NHS Operating Framework/Out of Hospital Strategy/Integrated Care Pilot Presentation to Health and Well & Being Board ; Dr Mohini Parmar Chair Ealing Clinical Commissioning Group
NHS Outcomes Framework Domain 1 Preventing people from dying prematurely; Domain 2 Enhancing quality of life for people with long-term conditions; Domain 3 Helping people to recover from episodes of ill health or following injury; Domain 4 Ensuring that people have a positive experience of care; and Domain 5 Treating and caring for people in a safe environment; and protecting them from avoidable harm.
Contents and Agenda NHS Operating Framework; Everyone Counts; Planning For Patients 2013/4; CCG s Proposed Local Priorities Plan on a Page Planning requirements Out Of Hospital Strategy ; Development of networks Update on OOH delivery Update on OOH Strategy; Diabetes Update on OOH Strategy; Other Developments Mental Health Services Mental Health Services; Dementia update Integrated Care Pilot Progress to Date Feedback and Views Next Steps
Every One Counts; Planning For Patients 2013/4 Requirement for CCGs increasingly to develop local priorities through their input into Joint Health and Well Being strategies National Commissioning Board (NCB) asked CCGs to identify 3 local priorities against which it will make progress during 2013/4 These priorities will be taken into account when determining if the CCG should be rewarded through a Quality Premium Ealing CCG propose (subject to views of H&WB Board following indicators): Priority 1; Diabetes :( numbers with a completed care plan) Priority 2; Alcohol: % of people aged 15-75 registered with an Ealing GP who receive alcohol screening 4% Priority 3; Heart Disease: Indicator either reduction in CVD mortality or Increase in number of Health Checks By April; CCG will publish its prospectus that provides further details on its delivery of Every One Counts
Plan on a Page EALING SUMMARY PLAN ON-A-PAGE 2013-14 Context Vision Strategies and Vehicle for Change Outcome Aspiration Programmes Commissioning Developments Crosscutting Themes Maternity & Early Years Depravation, Ethnicity & wider determinants of health Poor lifestyles Cultural dependence on & high use of hospitals Growing Elderly Population Excess Cancer, CVD and Respiratory deaths Shaping a Healthier Future Secondary Care Quality Standards No growth expected Quality Standards, SaHF Providing the right care, at the right time in the right place for the population of Ealing High Quality Service Better Health Best Value for Money Right Services in the Right Place at the Right Time Increased productivity & value Reduced duplication & waste Health Promotion & Prevention Partnership Working High Quality, Cost effective services closer to patients Moving from Unplanned to Planned Improving Quality of Primary Care Services Closer to Home Patient, Public and Carer Engagement Quality Assurance Professional Education Patient Education Member Practice engagement Health Networks Out of Hospital Strategy A better start in Life Increasing breastfeeding initiation Reducing infant, neonatal mortality and still birth rates Reducing smoking in pregnancy Reducing child obesity at year 6 Reduce avoidable childhood injuries Increase childhood immunisations Increasing Life expectancy Increasing male and female life expectancy and reducing the gap with England Reduce CVD mortality Reduce respiratory mortality Reduce cancer mortality Reduce alcohol related admissions Shift Unplanned towards Planned Care Further bedding in of care-coordination and management Whole system redesign and implementation of unplanned care services across Ealing Increase the percentage of services delivered in a community setting Reduction in unplanned and emergency admissions for Ambulatory Sensitive Conditions Reduction in emergency readmissions within 30 days Reduction in delays in hospital discharge Reducing variation in primary care Improve early diagnosis and intervention Reduce variation in hospital referral patterns across Ealing GPs Improving recovery by increasing the range of and thereby access to rehabilitation service Enhanced Mental Health Services Increase the provision of community services that are responsive to need 24/7 for adults and children Reduce emergency and crisis admissions to mental health services Improve care at the end of life Increaese in proportion of deaths at preferred place Improved primary care knowledge and management of end of life symptoms Maternity & Women's Health Child Health CVD Respiratory Cancer Diabetes Alcohol Urgent and Unscheduled Care Planned Care Rehabilitation Mental Health End of Life Care Maternity Services - review and implementation of best practice Gynaecology - pathway review and recommission Safeguarding Children - bed in new organisation structure and work jointly with LA Community Children's Nursing Service - extend the scope and range of services provided Implement Diabeties Best Practice Tariff Implementation of Healthy Child Programme Implement Ealing's Child Accident Prevention Strategy Implement Healthy Weight Strategy Implement Sport and Physical Activity Strategy Cardiology - review and recommissiong community cardiology pathway Anticoagulation - roll out new community based service Increase uptake of CVD health checks in primary care COPD - bed down the new Pulmonary Rehabilitation Service Asthma - review and strengthen ashtma management in the community for adults and children Improve access to diagnostics and waiting times Improve access to cancer screening Fully bed in the Integrated Care Pilot Fully roll out Community Diabetic Model of Care Introduce alcohol awareness into Health Checks integrate alcohol service into network hubs Roll out Identification and Brief Advice (IBA) across primary care staff Targeted interventions for individuals with a high rate of alcohol related hospital admissions Roll-out and implemenation of 111 Programme Review criteria for patients attending The Urgent Care Centre and A&E at Ealing Hospital Trust Review and recomission urgent care pathway at Ealing Hospital Trust Evaluate and scale up Ealing ICE (prevention of admission service) Traingulate care pathway work to ensure better management of long term