SECTION B PART 1 - SERVICE SPECIFICATIONS

Transcription

1 SECTION B PART 1 - SERVICE SPECIFICATIONS Service Specification No. Service Planned Commissioner Lead Provider Lead Sue Baldwin Period 31/03/ /04/2013 Date of Review March Population Needs 1.1 National/local context and evidence base The services have been developed to comply with a broad evidence base, which is largely client group specific. This includes: SLT The National Service Frameworks and Directives Improving Life Chances for Disabled People Cabinet Office National Clinical Guidelines for Stroke Royal College of Physicians nd Edition. Audit Commission Report Fully Equipped: Assisting independence. London Rehabilitation following acquired brain injury: National Clinical Guidelines Royal College of Physicians NICE guidance Improving Outcomes for Head and Neck Cancers Communicating Quality 3, Royal College of Speech and Language Therapists Lays out the standards set for people with communication and swallowing impairment Our Health, Our Care, Our Say DoH 2006 The Mental Capacity Act Enderby, P, Phillip, R. (1986) Speech and Language handicap; towards knowing the size of the problem British Journal of Disorders of Communication 21, Enderby, P, Davies, P. (1989) Communication disorders; planning a service to meet the needs. British Journal of Disorders of Communication 24, NHS National Cancer Action Team. Manual for Cancer Services Head and Neck Measures Royal College of Speech and Language Therapists, Prosthetic Surgical Voice Restoration, Policy Statement 2010 Kent Pathway for the Management of Foot and Ankle conditions and the agreed Kent and Medway Referral and Treatment Criteria. Specific evidence includes: Royal College of Speech and Language Therapists Clinical Guidelines, Augmentative and Alternative Communication (AAC) Services Quality Standard for Commissioners Communication Matters Assistive Technology: Standards for Service Provision, The Assistive Technology

2 Forum, 2006 MSK Specific evidence includes: The Map of Medicine refers to physical therapies as part of a number of pathways, but there is no specific physical therapy pathway. Specific evidence for MSK service includes: Musculoskeletal Service Framework DOH, 2006 The Operating Framework for 2009/10 for the NHS in England High Quality Care for All DOH, Nov 2008 Self Referral Pilots to Musculoskeletal Physiotherapy and the implications for improving access to other AHP Services DOH, Oct 2008 Clinical Guidelines for the Physiotherapy Management of Persistent Low Back Pain Chartered Society of Physiotherapy., 2006 Clinical Guidelines for the Physiotherapy Management of Whiplash Associated Disorders Chartered Society of Physiotherapy, Effectiveness and Cost effectiveness of three types of Physiotherapy to reduce Chronic Low Back Pain disability Critchley J. Spine Volume 32,Number 14.pp , There is no specific NICE Guidance that covers physical therapies, however, the NICE Guideline published in May 2009 Low back pain outlines the treatment that patients can expect from the NHS around pain relief for persistent non specific back pain. Podiatry Specific evidence includes: Feet First Report, DOH and NHS podiatry taskforce 1994 Standards of Care for people with Musculoskeletal Foot Health Problems Towards the Best Together (2008) Healthy Lives Brighter Futures (2009) British and Irish Orthoptic Society (BIOS) Competency Standards and Professional Practice Guidelines and Rules of professional conduct and code of ethics. Health professions Council (HPC) Standards of Proficiency Orthoptists Ophthalmic Services for children - Paediatric Subcommittee of the Royal College of Ophthalmologists regarding best practice and minimum standards in relation to health services for children with ophthalmic disorders and/or visual impairment (2005) General Medical Council/British Medical Association Nutrition Specific evidence includes: Diabetes in pregnancy NICE CG63 Type 1 diabetes NICE CG15 Diabetes Insulin Pump Therapy NICE TA151 Type 2 Diabetes NICE CG66 Diabetes Type 1 and 2 patient education models NICE TA60 Nutrition support in adults NICE CG32 Obesity NICE CG43 B1

3 Irritable bowel syndrome NICE CG61 Coeliac Disease NICE CG86 2. Scope Care is provided by trained and skilled clinicians utilising best practice, working and liaising with other health professionals to ensure coordination of the most appropriate care pathway for each individuals needs. The community based uni and multidisciplinary teams offer assessment, treatment, advice and education including self management of their condition to patients. The teams work collaboratively with other primary and secondary care teams to ensure a streamlined, seamless service for patients. The services are well placed to assist in achieving local and national targets e.g. 18 weeks (a requirement of the NHS Constitution) and Care Closer to Home. The services provide a holistic approach to the management of acute chronic conditions with the emphasis on providing support to enable patients to manage their condition long term. Patients will be clinically reviewed at their first appointment and following assessment a treatment plan will be agreed between them and their clinician. The services will offer a range of interventions including group sessions. The Pain management education sessions are offered to patients, carers and families to support patients to self manage their condition in the long term. Through collaborative working with secondary care, a Referral Point will be operated for all referrals into East Kent Pain Services. Services are available to patients registered with a GP Practice within Kent. The services will provide a fast, flexible community based service closer to home, reducing unnecessary demand for referrals into secondary care. Planned services include: ICATS and Chronic Pain ACAT service Podiatry and Orthotics Podiatric Surgery Dietetics and Nutrition MSK 2.1 Aims and objectives of services The objectives of the services are to: Ensure patients are on the appropriate pathway, enabling them to be seen by the correct healthcare professional first time, without delay. Ensure that all patients referred and accepted into the services receive a comprehensive assessment of their condition Provide the necessary advice, health education and self management strategies to B2

