DEMONSTRATING THE VALUE OF COMMUNITY SERVICES

Summer 2014

Christina Walters, Programme Director

Andrew Barber, Technical Consultant

http://www.bridgewater.nhs.uk/demonstratingthevalueofcommunityservices

To demonstrate the value of community services

The programme will establish a set of quality indicators including outcome measures, which will; • Provide evidence of the effectiveness and quality of community services • Provide a clear picture of the community ‘offer’

• Support meaningful national benchmarking of NHS community services

• Contribute to the evidence base on clinical effectiveness to support development and

improvement

• Provide information in an accessible form on the quality and value

• Support meaningful national benchmarking of NHS community services

• Underpin the development of currency and payment systems for NHS community services

For whom? For providers and the people using services, for commissioners and regulators.

Vision

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Commissioned in full by… Aspirant Community Foundation Trusts’ Network

Because:

• 18 trusts who are all on the journey to becoming an FT

• Policy gap

• National regulatory encouragement

• Self funding model works quickly

• Wide range of previous work to incorporate

• Open invitation to others brings sector and patient benefits

Who commissioned this?

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Initiated by… Bridgewater Community Healthcare NHS Trust & Southern Health NHS FT With:

• An imperative to create a range of common measures within a framework to demonstrate the quality of community services

• A range of locally developed measures in existence

• A summit for potential stakeholders

• A business case for funding

‘Aspirant foundation trust’ network of community trusts: Aspirant Community Foundation Trust Network (aCFTN): Birmingham Community Healthcare NHS Trust Bridgewater Community Healthcare NHS Trust Cambridgeshire Community Services NHS Trust Central London Community Healthcare NHS Trust Derbyshire Community Health Services NHS Trust Hertfordshire Community NHS Trust Hounslow and Richmond Community Healthcare NHS Trust Kent Community Health NHS Trust Leeds Community Healthcare NHS Trust Lincolnshire Community Health Services NHS Trust Liverpool Community Health NHS Trust Norfolk Community Health and Care NHS Trust Shropshire Community Health NHS Trust Solent NHS Trust Staffordshire and Stoke on Trent Partnership NHS Trust Sussex Community NHS Trust Worcestershire Health and Care NHS Trust Wirral Community NHS Trust

Who’s involved?

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And: Acorns Childrens Hospice Alderhey Barts Berkshire Central and North West London Cumbria Dudley Hospitals Gloucester Care Services Greater Glasgow and Clyde Isle of Man Leiccestershire Partnership Northamptonshire Healthcare North West London Peninsula Community Health CIC Pennine Care NHS FT Pennine Acute Hospitals NHS Trust QNI Royal Wolverhampton Trust Solihull South Warwickshire FT Southern Health NHS FT St Georges Suffolk Community University Hospitals Soiuthampton York Hospital FT

And…

NHS TDA

CQC Monitor

HSCIC FTN

NHS England NHS Confederation

NHS Commissioning Assembly Community Tariff Working Group

Time Clinical frameworks’

Workstreams Data and Finance

interface Engagement of

participant trusts Engagement of commissioners

National alignment & endorsement

Clinical services, teams described

Formal links & alignment of programmes

Expressions of interest from trusts

Links to Commissioning

assembly

Scoping via networks

Agreed series to develop

Representation on Programme Executive

Development of communications

Links to Local CCGs Formal links & alignment of programmes

Design frameworks Endorsement - at

each stage Resources secured

for programme Joint programme learning events

Representation on Programme Executive

Build frameworks – through workshops

Joint working to achieve data

collection mandate

Active participation - at each stage

Endorsement - at each stage

Endorsement - at each stage

Initial validation with peers,

networks, experts

Joint working to achieve currency

mandate

Ownership of clinical frameworks

with local & national value

Incorporation into commissioning

frameworks

Incorporation into quality metrics &

outcomes frameworks

Piloting, wider evaluation, revision

Sign off for national use

Timelines – where are we?

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• Community trusts collaborate

• Clinically focused steering group

• Agree definitions, scope • Agree domains for an

indicators and outcomes template

• Working groups define indicators and outcomes which map to care

• Information requirements reviewed by sector

• CIDS, CYPHS • Other assurance/outcome

frameworks • Evaluate for utility across

sector – quality, benchmarking, service offer

• Develop as currency for payment system

Clinical evidence base and consistent

approaches

Needs based quality care

with focus on outcomes

Clinical information

recorded and reported

Granular costing based on outcomes

not just activity

6 Schedule of clinical workshops

What is the overall process?

