Clinical Framework 2015 to 2018

Transcription

1 Clinical Framework 2015 to 2018 Author(s), Owner: Medical Director Executive Group: ELT Policy No.: Version No.: 6 ( ) Implementation Date Various see timetable and Validity Period: Target Audience: CLCH Trust Board Consultation: 2014 Central London Community Healthcare NHS Trust

2 Foreword At CLCH we plan services around our patients, their families and carers. Putting patients needs at the heart of our planning and service delivery means that we consider what good services look like based on real people in the communities we serve. Bringing patients to life in this way helps us ensure that we focus on what really matters to our patients. This clinical framework is focused on a patient called Rosemary, her family and her carers. Our clinical framework has been written to tell patients like Rosemary and her family, about the work of Central London Community Healthcare, (CLCH) and how that work will develop across the next three years. It highlights CLCH s commitments to transforming our services to make sure all of our Rosemary s get the care they require to live independent lives, whilst enabling children and young people to get the best start in life. While the NHS is valued by all, it is undergoing major reform to respond to changes in the population, its health and reducing resources. A big part of this change is to prevent people going into hospital and to support people coming out of hospital to be cared for in their own homes, within their communities. People just like Rosemary. Excellent and compassionate care for our patients relies on the quality of our clinical staff. They are close to patients; they understand their needs and hopes and with the support of management, can help to make changes to achieve better outcomes for people. This framework has been developed with CLCH s clinicians, working alongside the health care managers who ensure our service is run effectively and well. It is intended to be read by patients, the public, staff and commissioners as a clear statement of the clinical excellence the Trust strives for now and in the future. In a time of rapid change for the NHS, it is important to maintain our focus on the delivery of excellent care, including the experience of care that patients receive from the Trust. This framework will help us keep our focus on getting care right for Rosemary and meet our goal to embody the best of the NHS for our patients. Pamela Chesters CBE, Chairman James Reilly, Chief Executive Dr Joanne Medhurst, Medical Director Louise Ashley, Chief Nurse 2

3 Executive Summary This CLCH clinical framework for , has been written about and for the patients to whom we deliver care. To personalise this framework, it has been developed around a patient called Rosemary. As well as being a real person, she is a metaphor for all our patients, adults and children. Figure 1 The clinical framework describes to patients like Rosemary, her family and the wider general public, what CLCH is doing for them. The clinical framework sits at the heart of the work of the organisation and links to CLCH s other strategies shown in Figure 1. The framework sets out: A summary of what patients, like Rosemary, have told CLCH. What changes are affecting Rosemary? What does CLCH, as a community trust, do for Rosemary? What outcomes can Rosemary expect to receive from the care we deliver? How do the clinicians who work for the Trust who understand Rosemary s needs communicate with the management of the Trust? What would Rosemary tell us to do differently? What changes can Rosemary expect? A set of ten principles define the type of care CLCH delivers and is expected to deliver the outcomes shown. Table 1 sets out these ten clinical principles and how they align with our organisational goals. 3

4 Table 1. Clinical Principles 1. Optimise clinical outcomes and patient safety 2. Develop and strengthen care pathways 3. Embed an organisational approach to improvement 4. Have system wide perspective 5. Develop partnerships that promote integration of care 6. Improve patient experience (no care about me, without me) 7. Develop clinical and organisational leaders 8. Have a unified culture of high standards that promotes compassion, openness and candour 9. Be innovative and bold in the use of technological innovations 10. Deliver improved services Alignment to CLCH s Goals Support people safely out of hospital Deliver better value than competitors in our selected markets Be responsive to our patients and partners needs Employ only the best staff Be innovation and technology pioneers The 10 principles align with CLCHs goal one To embody the best of the NHS for our patients 4