4 patients to optimise outcome of their condition in the long term. Work with primary care to ensure that services delivered are in line with the needs of local GP population Provide advice, guidance and education for referrers Enable earlier intervention of treatment, with better and consistent outcomes Utilise the skills of a wide range of health care professionals. Deliver a service that demonstrates equity of access Ensure timely access to services ICATS (East Kent only) The service aims to provide excellent clinical outcomes and reduce health inequalities, ensuring consistency of health outcomes for patients in regards specialist musculoskeletal health. Chronic Pain (East Kent only) The aims of this service are to: Assess and treat patients with chronic pain that do not require the intervention of a specialist within secondary care. Ensure patients are seen by the most appropriate health professional first time without delay Reduce multiple referrals for patients with a definitive diagnosis for who surgical intervention is not appropriate. Integrate chronic pain with other musculoskeletal services e.g: orthopaedics, rheumatology, physiotherapy, podiatry. Develop and provide definitive treatment plans in accordance with the needs of the individual. Provide a range of support services within primary care to help people manage their pain and improve their quality of life. Provide expertise and deliver education on chronic pain management across the wider health economy. Provide a comprehensive chronic pain service within Swale Prison Cluster in Sheppey, working with health professionals within the Prison cluster to provide advice and education on the long term management of chronic pain conditions. Adult Speech and Language Therapy (SLT) Service (West Kent, Canterbury, Swale & Thanet CCGs only) The aims of this service are: To provide specialist assessment of speech, voice, language or swallow and contribute to a differential diagnosis, for adults aged 18 years and above. To restore communicative competency and/or swallowing to maximum potential. This includes teaching alternative strategies to clients and carers. To maintain speech levels and to provide compensatory strategies for both speech and swallow, including provision of Augmentative and Assistive Communication (AAC) if needed, through the ACAT service. To actively manage communication and swallowing disorders and to avoid risk that these cause. To improve speech fluency and communicative competence. To resolve voice disorder to normal or to maximum potential. B3

5 To support the voice restoration programme through providing an alternative means of voice for those who have undergone laryngectomy. To provide training and support for carers and professionals that raises awareness and improves knowledge of communication and swallowing impairment, in order to improve outcomes for patients To enhance and maintain the quality of life and achieve the best healthcare outcomes for people with communication and swallowing dysfunction. To provide an integrated and flexible service which promotes continuity of care for patient, particularly interfacing with other trusts and intermediate care teams. Adult Communication and Assistive Technology (CAT) Service Eastern & Coastal Kent CCGs only The Adult CAT Service will support people who have difficulties with communication and accessing technology. The aims of the service are: To assess and support all adults across the Eastern and Coastal Kent locality who have disabilities and complex needs in the use of communication and assistive technology, through a specialist multidisciplinary team. To provide an equitable and efficient service to adults to ensure that their needs for communication and assistive technology are met in a timely manner especially for that group with rapidly deteriorating neurological conditions. To enable communication to enhance the autonomy, independence and quality of life for clients. To reduce the burden of responsibility and improve the quality of life for families and carers. To provide a client centred service, which integrates communication, postural management, powered mobility and environmental controls. To ensure that adolescents experience a smooth transition from the East Kent Children s CAT service to the Adult CAT service. To maximise efficient use of equipment budgets through avoidance of duplication and through effective knowledge of the market place. To provide, on short or long term loan, equipment/software that enables people with disabilities to communicate and/or access their computer as a means to communication. To develop a model of best practice for the county. [Comment: Should this be included as it is in our original SLA and is an intention?] To provide, on short or long term loan, equipment/software that enables people with disabilities to communicate and/or access their computer as a means to communication. To develop a model of best practice for the county. Podiatry and Orthotics The purpose of the service is to provide high quality intervention for those individuals considered to be at greatest risk of developing foot health complications as a result of complex medical history and podiatric needs. The service concentrates on treating those patients to be considered at high risk of potentially developing acute complications including infections, ulceration and amputation, predominantly in the following categories : Systemic medical complaints e.g. Diabetes, Rheumatoid Arthritis B4

