Healthier together, clinical leadership in action: Health & Social Care: Service Transformation in...
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Transcript of Healthier together, clinical leadership in action: Health & Social Care: Service Transformation in...
Health & Social Care: Service Transformation in Greater Manchester
Leila Williams Director of Service Transformation
Dr Chris BrookesMedical Director for Healthier Together
2011 - 2013
2007 - 2012
2004 - 2012
People can expect services to support them to retain their independence and be in control of their lives, recognising the importance of family and community in supporting health and well being
People should expect improved access to GP and other primary care services
Where people need services provided in their home by a number of different agencies they should expect them to planned and delivered in a more joined up way.
When people need hospital services they should expect to receive outcomes delivered in accordance with best practice standards with quality and safety paramount – the right staff, doing the right things, at the right time.
Where possible we will bring more services closer to home
For a relatively small number of patients better outcomes depend on having a smaller number of bigger services.
Planning such services will take account of the sustainable transport needs of patients and carers.
This may change what services are provided in some local hospitals, but no hospital sites will close
“The future health and social care system will look substantially different and improved quality of health care for Greater Manchester residents will be underpinned by the following key principles of a new
system:
• Healthier Together is a review of health and social care and is part of a wider public service reform, seeking to improve outcomes for all Greater Manchester residents.
• The overall aim is to improve the quality of treatment in and out of hospital under integrated care, primary care and hospital care.
• The Healthier Together programme is clinically led, and is managed by the Service Transformation team which is accountable to Greater Manchester’s 12 CCGs.
Multidisciplinary Care
Identification of Long Term Conditions
Best care pathways Medicines optimisation Integrated care teams
GP as co-ordinator of care
Involvement in Care
Access to care records Promotion of self care
Primary prevention People die in the place of their
choosing
Access and Responsiveness
Digital technology; range of access mediums
Continuity of care Increased access to primary
care services
Increased out of hospital services
Locally based enhanced services
Smooth primary/secondary care interface
Inter-practice referrals
Quality and Safety
Primary Care Strategy Themes:
Middleton Demonstrator Site
GM Integrated Care Programme
• This element of the programme is jointly led by each Clinical Commissioning Group (CCG) and Local Authority
• We are describing new out of hospital standards and service models, and the associated and necessary activity and financial shift, as part of the public conversation and engagement process on whole system reform, commencing January 2014
• We will support all 10 localities models to overcome the challenges of integrated care implementation, including:
• Models of Contracting and Reimbursement• Competition and Collaboration• Workforce• Information sharing and new technology deployment
• 10 models of integrated care will be in shadow operation by 1st April 2014 and in full operation, backed by the HM Treasury approved CBA by 1st April 2015.
v
PARTNERSHIPS
1) Leadership sign-up to new models of integrated working
2) Partnerships between NHS, local authority and 3rd sector organisations formed
3) Local programme governance arrangements established
SCOPE
4) Population to be included agreed
5) Outcomes to be delivered agreed
6) Budgets to be included identified
MODELDEVELOPMENT
7) New models of care developed and tested
8) Practice, ideas and challenges shared with other localities, working together where this makes sense
9) Investable propositions developed that will enable budgets to be moved to support new model of working
COMMISSIONING & IMPLEMENTATION
10) Approach to sharing investment and risk agreed by commissioners and providers
11) New models of care implemented
12) Outcomes continually measured, assessed & evaluated, making changes as required
Enablers: IT, workforce, estates, contracting models, service user engagement, primary care development
Process for establishing new models of Integrated Care in Greater Manchester
v
Out of Hospital Standards - ExampleQUALITY AND SAFETY STANDARDS
All providers of health and social care (like hospitals and local authorities) will: o Have ways to ensure high quality services are delivered o Publish how well they are doing against a set of standards o Learn from incident reporting, complaints and peer review
All commissioners (who buy services on behalf of a population) of health and social care will expect high quality services and will investigate unexpected variations in care All commissioners and providers of health and social care will work together to identify people whose circumstances make them vulnerable and as far as possible, protect them
from avoidable harm All members of the health and social care workforce will have the right skills and experience to deliver high quality care
THE STANDARD WILL DELIVER THE FOLLOWING OUTCOMES WHAT THIS WILL MEAN FOR YOU
People will feel confident that care and treatment is delivered to agreed safety and quality standards
People will receive consistent, high quality care People will have a positive experience of care and support
THE STANDARD MAY BE MEASURED IN A NUMBER OF WAYS
More consistent outcomes across Greater Manchester in primary care Better reporting of incidents, near misses and errors that is timely and transparent Better GP patient satisfaction survey results More people and carers who are satisfied with their experience of care and support
services More people able to access their own records More people reporting they feel safe in the care they receive Better Friends and Family test results Better staff satisfaction and reduced staff turnover rates In development: Specific Greater Manchester primary care data measures and benchmarking tool which
will include GP practice level measures
You can access information regarding the quality of
your health and social care services You can compare your health and social care services
to services elsewhere in Greater Manchester You know the care you receive is safe Your health and social care services communicate with
you openly and honestly and admit when they’ve got it wrong
You can access high quality care wherever you live In Greater Manchester
You are given information and have the knowledge about any medicines you take, their purpose, how to take them, and potential side effects
OUR JOINT COMMITMENTS
Greater Manchester health and social care commissioners give you the following commitments We will continuously strive to improve the quality of services and ensure that care is safe We will support all health and social care organisations to be open and honest, learning
from their mistakes We will learn from what people tell us about their experience of the care they receive
You give Greater Manchester the following commitments
Hospital Future Model of Care
Dr Chris Brookes
In Hospital – In Scope
• Urgent and Emergency Medicine• Acute Medicine• General Surgery• Children’s Services
Paediatrics is intrinsically linked to Maternity and Neonatal services and so these are also in scope:• Maternity Services• Neonatal Services
GM In Hospital Case for Change
For Greater Manchester to have the best health and care in the
country
GM Vision
Hospital VisionHospital services delivered in accordance with best practice standards with quality and safety paramount – the right staff, doing the right things, at the
right time
Consultant delivered care
Seven day services
Consistent, high quality care across GM
Improved outcomes and experience for patients
Effective use of workforce – right staff, doing the right things at the right time
Sustainable workforce model
Hospital Vision
Greater Manchester Quality and Safety standards were developed to describe how we might achieve the vision.