5 Introduction Central London Community Healthcare, (CLCH), is one of a new generation of health providers who provide care for patients who require help and support at home or within community settings. CLCH provides care in London a world city with around 270 nationalities speaking more than 300 languages. Ethnic diversity is matched by religious diversity, with London providing home to sizeable Muslim, Hindu, Sikh and Jewish communities. London also has extremes of wealth and deprivation, with its richest and poorest residents often living in close proximity. Recently we have been successful in being chosen to provide services in new boroughs such as Hertfordshire. CLCH serves 1 million people in the London Boroughs of Barnet, Hammersmith & Fulham, (H&F), Kensington & Chelsea, (K&C) and Westminster. We also provide COPD, respiratory and sexual health services in Hertfordshire to a demographic of over 1 million people. We provide care for approximately 275,000 patients, with around 2 million individual clinical contacts every year with nearly 45% of all recorded patient contacts take place in their own homes. Added to this is the considerable influx of daily workers and tourists into the central boroughs, which more than trebles the resident population during the working week. Alongside children s community services, supported hospital discharge and integrated care, we also provide continuing care, community nursing, rehabilitation and palliative care beds, a day surgery unit at Edgware Hospital, four Walk in Centers, three Urgent Care Centers and offender healthcare at HMP Wormwood Scrubs. What changes are affecting Rosemary The key drivers for change stem from patients changing needs, commissioners strategies and developments in technology, economic pressures and government policy. Population growth is happening in all the boroughs we cover and across London (Figure 2). As population growth is directly correlated with healthcare needs, we expect to see more healthcare activity in all of our boroughs and London overall. Figure 2, population projections by geography, , in thousands. 5

6 Source: Office of National Statistics Each borough and county that CLCH serves has an individual profile but all are expecting growth in the over 65 population (figure 3). Although London currently has lower levels of people with long term conditions than the England average, demographic trends mean that in the future we will have a much older population with more complex health needs. Combined with a growing population, there is increasing health needs in London. Figure 3: Population % with LTC, by common LTC types. Source: Quality and Outcomes Framework, Disease Register, 2012 Increasing numbers of patients with multiple long term conditions adds to the complexity of their healthcare needs and the impact of multi-morbidity is profound. People with several long term conditions have markedly poorer quality of life, poorer clinical outcomes and longer hospital stays. Providers of community healthcare, such as CLCH, have the expertise to manage multiple conditions and can seamlessly integrate with partners, such as primary care, which means that most patients with long term conditions can be effectively managed outside of acute hospitals, reducing the cost to the NHS whilst improving patient experience. Other notable factors include: 6

7 The total number of children under 18 is rising, the main growth taking place in the over 5s, which shows there is a rising demand for school nursing. An increasingly diverse population with contrasting deprivation profiles. Community health care services need to be tailored to the needs of an ethnically diverse population, for example by providing non-english language support, supporting access to healthcare and self-management. CLCH s listening events identified the following areas as being important to our patients and staff. Keep the patient/ Rosemary at the centre of everything we do.. Ensure staff, patients and families can report any concerns and that these are taken seriously Free- up staff time so staff can see more patients Use targets to improve care! Ensure leaders do not become divorced from front line services and support teams to develop a sense of team cohesion. Use technology to enhance the care we provide and the efficiency of staff. The redesign of services is driven by CLCH s clinical commissioners, and service delivery is affected by developments in technology; economic pressures and government policy -shown in Table 2. Our ageing population and the increased prevalence of chronic diseases require a strong reorientation away from the current emphasis on acute and episodic care towards prevention, self-care, more consistent standards and community care that is well coordinated and integrated. Recent multi-stakeholder feedback has indicated the value of providing compassionate, person centred care, advising that: Small things such as courtesy and a smile make a difference Patients find health and social care boundaries difficult to understand, and therefore difficult to access and raise concerns. 7