6 Peripheral Neuropathy Peripheral vascular disease Compromised immune systems Infection Ulceration Steroid therapy Anticoagulant therapy General podiatric care is provided to those individuals who require ongoing treatment where their risk status is significantly increased due to neurological or vascular deterioration, often in combination with other risk factors e.g. deformity, anticoagulant medication. These patients often suffer from long-term conditions and as such are unlikely to be able to be discharged from the service. E.g. Diabetes, Rheumatoid Arthritis. There are 3 locality teams within West Kent: the Dartford locality in the north is subcontracted with Medway PCT Podiatry Service the Maidstone locality } services are the Tonbridge locality } provided in house. Modalities / Specialties offered: Nail surgery with matrix phenolisation under local anaesthesia for painful nail pathologies not able to be maintained through conservative treatment. Specialist diabetic ulcer service for patients require a multidisciplinary approach for optimal outcome and quality of life: Wound care including ulcer debridement and redressing Diabetes care General podiatry care for high risk individuals Provision of orthotics to offload excess pressure from vulnerable areas Health education Advice and information Podiatric Surgery Podiatric surgery is suitable for most patients who require surgical correction of their feet. Conditions included fore foot and rear foot problems, typically bunions, hammertoes, degenerative joints, chronic corns, bony and soft tissue lumps, neuromas, heel pathology and structural problems such as cavoid and flat feet. Most Podiatric Surgery is carried out as day case surgery using local anaesthetic, negating the need for a stay in hospital, minimising disruption to home life and reducing postoperative discomfort. Procedures under general anaesthetic are offered where necessary. These will be carried out in main theatres and managed through arrangements with the acute Trust. Internal fixation and implant techniques are used ensuring patients, in most cases, are walking soon after surgery, and in most cases, without the need for casts on their feet. Diagnostics are accessed in order to aid diagnosis or as part of the preoperative planning process, commonly x-rays and ultra sound, although MRI and CT scans are accessed where necessary. B5

7 Dressing changes and suture removal are undertaken postoperatively. The patient is followed up once discharged, usually at six months following surgery. To ensure equity of access and to meet the requirements of Care Closer to Home, the service will look to utilise other localities for outpatient and surgical procedures, to meet the needs of their patients. The need for this will be monitored by the Service and the Commissioner. The Podiatric Surgery Department provides a full range of surgical options for the treatment of foot conditions on a day case basis under local or general anaesthesia. The aims of the service are to : Provide the best options of care for patients Ensure patients are seen in a timely and by the most appropriate health professional. Provide a high quality of patient care Dietetics and Nutrition Specific evidence relating to Clinical Nutrition and Dietetics includes: Diabetes in pregnancy NICE CG63 Type 1 diabetes NICE CG15 Diabetes Insulin Pump Therapy NICE TA151 Type 2 Diabetes NICE CG66 Diabetes Type 1 and 2 patient education models NICE TA60 Nutrition support in adults NICE CG32 Obesity NICE CG43 Irritable bowel syndrome NICE CG61 Coeliac Disease NICE CG86 Clinical Nutrition and Dietetics (east Kent) The service is provided to all patients registered with a GP in east Kent excluding Swale area*. The service accepts referrals from general practitioners and other healthcare professionals. All patients are seen at the most appropriate venue, which may vary dependent on the patient s condition and needs. Dietitian s conduct one to one consultations ensuring nutritional advice and support is appropriate to all patients referred to the service. Group education is provided where appropriate to patient pathways. All patients are monitored and supported throughout their care pathway and discharged according to need / pathway. Clinical Nutrition and Dietetics aims: To provide therapeutic dietary advice for a range of specific clinical conditions To monitor the effectiveness of dietetic treatment to ensure patients receive clinical care which is evidence based, meets the needs of the individual and demonstrates good clinical outcomes. To facilitate training for community health care professionals who are frequently B6

8 required to give dietary advice as apart of their clinical role, including the provision of appropriate patient information. To support and develop dietetic staff to ensure clinical competencies in all areas of service provision. Clinical Nutrition and Dietetics has four clinical teams and a centralised appointments team. The Home Enteral Nutrition Service (HENS) is a specialist comprehensive support service which provides a community service to adults and children who are enterally fed and reside in east Kent. The team accept referrals from both tertiary and local hospitals. The Diabetes and Obesity Dietitian s provide a high quality diabetes, weight management and obesity dietetic service for people of all ages and their carers across east Kent. *The team provide the dietetic expertise to the Specialist Weight Management Service (SWMS) for Swale area. The Community Nutrition Service (CNS) provides clients with individual advice for management of malnutrition, allergies or gastrointestinal disorders. Clinical Nutrition and Dietetics has an SLA to provide inpatient and outpatient service to all directorates within EKHUFT with the exception of renal speciality. The Acute Nutrition and Dietetics Service provides integrated services within each of the specialist teams (for example, oncology, stroke, diabetes). The department accepts electronic referrals form all health care professionals within EKHUFT. Clinical Nutrition and Dietetics works closely with other health care professionals to ensure the service fits into care pathways and meets national targets. MSK Physio Therapy Service East Kent (AQP) The service will provide a local, high quality, responsive and easily accessible physical therapy service for those affected with musculoskeletal problems. Timely intervention by skilled and experienced physical therapists. The service will include physiotherapy, but may also include the alternative evidence based practices of osteopathy, chiropractic and acupuncture. The service will be available to patients registered with a GP Practice within the NHS East Kent area. The expected outcomes of the service are: Positive outcome of treatment, based upon both clinical and patient experience Improved patient quality of life, and return to work or normal social function Primary aims to provide a best value GP referral service, where therapists assess and treat people with physical problems caused by accidents, illness and ageing with the aim of: restoring function and enabling return to work or normal social function alleviating symptoms preventing injury maximizing potential for movement B7

