midlands and east ltc learning event 3 nov 15
TRANSCRIPT
www.england.nhs.uk
The Big Shed, Leicester
Midlands & East Region
LTC Person Centred Care
Learning Event
3rd November 2015#A4PCC
www.england.nhs.uk
David Levy
NHSE Medical Director,
Midlands and East
Long term conditions
Getting it right
15th October 2015
www.england.nhs.uk
Why a New model of care?
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Unaffordable healthcare
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Social care changes
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Gearing of investment across the system
170
330
1000
500
0
100
200
300
400
500
600
700
800
900
1000
Primary Care Community and Mental Health
Acute Specialist
FOR EVERY £2000 SPENT…
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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The future: 2015 - 2020
7
Community
Care
Primary
Care
General
Hospital
University/
Specialist
Facilities
Social Care
General
Hospital
ICare
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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• Serious about prevention
Diabetes prevention
• Serious about new models of care
Patient focused
• Serious about efficiencies
5YFV
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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New Models
• Patient-led care
• Vanguards
• 7 days services
• Your model
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Patient led care
• Patients have a right to lead, not just to be involved
• Technology is an enabler
• Offer choice and listen
• Clinicians attitudes and our systems are a stumbling
block
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
www.england.nhs.ukSustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
www.england.nhs.ukSustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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The 7 day services jigsaw
11/23/2015
Hospital
Acute care
pathway
Acute care
out of
hospital
7 day
Primary
Care
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Urgent and Emergency Care Review
Implementation:
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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The review will be underpinned by two key principles:
• For those people with urgent care
needs, including people experiencing
mental health crisis, we should
provide a highly responsive
service that delivers care as close
to home as possible, minimising
disruption and inconvenience for
patients and their families.
• For those people with more serious
or life threatening emergency care
needs, we should ensure they are
treated in centres with the very
best expertise and facilities in
order to maximise the chances of
survival and a good recovery.
1
5
432
6
7Parity of
esteem for
mental
health
Urgent and Emergency Care pathways
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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• Urgent care centres
• Typically non-medical clinical staff
• At least 0800-2400 each day
• Support and advice from primary and secondary care doctors
• Emergency centres
• Continuous supervision by a team of consultants trained in Emergency Medicine
• Emergency centres, with specialist care services
Out of home services
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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• Now is the once in a life time opportunity
• Its about improving
• Care
• Experience
• Outcomes, that matter to the patient
Your model
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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We need to get on with it…
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Beverley Matthews
Long term conditions programme lead
@Bev_J_Matthews
Icebreaker and introductions
#A4PCC
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Trevor Fossey
Twitter: @Trevor Fossey
Email: [email protected]
Empowerment enhances Engagement
A personal experience
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Power of
Information
• GP records
• Engagement
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Personal empowerment
Brief background to personal engagement as a result of empowerment
• Online access to
GP record
• Benefit for GPs
• Mental Health
Benefits
• Other benefits
201520142013Pre-2012
• Experience in
working role
• Health & Care
Issues
• Experience in
NHS as a patient
& Carer
Promote to citizens
• @PatientOnline
• @Co4CC
• Black Country LCG
• Other opportunities
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Access to Notes & Test Results
• Check accuracy of record
• Review & contemplate GP notes
• Time to understand test results
Information about this test
How is it used?
When is it requested?
What does the test result mean
Is there anything else I should know?