8 Long term condition management and support services need to be well publicised Excellent communication is essential to providing integrated care The needs of carers must be prioritized alongside the patient. Table 2. Policy Changes Patient Choice and Experience Economic Pressures Technology A Culture of Harm Free Care Commissioning Intentions System Changes Two themes in national policy that are currently influencing our healthcare environment are the drive for greater health and social care integration and the desire to shift care out of hospital settings, closer to home. The Five Year Forward View has clearly stated the importance of supporting health prevention, promotion and well-being in the populations. Two new service models will make a difference to patients - the primary and acute care system (PACS) model, and the multispecialty community provider (MCP) model. The Trust will be working with closely with commissioners and other healthcare organisations to explore the potential impact these could have on patient care and us as a standalone community trust Increasing patient expectations for choice and personalised budgets. Patient choice is a particularly important driver where there is competition between providers. All NHS services are under funding pressure, driving a need for greater efficiency whilst maintaining or improving quality of services. New technology in community settings offers opportunities to improve quality and experience whilst making efficiencies for providers and reducing costs. The Francis report, (February 2013), The Berwick report, (August 2013) and Keogh report, (July 2013) restate the duty of healthcare providers to make paramount the quality of patient care, especially patient safety. The most important of these, reflected both in national and local intentions, are co-ordination of care and managing conditions out of acute hospitals to reduce unnecessary attendances. In October 2013 the Secretary of State accepted the proposed changes to NHS services in North West London which will reduce the current hospital provision to five major acute hospitals as the implementation of the strategy named Shaping a healthier future begins. Co-commissioning by Barnet CCG and London Borough of Barnet is leading to integrated locality based teams. 8

9 The following section describes the healthcare delivered in the community, the principles that guide CLCH in the development of its clinical services, which are applied to these segments of healthcare that define a community Trust. The section ends by describing what that means for patients like Rosemary. What does CLCH, as a community trust, do for Rosemary CLCH provides a broad range of services, and a patient like Rosemary may have many complex conditions which will require interventions from various services. This may include clinics for problems such as Diabetes, Parkinson s disease and respiratory, or other chronic disease management. Support services are provided by teams such as physiotherapists, district nurses, podiatrists, eye screening ophthalmologists, dentists, dieticians, along with speech and language therapists. Patients such as Rosemary may also be seen in a community health care environment by GPs with a special interest in minor surgery or dermatology. More acute services are also available for patients in the form of walk-in and urgent care centres. Some bedded areas are also provided for community for rehabilitation, and more specifically neuro-rehabilitation, as well as Palliative care services and nursing homes. Services are also provided for people who are in prison, and the homeless as well as for those with a learning disability. Specialist services are provided for children in CLCH too. Children and their parents/carers can expect to receive a broad range of services provided from birth, with services such as health visiting and immunisation provided, up to school age with school nurses providing an ongoing service. A child can be seen in the Child Development Service, see a dietician as well as receive speech and language therapy. Occupational and physiotherapy services are provided for children and young people. The trust, and the children s service in particular, provides a well-skilled staffed service which upholds the values and safety of patients through mandatory safeguarding training. Other community services are available to people of all ages, such as smoking cessation and sexual health services. CLCH ensures there is a focus on musculo-skeletal services and falls management as well as the management of wounds/leg ulcers/tissue viability, stoma care, continence and the provision of a wheelchair service. In February 2014 the Kings Fund published a report Community services - How they can Transform Care. This document reports that, despite the lack of complete evidence, there is an emerging consensus about the impact that community services can have and what is needed to improve their effectiveness. The main steps identified to transform care include: Providing services which: Reduce the complexity of services Build multidisciplinary teams for people with complex needs, including social care, mental health and other services Support these teams with specialist medical input and redesigned approaches to consultant services particularly for older people and those with chronic conditions Offer an alternative to hospital stay Organising services in order to: Wrap services around primary care Build an infrastructure to support the model based on these components including 9

