Your SlideShare is downloading. ×
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services

596

Published on

Health and Care Innovation Expo 2014, Pop-up University …

Health and Care Innovation Expo 2014, Pop-up University

S200 - Day 1 - 0930 - Commissioning for outcomes in specialised services

Fiona Marley
Donna Hakes

#Expo14NHS

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
596
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
11
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Specialised services Presented by: Fiona Marley and Donna Hakes EXPO / March 2014
  • 2. The history of specialised services • Before April 2013, specialised services in England were commissioned by 10 regionally based, specialised commissioning teams and a national team, which commissioned highly specialised services • The regional teams commissioned services for their resident populations • The regional teams evolved and operated in different ways according to the particular agreements and arrangements with their constituent Primary Care Trusts, who collaborated together to commission specialised services • This resulted in commissioning variation and differential access, service standards and specifications for services across regions (sometimes with the same provider) • A Specialised Services National Definitions Set (SSNDS) provided a collection of 34 service definitions but its application was inconsistent and no region commissioned all the services in the SSNDS
  • 3. The Health & Social Care Act 2012 • From April 2013/14,the Health and Social Care Act has defined specialised services as directly commissioned 'prescribed' services, based on four factors: • The number of individuals who require provision of the service or facility • The number of persons able to provide the service or facility • The cost of providing the service or facility • The financial implications for Clinical Commissioning Groups (CCGs) if they were required to arrange for the provision of the service or facility themselves • The four factors determine whether NHS England commissions a service as a prescribed specialised service; it must also be possible to identify the prescribed activity separately to CCG-commissioned activity
  • 4. How services are ‘prescribed’ • Ministers receive advice and consult with NHS England • In 2013/14 there are 143 prescribed specialised services • Listed in Regulations • Described in the ‘Manual’ 4
  • 5. How are changes made to the list? services?HMinisters take advice about: • The services currently included on the list • Services currently commissioned by NHS England that might more appropriately be commissioned by CCGs • Services currently commissioned by CCGs that might more appropriately be commissioned by NHS England • Innovative new treatments that are not part of existing services and which might be assessed by the new NICE HST Programme It is not anticipated that there will be significant changes to the list for 2014/15 5
  • 6. Approach to commissioning Specialised Services • NHS England is working with a range of stakeholders at a national level to determine the outcomes expected for specialised services • This is being achieved through evidence based, cost effective, patient- focused commissioning, based on nationally developed clinical strategies through the five National Programmes of Care (PoC), which group together the prescribed specialised services • The programmes span three portfolios covering acute, highly specialised and mental health services • A national matrix team ensures a single national approach to specialised commissioning, working with the four regions and the 10 Area Teams (ATs) that have responsibility for contracting specialised services
  • 7. Making it Happen: NHS England Medical and Operations Directorates Medical Directorate Operations Directorate National Clinical Lead NPM 8d Portfolio PB9 NPM 8d NPM 8d NPM 8d Internal Med Cancer & Blood NPM 8d NPM 8dTrauma NPM 8d NPM 8d Women & Children RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b Medical Director Medical Director Medical Director Medical Director Regional Director Regional Director Regional Director Regional Director RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b Mental Health Portfolio PB9 Portfolio PB9 Mental Health 8d NPM 8d NPM 8d Medical Director Local Area Director N1 Medical Director Local Area Director N2 Medical Director Local Area Director N3 Medical Director Local Area Director M1 Medical Director