9 preventing recurrence to improve the quality of physical therapy treatment to patients, both in terms of physical access to services and reduced waiting time by providing an additional local service Musculoskeletal Physio Service - West Kent (includes AQP) Service Description The Out Patient Musculoskeletal Therapy Service comprises : Physiotherapy Service including advanced Practitioners Provision of direct access physiotherapy out patient assessment, treatment advice and education. Modalities of treatment offered:- Musculoskeletal assessment Individual Exercise therapy Manual therapy Electrotherapy Acupuncture Group Therapy e.g. Back to Fitness, Knee groups Hydrotherapy this is provided at Sevenoaks and Churchill Centre. Patients in Dartford and Gravesham access this service at Darent Valley Hospital Women s Health Service The service provides an interface between primary and secondary care and aims to reduce referrals to secondary care. The service forms part of the eighteen week Pathway and works closely with the Acute Trust to ensure that these RTT targets are met The service is comprised of the following teams: Tier II Advanced Musculoskeletal Practitioner service (AMPS) Physiotherapy Out Patient Service Podiatry biomechanics/ orthotics service Nail surgery Podiatric surgery Outcomes Expected Outcomes for specific services SLT - CAT The expected outcome is that each completed episode of care, and completed care plan, will achieve at least 70% successful achievement of the clinical objectives set. This is considered a good clinical outcome. Specific outcomes will be used relevant to each treatment pathway. Improved Cost Efficiency B8

10 Informed choice of equipment will avoid potentially expensive and inappropriate bias of a particular supplier Provision of local specialist support will reduce wastage due to rejection of the aid. Improved Access Short waiting times for assessment. A single point of access and well defined care pathway will result in quicker provision of the aid. Quick response time to patients with rapidly changing neurological conditions 2.2 Service description/care pathway Response time and prioritisation Specific services will contribute towards delivering the 18 week referral to treatment national target for waiting times. Specific details for each service are in Annexes. Referrals will be triaged within 2 working days of receipt. Referrals must be discussed with the referrer where other approaches may be more appropriate The provider will offer the patient a choice of appointment time and venue if relevant. Review Patients will be reviewed subject to clinical need and treatment pathway Days/hours of operation Services will operate from a range of locations excluding bank holidays. Generally 9am to 5pm but some services provide extended hours and weekend cover. For some community venues services will be operated on a regular day/session Care Pathways Patients will be triaged following referral into the service to ensure there are seen by the most appropriate health professional. Referrals will be accepted in a letter format or standard form by the primary/community service (via Choose and Book or paper format, where available) provided demographic and relevant medical/drug history is included. If a patient presents again for the same condition within 6 months they must be classed as a follow up and not a new appointment. Referrals deemed to be incomplete or inappropriate will be returned with advice to the GP. Where possible the GP will be contacted and asked for further information to prevent the need to return the referral. Any referral to secondary care will follow national Choose and Book Guidance. B9

11 2.3 Population covered Exclusions are covered in individual service annex. Adult Service SLT The Adult SLT Service may see patients registered with a Kent GP with the exception of patients in Dover, Deal, Ashford, Shepway and Medway where services are provided by other providers. CAT Service The service is delivered to patients registered with GPs across the Eastern & Coastal Kent CCGs. The service will accept rferrals for young people once they have left full time education and/or require transfer from the Kent Children s CAT Service typically at the age of Any acceptance and exclusion criteria All Services See Appendix for each service Referral criteria and sources Please see annex for each service All Services Where possible through a dedicated contact/single point of contact as defined for each service Referral processes See details for each service in Appendix Exclusions See Appendix for each service Discharge processes Following the completion of the agreed treatment plan patients will be discharged at the discretion of the lead clinician and have access to patient initiated phone support should they require further advice. On completion of treatment a comprehensive final report which includes diagnosis, management and recommendations will be sent to the referring GP within 7 working days of completion of treatment. If a patient presents again for the same condition within 6 months they must be classed as a follow up and not a new appointment. B10