http://www.labtestsonline.org.uk/
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Benefits of Empowerment via access to my own records
• Online access to my own records has
• helped change my own ‘culture’ towards my own health care
• benefitted my wellbeing, particularly mental health
• Overview/summary of experience
• Greater involvement in own wellbeing
• Feel more in control & engaged with my own health
Empowerment “has first enhanced the relationship that I have with my GP practice - and I am confident that it will continue to improve my health & wellbeing”
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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NHS England Vision and scope workshop
Summary of output
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Patient
Centred
Model
I can see my care across
the continuum of :
• time
• health and care
• different services
I have online access:
• to all services
• all information in my
records
• from anywhere
I can contribute to my records
We care about:
• those not online
• equity of access across
the country
• special needs
Patients are empowered to understand and take control
Records are a vehicle for sharing between
the patient and the practice
We need in place:
• adequate capacity (appointments)
• contracts that support us
• trained clinicians
• transparency
• clear guidance
• technical infrastructure
We need to understand:
• what is possible
• the benefits
• the mechanisms
• the constraints
• the risks
• our learning and experience so far
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Patient Representative
NHS England - Patient Online Programme
Shadow Co-Chair & member of Co-production group
Coalition for Collaborative Care
Twitter: @TrevorFossey #PatientOnline
LinkedIn: http://www.linkedin.com/pub/trevor-fossey/15/b44/10a
Mobile: +44 7932223449
eMail: [email protected]
Any Questions?
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Susie Peachey
Delivery support manager
@PeacheySusie
Using simulation to drive
commissioning for value
#A4PCC
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Launched in June 2012 under Department of Health QIPP programme
Transferred to NHS England in December 2013 and delivered by NHSIQ from April 2014, and now the Sustainable Improvement Team
SRO is Dr Martin McShane, Medical Director for LTCs, NHSE England
LTC Year of Care Commissioning Programme:
Early Implementer Care Economy Region
Leeds North
Southend Midlands and East
Kent South
West Hampshire South
Barking, Havering and Redbridge London
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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LTC Year of Care Commissioning Developing a Year of Care Capitated Budget approach for those
with Complex Care Needs
• 5 Early Implementer sites
• Approx 18 Fast Followers
• Whole Population Datasets
• Implementation Guide
• Simulation Modelling
• Specialist Support Team
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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A service and system redesign
Understanding the impact of changing service utilisation on: Flow
Cost
Capacity/Resource
No historic data
Different impacts on organisations, costs and patients
Identify patients in each “state” A likelihood of accessing certain types of service (Acute, Community, Mental
Health, Social Care), including accessing services more than once
Demonstrate costs associated with those services.
Why Use Simulation Modelling?
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Dataset Requirements:
Whole population activity and cost dataset, including acute,
community, mental health and GP practice activity data
Risk population segmentation
SIMUL8 simulation model parameters:
Distributions for activity and costs, for each cohort and activity type
Set access rate and staff FTE resource, for each cohort and activity
type
Rate of movement of patients into cohorts, between cohorts and
death
Compare current service model with new service model
Preparing for Simulation
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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The Simulation Model
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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• Group
patients by
level of acuity
• Increasing
numbers of
long term
conditions
What drives the model?
Patients with long term conditions by acuity
#LTCImp #A4PCC
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Simulation Model Results
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Simulation Model Results
Estimated staff shift (FTE)
Acute Community
Mental
Health
Primary
Care
Total -83.5 53.8 3.1 68.4
Patients Mean annual cost per
patient (£)
Potential capitated
budget (£ mill.)
Current New Current New
31,987 £5,881 £5,830 £188.1 £186.5
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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• Patients in each group
access services
• Often more than once
• Each service is a
associated with a range
of costs
• Each service has an
associated capacity
How it works
Patient
Services
Costs
Capacity
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Lunch and networking
#A4PCC
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Beverley Matthews
Long term conditions programme lead
@Bev_J_Matthews
Ideation workshop
#A4PCC
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Randomised coffee trial
#A4PCC
Discuss and share one thing you are doing
on your patch around
person centred coordinated care
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
www.england.nhs.uk
Beverley Matthews
Long term conditions programme lead
@Bev_J_Matthews
Ideation workshop
#A4PCC
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Lynnette Leman
Delivery support manager
@LynnetteNHS
Our Declaration,
My Declaration
#A4PCC
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Long Term Conditions Behavioural Change Programme
I
#A4PCC – Action for Person-Centred Care
#LTCImp #A4PCC
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Long term conditions: the facts
2o 15 million people in England with long term conditions
have the greatest healthcare needs of the population
(50% of all GP appointments and 70% of all bed days)
o Their treatment and care absorbs 70% of NHS and
social care budgets in England
o 30% have more than one LTC, which increases with
age and deprivation
o People living longer but not always well
o Focus on treating the disease not the person
o Increasing evidence on over-treatment and harm
o System working as individual components
o Major spending cuts to public sector including a recent
£200m reduction in public health budgets
#A4PCC – Action for Person-Centred Care
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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LTC Framework 3o House of Care
o Empowered patient and carers
o Professional collaboration
o Best practice (clinical and
organisational)
o Commissioning
o Delivering person-centred co-
ordinated care
#A4PCC – Action for Person-Centred Care
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Why is person-centred care important for people with long term conditions?