conditions within primary and community care and facilitate a reduction in aviodable UCC and A&E attendances conditions (ICP, COPD, diabetes, asthma) Review current arrangements for supported discharge - commission a range of services to ensure timely discharge from hospital and reduce excess bed days Mobilise newly commissioned Care Home Service for Nursing Home residents Fully bed in the Referral Facilitation Service - consider extension to mental health referrals Retender primary care out of hours service Review and implement new arrangements for direct access diagnostics Set up and deliver and educational programme for primary care Review and consider recommissioning the following planned care pathways - Dermatology, Opthamology, Gastro, E.N.T and Urology Implementation of prescribing initiatives Extend the scope of capacity of the community MSK Service by commissioning an Interface Clinic and additional physio capacity Commission a new enhanced falls service for patients at risk of falls or fragility fractures 1. Work with WLMHT to implement NWL Mental health Strategy including shifting settings of care. 2. Implement action plan as agreed by Ealing Dementia Board. Implement recommendations form the End of Life Service Review with the Ealing Community Services Bed in newly commissioned Macmillan GP and supported discharge service Wellbeing and Prevention Primary Care Strategy Partnership Working Use of Technology Workforce Development Community Empowerment
NHS Outcomes Framework Domain One; Preventing People dying Prematurely Actions To Date Focus on improving cancer screening rates especially for breast, bowel and cervical cytology Learning disability ; Promote uptake of Health checks People with Severe and Enduring Mental health; Use current contracting round to promote focus on physical health e.g. smoking cessation Domain Two; Enhancing Quality of Life For people with Long Term Conditions Dementia Board leading on improvements ( se later slide) Integrated Care Plot; Focus currently on diabetes but will be extended Focus on ambulatory sensitive conditions e.g. management of DVTs in ANE as part of redesign work of emergency pathway
NHS Outcomes Framework Domain 3 Helping People to Recover From Episodes of Ill Health or Following Injury Domain 4; Ensuring that People have positive Experience of Care Domain 5; Treating and caring for People in a Sage Environment, and protecting them from avoidable harm Actions Transfer of IAPT service into WLMHT (subject to agreement), Recruitment to vacant posts Use of PROMs Work with Children Community Nursing Team to reduce A&E and emergency admissions from asthma Implement Friends and Family Test starting in A&E and inpatients and then maternity ICP; focus on patient education and involve with care planning CCG plans to develop improvements to access Use 2013/4 contracting round to embed improvements in management of VTEs Use of Safety Thermometer Focus on reducing health Acquired Infections e.g. MRSA
Everyone Counts; Technical requirements CCG has to complete a template covering : Self certification of commitment to delivery of the rights and pledges of the NHS Constitution, Mandate and Clostridium difficile objective Self certification of assurance that provider cost improvement plans are deliverable without impacting on the quality and safety of patient care Trajectory for dementia diagnosis rates and Improving Access to Psychological Therapies (IAPT) - proportion of people entering treatment Trajectories for locally selected priorities; Suggested diabetes, alcohol screening and CVD in Ealing Activity trajectories for 4 key measures elective admissions for operations non-elective admissions, first outpatient attendances, A&E attendances Financial information, including a brief overview of financial position, underlying assumptions and associated risks.
Out Of Hospital Strategy Focus for CCG to deliver its aspiration of Right Care, Right Time, Right Place Builds on a number of developments that took place in 2011/12 and 2012/3 as well as new schemes Aim for both physical and mental health care to be delivered in the lowest intensity settings that are consistent with high quality care, as close to home as possible Work to date will increasingly be scaled up once CCG Clinical leads and member practices are confident in the quality and safety of service delivery Investment and Delivery is being closely monitored to be able to demonstrate to member practices, patients and the public that out of hospital services are ready to support changes to inpatient services.
Development Of Clinical Networks Organisation of practices into 7 networks across Ealing, supported by Clinical CCG Board members and Multi-Disciplinary Group (MDG)Chairs Used as basis to start to deliver out of hospital services. So far anticoagulation and paediatric phlebotomy services are network based Appointed a Head of Localities who is due to start in early April Exchange of ideas from practices to share expertise at a practice level and start to cross refer e.g. for minor surgery, etc. can be developed as basis for a number of services. CCG is working to agree with local networks, service priorities for network delivery = equitable access for patients not currently possible for services that are provided by Local Enhanced Schemes Building block for Integrated Care Pilots and multi-disciplinary working opportunity for different agencies e.g. health, social care to meet together.
Update on Out of Hospital Delivery CCG has previously reported on a number of new services being delivered in the community; Integrated Care in Ealing or ICE; delivery of intermediate care. So far 1660 patients have been seen since the 1 st April 2012. We will review this in April 2013 before further developments are agreed Anti-coagulation Services; Services are provided in all 7 of the networks. To date 223 patients have moved from hospital to primary care management since October 2012 Pulmonary Rehabilitation; Service provided by Ealing ICO. Has been in place since November 2013. To date 134 referrals and 95 have started the rolling training programme Community Ophthalmology Service; To date X patients have been seen in our 2 community clinics.