12 Specific for each service are: Adult SLT Discharge planning will start at the beginning of the care pathway. A programme of care will be set within the EKOS system at outset, each treatment episode having a beginning and an end. The EKOS system will record the reason for discharge, reports available. The speech and language therapist will plan the discharge and discusses this carefully with the client and carer. Clients will be discharged when Assessment indicates that therapy is not appropriate The client has reached full resolution of their difficulty or the client has reached maximum potential. If there are contributing factors that make therapy inappropriate. If the client requests discharge. Adult CAT Service Patients using the Adult CAT Service are likely to have either long term conditions or a progressive neurological condition e.g. MND. Therefore patients will not be discharged. An annual review of equipment both for safety and for effectiveness of use will be undertaken. Podiatry and Orthotics All GPs will receive correspondence of their patients treatment GPs will be informed of patients that are discharged from the service. All patients can reapply to the service for treatment if problems reoccur. Patients that are discharged from the service following a course of treatment, for example Nail Avulsions or resolution of symptoms or following Biomechanical intervention, may be referred on to another department/service for alternative care or discharged with appropriate self care advice. Patients are frequently put on to self-referral maintenance plan to access podiatry as and when needs arise. On completion of treatment Resolution of original presenting complaint Non concordance Non attendance as per the PCT Access policy Discharge is not always appropriate particularly for those patients who have ongoing or deteriorating health complaints or fit into the high risk category of care Podiatric Surgery The Service will provide patients with (unless determined to be clinically inappropriate) clear information and feedback on the outcome of their procedures. Evidence based Information and advice regarding treatment will be made available on an individual basis to meet the needs of the patient, and provision of education to support the patient in self management of their condition. B11

13 When treatment is complete When patient has been referred on to the biomechanics team for orthotics If treatment is either inadvisable or unnecessary Dietetics and Nutrition Generally, once patient is confident to self manage dietetically, patient will be discharged. Patients are advised they can contact the department if problems occur. Specifically; Diabetes and Obesity criteria within the care packages will be followed. Coeliac ongoing annual review, case not closed - open access. HEN Patients will be discharged when artificial nutrition is no longer required. Acute - patients discharged to community dietetic teams where ongoing nutritional needs identified. Musculoskeletal Physiotherapy: Patients will receive a maximum of six treatment sessions. If additional sessions are required this will only be with the Team Leaders approval. Physiotherapists with patients not responding to treatment after 3 sessions will discuss their patient s management with a Senior clinician. Discharge letters will be written to the referrer within 7 working days. DNA s / cancellations : managed in accordance with the West Kent Access Policy 2.5 Interdependencies with other services Services depend on referrals from GPs and other health professionals. The Services will develop links with referrers to ensure streamlined pathways for patients. The Provider s clinical staff will work collaboratively with other service providers to provide an overall streamlined service. Clinicians will work closely with voluntary agencies such as Age UK and other carers to provide foot care training through the learning and development department. Interdependencies with other clinical teams: Services in Acute Trusts, Intermediate Care Teams, Paediatric teams for transition Home Enteral Nutrition Team (HEN) in the community, The Care Homes Team, The Hospice Teams Palliative Care Team Stroke Team in Medway, Children s CAT Service ALD speech and language therapy service. The hospital and community speech and language therapy services, Acute services especially the Neuro Rehabilitation team, B12

14 Social Services, The wheelchair service in East Kent. East Kent Motor Neurone Disease Team Services are primarily stand alone but rely on the support of estates and hotel services in order to maintain the high quality of standards required. Services are reliant on effective referral transmission on the nhs.net system/fax and the Choose and Book system where available. The Provider s clinical staff will work collaboratively with other service providers to provide an overall streamlined service. In addition to those services listed in 2.5 above, these include: Voluntary services e.g. Age UK, voluntary car services IT support Patient transport Logistics Prescribing Ophthalmologists visiting from acute trusts High street optometrists GPs Health visitors School nurses Community paediatricians Other consultants eg neurologists Falls team Training department for Statutory and Mandatory training British and Irish Orthoptic Society, Royal Society of Medicine and various orthoptic departments, for orthoptic training days. IT Human Resources Outpatients clerks for access to hospital records. Admin staff for ordering equipment and supplies Kent Association for the Blind for support for patients with ongoing problems Social services (adult and child protection) Whole system relationships The key stakeholders for these services are: The hospital services at EKHUFT, Medway Hospital and MTW GPs The Intermediate Care Teams. Community Matron Team Specialist Nurses Patients are to be referred from any or all stakeholders. Working together across these services is essential in order to ensure a smooth transition of care for patients and well coordinated and appropriate care. B13

15 Meetings will be held regularly between clinicians triaging within the Referral Point to ensure best practice and the ongoing improvement of patient pathways. These meetings will also provide the opportunity to ensure triage guidelines are interpreted appropriately and consistently by all parties. Services will work closely with GPs and secondary care providers to ensure patients access the most appropriate service for their condition, streamlining pathways and reducing demand in secondary care. The Provider shall: establish a positive working relationship with all relevant parties, including the Clinical Commissioner, and local Consultants engage with managed local clinical networks appropriate for the delivery of the necessary services engage in peer review activities The Provider must organise and maintain records of this activity 2.6 Prescribing The provider will be liable for costs allocated to the providers prescribing code and reimburse this cost to the PCT on invoice. Providers are to develop formulary for items which will impact on primary care prescribing referred to as a Primary Care Formulary and submit to PCT/CCG prescribing forum for approval. Requests to GPs to initiate or continue prescribing from the provider will be within the Primary Care Formulary. Prescribing outside of the Primary Care Formulary will remain as the responsibility of the provider Providers will develop shared care agreements where required by GPs and submit to PCT/CCG prescribing forum for approval. Providers will continue to prescribe medication under shared care until accepted by the GP Use of medication excluded from payment by results will be applied for through the PCTs process (e.g. MM1 form) in line with the requirements of the Kent and Medway Health Economy High cost drugs- summary of current arrangements available at Providers will provided GPs with access to patient s test results where required for shared care If Patient Group Directions (PGDs) are required, providers will develop them within the PCTs framework. Providers will have an auditable process to support robust clinical governance for use of medication within their service and supply results of audit to the PCT on request. 2.7 Personal Health Budgets Not used. B14

