UCLPartners and Health Education North Central and East London (HE NCEL) Members and Stakeholders Council Thursday 23 May 2013
Welcome and introduction Sir Cyril Chantler, Chairman, UCLPartners
Agenda 2.40pm Welcome and introduction Health Education North Central and East London update Delivery of innovation into practice UCLPartners update UCLPartners a cohesive partnership NCL Maternity Network Mumspower UCLPartners mental health 3.35pm 3.50pm Tea and coffee break Group discussion Feedback from this meeting 4.45pm Meeting ends
Health Education NCEL Chris Fowler Managing Director
Delivery of innovation into practice Professor David Fish, Managing Director, and Julian Dixon, Chief Operating Officer, UCLPartners
Who are UCLPartners? 6m population across NE and NW London, Herts, Beds and Essex 24 healthcare organisations acute and mental health trusts; community providers 19 Clinical Commissioning Groups (CCGs) 26 Boroughs and Local Councils 14 Higher Education Institutes and research networks
Our levers DISCOVERY CLINICAL TRIALS IMPLEMENTATION EVALUATION CAPABILITY Academic Health Science Centre Clinical Research Network Academic Health Science Network Applied Health Research Education and Training Relationships Patient Pull Alignment Outcomes
UCLPartners a cohesive partnership Introduction by Julian Dixon, Chief Operating Officer, UCLPartners
NCL Maternity Network Mumspower Donald Peebles, Obstetric Lead for the North Central London Maternity Network
Empowering pregnant women: enhancing key relationships through the M(ums) Power movement
The project Timescale: 2 years (started in March 2011) Based at: UCH and Barts Health Funded by: The Health Foundation as part of 7 other projects in the Closing the Gap programme Who s involved?
The case for change - M(ums)Power is committed to making antenatal services more Positive Growing numbers of women and midwives complain that antenatal services are becoming increasingly medicalised and impersonal. M(ums)Power is aiming to make antenatal care a more positive and memorable experience. I felt passed around from person to person I felt like a burden Empowering Women are often cast as the passive recipients of care, with more vulnerable groups being particularly disempowered. M(ums)Power seeks to tackle inequality through enabling and empowering every woman to take control of her pregnancy. I felt guilty asking questions in case they were stupid, the midwife seemed so busy Prospective Rising levels of postnatal depression and child inequalities have prompted widespread criticisms about the failure of antenatal care to prepare women and their families for the postnatal period and parenthood. M(ums)Power hopes to promote the health, wellbeing and opportunities of women and babies throughout pregnancy and beyond. You get home and you just don t know where to start (e)-connected Women often report feeling isolated during both their pregnancy and as new mothers. M(ums)Power is exploring ways for antenatal care services to tap into the power of relationships through cultural and technological change that builds local, social and family networks. No one tells you how lonely pregnancy can be I don t have many friends with children
Aims To change the relationship between pregnant women and clinicians by: Changing how information is delivered Making antenatal care services more personal Promoting peer-to-peer networks
The interventions
Group appointments Testing group bookings and 16 week group appointments with groups of 3-12 women to: Improve information sharing Encourage patient enquiry Encourage peer support and peer-to-peer learning We had a chance to get all the information in a relaxed environment, no rushing and I didn't need to ask for everything Make appointments more efficient It s a good opportunity for women to meet other women who are at the same stage of pregnancy
Group booking appointments A group information session (approximately 30 mins) Led by midwife Introduce women to each other Introduction to maternity services - care pathways Discussion of screening tests available including time for questions Discussion of advice in pregnancy Facilitated discussion of common concerns Tested 54 group bookings at UCLH and Bart s to date with over 150 women One-to-one with midwife (approximately 30 mins) Individualised risk assessment for pregnancy Individualised pregnancy care pathway planning Private discussion of concerns or worries Referral for blood tests, scans I like being able to dedicate more time to individual needs rather than general information sharing in the one to one
Impact Efficiency savings Women s confidence about next steps in their pregnancy CARE index A 60 minute group appointment with 5 women at 16 weeks will save 40 minutes of midwife time compared to standard care
My Pregnancy Journey It's great because it's hospital specific, and it's from a source of trust. An information site that aims to: Improve information sharing providing more personalised, tailored, local information Demystify the pregnancy journey Build bridges between clinical and community-based support Provide women with the information to take more control of their antenatal care
Impact of My Pregnancy Journey 73% of women had a question resolved by the website 82% felt that the site gave them confidence about the next steps in their pregnancy 73% would recommend this site to other pregnant women Most information is out there on the internet but it is very fragmented and not always hospital specific. I personally found hospital pretty daunting and not sure what to expect, this new website allows all of the information relevant to your hospital all in one place, easy to access, clear and user friendly. 96% of women felt that this website offered something not offered by other websites many of them commented that this was because the website offered hospital specific information When you start to plan your labour it's good to familiarise your self with staff and the hospitals services.