10 much better ways to measure and pay for services Develop the capability to harness the power of the wider community In addition, Managing quality in community health care services, was published by the King s Fund in December 2014, and sets out the findings from a small primary research study. This paper provides a valuable review of CLCHs organisational peers, a critique of current measures and indicators and acknowledges that there is a dearth of robust nationally available data. The full reports are available on the Kings Fund website; This is being followed in spring 2015 by an event Community health services: what does good look like? Figure 4, below, illustrates the clinical domains, (areas), of care delivered by community providers which are described as the clinical model. Figure 4. Active support for self management Care co-ordination Managing Ambulatory Conditions The Clinical Model Primary Prevention/Health Promotion Secondary Prevention Effective medicines management Improving management of end-of-life care Active support for self-management Self-management support can be viewed in two ways: 1. A portfolio of techniques and tools to help patients choose healthy behaviours. 2. A fundamental transformation of the patient caregiver relationship into a collaborative partnership. Both are important in the holistic management of patients that receive care from CLCH and will be supported by innovative solutions to health choices, the development of personal budgets and by a cultural shift that always puts Rosemary, our metaphorical patient, at the center of the clinical decision making process. 10

11 Primary prevention Effective primary prevention helps patients to avoid health problems before they occur. Giving children the best start in life provides the greatest benefits, for example CLCH supports and encourages mothers to breastfeed and provides immunization programmes. However primary prevention is valuable at any point in life. Working with other primary care providers especially general practitioners, CLCH is committed to take action to reduce the incidence of disease and health problems within the population either through universal measures that reduce lifestyle risks or by targeting high-risk groups. Secondary prevention Secondary prevention, systematically detecting the early stages of disease and intervening before full symptoms develop, is based on a range of interventions that are often highly effective in reducing the widening gaps in life expectancy and health outcomes (Marmot Review 2010). Working with local commissioners, CLCH s clinicians will have a major impact on health outcomes, in terms of improvement in life expectancy and reduction in complications, as the trust provides services to patients with conditions such as Chronic Obstructive Pulmonary Disease, (COPD), Heart Disease and Diabetes. Improving the management of end-of-life care The annual number of deaths in England and Wales is expected to rise by 17 per cent from 2012 to Further, the average age at death is set to increase markedly, with the percentage of deaths among those aged 85 or over expected to rise from 32 per cent in 2003 to 44 per cent in The number of deaths caused by cancer is expected to increase (30% for men and 12% for women by 2023). It is predicted that over a million people will have dementia in the UK in The INWL Public Health Department is forecasting that the proportion of palliative care deaths at home will increase from an average of 23% in 2012 to 35% by 2020, placing significantly increased responsibility on community services to support the out-of-hospital strategy. To meet patients needs a whole-systems approach is needed that co-ordinates care across professional and organisational boundaries which: Identifies patients towards the end of life Ensures patients have individualised care plans for end of life care Supports patients to be cared for with dignity in their preferred place of care Facilitates appropriate discharge from the acute setting Delivers a rapid and sufficiently skilled response service in the community setting Ensures that patients have their symptom needs identified and addressed preemptively if possible Ensures centralised co-ordination of 24/7 care provision in the community (including use of an electronic palliative care co-ordination system) Identifies the need for bereavement support and signposts appropriate support Supports and empowers staff to deliver high quality end of life care. Effective medicines management Medicines management optimises the use of medicines both by patients and the NHS, protecting against the risks associated with the unsafe use and handling of medicines. It 11

12 supports safe, appropriate and cost-effective prescribing, as well as helping patients to have their medicines at the times they need them, in a safe way and have information about their medicines made available to them. Good medicines management can help to reduce the likelihood of medication incidents and hence patient harm. CLCH continues to work hard to improve the management of medicines by delivering: Medication reviews in patients homes, residential and nursing care settings to ensure prescribing standards are met and help with co-ordination of domiciliary support to avoid hospital readmissions due to suboptimal medicines use. Medicines reconciliation on admission and written notification on discharge for patients in our rehabilitation, continuing, intermediate and palliative care wards to support safe transfer of information about patient medication on admission and discharge. Analysis of prescribing data and provide non-medical prescribers with information to benchmark prescribing performance. Managing ambulatory care sensitive conditions Ambulatory care sensitive conditions, (ACS), are chronic conditions for which it is possible to prevent acute disease deterioration and reduce the need for admission to hospital. This can be achieved through: active management such as vaccinations and vaccination programmes better self-management disease management or case-management lifestyle interventions primary/community and outpatient service provision social and integrated health and social care provision ACS conditions are categorised as being acute, chronic and other/vaccine preventable. Examples are shown in table 3. ACS emergency admissions are avoidable and emergency admission rates for ACS conditions are viewed as an indicator for the quality of primary and community healthcare provision. Table 3. Acute conditions Chronic conditions Other Vaccine Preventable (OVP) conditions Cellulitis Angina Influenza Dehydration Asthma Pneumonia Dental conditions Chronic obstructive Tuberculosis pulmonary disease Ear, nose and throat Congestive heart failure Gangrene Convulsions and epilepsy Gastroenteritis Diabetes complications Children s services are investigating what illnesses generate emergency admissions for local children and plan to define that suite of conditions enabling focused work on supporting management of these conditions in the community. There is significant variation in how effectively ACS conditions are managed for example, the NHS Atlas of Variation in Healthcare showed a five-fold variation in emergency admission rates for asthma across England (after standardising for population 12