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o Wellbeing is about more than just medically managing a condition
o Is it acceptable for life to be just endured and not really lived well?
o It’s an ethical, social and financial issue
o Shared decision-making is key
o We need to take account of self-care, feeling in control and the impact on mental health
o No one knows more about their condition than the patient
#A4PCC – Action for Person-Centred Care
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Our Declaration 5o Launched at Expo 2015
o The importance of person-centred care for
people with long-term conditions, what
needs to change and why we need to
change
o Co-produced with NHS England and
Coalition for Collaborative Care and
developed with health and care
professionals, policy makers and people
with long-term conditions
o We need to motivate health and care
professionals to help us make it a reality#A4PCC – Action for Person-Centred Care
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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6 My Declarationo We want health and care professionals
to declare their commitment to
embedding patient-centred care in their
work
o On a postcard or online at
www.engage.england.nhs.uk/survey/ltc-
declaration
o Ideas that can be shared and developed
o “We want to do this – but we need
support to make it happen”
o Our offer: expertise in engagement,
problem-solving and partnership working#A4PCC – Action for Person-Centred Care
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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7Using behavioural
change to open minds
o Our Declaration, My Declaration
o Building the brand
o Using social and digital media to spread the message
o #A4PCC (Action for Person-Centred Care)
o Mini case studies to inspire and share best practice
o Grassroots campaign – foundation and acute trusts
o Understanding what CCGs and GPs need
o Bespoke improvement support
o Animation and eBook about Our Declaration
o LTC monthly newsletter
o Ethnographic work with Ipsos MORI
o Toolkit of resources and products
o Lunch and Learn webinars and Tweetchats
o Clinical champions
#A4PCC – Action for Person-Centred Care
Person with long
term condition
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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8 What part will you play?o Make a declaration at
www.engage.england.nhs.uk/survey/ltc-
declaration
o Tell your teams about our work
o Encourage them to make a declaration
o Ask them to feed back thoughts and ideas
o Use our hashtag – #A4PCC – when you see
work that is relevant to person-centred care
for people with LTCs
o Let us know of any events, activities or social
media opportunities that we can join forces
with you#A4PCC – Action for Person-Centred Care
YOU CAN MAKE A DIFFERENCE
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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E
#A4PCC – Action for Person-Centred Care
Questions?
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Trevor Fossey
@TrevorFossey
Beverley Matthews
@Bev_J_Matthews
Summary of the day and next
steps
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Long term conditions resources
Simulation model
Unbundling recovery simulation model
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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• Patient access to, and understanding their records
• West Essex – delivering person centred care
• Living Well – Cornwall delivering person centred care
• Better Together – Dorset CCG
• Personal records underpin integrated care on the Isle
of Wight
• Volunteer-led support within the MDT helps older
people to achieve their aspirations, improving quality
of life and reducing costs across the system
Case study links
• 3 November 2015 #A4PCC
#LTCImp #A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
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Stepping forward - RCGP
http://www.rcgp.org.uk/clinical-and-research/our-programmes/~/media/Files/CIRC/Quality-Improvement/RCGP-Stepping-Forward-2016.ash x
#A4PCC
Sustainable Improvement Team long term conditions networking event 3 November 2015, Leicester
#LTCImp #A4PCC