MumsTalk a secure, social network A secure online social network for women receiving care at UCLH that enables women to: Talk to other women who are using the same maternity services Share information about local services and groups in their area Keep in touch with women they have met at antenatal classes and at UCLH It s a really nice idea to have a community based forum where everyone has a connection to the same hospital. Often people on more general mums forums don t live near each other and are unable to exchange stories on the care they ve received. I would have loved something like this my first time round to get tips from mums that had been to the hospital on what the staff are like, what to bring e.g. flip-flops for the wet rooms
Challenges and enablers
Key challenges Clinical environment, culture and staff Intervention design and implementation Frontline practitioner resistance Risk averseness Tension between competing agendas, priorities and expectations Tension between lower cost services and improved services Evaluation challenges Patients Patient expectations and behaviour Patient behaviour
Key enablers Clinical environment, culture and staff Intervention design and implementation Strong leadership Frontline innovators people who are passionate and not afraid of failure Staff with the right skills and capabilities to work in new ways Appropriate space Toolkits and proformas are useful Develop range of interventions and platforms to support women not just one-off interactions Patients Set clear expectations Co-design with patients Segment patients according to need and risk levels
Questions?
Appendix
The state of maternity services Services under strain A 22% rise in birth rates from 2001 to 2011 Coupled with a shortage of midwives New pathway tariffs Payment for maternity services will be based on the demographic and risk profile of the women A two-tier system of antenatal care is emerging 30% of first-time parents are not offered any NHS antenatal classes NCT classes which cost 200-300 are booming Inequalities in maternity services persist Ethnic minority women, single mothers and those with a lower level of education are more likely to access services late, report poorer experiences of care and have poorer health outcomes Services not meeting women s need 1/3 of women felt that they weren t involved enough about decision about their care 1/2 would have liked more time with their midwife during their pregnancy
Developing a whole system approach to training: learning from HIET Professor Peter Fonagy, Clinical Lead for Mental Health and Wellbeing and Anna Moore, Programme Director
Costs the most: Nearly 11% of England s annual secondary care health budget is allocated to mental health care. These costs are projected to increase by 45% to 32.6 billion in 2026 (at 2007 prices) Global burden of disease report (World Health Organisation) 2008 Counting the Cost (The Kings Fund) 2011 The Challenge Mental illness accounts for the largest disease prevalence: 1 in 4 people have a mental health problem in the UK Mental illness accounts for the greatest morbidity: mental ill health is the single largest cause of disability in the UK, contributing up to 22.8% of the total burden of disease, compared to 15.9% for cancer and 16.2% for cardiovascular disease MH problems affect all parts of the system and are dealt with poorly across whole pathway: poor case recognition (takes over 4 years for person with anxiety/depression to present) poor clinical outcomes (people with MH problems die 17-25 years early) poor patient experience measures (people with MH problems are less satisfied with their care) poor functional outcomes (worse employment, do worse at school, have a worse quality of life and less likely to be integrated well into society This is true for both patients with MH problems as a primary problem and with co-morbid MH problems
Analysis Systemic problems (structure of services, poor integration of MH/PH, and between primary & secondary care) No consistent measurement of outcomes Lack of clarity about aetiology nor consistency in classification/ case identification Problems & solutions do not lie primarily within the health system Widespread competency gaps in all parts of the pathways and multidisciplinary teams Lack of funding for basic research Little consideration of preventative mental health/ focus on wellbeing Problem recruiting and retaining the workforce However..MH interventions work and are cost effective
