Transcript Creating Integrated Care Teams in Surrey Heath Whole

Public Meeting
and Healthcare Exhibition
27th January 2015
‘The best possible health outcomes for our local community’
Dr John Guy OBE
Chair
Welcome
‘The best possible health outcomes for our local community’
You said ….we did
Progress since September
(warts and all…….)
Nicola Airey
Director of Planning and Delivery
‘The best possible health outcomes for our local community’
Integrated Care Teams and access
to General Practice
Our Model
Integrated Team 1
Integrated Team 2
IntegratedTeam 3
Lightwater
Heatherside
Old Dean
Bagshot
Camberley Health Centre
Park Road
Upper Gordon Road
Station Road
Frimley Green Medical Centre
Ash Vale Medical Centre
Integrated team:
Integrated team:
Integrated team:
GP
Practice Nurse
Community
Nurses
GP
Practice nurse
Community
Nurses
GP
Practice Nurse
Community
Nurses
Community
Matron
Mental Health
Worker
Community
Matron
Mental Health
Worker
Community
Matron
Mental Health
Worker
Social Worker
Pharmacist
Social Worker
Pharmacist
Social Worker
Pharmacist
Single Point of Access
Nurse
Services
available
8am – 8pm
Monday Friday
Mental Health
Worker
Social Worker
Voluntary
Sector
Surrey Heath-wide staff
Rapid response
Reablement
Community
rehabilitation
Specialist nurses, eg
COPD, heart failure
Therapies i.e. Physio,
Occupational, Speech
& Language, dietetics
Integrated Care Teams
• Delay from December “go live” until April
• Will be first community in Surrey to receive
• Estates –you said……..use surgeries as health hub for
communities
• Investment made – 2/3 staff recruited
• Leadership in place
• Working through practicalities eg care plans.
• Volunteers wanted for patient reference group
Access to General Practice
• Practices now open until 8.00 p.m. Monday to Friday
• An additional 75 hours Practice time per week
including GP, Practice Nurse and healthcare assistant
services (you said…use whole team)
• 3 sites are delivering services across Practices
a) Lightwater Surgery, Park House Surgery & Heatherside Surgery
b) Park Road Surgery & Old Dean Surgery
c) Camberley Health Centre & Station Road Surgery*
• *Some difficulties sharing data causing restrictions
• CCG funded bank holiday openings over Xmas/New
year.
Access to General Practice
Specific investment in access for over 75 years.
• Since October the following activities have been
delivered:
– Longer Consultations
– Healthchecks
– Early Support on Discharge
– Proactive Home Visits
– Practice Care Co-ordinators
– Care Co-ordinator role to support patients >75
and act as single point of contact in the Practice
•
What’s next?
• As part of the Quality Premium Payment GP Practices will be
providing support to families of children aged 2 and under
that have experienced an emergency episode in hospital
• The local GP Practices have submitted an application to the
Prime Ministers Challenge Fund to propose a weekend
working model and thereby extend current working to 7 days
• GP Practices are currently reviewing the invitation to apply for
national premises funding (15/16 £250m). The criteria for this
funding is:
– Extend access to General Practice and associated Community Services
– Improve services for the frail and elderly
– Building the foundations for more integrated care in the community
Planned Care
‘The best possible health outcomes for our local community’
Slide 11
Care Closer to Home
Community Skin
• Waiting times reduced
• Positive patient
feedback
• See and treat reducing
attendances for
patients & carers
Community pain
• Waiting times reduced
• Pain and quality of life
scores improved (before
& after)
• Positive feedback on
multi-disciplinary &
personalised approach
Mental Health
Mental health services
Since September
• Additional investment
access to psychological
therapy (adults)
– Group therapy & self
referral
• MH nurses for elderly as
part of ICT (Inc dementia)
• Befriending project
• Dementia friendly
communities
• Early dementia diagnosis
Working on now for 2015/16
• CAMHS (children and
adolescent MH services)
– Behavioural pathway
– Access to psychological
therapies
• Crisis café
• Acute hospital services &
psychiatric liaison
• MH expertise in NHS 111
• Suicide awareness training
Dr Andy Brooks
Chief Officer
Update and Where We Are Now
‘The best possible health outcomes for our local community’
The Forward View into action
Planning for 2015/16
Published December 2014
Key Points
‘The best possible health outcomes for our local community’
• 2015/16 NHS extra £1.83bn. Still significant financial
challenge
• Dependent on new care models
– Urgent and emergency care, maternity services, cancer
and specialised services
• Remove artificial barriers:
– Prevention/treatment, physical/mental health,
primary/community/acute care
• Whilst delivering significant structural change must deliver
core standards
• Getting serious about prevention: National action on
prevention – and actions for local areas – alcohol, fast food,
tobacco, diabetes prevention
‘The best possible health outcomes for our local community’
Slide 17
Empowering patients
• Fully interoperable digital health records (2018)
• Expansion in personal health budgets in areas where
evidence shows benefits. Can be across health & social care.