13 characteristics). Early identification of ACS patients is crucial, as this will deliver improved patient care and system efficiency. Increasing understanding of how vulnerable people need help to avoid their conditions worsening, some of which can be long-term or chronic in nature, is a core objective of this framework. Developing ways of identifying and predicting individuals most at risk and working with GPs, social workers and hospitals to help patients find their way back to a stable situation will require us to work in different ways and to develop new skills. Delivery of improvements requires the use of risk stratification tools and clinical decision support software, within the community. We will work with partners to develop risk stratification tools that use hard information, for example identifying people who go to an Accident and Emergency Department more than others and soft information such as feedback from carers, to identify patients who are at the early stages of becoming unwell and target services to reduce the chances of them deteriorating. This early disease identification enables active disease management using: treatment decisions based on explicit proven guidelines case management to support people with complex long-term conditions disease management and support for self-management for those with less complex long-term conditions telephone health coaching, and other behavioural change programmes, to encourage patient lifestyle change easy access to urgent care for those with acute aggravated conditions. Tracking and measuring the impact of CLCH s clinical interventions have on these diseases will provide reassurance to our patients, like Rosemary, and assurance to our commissioners. Care co-ordination through integrated health and social care teams CLCH is committed to working with partners within our local health economy to participate in the development of an integrated system of care, targeted at those who will benefit the most. The Trust is collaborating with partners across North West London to explore how best to achieve an integrated model that delivers the best outcomes for the population across all levels of integrated care. As part of this, CLCH has initiated a series of new posts to deliver this function for our patients called Care Navigation. This service, (called care co-ordination in the boroughs of Hammersmith and Fulham and Kensington and Chelsea), is designed to assist patients and carers in organising services to meet their needs and to ensure community and primary staff are working together to an agreed plan. We want patients to have the necessary help to navigate around the health system. The children s service has mapped the pathways of care that local children use and how services connect together, which is described as a care bundle. We are now committed to working with the 3 inner Boroughs on an integrated early years approach. What outcomes can Rosemary, and her family, expect to receive from the care we deliver The Trust is committed to providing evidence based care. The primary source evidence 13

14 based clinical guidance is from NICE, but where this is not available in a specific topic area, clinical teams may follow guidance from Royal Colleges (who also provide the guidelines for NICE), Professional bodies and reputable societies. The NICE clinical guidelines are advisory, and are usually recommended for local implementation according to the local provision of services, multi-disciplinary mix etc. Clinical guidelines also need to be implemented in line with the individual needs of the patient. In order to ensure that the implementation of evidence based medicine is clinically effective, the trust uses a system of clinical standards, clinical audit and clinical outcomes measurement to ensure that care is safe and effective. Table 4 below illustrates some of the outcomes that Rosemary and her family should expect to receive from the care that is delivered by the Trust. Table 4 Organisational Clinical Outcome What this means Illustrative service level clinical outcome Safe, Effective Care Based on the registered population where applicable Integrated Improved outcomes - adults Delivery of safe and effective clinical services in an increasingly competitive and financially challenged health and social care economy. Services planned on the basis of registered patient populations to align our teams to the CCG networks, in order to achieve a closer fit with primary care. Focus on the delivery of integrated care, out of hospital and closer to people s homes - working closely with colleagues in primary care, maximising opportunities for delivering robust pathways that meet both service users needs and commissioner requirements for more joined-up, seamless services between primary care, social care and the acute sector. Focus on long term conditions; care of the frail elderly; care at end of life and ill health prevention in out-of-hospital care settings 14 Health and social care professionals work to clear standards that are peer reviewed. Patients receive support and services tailored to individual level of illness, level of knowledge, confidence about managing their condition and the risk of hospital admission. Expert support given to help prevent worsening of condition. Patients confident that CLCH staff are working alongside GPs and other key health professionals involved in their care to ensure that all their needs are being met. Patients supported by a multi professional team at home or in a home-like setting instead of the hospital. This is a safe way of being treated. A single person is responsible for ensuring that all the services needed are delivered on time and work together effectively and smoothly. Patients play an active part in setting goals to improve their own health.

