Post on 23-Jan-2016
description
Paediatric Quality Indicators Workshop
Introduction to developing and
commissioning pathways
Simon Lenton, Children’s & Young Peoples Outcome Forum
CYP HOF
Scope1. Identify the health outcomes that matter most for
children and young people.
2. Consider how well these are supported by the NHS and public health outcomes frameworks
3. Set out how different parts of the health system – DH, NHSCB, PHE, HEE and others will contribute to delivery of these outcomes, and how they will work with each other and with other partners to this end.
Systems thinking
A health system has been defined as
“all organisations, people and actions whose primary intent is to promote, restore
or maintain health.”
Its purpose is to “improve health and health equity in ways that are responsive, financially fair and make the best use of available resources”. (WHO)
Integrated care – a culture
"integrated care demands a culture of its own, one that spans differing organisational and professional mindsets, eliminates boundaries and biases.
It shares a common space to facilitate a much needed interagency collaboration and interdisciplinary teamwork on behalf of the patient"
(Kodner 2009)
Ref: BACCH – “the meaning of integration”
What do we all want?
• Right interventions• Right children• Right professionals• Right place• Right time• Right support• Right cost
Safety, good experience, great outcomes
“All in place and working well together”
Partnerships - key criteria• a collaborative relationship among multiple
organisations in which risks and benefits are shared in pursuit of a shared goal.
plus shared
• values – principles – practice
plus
• leadership
to createsynergy and alignment
Commissioning
“the process of allocating public resources to achieve the greatest gains in health within a defined population”.
Truly effective commissioning requires strong collaboration
between commissioners, providers and regulators, with integration of functions whenever possible
Start here
Not Here
With thanks to Charlie Keeney
What is the CFHC approach?
• Distil the Conventions into simple concepts
• Easily understandable framework for change
• Transcend the concept and language issues
• Adopted and adapted by health care systems
• The new model must create alignment – at a high level between politicians – planners and financiers, between agencies – between patients, clinicians and managers
• Drive learning and improvementCFHC = Child Friendly Health Care
Development of the CFHC approach
Human rights
Children’s rights
Principles
CFHC
approach
Needs Services Outcomes
Principles for children’s services
• Participation
• Promotion
• Protection
• Prevention
• Provision– pathways
PATHOGENIC APPROACH
- Individual
- Family
- Community
- Society
PROTECTION
SALUTOGENICAPPROACH
- Individual
- Family
- Community
- Society
PROMOTION
Promotion and protection a new framework
Health and illnessWhat creates health?What creates illness?
Slide: adapted from Fabrizio Simonelli
Promotion
• Healthy eating
• Screening
• 20 disability
• Competent staff
Prevention
• Primary
• Secondary
• Tertiary
• Quaternary
Protection
• Fluoridisation
• Domestic violence
• Poverty
• Drug errors
Alignment and synergy
needs services outcomes
health harming
determinants
Society
health promoting
determinants
communityinterventions
health harming lifestyles
health promoting lifestyles
lifestyleinterventions
Provision based on pathwaysPurpose, values, evidence and learning.
needs outcomesp r a i
Needs Outcomes
Health
Equity
Sustainable
Prevention Recognition Assessment Interventions
Protection
Promotion
Concern
Screening
Family
Child
Social
Psychiatric
Child
Family
Community
Short term condition pathway
Condition
Community Educational
Medical
Behavioural
Surgical
Pathway componentsPurpose, values, evidence and learning.
PurposePrinciples
needs outcomes
healthequitysustainable
participationpreventionprovision
p r a i
Pathway componentsPurpose, values, evidence and learning.
PurposeValues/rights
needs outcomes
healthequitysustainable
participationpreventionprovision
Learning
LearningEvidence
p r a i
quantitativequalitativeeconometric
measuresfeedbackimprovement
Long term condition
Initialpathway
Transition pathway
NeedsCondition
FamilyCommunity
OutcomesEffectiveness
EfficiencyEquity
Reviewpathway
Network of services
Environment
Initial, review and transition pathways
Myriad of measures!!!
needs c outcomesc c c c
Child
Community
Family
Determinants
Harm Exposure
Effectiveness
EquityEfficiency
AccessibilityAffordability
Acceptability
Outputs
Components
ProcessStructure
Environment
c = component
Key measures
Health service outcomemeasures
Life course outcomemeasures
Healthimpact
measures
Health measures
Health service impact
measures
Health service measures
Public service
measures
Determinants and lifestylemeasures
Needs Outcomes
Wholepathway
NHS CB
PHLA
CCG
Commissioners
AcademiesPersonal budgetsHealth insurance
‘CJS’
WorkforceResearch
Innovation???
Commissioning pathway components
p r a i
NHS CB
Pregnancy care CMV
(primary)
Cochlear
Implants
(specialist)
Booking <12 w
Timeliness
CCG
Genetic
counselling
Paediatric
audiology
assessment
SaLT
Parent support
Yield
Hearing@12m
LA
Hearing
Advisers
Hearing loops
Language dev
Ed achievement
PH
MMR
immunisation
Neonatal
Screening
Healthy Child
Uptake
needs outcomes
Commissioning – what should it look like in the future?
• a shift from contracting services towards commissioning programmes of care
• supported by a series of measures that reflect quality and can identify the weakest link in the pathway
• commissioning for quality improvement being integral to the contracting process
• a pooled commissioning budget and the capacity to vire resources within a network.
• network collaboration by different service providers whether NHS Trusts/social enterprise/private sectors
• a reduction in the number of commissioners involved or integrated working of the commissioners involved.
Thank you
Health service
outcomes
Public health outcomes
Health outcomes
Life coursepathway
Review cycle
Social impact
Environmentalimpact
Health impact
Review cycle
Service pathways
Sustainable
Equity
Life coursepathway
Health outcomes
Life coursepathway Bringing outcomes together
Quality Compass
Efficacy
Effectiveness
Efficiency
Equity
Acceptable
Accessible
Affordable
Appropriate
Safety, experience and outcomes
Quality, innovation, prevention, productivity
Managed networks
• “Linked groups of health professionals from primary, secondary and tertiary care, working in a co-ordinated manner, unconstrained by existing professional and Trust/Health Authority boundaries, to ensure equitable provision of high quality and clinically effective services.”
A later definition describes the function of managed networks is being
• "a group of organisations, services and professionals working collaboratively to continually improve the services they provide through a process of learning from innovation and quality improvement".
•
CYP HOF
Purpose
The strategy will aim to maximise health outcomes for all children and young
people, showing how all parts of the health system, with partners, will contribute to
enabling every child and young person to reach their full potential
Needs Outcomes
Network
NHS
PrivateLA
Social Enterprise
Providers
‘CJS’
‘Public health’
Needs Outcomes
Network
Quality
OrganisationalProfessional
Economic
Regulators
Implications of integrated pathway based networks (1)
1. Combined commissioning strategies across health, education, social care and criminal justice systems.
2. Provider organisations sharing the same knowledge base and approach to implementation of evidence-based guidelines.
3. Shared governance systems across organisations.4. A shared approach to measurement and improvement5. Financing systems where resources follow patients
through pathways and networks - introduction of program budgeting.
Implications of integrated pathway based networks (2)
6. Workforce planning based on the right skill mix to ensure competent teams working in networks.
7. Integrating public health approaches to prevention across all pathways.
8. Greater emphasis on both equity of access and outcomes.
9. Combining regulation to ensure effectiveness, efficiency and equity bringing together quality and economic regulators and a greater emphasis on equity