What’s our scope? Our schedule of clinical workshops

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Theme Workshop month - 2014 Theme Workshop month - 2014

Podiatry COMPLETED – DRAFT IN PREP

March

Speech and Language Therapy – Adults

October

Safeguarding and Children in Care/LAC COMPLETED – DRAFT IN PREP

April (joint with HV & SN)

Dietetics

October

Health Visiting COMPLETED – DRAFT IN PREP

April (2-group event) Occupational Therapy –Adults

October

School Nursing COMPLETED – DRAFT IN PREP

April (2-group event) Dermatology November

Physiotherapy – Adults MSK COMPLETED – DRAFT IN PREP

May (Adults MSK) Audiology

November

Respiratory – Adults COMPLETED – DRAFT IN PREP

June (Adults)

IV Therapy

During 2014

Physiotherapy – Adults – Community/ Neuro Rehab/General COMPLETED – DRAFT IN PREP

June (Adults ‘non MSK’)

Community Dentistry

During 2014

Homeless & Vulnerable COMPLETED – DRAFT IN PREP

July

Prison Health

During 2014

Falls COMPLETED – DRAFT IN PREP

July

Walk in Centres

During 2014

Joint children’s therapies session: Occupational Therapy Respiratory Speech and Language Therapy Physiotherapy

July (Children)

Continence Completed in draft form

Diabetes August

Wheelchairs Completed in draft form

District Nursing September

Tissue Viability Completed in draft form

Health Improvement / Promotion September

Family Nurse Partnership On hold

WHEELCHAIR SERVICE

Service :

Purpose (Outcome) Statement:

Ref. Title Indicator description Threshold

WC01 Referrals screened The percentage of referrals accepted that are screened within two working days of receipt of

the referral95% Responsiveness

WC02 Referrals acknowledgedThe percentage of referrers sent a written or electronic acknowledgement within five working

days of the referral being received95% Responsiveness

WC03 Referrals assessedWC03a: The percentage of referrals accepted classed as 'urgent' whose assessment takes place

within 10 working days95% Responsiveness

WC03b: The percentage of referrals accepted classed as 'routine' whose assessment takes place

within 15 working days95% Responsiveness

WC04 Tissue viability risk assessmentThe percentage of assessments, including any prior nurse assessments, that include a

documented tissue viability assessmenttbc Safety

WC05 Voucher provision The percentage of service users registered with the service who have been offered a voucher tbc Equity

WC06 Wheelchair deliveryWC06a: The percentage of service users prescribed a wheelchair who received delivery of their

wheelchair within three weeks of their prescription being written (locally held stock)tbc Responsiveness

WC06b: The percentage of service users prescribed a wheelchair who received delivery of their

wheelchair within six weeks of their prescription being written (standard manufacturer's

equipment)

tbc Responsiveness

WC06c: The percentage of service users prescribed a wheelchair who received delivery of their

wheelchair within 12 weeks of their prescription being written (bespoke seating)tbc Responsiveness

WC07 Handover certificate signedThe percentage of service users who sign a handover certificate to confirm receipt of a

handover package (on or after delivery)100% Safety

WC08 Friends and Family test score Friends and Family test score tbc Patient experience Social value

WC09Community Equipment Patient

Experience Surveytbc Social value Patient experience

WC10Single point of contact for

repairs/concernstbc Equity Responsiveness

WC11 Completion of repairs WC11a: The percentage of repairs completed within 24 hours (for emergency repairs) 95% Timeliness

WC11b: The percentage of repairs completed within three working days (for non-emergency

repairs)95% Timeliness

WC12 Clinical reviewWC12a: The percentage of wheelchair and equipment provision for children that is reviewed

within one year of provision95% Timeliness Safety

WC12b: The percentage of wheelchair and equipment provision for adults that is reviewed

within one year of provision95% Timeliness Safety

Indicator type (max. 2)

Wheelchair Service - to address a person's enduring mobility problems through assessment and provision of a wheelchair and associated postural and pressure equipment

Outcome: Service users can access a range of environments whilst safety and comfort is maximised

Quality Indicators - what do the frameworks look like?

Overarching outcome(s) Type of care

Thresholds

Performance measures: activity, responsiveness, timeliness

Descriptive Measures – drawn from evidence base and good practice

Social value, equity and inclusiveness measures

Quality measures: outcomes, patient experience, PROMS, safety

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Process of indicators development

Expert workshop

group

On the day + After the day review and comment DRAFT 1

aCFTN + Other trusts

Web site

DRAFT 2

DRAFT 3

6 - 8 weeks

4 weeks

8 weeks

Open access review and comment

Sector review and comment

Community services

Group A

A1

A2

Group B

B1

B2

B3

Group C C1

Provider Common care,

risk stratified or population

groups

Commonly applicable Quality

indicators & Outcome measures

y

x

z

Local services/teams – to

which they apply

Local Local National National

How do we get products for national use?

Can A1 – C1 be used as

Currency for Commissioning?

From our clinical workshops

• It represents a move away from how services have been commissioned in the past

• To date, the basis for commissioning services predominantly input based, paid for through cost and volume, block or a combination of both

• Often put on the “…too difficult…” pile

BUT…

• CQUIN schemes provide incentives for providers through an agreed framework

• Outcome-based service specifications

Commissioning outcomes

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• What do we mean by an outcome?

• How can we evidence outcomes?

Quantifying and agreeing outcomes

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• What do we mean by commissioning based on outcomes?

• How might this be different to current commissioning?

• What are the barriers to including commissioning arrangements based on outcomes?

• And how do we link payment to outcomes? Or is it still on block…?

Commissioning outcomes

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