16 2.8 Sub-contractors Adult CAT service Part of the ACAT service will be sub-contracted to The East Kent Hospitals University Foundation Trust. EKHUFT will provide the Clinical Engineering and the secretarial support to the team. The Lead Clinical Engineer within EKHUFT will also provide day to day operational management of the whole team. KCHT Services will have a service level agreement with EKHUFT for their element of the ACAT service Enteral Nutrition feed companies: Nutrica clinical care (East Kent) Nestle medical nutrition Abbotts (West Kent) CSSD services In Health Sterile Services (IHSS) contract Trust wide Services also rely on support trust wide from: EME Procurement Facilities Logistics Kent and Medway Shared Services logistics, procurement, EME Services Medway PCT Podiatry Service MTW Direct Access Physiotherapy GPwSIs Within AMPS Benenden Hospital } provision of theatre facilities Fawkham Hospital } for Podiatric Surgery 2.9 Patient Choice Patients will be offered a choice of appointment time and venue. Patients who do not attend (DNA) will be offered a single further opportunity to attend the clinic; the referral will be returned to the GP if the patient DNAs a second time. The Service on tariff will not be paid for DNAs. Where the necessity for a referral into secondary care is identified through triage, assessment or red flag, the patient will be offered the appropriate choice of a secondary care provider or referred back to their GP. Choice options will be discussed impartially with patients either by telephone or face to face and the onward referral into secondary care will be made through the national Choose and Book service Where the initial referral has been made through choose and book. B15

17 Choose and Book Onward referrals into secondary care will be made through the Choose and Book service (where available) or the GP. The service will have access to Choose and Book with sufficient administrative support. 3. Applicable Service Standards 3.1 Applicable national standards eg NICE, Royal College The Provider must comply with: Care Quality Commission Standards the revised hygiene code, The Health and Social Care Act 2008, Code of Practice for the NHS on the prevention and control of healthcare associate infections and related guidance; relevant standards to assure safeguarding of vulnerable adults, and in particular to: ensure all staff in contact with, or accessing data about, vulnerable adults have enhanced CRB checks work with the Commissioner to develop a phased adult protection training plan for staff adhere to the Commissioner s procedures, protocols and guidance on Adult Protection embed learning s from Serious Untoward Incidents into internal procedures and protocols adhere to the requirements of the Mental Capacity Act 2005 (amended 2007) The standards of their professional registration body e.g. HPC, RCSLT The Provider must comply with the following regulations and legislation: Equal Pay Act 1970 Sex Discrimination Act (as amended) 1975 Race Relations Act 1976 (as amended by the Race Relations (Amendment) Act 2000 Disability Discrimination Act 1995 (as amended) 2005 Human Rights Act 1998 Sex discrimination (Gender Reassignment) regulations 1999 Employment Equality (Religion and Belief) regulations 2003 Employment Equality (Sexual Orientation) regulations 2003 Gender Recognition Act 2004 Age Discrimination Regulations 2004, and Equality Act 2006 (Gender Equality Duty) The legislation requires public organisations to demonstrate specific duties in relation to the legislation. The Provider must publish these schemes within the public domain and provide evidence of the sensitivity and accessibility of Service, including providing of information on service usage by patients under the following categories: ethnicity age B16

18 gender/sexual orientation disability religion and belief provide evidence in relation to the staff employed by the organisation, including providing information on workforce composition under the following categories: age ethnicity gender/sexual orientation disability This evidence must be published within the annual report of the organisation. Relevant networks and screening programmes Adult SLT The service Managers network with the Royal College of Speech and Language Therapists Management Board through its representative in the South. Clinically the service has a number of local, regional and national networks that are sustained through its clinical advisors. These include: The Head and Neck Special Interest Group for the South The British Voice Association Voice and Laryngectomy Special Interest Group for London and South The Voice Care Network UK The British Aphasiology Society The British Stammering Association The Stroke Association The Motor Neurone Disease Association local branch The Parkinson s Disease Society The Stammering Special Interest Group for London/South NB: The Special Interest Groups are affiliated to The Royal College of Speech and Language Therapy Adult CAT Service Rehabilitation, Engineering and Biomechanics special interest group (organised by Institute of Physics and Engineering Medicine. AAC Assessment Services meeting (organised by Communication Matters). Rehabilitation Engineering Services management group for Electronic Assistive Technology (RESMaG). Communication Matters Symposium (annual). OT Access Group meetings. Links with EKHUT: East Kent Nutrition steering committee East Kent nutrition group Service improvement groups (Gastro / Diabetes / Oncology / obesity ) B17

