Sustainable clinical and care models

Transcription

1 England Sustainable, Resilient, Healthy People & Places Module: Sustainable clinical and care models

2 Module: Sustainable clinical and care models Vision: Quality services and systems include sustainability as a fundamental principle. This means minimising environmental impacts, enhancing health and building resilience with individuals and their communities The measures of success by 2020 are: Professionals are encouraged to consider sustainability principles when deciding what is right for patients and clients Service transformations deliver improved health outcomes coupled with social and environmental benefits Sustainability is a core and measurable dimension that underpins quality Funding solutions and contracts that incentivise more sustainable models of care and enable the reconfiguration of services away from acute settings are jointly developed by commissioners, regulators and providers. Introduction All services aim to deliver the best quality of care within the resources available. This has always been a challenge and will become increasingly so as costs escalate, scarce resources diminish and weather patterns become more unpredictable. To be prepared for changing times, climates and events it is increasingly important to consider the environmental and social impact of how services are delivered. Preserving the values that underpin a universal health service, free at the point of use, will mean fundamental changes to how we deliver and use health and care services. The principles of sustainability are aligned with the policy direction in the health and care sector: more integrated health and social care service provision, integrated connections between service providers, empowered patients, improved use of information and communications technology (ICT), supported self-care and management of long term conditions. These will transform the way we deliver care and provide an opportunity to think about services differently. These issues need to be discussed with people and their communities so that they are at the heart of the design and delivery of care. NHS England through its Call to Action 1 is developing an in depth approach to ensure that services are sustained and affordable in the future. 2 Sustainable Resilient Healthy People & Places

3 Sheffield Right First Time programme The Right First Time programme focusses on developing a primary and community model of care that supports the physical, mental health and social care needs of those most at risk. One element of the programme is to target 16,500 people in the city with a high risk of admission to hospital with a joined up care plan. This helps these more vulnerable people remain as independent as possible. Early results suggest the approach is better for patients, better for staff and appears to be delivering value for money. There are the financial and environmental benefits of both reducing emergency hospital admissions and reducing delays to hospital discharge. The programme is a collaboration between Sheffield s hospitals, mental health services, NHS commissioners of services, GPs, community healthcare professionals and the City Council 2. Transforming the way care is delivered provides an opportunity to take a whole systems approach. Taking account of the environmental and social impacts of service models can support the development and delivery of more integrated and sustainable models of care in the future. This module is divided into two parts that focus on: 1. Sustainability as a factor underpinning high quality care 2. Transformational care Sustainable clinical and care models 3

4 1. Sustainability as a factor underpinning high quality care Every organisation considers high quality of care as a key responsibility. The Health and Social Care Act (2012) 3 defines high quality care as safe and effective with a positive patient experience. These are clearly fundamental to any service. Three additional elements can underpin this definition to develop a system-wide approach to quality services. These relate to functions that include a wider societal impact to the delivery of services and include fairness, best value and sustainability. The diagram below highlights these system pillars that underpin individual quality care. Every service, organisation, professional and carer can take the opportunity to consider how these concepts apply to their service planning, delivery and monitoring. Clinical effectiveness ectiveness Patient experience e Patient safety The elements can be described as follows: Effective care: The right evidenced based intervention and sound care that is delivered at the right time in the right place Positive experience: People are treated with compassion, respect and dignity and care is tailored to their needs Safe care: People are protected from physical, psychological or emotional harm. Supported by: Best value: Based on sound evidence of value for money for outcomes achieved Fair: Ensures equity in the distribution of resources and delivery of services Sustainable: Delivered within environmental limits and building on social value. 4 Sustainable Resilient Healthy People & Places

5 "Any quality aims that cannot be maintained with the resources available to us are set up to fail. It is important to realise that working to improve sustainability will seldom be in conflict with the other dimensions of quality. In particular, low carbon, environmentally sustainable healthcare is likely to improve cost efficiency and patient empowerment. Professor Donal O'Donoghue - Nephrologist Salford Royal NHS Foundation Trust and Board Member Liverpool CCG Integrated care for an ageing population Severe floods in 2009 in Cockermouth, Cumbria, acted as a catalyst to integrating health and social care services. A new hub for healthcare in the community was established called Centre for the Third Age. The centre allows the colocation of GP surgeries and community services with referral services geared to meet patient needs. The centre offers a range of support services in one place including advice on benefits, supported discharge from hospital, friendship groups and help at home. The result has been improved cooperation between health services, the third sector and the community. By supporting independence and improving overall health and wellbeing for the elderly, hospital admissions and associated costs have been reduced 4. Sustainable clinical and care models 5