• Concept of “year of care” budgets
• Promote choice: mental health & maternity services
specifically mentioned
‘The best possible health outcomes for our local community’
Slide 18
Engaging communities
- CCG/LA plans to identify and support carers. Voluntary
sector and General Practice, young & >85 yrs.
- Community volunteering and new roles for volunteers
- Grant agreements used for charitable and voluntary sectorless time and complexity than NHS contract.
- NHS employers to be progressive – reflect the communities
they serve & meet race equality standard
‘The best possible health outcomes for our local community’
Slide 19
Engaging communities
1.CCG/LA plans to identify and support carers. Voluntary
sector and General Practice, young & over 85 yrs.
2.Community volunteering and new roles for volunteers
3.Grant agreements used for charitable and voluntary
sector- less time and complexity than NHS contract.
4.NHS employers to be progressive – reflect the
communities they serve. All employers and boards must
meet race equality standard
‘The best possible health outcomes for our local community’
Slide 20
Improving patient quality, outcomes & safety
• Published outcomes data this year: 13 medical and
surgical specialties
• Clinical priorities: Sepsis and acute kidney injury (AKI)
• Improve antibiotic prescribing in primary and
secondary care. Overuse and incorrect use major
drivers of resistance & threat to safe and effective
healthcare.
‘The best possible health outcomes for our local community’
Slide 21
Achieving parity for mental health
Standards
•Deliver existing standards around dementia diagnosis
& IAPTS (improving access to psychological therapies)
• New access and waiting time standards introduced
and delivered from April 2016:
– 50% experiencing first episode of psychosis
treatment started in 2 weeks
– IAPTs 75% first treatment in 6 weeks, 95% in 18
weeks
‘The best possible health outcomes for our local community’
Slide 22
Achieving parity for mental health
Services
•Develop adequate liaison psychiatry in Hospitals
•Crisis Care Concordat – describes the actions required
to ensure that those experiencing a mental health crisis
are properly supported. Includes: MH as part of NHS
111, 24/7 Crisis Care Home treatment teams, enough
capacity for assessment not in police cells
•Investment in Child and Adolescent Mental Health
Services (CAMHS)
•Reducing reliance on inpatient care for people with LD
‘The best possible health outcomes for our local community’
Slide 23
Co-creating new models of care
• Different starting points for local health economies
• Four prototypes:
– Multispecialty community providers (MCPs) includes
variants
– Integrated Primary and acute care systems (PACs)
– Viable smaller hospitals (franchises or chains)
– Models of enhanced health in care homes
‘The best possible health outcomes for our local community’
Slide 24
Co-creating new models of care
Building the foundations
• The future direction for CCGs and providers will be
developed by its own leadership in conjunction with
partners, patients, communities and staff
• All local areas encouraged to develop a local vision,
look at medium term strategies and take steps now
for rapid adoption. For example, rather than proceed
with a stand alone re-procurement of community
services, consider how to integrate into MCP model.
‘The best possible health outcomes for our local community’
Slide 25
New models of care
1) Multispecialty Community Providers (MCPs)
Will permit groups of GPs to combine with nurses, other
community health services, hospital specialists and perhaps
mental health and social care to create integrated out-ofhospital care .
2) Integrated Primary and Acute Care systems (PACs)
An integrated hospital and primary care provider combining for
the first time general practice and hospital services.
What do you think? Pros & Cons
‘The best possible health outcomes for our local community’
Slide 26
Aline Poulter
Community Services, Surrey Heath Borough Council
Being a Dementia Friend
Surrey Heath Health & Wellbeing Centre
‘The best possible health outcomes for our local community’
Break
‘The best possible health outcomes for our local community’
Andrew D’Souza
Janet Cohen
Surrey School Service
Young People’s Mental health & Wellbeing
‘The best possible health outcomes for our local community’
Andy D’Souza & Janet Cohen
Young people’s mental health & advice
for parents
School Nursing Service
Role of the Camhs Community Nurse for
Schools
One in ten children between the ages of one and 15 has
a mental health disorder.
(The Office for National Statistics Mental health in
children and young people in Great Britain, 2005)
Estimates vary, but research suggests that 20% of
children have a mental health problem in any given
year, and about 10% at any one time.
(Lifetime Impacts: Childhood and Adolescent Mental
Health, Understanding The Lifetime Impacts, Mental
Health Foundation, 2005)
Rates of mental health problems among:children:
increase as they reach adolescence
Disorders affect 10.4% of boys aged 5-10
Rising to 12.8% of boys aged 11-15
5.9% of girls aged 5-10
Rising to 9.65% of girls aged 11-15.
