OOH Delivery; Other
Developments
•
General Medical services (GMS) Nursing Home Tender; Currently out to
tender for new GMS Nursing home Service ; Will support 1200 residents in
Nursing Homes. Currently at moderation stage , and hope to announce
successful bidder in next few week with service to be in place by July 2013
Other Developments as part of Contracting Round
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Intra- Venous Medication Delivery service in the community; Will support
people with long term infections ( e.g. osteomyelitis) to be treated at home
rather that have long stay in hospital
End Of Life Care; New Service Specification being developed to focus on
implementing delivery of new pathways of care , supporting more choice in
place of death and with the ambitious targets of reducing deaths in hospitals
by 14% in 2013/14 and 20% 2014/5 and consequent transfer of resources
from acute to community based palliative care.
Cardiology; Currently looking at new models of care to provide care closer to
home, increase access to rehabilitation and specialist heart failure nursing
services
Mental Health Services
• Working closely with colleagues from Hammersmith and Fulham and
Hounslow CCGs and WLMHT to develop a transformational programme
• Work on ‘Shifting Settings of Care’ so those with mental health problems
can better access care in primary care
To prepare for this we are developing plans to;
• Commissioning an ‘Enhanced Primary Mental Health Service’ which will
include developing the role of mental healthcare workers, support for
primary care, and an emphasis on support to achieve personal goals and
recovery
• Development of Detailed Plans for new roles for Mental Health staff,
support for GPs e.g. pilot of a help/advice line for GPs staffed by local
consultants
• Project Plan being developed includes developing patient and carer
engagement , work with the voluntary sector as well as with member
practices
Mental Health services; Dementia
Update
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Multi-agency Dementia Board set up with a focus on health and social care as well as
working with the voluntary sector and carers
Plans for an ‘ Ealing Dementia Model’ is being discussed at Development Day scheduled
for April 8th
Work with primary care to raise awareness through education events and feedback.
Aim is to increase diagnosis rates from current (49.4%) to 60% in next 2 years.
Gap analysis to identify where new services will be needed or where existing services
could be reshaped e.g. discussion on Dementia advisors role to support primary care
Work with existing general services e.g. ICE, District nursing to ensure general service
can better managed those at lower end of model with easy escalation to more
specialist support
Fit with plans by LBE to re-model some Residential Home provision to support more
dementia placements
Work with WLMHT to review ‘ The Limes’ Nursing Home in Southall as potential
specialist dementia service to support local care of complex dementia patients
Integrated Care Pilot
• Rollout in Ealing started in July 2012 ; to date 83% of practices in Ealing are
now actively engaged in care planning and MDG working e.g. case
conferences, shared learning
• Currently focused on two key groups; Older People over 75, and all ages
with diabetes. From April 2013 will include COPD ( Chronic Obstructive
Pulmonary Disease) and Cardiac Diseases patients
• Key to ICP is work to reduce reliance on unplanned care by preventing
deterioration . Gives opportunities for groups of staff to discus individual
patients.
• To date (Feb 2013) 1693 care plans have been completed , 6 MDTs have
ben set up and 72 case conferences have ben held with 340 patients
discussed(with patient consent)
• Acton MDG group to join Ealing ICP, moving from Inner Pilot
ICP Feedback
• Patient Benefit; survey of patients has shown ‘ 100%
of patients asked said what they discussed was more
important to them in managing their own health
• 96% of patients thought care planning discussions
would improve their own efforts to self-management
• Feedback from GPs and Practice Nurses ; said ICP had
changed the way they practice. Work in practices had
developed to emphasised high risk patients and
proactively manage them
• Development of Education Programme to support
ICP working has also been seen as useful
Next Steps; ICP
• Extend conditions discussed in MDGs; involve Consultants from local
Trusts, Speciality Nurses as well as practice staff, social care etc.
• Pilots from innovation funds being developed ; opportunities to test out
new models of care e.g. night sitting service, falls plus service
• Focus on outcomes as part of delivery of ICP e.g. in disease management
such as good blood control in diabetes, reduction in readmissions etc.
• Funding currently via NHS London ; ICP team looking at evaluating
evidence from impact of ICP as part of securing on-going funding