QIPP: An Overview

Elizabeth Foley10 November 2010

Overview

• QIPP is the key

• AHPs are the solution

• Liberating the NHS

• Are you up for it?

Background

• National Work

• AHP matrix

• QIPP overview

• NHS Yorkshire and the Humber

The approach in Yorkshire and Humber

Phase one: Mobilisation

• Numerous network meetings

• QIPP Resource Packs

• Better for Less briefings

• Leadership events

Phase two: Implementation

• Mainstreaming QIPP into core business

• Regional workstreams

• Grip and pace

6

Our approach – regional workstreams

T-healthRegional Telehealth HubRegional Telemedicine Stroke resourceComprehensive Regional Telehealth Strategy

12 Clinically owned thresholdsClinical Thresholds

Dementia

Evidence Based Commissioning

System Wide Incentive

Staff Productivity

Future Commissioner Landscape

Future Provider Landscape

Urgent Care

Best practice and analysis of key success factorsAdvice on the key system changesLocal implementation plans

Regional policy gateway

Set of regionally owned workforce and human resources metrics and trajectories

New contract framework for non-elective services and long-term conditions

Think Tank pieces and briefingsDoncaster as a test bed

Model for new commissioning landscape

Models for the provider landscape

What do local plans tell us?

Some specific areas of potential

• Falls

• Dementia

• COPD

• Diabetes: t-health

Falls Prevention

• Pathway for Paramedics

• North Yorks County Council Pathway

• Falls Co-ordinator

• Fracture Liaison Service

ROTHERHAM COMMUNITY HEALTH SERVICES

Intermediate Care ServicesTE CARE SERVICES INTERMEDIATE CARE SERVICES

• Evidencing Quality, Innovation, Productivity and Prevention (QIPP)

• Promoting a model of care that develops alternatives to admission, reduced length of stay and care closer to home

• Delivering an interdisciplinary approach to care

• Demonstrating best practice and improved health and wellbeing

Description of Rotherham’s Service

• A joint commissioned service by NHS Rotherham and Rotherham Metropolitan Borough Council (RMBC)

• Delivered by RCHS and RMBC Providers

Providing:

• Residential rehabilitation services• Day rehabilitation services• Community rehabilitation services

Delivering:

• 6 x week rehabilitation programmes

Team:

• Joint Clinical Lead – OT and PT

• PTs, OTs, Social Care Officers, Support Workers, Home Care Enablers, Therapy support workers

Community Rehabilitation Service

Team:

• PTs, OTs and Home Care Enablers

Delivering:

• Rehabilitation to clients in their homes

• Improving/maintaining independence and function

• Supporting carers and decreasing dependence

• Maximising abilities, reducing care packages

• Improving health and wellbeing

• Client centred treatment plans

Intermediate Care Services Productivity Assumptions

2008/9 - following teams intervention impact on social care packages:

• Reduction of = 578 hours

• Cost of care = £11.50 per hour

• Saving in care = £345,644

2009/10 prediction based on 9 months data:

• Reduction of = 827 hours

• Cost of care = £11.90 per hour

• Saving in care = £507,244

• Deliverability = 3 (achievable 2 - 3 years)

• Level of evidence = 4 (research evidence NICE L2)

Intermediate Care Services Key Performance Indicators

NI 125 at 91 days post discharge from IC services and

NHS Rotherham Vital sign 04

• % of people living at home = 84.26% (target 81%

top quartile)

• % of people where health/condition has

improved/stable = 97%

• % of people reported that the service was good or

excellent = 98%

ROTHERHAM COMMUNITY HEALTH SERVICES

Description of Care Homes Liaison Service• Commissioned by NHS Rotherham

• Delivered by RCHS Adult Therapy and Adult Nursing Services

Providing:• Planned, targeted support to residential and nursing homes

By:

• Working in partnership with Care Homes Managers and Care Home Staff

• Developing a culture of person centred care• Maintaining health and wellbeing

• Promoting independence and where ill health is avoided or acted on appropriately

Care Homes Service

Delivering:

•Advice and support in the management of residents with complex needs

•Screening and identification of physical and mental health needs

•Assessments, training and rehabilitation

•Multi-factorial falls assessments and falls prevention strategies

Team:

•Joint Clinical Lead – Clinical Specialist OT-Older people and Community Matron

•PTs, OTs, SALTs, Dietician, Generic Support Workers, Reviewing Officer, Community Psychiatric Nurse

Care Homes Liaison Service

Productivity Assumptions

2008/9 - 440 admissions to hospital from 6 x Care Homes (449 beds)

(Cost of admission = £1,389,520)

From April 2009 - December 2009 - following teams intervention:

Admissions = 261

(Cost of admission) = £824,238

Care Homes Liaison Service

Productivity Assumptions

2009/2010 prediction:

• Admissions = 330

• Cost of admissions = £1,042,140

• Cash releasable = £347,380

• Deliverability = 3 (achievable 2-3 years)

• Level of evidence = 4 (NICE L2)

Care Homes Liaison Service

Key findings from review of 2 Care Homes by NHSR Commissioning team following teams interventions:

• 90% reported that the service was either good/excellent

• “training around falls was brilliant - made us think more about why people fall and preventing hospital admissions

• “Safe feeding and position training was excellent - now have dedicated meal times and this has minimised weight loss for some residents”

• “Care plans have now been adapted which are much more personalised to meet residents needs”

• The training on tissue viability was excellent - this has empowered staff to identify problems with skin tissue and refer onto services quicker”

The White Paper

• NHS Vision

• GP Consortia

• NHS Commissioning Board

• Local Authorities

• Foundation trusts

Key Themes

• Putting Patients first

• Improving Healthcare Outcomes

• Autonomy, accountability, democratic legitimacy

• Cutting bureaucracy, improving efficiency

What do AHPs need to do?

• Get organised

• Be Strategic

• Be Coherent

• Added Value – be succinct

• Have a narrative

NHS Networks Healthcare

Professions Commissioning Network

http://www.networks.nhs.uk/nhs-networks/healthcare-professionals-commissioning-network

Katherine Andrews

NHS Networks

Katherine.andrews@networks.nhs.uk

Tel 07805 027463

Thank you

Elizabeth Foley

Elizabeth.foley@yorksandhumber.nhs.uk