(Mental Disorder More Common In Boys, National
Statistics Online, 2004)
Worried about your
Child
• Their struggles last longer than
would be expected
• They have a cluster of things to
cope with & several signs they are
struggling
• They experience these feelings so
strongly they interfere with everyday
life
• Prolonged Unwanted Behaviour
Stay calm
Avoid Labelling
Use less emotion and less Language when dealing
with them
“I” Language is very powerful
Acknowledge your Child – I can see you have been really
down, I can see your really angry all the time, I want to
help
Contain – I need you to stop and calm down, I need you
to take a few breaths, I need you to stop this behaviour
Distract – Once you have calmed down I would like you
to come and have a sit down here and talk to me.
Wealth of support Nationally & locally for Emotional,
Psychological & Behaviour Needs
Available to you as parents.
Parent Line
Adhd – addis
website / frimley
park website
ADHD Specialist
Nurse
ChildLine
Anxiety UK
Young Minds
National Autistic society
Surrey Camhs
Website
Young Carers
Home School Link worker
Parent infant Mental
Health Support – Via
your Health Visitor
NCPCC website on parenting
behaviour
Youth Counselling
www.firststeps-surrey.nhs.uk
We are a small team offering a unique and
accessible service across Surrey, working alongside
0-19 teams (School Nurses & Health Visitors).
In addition to supporting the 0-19 teams we offer
short term interventions for school aged children
attending state primary, secondary or academy
schools with Mild to Moderate Emotional ,
Behavioural and mental health needs
Where do we fit in?
TIER 4
0.075%
Intensive/Inpatient
Severity
TIER 3
Multi-disciplinary team in a
community mental health clinic or
outpatient service
(Eg Clinical Psychologist)
Camhs SN
TIER 2
Services provided by specialists working in
community and primary care settings
(Eg Primary Mental Health Workers)
1.85%
7%
TIER 1
Practitioners working in universal services who are
not necessarily mental health specialists
(Eg, teachers, GPs)
Virgin Care private and confidential
CAMHS structure
15%
www.virgincare.co.uk
SURREY
CAMHS 2012
CAMHS Community Nurse for Schools
• Strengthening Tier 1 CAMHS provision
• Promoting awareness of psychological and emotional health of children and
families to other professionals
• Enhancing accessibility and equity for all children and families in NW &
SW Surrey
• Working across agency boundaries to develop a co-ordinated response to
children’s emotional and psychological health needs in schools
• Providing a short term intervention service to children and their families
• Consultation advice service to Schools (viaTAMHS)
• Camhs School Nurses main Focus is to support 0-19 team.
• Promote & support Secondary Drop in via School Nurses
• Ensure schools are accessing their E.P. & Behaviour Support effectively
• Transition support from primary school to secondary school
• Cognitive behavioural / solution focused therapeutic approaches
• Parenting Advice for Complex Behaviours
• Support Surrey & Borders NHS Trust with TAMHS
• Working links with HSLW & PMHW (SABP)
• Sign Posting to Other Services or Support in referring into Tier 3
Virgin Care private and confidential
www.virgincare.co.uk
TaMHS Role to support Schools
• Staff training (whole school, support staff)
• Staff support and on-going consultation
• 1:1 with children and their families (short term
intervention)
• Group work with children (with Schools)
• Support with transition to secondary school
(Complex parenting support)
• Strong working links with Schools & HSLW
Virgin Care private and confidential
www.virgincare.co.uk
HOW DO WE GET INVOLVED?
REFERRAL PATHWAY to CAMHS COMMUNITY NURSE FOR SCHOOLS
Parent
Young Person
GP
School (sencos, HSLW)
Advice & support to
child/young
person/family
0-19 Team member
(Health visitor/ School Nurse)
Joint work between
Initial Meeting with family /
Health Assessment
0-19 team member and
CAMHS Community
Nurse
Accepted for Direct
work by CAMHS
Community Nurse
Virgin Care private and confidential
Completed with Child/ young
person and family to identify need
for Emotional or Mental Health
Support (Mild/ Moderate)
CAMHS Community Nurse
Other
Professional
Recommend
Referral to other
Agency
Resource Provision by
CAMHS Community
Nurse
Direct referral to
CAMHS (support with referral
if required by CAMHS
Community Nurse for
Schools
www.virgincare.co.uk
Example
14 year old girl
School notice child low self esteem, low mood – discussed issues with
parents(?)
• School Nurse contacted and they complete FHNA with child and
family
• Identified mild moderate need for support
• Identify a possible referral to Camhs Community Nurse for Schools
• Up to 6 sessions with girl (and parents) on self-esteem/listening ear
/support visits
Virgin Care private and confidential
www.virgincare.co.uk
Questions
Thank you for coming
Please complete the feedback forms
‘The best possible health outcomes for our local community’