The competency gap Commissioning of education and training to meet the competency gaps across the whole system Commissioning Commissioners don t have training in MH problems preliminary review of JSNAs show MH is not consistently dealt with across the patch PH practitioners (write JSNAs and on HWBs) have little MH training Workforce problems Clinical training is mainly focused on people with specialist MH roles crisis for recruitment into MH and quality of workforce Front line staff in primary care and acute trusts do not receive MH training No MH training outside the health system (most problems dealt with in other sectors eg schools, criminal justice system, workplace)
The mission High Impact Strategic Mental Health Education & Training Programme (HIET) Building capacity for improved patient outcomes Improving services, implementing best practice and informing mental health commissioning Programme Board Chair: Matthew Patrick Programme Director: Geraldine Strathdee In partnership with: UCLPartners Integrated Mental Health Programme
Core Principles Focused on strategic priorities to improve patient outcomes Programme been a catalyst for partnership working Whole system approach: projects have delivered training across disciplines, professions and agencies, promoting truly collaborative learning Value-based Whole pathway approach Population based All programmes fully evaluated Legacy where appropriate networks and communities of practice are established for ongoign development and peer support, driving cultural change and developing learning organisations
The strategy HIET Projects Developing MH expertise and leadership in commissioners Developing expertise in providers (acute, mental health and primary care) Pathology: Improving use of the MH act in crisis Wellbeing: Developing psychological resilience Better trained staff Strengthened leadership capacity in MH Implementation of standards for high quality care Stronger networks and partnerships to share skills and coordinate care Domain 1 Preventing people from dying prematurely Domain 2 Enhancing quality of life for people with long term conditions Improving quality & outcomes Domain 3 Helping people to recover from episodes of ill health or following injury Domain 4 Ensuring people have a positive experience of care Domain 5 Treating and caring for people in a safe environment and protecting them from avoidable harm
The outputs (highlights) 32 GP CCG Mental Health leads trained across London trained in leadership and influencing, clinical best practice, mental health informatics and commissioning to improve outcomes in mental health. Formation of a CCG MH leads network as a partnership between CCGs, SCN and UCLP for on-going development & support Needs assessment and Care Pathway Profiling reports for every CCG borough in London Over 400 GP practice nurses trained to undertake NICE QOF recommended annual physical checks of people with severe and enduring mental illness who die 15-25 years early. Training manual on physical health care of mental health patients. Senior trainers established in every MH trust. Formation of a new MH/primary care nurses network Over 1000 front-line staff trained in dementia in acute trusts Training DVDs on use of the mental health act by NHS and partner agency staff National multi-agency communication strategy on S136 use with British Transport Police - reaching 2,900 police officers. Further plans include the poster to be displayed at London Underground sites and the Faculty of Emergency Medicine A/Es with additional interest from Metropolitan Police (25,000 officers, 200 forensic HCPs) A series of expert factsheets about premature mortality in people with physical ill health as a mental health to support commissioning best practice for care pathways in cancer, CHD, Stroke COPD. An innovative first course on evidence-based behaviour change and self management
Evaluation Core part of any programme of workforce training or service delivery Developing a manualised evaluation framework that can be used to evaluate educational interventions CPPD evaluation plan including handbook, evaluation templates, implementation plan and evaluation lead specification. Consistent measures of success and consistent standards in mental health care that engages patients / carers ("measurement-based care, 'outcome focused', guidelines, etc.)