15 as core areas. Patients participate in selfmanagement support and patient education programmes. Improved outcomes - children Clinically-led Continue to focus on early intervention and assessment for children, with initiatives such as team around the child, family nurse partnerships and the Healthy Child Programme. Ensure our services are led and developed by the clinicians who have the appropriate knowledge, skills and expertise to continually drive clinical quality improvement. Work with children and families to give them the best start in life. Children s health needs are identified early. Patients know that nurses, dentists, doctors and therapists reflect on how to make the service that is provided better. This knowledge is shared with managers ensuring the smooth running of the services to continuously improve. As services are transformed, this framework will be used as a template to ensure high quality service provision that delivers these specified outcomes. Specifically, CLCH is planning the transformation of four major services. Service Development Plan 1 The management of defined long-term conditions in the community We have and will continue to reconfigure models of care to improve patient pathways and management of LTCs, developing clinical models in collaboration with patients and service users, capitalising on community care expertise to promote self-management of LTCs We will increase the skills of our staff to be able to manage the more complex long term conditions (diabetes, chronic obstructive airways disease, heart failure, epilepsy etc.). and develop joint expertise with colleagues in the care of long term conditions (including GPs, care home staff and carers). We will actively work with primary care to develop long-term skill sin the community to support GPs to manage long-term conditions and maintain well-being and health for patients. 15

16 We will actively review and explore with our patients and partners the education packages we provide, ensuring that they meet the needs of an empowered and educated patient population. We believe we can manage an increase in the complexity of our community patients, which previously would have required a hospital admission, which will require the support of highly skilled specialists, real time patient records across community, primary and acute providers and using technology alongside a case management approach to achieve this shift of care into the community. Through active participation in whole systems work we will continue to support the MDT model of identifying patients with one or more long term condition and supporting them with integrated community and primary care services. Service Development Plan 2 Promoting early discharge and encouraging hospital avoidance There will be occasions where patients are admitted to hospital and require support to be discharged; we will aid transition from hospital to community based care settings. Hospital in-reach teams work with the local acute trusts to identify patients who could be discharged safely back to their homes or to a community or residential bed. Working closely together, the multi-disciplinary in reach teams, the inpatient staff and community therapy teams will enable patient s rehabilitation back to good health on discharge from hospital We will develop our model of providing rapid response services in the community, providing an alternative to attending the emergency department. Urgent Care Centres and integrated health and social care rapid response services already exist but will be improved and through enhanced care co-ordination, prevent unnecessary admissions or emergency department attendance. This may apply to patients who may be affected by conditions such as cellulitis, chest infections or renal infections, for example. This collaboratively work with local acute partners is delivering benefits such as; Enhanced discharge teams that support patient identification in acute care Experienced community clinicians acting as case finders bring community links and locality knowledge into the acute setting to create an integrated pathway back to the patient s home Shortened length of acute bed stay for patients who can be safely managed in the later stages of their acute care in their own homes High levels of patient satisfaction- they are happier and recover quicker at home Patients medical and social care needs are provided in the home by one team immediately post discharge creating continuity of care and support Reducing Delayed Transfers of Care, thereby ensuring patients are cared for in an appropriate environment in the community. In addition, we will need to support this development with a coherent Organisational Development programme which delivers a culture of devolved autonomy. Service Development Plan 3 A new model of care for children The number of children under nineteen years is rising across London, the main growth being 16