Local Area Director M2 Medical Director Local Area Director M3 Medical Director Local Area Director L1 Medical Director Local Area Director S1 Medical Director Local Area Director S2 Medical Director Local Area Director S3 Internal Med Cancer & Blood Trauma Women & Children Mental Health STRATEGICCLINICALNETWORKS NATIONAL CLINICAL REFERENCE GROUPS PROVIDERS HEALTH&WELLBEINGBOARDS CLINICAL SENATES CONTRACTING National Operational Lead Clinical Effectiveness Team PUBLIC HEALTH ENGLAND NHS COMMISSIONING BOARD PPE FORUM NATIONALCOMMISSIONINGPRODUCTS CLINICAL COMMISSIONING POLICY PPE FORUM PPE FORUM PPE FORUM PPE FORUM National Clinical Lead Patient Insight Directorate Highly Specialised Acute NPM REGIONAL IMPLEMENTATION North Midlands & East London South
  • 8. Commissioning Portfolios Medical Directorate Operations Directorate National Clinical Lead NPM 8d Portfolio PB9 NPM 8d NPM 8d NPM 8d Internal Med Cancer & Blood NPM 8d NPM 8dTrauma NPM 8d NPM 8d Women & Children RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b Medical Director Medical Director Medical Director Medical Director Regional Director Regional Director Regional Director Regional Director RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b Mental Health Portfolio PB9 Portfolio PB9 Mental Health 8d NPM 8d NPM 8d Medical Director Local Area Director N1 Medical Director Local Area Director N2 Medical Director Local Area Director N3 Medical Director Local Area Director M1 Medical Director Local Area Director M2 Medical Director Local Area Director M3 Medical Director Local Area Director L1 Medical Director Local Area Director S1 Medical Director Local Area Director S2 Medical Director Local Area Director S3 Internal Med Cancer & Blood Trauma Women & Children Mental Health STRATEGICCLINICALNETWORKS NATIONAL CLINICAL REFERENCE GROUPS PROVIDERS HEALTH&WELLBEINGBOARDS CLINICAL SENATES CONTRACTING National Operational Lead Clinical Effectiveness Team PUBLIC HEALTH ENGLAND NHS COMMISSIONING BOARD PPE FORUM NATIONALCOMMISSIONINGPRODUCTS CLINICAL COMMISSIONING POLICY PPE FORUM PPE FORUM PPE FORUM PPE FORUM National Clinical Lead Patient Insight Directorate Highly Specialised Acute NPM REGIONAL IMPLEMENTATION North Midlands & East London South 3 Commissioning Portfolios
  • 9. Programmes of Care Medical Directorate Operations Directorate National Clinical Lead NPM 8d Portfolio PB9 NPM 8d NPM 8d NPM 8d Internal Med Cancer & Blood NPM 8d NPM 8dTrauma NPM 8d NPM 8d Women & Children RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b Medical Director Medical Director Medical Director Medical Director Regional Director Regional Director Regional Director Regional Director RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b Mental Health Portfolio PB9 Portfolio PB9 Mental Health 8d NPM 8d NPM 8d Medical Director Local Area Director N1 Medical Director Local Area Director N2 Medical Director Local Area Director N3 Medical Director Local Area Director M1 Medical Director Local Area Director M2 Medical Director Local Area Director M3 Medical Director Local Area Director L1 Medical Director Local Area Director S1 Medical Director Local Area Director S2 Medical Director Local Area Director S3 Internal Med Cancer & Blood Trauma Women & Children Mental Health STRATEGICCLINICALNETWORKS NATIONAL CLINICAL REFERENCE GROUPS PROVIDERS HEALTH&WELLBEINGBOARDS CLINICAL SENATES CONTRACTING National Operational Lead Clinical Effectiveness Team PUBLIC HEALTH ENGLAND NHS COMMISSIONING BOARD PPE FORUM NATIONALCOMMISSIONINGPRODUCTS CLINICAL COMMISSIONING POLICY PPE FORUM PPE FORUM PPE FORUM PPE FORUM National Clinical Lead Patient Insight Directorate Highly Specialised Acute NPM REGIONAL IMPLEMENTATION North Midlands & East London South 5 Programmes of Care
  • 10. Regional Oversight Medical Directorate Operations Directorate National Clinical Lead NPM 8d Portfolio PB9 NPM 8d NPM 8d NPM 8d Internal Med Cancer & Blood NPM 8d NPM 8dTrauma NPM 8d NPM 8d Women & Children RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b Medical Director Medical Director Medical Director Medical Director Regional Director Regional Director Regional Director Regional Director RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b Mental Health Portfolio PB9 Portfolio PB9 Mental Health 8d NPM 8d NPM 8d Medical Director Local Area Director N1 Medical Director Local Area Director N2 Medical Director Local Area Director N3 Medical Director Local Area Director M1 Medical Director Local Area Director M2 Medical