For example:
Hospital Standards
UEAM01There will be a Consultant in Emergency Medicine present between the hours of 08:00 and 24:00 (16 hours), 7 days per week
CHS08 All general acute paediatric rotas are made up of at least 10 WTEs, all of whom are EWTD compliant
…However, audits of the standards show that not all of our hospitals are achieving the standards
Audit of standards
GM Quality and Safety Standards Audit
Because each Provider is trying to do everything...
• Limited workforce spread thinly across all sites
• Some clinicians are not seeing a ‘critical mass’ of patients to maintain skills
• Variation in cover at evenings and weekends
• Lack of joint working and sharing of best practice
• Inefficient use of our workforce and estate
• Variation in compliance of Quality & Safety Standards
• Variance in patient outcomes• Variation in patient and staff
experience
A single service provided in a number of locations
We need to do something different…
• Deliver care locally for the majority of patients – Local Services;
• Upgrade Local Services so all attain standards;
• Create a smaller number of Specialist Services for the few patients with ‘once in a
lifetime’ life threatening illness and injury delivered in line with GM standards;
• Create Single Services – multi-disciplinary teams responsible for Specialist and Local
Services for a population of GM;
• Work with the Ambulance Service to direct patients to the right place at the right
time;
• Consultant led care delivered to best practice standards, and;
• Effective clinical leadership and decision making.
Future Model of Care
In summary
Future Model of CareLocal Services
Future Model of Care Local Services
Local Emergency Department
• 24/7 Emergency Department
• ~96% of current patients
Local Acute Medical Unit• Consultant led, 12 hours per day, 7 days
per week• Supported by in-reach from Care of the
Elderly professionals
Local Planned General Surgical Service• Low risk elective and day case surgery• ~81% of general surgery procedures
delivered locally
Local Specialist Services• Rapid access clinics• Outpatients• Specialist treatment such as dialysis and
some chemotherapies
• Deliver care locally for the majority of patients – Local Services• Upgrade Local Services so all attain standards
Future Model of Care Specialist Services
‘Once in a lifetime’ conditions include:• Major trauma• Stroke• Emergency surgery• Highest level of Intensive Care
~8% of patients presenting at ED
Create a smaller number of Specialist Services for the few patients with ‘once in a lifetime’ life threatening illness and injury – delivered in line with GM
standards
Specialist Services:• Fewer sites• Serving a larger population• Attainment of standards
Concentration of specialist resources
Future Model of Care Specialist Services
Future Model of Care Single ServicesCreate Single Services – multi-disciplinary teams responsible for Specialist and
Local Services for a population of GM
Sing
le S
ervi
ce
A
Local Services
Local Services Local Services
Future Model of Care Single Services
Future Model of Care Single Services
Single Service A
Local Services
Local Services
Local Services
What is a Single Service?
• One team of staff working across the sites in the Single Service
• One performance framework
• One clinical governance structure
• One training programme
Future Model of Care NWAS PathfinderWork with the Ambulance Service to direct patients to the right place at the
right time
Integrated Primary and
Social Care
Self
Care
NWAS Pathfinder
NWAS have analysed 1000 historic records and found…
Specialist ED ~11%
Local ED~68%
Primary & Community Care
~21%
Future Model of Care NWAS Pathfinder
Future Model of Care Consultant-led wards
Consultant led wards delivered to best practice standards - paediatrics, maternity and acute medicine
Consultant delivered care on wards, 7 days per week;
Delivered to GM Quality & Safety Standards, and;
Effective discharge planning and regular ward rounds – reducing Length of Stay.
Future Model of Care Consultant-led wards
Future Model of Care Clinical Decision Making
Effective clinical leadership and decision making to ensure high quality, efficient care
Ensuring appropriate senior clinical decision makers are present at the
right time at the right place to make the right treatment decisions for patients is central to the model.
Strong clinical leadership teams within each single service will be a
key factor in the success of the model of care.
Future Model of Care Clinical Decision Making
Questions