17 in the over fives. To help us achieve our mission of Working together to give children a better start, we have developed a model of care for children from birth to aged nineteen years that will help improve their health and life chances. The Children s Health and Development Services division has been involved in significant transformation to improve the care of every child in our care. This included the management of referrals, children s records, looking at the pathways of care, assessing needs and risks, identifying where the children who are referred to our services live and how we can work towards a single children s health record. A number of recommendations came out of this work, including: where CLCH teams should be located the boundaries of their work (i.e. zoning) how care can be improved through better management of travel time and the use of mobile and web based technology what we do for children in terms of our pathways and care bundles the skills mix of teams Through a single point of access, the children s model of care aims to create multidisciplinary teams designed to deliver services via defined care pathways to children and young people based on their level of need. Clinically-led teams will be designed around patient pathways to meet the needs of the patient. Service Development Plan 4 Delivering improved care through technology In today s health economy, it is essential that data can be shared across organisational barriers. Information sharing - CLCH has procured TPP SystmOne to replace RiO as its core clinical system. SystmOne will enable GPs and community health practitioners to share patient records, giving easy access to changes in medicines, test results, etc. Recognising that we provide services in partnership with GPs who do not use SystmOne, the Trust will continue its development of Interoperability to enable sharing capabilities between systems. Mobile devices - Over the next two years, the Trust will focus on the implementation of mobile working and deployment of mobile devices to clinicians. Business intelligence - More integrated data flows are required across HR, Finance and SystmOne into the data warehouse. Building infrastructure and resource capability - Improving IM&T infrastructure is a priority, and an ambitious programme has been underway since July 2014 to strengthen and improve the entire network. 17

18 How do the clinicians who work for the Trust, who know about Rosemary, communicate with the management of the Trust Three quarters of our 3000 staff are clinical; they are often the first point of contact for patients. Effective leadership for improvement requires engaging clinicians to participate in change efforts and to build support for these activities among their colleagues. Leadership development therefore needs to extend from the board to the ward. There are talented and committed clinical leaders throughout CLCH and considerable potential to strengthen the clinical voice within the Trust. This can highlight the day-to daychallenges that hinder change and service improvement. Working together, managers and clinicians jointly solve these problems and drive improvement, culminating in better patient outcomes and experience. The function of clinical leadership is to: Actively seek to improve the quality of CLCH s delivery of clinical services. Champion improving patient safety through embedding a safety culture. Enable a positive patient experience through providing compassionate, patient and family centred care. Champion CLCH s services in the wider health economy. Align with CLCH s organisational goals. Contribute to the provision of smart, effective care. Be knowledgeable in areas of clinical expertise, evidence and sharing of best practice. Be knowledgeable and contribute to service reconfigurations. Contribute expertise into local and nationally driven service redesign. Give clinical input into contracting and commissioning processes. Understand and promote leadership throughout the clinical community. Work within national professional guidelines. CLCH is committed to the development of clinical leadership in three ways: 1. The development of a forum where organisational clinical leaders meet to review strategic information and inform strategic decisions through a clinical leadership group. 2. Enhanced medical/doctor leadership throughout the organisation through the appointment of medical leads. 3. Divisional level clinical leadership of our Clinical Business Units (CBUs). How do we ensure that those who care for Rosemary, have the required skills, behaviours and training? The education and development of our staff is essential in ensuring that our workforce has the right skills, behaviours and training and that they are available in the right numbers to support excellent healthcare and healthcare improvement. It is also essential that our clinical workforce meet their statutory requirements for training and is responsive to the changing needs of our services 18