Director Local Area Director M3 Medical Director Local Area Director L1 Medical Director Local Area Director S1 Medical Director Local Area Director S2 Medical Director Local Area Director S3 Internal Med Cancer & Blood Trauma Women & Children Mental Health STRATEGICCLINICALNETWORKS NATIONAL CLINICAL REFERENCE GROUPS PROVIDERS HEALTH&WELLBEINGBOARDS CLINICAL SENATES CONTRACTING National Operational Lead Clinical Effectiveness Team PUBLIC HEALTH ENGLAND NHS COMMISSIONING BOARD PPE FORUM NATIONALCOMMISSIONINGPRODUCTS CLINICAL COMMISSIONING POLICY PPE FORUM PPE FORUM PPE FORUM PPE FORUM National Clinical Lead Patient Insight Directorate Highly Specialised Acute NPM REGIONAL IMPLEMENTATION North Midlands & East London South 4 Regional Oversight Teams
  • 11. Area Teams Medical Directorate Operations Directorate National Clinical Lead NPM 8d Portfolio PB9 NPM 8d NPM 8d NPM 8d Internal Med Cancer & Blood NPM 8d NPM 8dTrauma NPM 8d NPM 8d Women & Children RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b Medical Director Medical Director Medical Director Medical Director Regional Director Regional Director Regional Director Regional Director RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b RPM 8b Mental Health Portfolio PB9 Portfolio PB9 Mental Health 8d NPM 8d NPM 8d Medical Director Local Area Director N1 Medical Director Local Area Director N2 Medical Director Local Area Director N3 Medical Director Local Area Director M1 Medical Director Local Area Director M2 Medical Director Local Area Director M3 Medical Director Local Area Director L1 Medical Director Local Area Director S1 Medical Director Local Area Director S2 Medical Director Local Area Director S3 Internal Med Cancer & Blood Trauma Women & Children Mental Health STRATEGICCLINICALNETWORKS NATIONAL CLINICAL REFERENCE GROUPS PROVIDERS HEALTH&WELLBEINGBOARDS CLINICAL SENATES CONTRACTING National Operational Lead Clinical Effectiveness Team PUBLIC HEALTH ENGLAND NHS COMMISSIONING BOARD PPE FORUM NATIONALCOMMISSIONINGPRODUCTS CLINICAL COMMISSIONING POLICY PPE FORUM PPE FORUM PPE FORUM PPE FORUM National Clinical Lead Patient Insight Directorate Highly Specialised Acute NPM REGIONAL IMPLEMENTATION North Midlands & East London South 10 Contracting Local Area Teams
  • 12. What has been achieved in 2013 / 2014 • Single national approach • Clinically led • Patient focused • Collaborative 12
  • 13. Goals 2000 clinicians and patients working to a common framework All inclusive stakeholder identification and participation in service development (pathfinder groups with CCGs) Service specifications across every service we commission A service specific innovation portfolio and commissioning through evaluation Service specific quality measures and dashboards across every service we commission A productivity workstream with focus on lean systems and transformational change to release money to invest 5 Year Specialised Services Strategy
  • 14. 14
  • 15. Clinical Reference Groups • Over 2000 clinicians, commissioners and patient/carer representatives working to a common framework • All inclusive stakeholder identification and participation in service development • Expanded to now cover 75 specialised service areas • Internal medicine - Digestion, Renal, Hepatobiliary, Circulation system • Cancer and Blood - Infection, Cancer, Immunity, Haematology • Trauma - Traumatic injuries, Orthopaedics, Head and Neck, Rehabilitation • Woman and Children - Congenital and Inherited Diseases • Mental Health 15
  • 16. Medicines Optimisation CRG • Provide support to all other CRGs • Provide advice to other stakeholders e.g. NICE • Products include gain share recommendations • Close links with National Pharmacy Supply Group /Pharmaceutical Market Support Group 16
  • 17. What is CPAG? • Advisory group covering all directly commissioned services, not just specialised services • The group for difficult decision making. Health care commissioners have a statutory responsibility to ensure that care, including medicines and treatments, is commissioned within available resources (Department of Health, 2010). In order to secure the best value healthcare and the greatest health benefit for their populations, CPAG members need to make recommendations to prioritise the allocation of limited resources and balance demands for medicines and treatments against a number of considerations. • Monthly meetings • Secretariat provided by the Clinical Effectiveness Team 17