19 Public health: Kent healthy eating sub group Specialist clinical groups: British Dietetic Association specialist sub groups (Diabetes, obesity, nutrition support, oncology) Supervision group: SEC Dietetic manages group Patient support groups: MSK Bowel Support Group Diabetes UK Oncology Coeliac disease Paula Carr A number of local and national networks support the provision of a high quality service; these include: Arthritis and Musculoskeletal Alliance (ARMA) Musculoskeletal Collaborative Group individual membership of nationally and professionally recognised clinical interest groups such as the: Acupuncture Association of Chartered Physiotherapists (AACP) Manipulation Association of Chartered Physiotherapists (MACP) Association of Chartered Physiotherapist in Orthopaedic Medicine (ACPOM) Association of Chartered Physiotherapists in Women s Health (ACPWH. Diabetes Network Board British and Irish Orthoptic Society Specific Learning Difficulties Special Interest Group Stroke Special Interest Group Kent Stroke Network 3.2 Applicable local standards Refer to main contract requirement. 3.3 Clinical Standards Refer to main contract requirement. 3.4 Information technology support Refer to main contract requirement. B18

20 4. Key Service Outcomes The expected outcomes of the service are detailed in Appendix for each service. See also KPI s. 5. Location of Provider Premises Geographic coverage/boundaries The services will be available to all patients registered with GPs in the Kent area. Exclusions and service geography detailed in Section 2 and Appendices. Adult SLT East Kent The Adult SLT Service may see patients registered with a Kent GP with the exception of patients in Dover, Deal, Ashford, Shepway and Medway where services are provided by other providers. Adult CAT Service The Adult CAT service will be available to all patients registered within the NHS Eastern and Coastal Kent CCG only. Location of Service Delivery Adults will be seen in a variety of locations, which are local to them and which are best suited to their needs. These locations include Health Centres, Hospital Out-patient venues, Community Hospitals and Rehabilitation Units, Hospices, Residential and Nursing Homes and Patient s own homes. 6. Individual Service User Placement Not used. 7. Prevention, self care and patient and carer information Each specialist service will have patient leaflets giving details of how to access the service, patient bookings and service location. The patient leaflet must give detailed information about any pre-test preparation which is required and explain what the patient can expect. The leaflet will give information in relation to complaints procedures. The Provider must provide patients with (unless determined to be clinically inappropriate) clear information and feedback on the outcome of their procedures and how information will be fed back to them on the outcomes. B19

21 Evidence based Information and advice regarding treatment will be made available on an individual basis to meet the needs of the patient, and provision of education to support the patient in self management of their condition The provider will provide appointment confirmation letters to the patient that contain or have attached, contact details of and directions to the site where the appointment is to be held along with the relevant patient information leaflets relating to that appointment. Information provided about services will be in a range of accessible formats taking into consideration issues of language, disability and literacy levels. Service users must be able to access appropriate interpretation services such as language and British Sign Language (BSL). The provider shall be responsible for ensuring that all patient communication written or verbal is available for patients in the appropriate language required. The provider shall ensure the privacy and dignity of patients is protected at all times, including having measures in place to chaperone patients when this is requested. Providers shall organise patient transport for all patients meeting agreed eligibility criteria. This is in line with updated Department of Health guidance and the policy direction set out in Our health, our care, our say which entitles all eligible patients referred by a health care professional for treatment in a primary care setting, and who have a medical need for transport, to receive access to Patient Transport Services and Hospital Travel Costs Scheme. Privacy and dignity The service will ensure the privacy and dignity of patients are protected at all times, including provision of measures for chaperones if requested by the patient. Information for Service Users The services will have a range of information, developed for clients and carers to understand and manage their difficulties. This information will be written in appropriately accessible formats to support people with communication disability. For example, with pictorial sign and symbol, simple language and large print. Client user groups will be set up as appropriate to enable cascading of information and learning and gaining user service feedback (eg talk back group for head and neck cancer patients. B20

22 Annexes included in document Service Description: 1. Adult SLT 2. Adult CAT Service 3. ICATS 4. Podiatry 5. Podiatric Surgery 6. Dietetic Services 7. Physiotherapy 8. Orthoptic B21