6 2. Transforming care By working in different ways service providers can deliver more sustainable health and care. This is likely to involve designing services with patients and users, a focus on prevention and health improvement, and rewarding health and social care staff to enhance wellness and enable independence. The model below highlights the different levels of support that a person may need at different times of their life in a more sustainable system. Evidence has shown that the need for acute and specialist interventions can be minimised when there is a system-wide focus on living well and supporting people to manage their lives in a positive way. ENABLEMENT AND SUPPORT HOSPITAL CARE SELF MANAGEMENT LIVING WELL ACUTE AND SPECIALIST REHABILITATION PREVENTION & EARLY INTERVENTION Description of different elements: Living well Being healthy throughout our life is an aim for every one of us. At different stages we are likely to come into contact with various forms of health and care support to help us lead a life we can value. Prevention and early intervention - Throughout our life there are ways in which our health can be enhanced and ill health prevented. For example through vaccination programmes, healthy food, active travel, warm homes or fall prevention programmes. Many of these can improve health and sustainability simultaneously. For instance, addressing the causes of ill health by switching from motorised travel to walking or cycling or by reducing the levels of consumption of animal fats. Enablement and support - Some periods of ill health will mean that we need support through enablement approaches such as talking therapies, assistive technology or volunteering schemes which ensure that we are supported to be more effective in our daily roles. Self-management - Many of us will want to learn more about how to manage our own conditions, such as depression, diabetes or vascular disease, by self-monitoring and taking action to support a healthier life. This might include regular and easy access to specialist support. Acute and specialist rehabilitation - At times we may need acute and specialist help following an emergency or an episode of significant ill health. Secondary and tertiary care will be crucial to assist us through the most acute phases with the emphasis being on early intervention and providing only the right care at the right time in the right place rather than a series of poorly coordinated interventions. Acute and specialist rehabilitation can support this process, minimise any hospital stay and equip us for a world of self-management and living well. Dying well - Every individual may have a different idea about what would, for them, constitute a good death. Changing attitudes and behaviours in society towards dying, death and bereavement is an important issue and needs to be considered with the dignity of those involved. 6 Sustainable Resilient Healthy People & Places

7 Independent Living Programme West Lindsey District Council implemented a more sustainable approach to reducing demand for residential care, hospital care and social care as part of a preventative strategy to enable greater care in a person s home. Integrating social care and health processes allowed better coordination and a streamlined pathway, placing less pressure on acute hospitals. Integration of services was not considered in isolation. Equal focus was given to: Addressing housing quality, including policies for future proofing housing - this was done in collaboration with the housing association and other housing professionals. Citizen self-help and community action - promoting schemes for befriending, rural transportation and other community activity that supports independent living. We will only be doing our best for patients of today and tomorrow by understanding the overlap between socially, financially and environmentally sustainable health systems. This is crucial to the role of clinical commissioners placing the right level of emphasis on high quality, prevention, care, cure and rehabilitation. Michael Dixon - Chair NHS Alliance and President NHS Clinical Commissioners As well as reducing demand on acute hospitals these measures also reduced travel and improved energy efficiency in people s homes 5. Sustainable clinical and care models 7

8 This document is one of a number of modules supporting the Sustainable, resilient, healthy people and places a sustainable development strategy ( For further information, guidance notes, tools and good practice to support the delivery of this module visit References 1. NHS England, The NHS belongs to the people: a call to action [Online] Available at: [Accessed 06 January 2014] 2. Right First Time, Right First Time Home [Online] Available at: [Accessed 06 January 2014] 3. HMSO, Health and Social Care Act 2012 (c.7) [Online] Available at: [Accessed 06 January 2014] 4. Cockermouth Centre for the Third Age, Cockermouth Centre for the Third Age [Online] Available at: [Accessed 06 January 2014] 5. West Lindsey District Council, Living Independently and Staying in your Home [Online] Available at: [Accessed 06 January 2014] Document produced by the Sustainable Development Unit (SDU) which is funded by, and accountable to, NHS England and Public Health England to work across the NHS, public health and social care system. The SDU supports the NHS, Public Health and Social Care system to be sustainable environmentally and socially. This is done by engaging across the system to identify the frameworks, networks and mechanisms that will encourage a healthier environment, better health and enable communities and services to be resilient to adverse weather events and climate change. Responsibility for the content of this document lies with the Sustainable Development Unit. The Sustainable Development Unit Victoria House, Capital Park, Fulbourn, Cambridge, CB21 5XB T: E: england.sdu@nhs.net Published January 2014 W: Follow us on Twitter Designed and produced by: MJWebb Associates Ltd This publication is printed on 100% recycled paper and is printed using vegetable-based inks and a water-based sealant.