Recommendations from evaluations Commissioning Development of the formalised CCG network in partnership between CCGs, UCLP and SCN with the aim of improving patient outcomes through building capacity for evidence-based commissioning for outcomes. Use network to develop future CCG leaders Similar programmes and networks to be developed for public health and mental health communities Competency framework setting out the skills and knowledge required for primary care to effectively manage mental health has been developed to develop clinicians in the following domains: Clinicians Commissioners Community leaders Public health Leaders and managers of their practice
Nursing: Mental health master-classes for practice nurses focussing on management of specific MH problems Roll out across the whole patch of the basic physical health training facilitated through MH/primary care nursing network Wellbeing & resilience: Phase 2 behaviour change After successful pilot, roll out of behaviour change programme to build capacity in acute care Develop training tackling behaviour change in the work-place Development of e-modules to aid dissemination Informatics & Public Health Developing a PH Directors network and will provide training in MH public health Scoping of the competencies, information requirements and the development of the tools and resources that could enable better understanding of mental health needs, services and interventions Mental health informatics leadership workshop/ identification of options for developing a more strategic and coordinated approach to mental health informatics and to plan training programmes for the future
Appendix Workstream 1 Developing Primary Care Leadership Primary Care Mental Health Leadership Development Programme (NHSL, Lucent & UCLPartners) Primary Care Academy: Barnet, Enfield and Haringey Trust and Mental Health CCGs Train the Trainer GP Master Classes: Sharing Clinical Expertise across Primary Care: new models of primary care training in GP practices (Oxleas) Mental Health Master Classes and network building for GP Practice Nurses (Camden & Islington) Primary Care Mental Health Leadership Development for Practice Managers
Workstream 2 Improving Integrated Care for People with Depression Acute Hospitals: Psychological Support and Training for Staff in Major Trauma Centres Training Programme for Community and District Nurses to detect and manage Mental Illness and Premature Mortality (Oxleas) Training for Community Health Staff: Understanding and managing risk to improve safety and reduce suicide and Mental Ill Health (NELFT) Behaviour Change Programme for Health Professionals: An Introductory Course (UCLP) Suicide Prevention on the London Transport System: Literature Review and Data Analysis to Inform Commissioning, Service Delivery and Practice Models Suicide Prevention on the London Transport hot spot System (North London) Suicide Prevention on the London Transport System (Southall & Ealing) Implementation of Evidence Based care for Depression in Primary Care Practice: (London CCGs/ Strategic Clinical Network/ UCLP/ RCGP)
Workstream 3 Building Resilience in Young People and Addressing the Needs of the Top 10% London Perinatal Multi Disciplinary Network: workforce and care pathway needs from Tiers 1-4 Development of Core Competencies to Build Psychological Resilience in Vulnerable Young People through School Nurse Training Heads Up Building Resilience Programme in Schools: (Pilot from Kings primary care AHSC) Development of a Workforce Model to Address the Needs of Young adults with complex comorbidities and high risk: service use in London Boroughs Workstream 4 Improving the Use of the Mental Health Act Development of a Mental Health Informatics Competency S17 and S18/ AWOL Steli Training S136 Training Programme and multi agency induction Implementing best practice standards and Professional Development for London s S12 Doctors and Approved Mental Health Clinicians To support commissioning and delivery of best practice in integrated physical and mental health care 22 Mental Health Briefings/Factsheets Programme Evaluation: A handbook providing a practical guide to evaluation tools and embedding evaluation activity into projects is being produced, this will encourage and enable evaluation to become a core part of health professionals way of working
Group discussion
Group discussion 1. What engagement techniques work well/have members experience of using successfully? 2. How can we empower patients and communities through the work of UCLPartners and HE NCEL? 3. How can members and stakeholders support more patient and public engagement in UCLPartners?
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