23 ANNEX 1 Care Pathway/Service Adult SALT The adult SLT service is delivered to the adult population with a Kent GP with the exception of patients in Dover, Deal, Ashford, Shepway and Medway where services are provided by other providers. Service model The service will be managed by a Head of Service. The therapists will work within a number of clinical teams. Importantly, in order to ensure a smooth transition of care between acute and community, the speech and language therapists have a strong interdependence with the speech and language therapists who provide services into the East Kent Hospitals University Foundation Trust. Within the structure the service will have a number of specialist clinical advisors who will have developed a high level of skill in a range of clinical areas. These therapists will provide specialist advice, supervision and teaching across the team and the trust and provide an expert second opinion service. Accessibility/acceptability The service will work with people who are typically 18 years above, although it may sometimes be appropriate to accept young people of 16 years or younger this would be agreed with the paediatric speech and language therapy service. The service presents no barrier to age beyond 18 years, nor to culture, disability or gender. The service will deliver its work through a flexible and responsive approach to supporting people of all ages and people with physical and sensory disability. For example, out-patient appointment times for people in work will be tailored to their needs where ever possible, and the elderly or people with physical disabilities and frailties will be visited in their own homes. The service will promote access to its services for people with a physical and sensory disability through a range of tailored information and communication packs. Referral Criteria & Sources: The service will be offered to all adults with a communication, voice or swallowing impairment. Although there is open access to the service from any referrer, including the client, any non-medical referral is notified and confirmed with either the GP or Consultant. Exclusion Criteria: A service is provided to in-patients in Mental Health sites who have acquired a neurological deficit, in order to provide assessment, differential diagnosis and advice. However, there is no designated speech and language therapy service to clients with a primary mental health disorder in the eastern and coastal kent CCG localities. Objectives: The objectives of this service are: To provide specialist assessment of speech, voice, language or swallow and B22

24 contribute to a differential diagnosis, for adults aged 18 years and above. To restore communicative competency and/or swallowing to maximum potential. This includes teaching alternative strategies to clients and carers. To maintain speech levels and to provide compensatory strategies for both speech and swallow, including provision of Augmentative and Assistive Communication (AAC) if needed, through the ACAT service. To actively manage communication and swallowing disorders and to avoid risk that these cause. To improve speech fluency and communicative competence. To resolve voice disorder to normal or to maximum potential. To support the voice restoration programme through providing an alternative means of voice for those who have undergone laryngectomy. To provide training and support for carers and professionals that raises awareness and improves knowledge of communication and swallowing impairment, in order to improve outcomes for patients To enhance and maintain the quality of life and achieve the best healthcare outcomes for people with communication and swallowing dysfunction. To provide an integrated and flexible service which promotes continuity of care for patient, particularly interfacing with other trusts and intermediate care teams. Outcomes: The Adult SLT Service measures their clinical effectiveness through the use of the East Kent Outcome System EKOS. This relies on a SMART (specific, measurable, achievable, relevant, time limited) care planning system whereby each care plan is written with clear aims and objectives which are specific to that client needs group and which have been set with knowledge of the evidence base for the treatment of that disorder. The expected outcome is that each completed episode of care, and completed careplan, will achieve at least 70% successful achievement of the clinical objectives set. This is considered a good clinical outcome. These clinical outcomes are mapped against one of ten Health Benefits, or health gains, for the client. These are: Client Reassured Problem Resolved Function Restored Facilitated Development Function Preserved Modified/Adapted Regime Client Supported Harm Avoided Information Provided Health Promotion EKOS provides a range of reports on the clinical outcomes and the measurement of good outcomes achieved, described above, is included as a key performance indicator. The service expects to deliver 80% good outcomes overall. B23

25 Referral Management & Prioritisation: A triage system operates on receipt of referral as follows: Priority Level Waiting times Examples Level 1: High risk Within 10 working days of receipt of referral These are patients who are at high physical and psychosocial risk. It will also include some end of life patients. Examples: - patients at high risk of aspiration pneumonia, choking, malnutrition and dehydration due to new or deteriorating swallowing ability - patients at risk of immediate or severe psychosocial harm due to new or worsening communication skills and unable to function in daily life. - where there is risk due to increased care strain and anxiety - End of life patients- including hospice referrals - MND patients first phone contact should be made within this timescale to assess their needs and wishes - All patients with aphonia -Head and Neck: Patients who are at the beginning of the care pathway and have dysphagia or need pre-op counselling and advice. Level 2: Medium risk Level 3: Low risk Within 6 weeks of receipt of referral Within 12 weeks of receipt of referral These are patients who have medium risk and whose risk may increase if they wait for longer than four weeks. Examples: - patients referred from hospital who need ongoing intervention from which they will benefit - patients referred from Intermediate Care Team (ICT) who require ongoing rehabilitation from which they are predicted tobenefit - patients whose risks are already being managed safely but may be able to be upgraded and discharged quickly. -Head and Neck patients: who have shown deterioration or have moved to the area -All other patients with voice disorders (excluding aphonia see above) These are patients where their difficulties are causing low impact on their lives and low risk to health and psychosocial well being. Examples: - Patients referred from inpatients who are at low risk and do not fall into the other categories - patients from ICT who have no risks or concerns and do not fall into the other categories - mild dysarthrias - stammerers - patients where we will have little impact due to poor prognosis or motivation. - patients who request a delay in our treatment B24