2150 Number of anticaogulation patients managed in the community 2100 2050 2000 1950 Introduction of the new anticoagulation pathway in October 2012 1900 1850 1800 1750 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13
Update on OOH Delivery; Diabetes Model based on one stop shops with Multi-disciplinary Teams working together ; To date 3 locations ( GUV, Featherstone Rd Clinic and community clinic at Ealing Hospital site) in place with plans developing to roll out to other locations in Ealing Nurse Consultant to lead Diabetic Specialist Nurses (DSN) will start at beginning of April and will support the DSNs as well as providing input into the training of practice nurses etc. Working with the ICO the CCG plans to recruit 3 new DSNs as well as appoint a specialist Community Based Diabetologist to support service delivery; increased support from other services such as dietetics and podiatry as part of diabetes delivery model Agreed model also involves commissioning Education support and Training for diabetic patients, ensuring more patients are able to work as expert patient partners Work with ICO to implement Best Practice Tariff For young diabetic patients; new package of care for children and adolescents to deliver consistent care with support to schools etc.
Update on OOH Delivery; Other Developments General Medical services (GMS) Nursing Home Tender; Currently out to tender for new GMS Nursing home Service ; Will support 1200 residents in Nursing Homes. Currently at moderation stage, and hope to announce successful bidder in next few week with service to be in place by July 2013 Other Developments as part of Contracting Round Intra- Venous Medication Delivery service in the community; Will support people with long term infections ( e.g. osteomyelitis) to be treated at home rather that have long stay in hospital End Of Life Care; New Service Specification being developed to focus on implementing delivery of new pathways of care, supporting more choice in place of death and with the ambitious targets of reducing deaths in hospitals by 14% in 2013/14 and 20% 2014/5 and consequent transfer of resources from acute to community based palliative care. Cardiology; Currently looking at new models of care to provide care closer to home, increase access to rehabilitation and specialist heart failure nursing services
Mental Health Services Working closely with colleagues from Hammersmith and Fulham and Hounslow CCGs and WLMHT to develop a transformational programme Work on Shifting Settings of Care so those with mental health problems can better access care in primary care To prepare for this we are developing plans to; Commissioning an Enhanced Primary Mental Health Service which will include developing the role of mental healthcare workers, support for primary care, and an emphasis on support to achieve personal goals and recovery Development of Detailed Plans for new roles for Mental Health staff, support for GPs e.g. pilot of a help/advice line for GPs staffed by local consultants Project Plan being developed includes developing patient and carer engagement, work with the voluntary sector as well as with member practices
Mental Health services; Dementia Update Multi-agency Dementia Board set up with a focus on health and social care as well as working with the voluntary sector and carers Plans for an Ealing Dementia Model is being discussed at Development Day scheduled for April 8 th Work with primary care to raise awareness through education events and feedback. Aim is to increase diagnosis rates from current (49.4%) to 60% in next 2 years. Gap analysis to identify where new services will be needed or where existing services could be reshaped e.g. discussion on Dementia advisors role to support primary care Work with existing general services e.g. ICE, District nursing to ensure general service can better managed those at lower end of model with easy escalation to more specialist support Fit with plans by LBE to re-model some Residential Home provision to support more dementia placements Work with WLMHT to review The Limes Nursing Home in Southall as potential specialist dementia service to support local care of complex dementia patients
Integrated Care Pilot Rollout in Ealing started in July 2012 ; to date 83% of practices in Ealing are now actively engaged in care planning and MDG working e.g. case conferences, shared learning Currently focused on two key groups; Older People over 75, and all ages with diabetes. From April 2013 will include COPD ( Chronic Obstructive Pulmonary Disease) and Cardiac Diseases patients Key to ICP is work to reduce reliance on unplanned care by preventing deterioration. Gives opportunities for groups of staff to discus individual patients. To date (Feb 2013) 1693 care plans have been completed, 6 MDTs have ben set up and 72 case conferences have ben held with 340 patients discussed(with patient consent) Acton MDG group to join Ealing ICP, moving from Inner Pilot
ICP Feedback Patient Benefit; survey of patients has shown 100% of patients asked said what they discussed was more important to them in managing their own health 96% of patients thought care planning discussions would improve their own efforts to self-management Feedback from GPs and Practice Nurses ; said ICP had changed the way they practice. Work in practices had developed to emphasised high risk patients and proactively manage them Development of Education Programme to support ICP working has also been seen as useful
Next Steps; ICP Extend conditions discussed in MDGs; involve Consultants from local Trusts, Speciality Nurses as well as practice staff, social care etc. Pilots from innovation funds being developed ; opportunities to test out new models of care e.g. night sitting service, falls plus service Focus on outcomes as part of delivery of ICP e.g. in disease management such as good blood control in diabetes, reduction in readmissions etc. Funding currently via NHS London ; ICP team looking at evaluating evidence from impact of ICP as part of securing on-going funding