19 Supporting the education and continuing professional development of our clinical staff is fundamental in enabling CLCH to provide highest quality, patient and family centred care and to in supporting a culture of continuing service improvement. Specifically, the education and training of our staff will enable Rosemary to have a positive experience of effective and safe care. To support these aims, our strategy links education to improvements in patient outcomes through focussing on 5 domains of; Excellent education A competent and capable workforce, A flexible workforce that is receptive to research and innovation, Professional practice which is underpinned by our organisational values and behaviours Enabling and supporting participation. Through our educational strategy, we will ensure that our clinical workforce continues to competently meet the changing and evolving needs of our service What would Rosemary tell us to do differently? The NHS should become a learning organisation. Its leaders should create and support the capability for learning, and therefore change, at scale, within the NHS. (Berwick Report). Rosemary and her family assume that she will get the best care, delivered in the best way by the most appropriately skilled practitioner. In many instances there is clear evidence about what that best care should be, delivered to our patients. When considering the seven themes outlined in the Clinical Model, much information and knowledge already exists. NICE and other guidelines along with current medical literature should be utilised to support clinical decision-making as clinical teams support self-management, focus on primary and secondary prevention, coordinate care through health and social care teams, improve end of life care and effectively manage medicines. CLCH will consider how best to support staff to access and use the best medical evidence. This will assure Rosemary and other patients that her assumption, outlined above, is accurate. However, more research is required in community healthcare, as set out in CLCH s Research Strategy, to identify best practice. Undertaking research as individual practitioners, as well as joint research with partners, is important to continuously improve outcomes for the patients we serve. Continuous improvement to services will be supported using a standard organisational improvement methodology that focuses on three core areas: Problem solving techniques Service improvement skills Involving others in improvement. Technological innovation, as set out within our IMT Strategy, enables timely access to information for practitioners and service-users. Technology can minimise the impact of geographical distances, increase staff efficiency and facilitate care that is more instantaneous and responsive. 19

20 Research Much work has been done and much more is needed to deliver the very best care to the communities we serve. CLCH s clinicians and managers, working together in partnership with patients, are ready to respond to the changes set out in this document. There are a number of ways in which we seek to involve and engage patients in this and other aspects of research including: Highlighting research at CLCH Membership forum- membership has a major role in supporting the achievement of the Trust s objective, as set out in our Membership Strategy, Get involved with healthcare. There is a focus on continuing to grow an inclusive culture of public engagement with the organisation. By giving staff, patients, the pubic and our partners a stake in the organisation, we can develop the Trust into an open, outward-facing organisation that uses its members as a valuable resource to improve our performance and quality outcomes Liaise with researchers and advertise studies in GP surgeries and health centres to increase and facilitate recruitment to studies Utilise CLCH s external webpage currently research features there and members of the public are directed to the Head of Research & Development Encourage researchers to involve patients at the outset in their research projects including in the design Draw on the national research campaign by the NIHR: Research saved my life Raise awareness at annual CLCH research conference Raise awareness at CLCH s annual Open Day Liaise with the NIHR Clinical Research Network (CRN) in relation to current multicentre portfolio studies and offer to host these. This will increase recruitment from members of the public Undertake service-user surveys in relation to research and gage if they would be keen to take part in prospective studies or to identify which areas/studies they would like to be more involved in i.e. cancer, heart disease. Conclusion This Clinical Framework sets out how CLCH will respond to the complex factors that are driving health care delivery. The framework emphasises that the patient, Rosemary, remains the consistent and central organising principle when CLCH considers how it will adapt to policy, commissioning and demographic changes. This framework is a living document and as such it will continue to be built upon as CLCH develops. A user-friendly summary has been developed and is presented alongside this document. 20

21 References The Berwick Report: A Promise to Learn a Commitment to Act. August Quality Watch, 2013 Seven Leadership Leverage Points for Organization: Level Improvement in Health Care. (Second Edition), Reinertsen JL, Bisognano M, Pugh MD. Cambridge, Massachusetts: Institute for Healthcare, Improvement; (Available on Transforming our health care system, The Kings Fund Community services- How can they transform care. February 2014;The Kings Fund Managing quality in community health care services. December 2014; The King s Fund 21