  • 18. CPAG Objectives • To provide a recommendation to the Directly Commissioned Services Committee on the commissioning of services where there could be a substantial change in service provision. • Such change will include a call on resources as defined by clinical effectiveness, cost effectiveness, appropriateness and relative priority of new and existing treatments / services. • If treatment is of unproven effectiveness, poor cost effectiveness or of low overall priority, the group will advise under what circumstances the treatment should be made available to patients. • The process of priority setting by CPAG is designed to be open, transparent and consistent. 18
  • 19. Clinical Policies • Clinical commissioning policies set out NHS England’s position in relation to the commissioning of particular treatment, describing what will, and will not, be commissioned. • Policies may be described as ‘interim’ for example if NICE are considering the treatment/indication under the Technology Appraisal programme and will be publishing findings within the near future, but there is a clinical urgency for a policy position in the meantime. • 44 national clinical policies in place on 1 April 2013. 61 now published. • Programme of over 80 policies in development, most dealing with transitional issues • Feedback received during consultation is used by the relevant specialised services Clinical Reference Groups (CRGs) in the development of full policies for future use. 19
  • 20. Policy development governance flowchart
  • 21. Service Specifications • Service specifications set out what is expected from providers and define access to a service. They also set out a series of core and developmental standards. Core standards are those which any reasonable provider of a service should be able to demonstrate, whilst developmental standards are in place to improve services over a period of time. • Pre- 1 April 2013, very few in existence. • Now over 200 in place, including approx 70 for Highly Specialised Services • Programme underway for CRGs to review existing documentation and update • Derogation / compliance process completed 21
  • 22. Public consultation on products (1) • Rolling programme now in place - four consultation windows per annum could include a mix of service specifications and commissioning policies • Consultation is for 12 weeks, documents published on NHS England website • Out to consultation currently on 14 specifications • Given that the development of these commissioning products is continual, which will be agreed through an annual commissioning cycle, each of the consultation periods will involve NHS England consultation on both material changes to existing service specifications and policies, which may require some clarification or amendment, considered significant enough to require consultation; as well as on new specifications and/or policies. 22
  • 23. Public consultation on products (2) • Any changes proposed to existing specifications and/or policies will have been tested with stakeholders registered with the relevant CRGs prior to consultation. It is this testing phase which determines whether or not a proposed amendment is significant enough to warrant public consultation. Minor amendments, such as typographical errors, do not require public consultation. • Following 12 weeks of consultation, any feedback received will be reviewed by the Programmes of Care and CRGs as required, before CPAG recommends any new and amended documents for adoption by NHS England. Providers will then have six months’ notice for specifications of any changes due to come into effect. Policies are published with immediate effect. • A report of the consultation process, outlining key themes from the feedback, will also be published following publication of the final documents. 23
  • 24. Specialised Services Innovation Portfolio (1) • The SSIP will serve as a library of promising innovations to alert NHS England’s commissioners of the potential improved outcomes or efficiency from new innovations. • Is an online virtual ‘library’ of new and in development innovations which have been registered by innovators, (split by invention/adoption and diffusion elements of the end to end innovation pipeline). Launch took place 1 December 2013 of public facing view. • NHS England’s specialised services commissioners will be able to understand the additional offer from new innovations as compared to what is already available. • Scope: • Now - innovations which are already on the market, • From Summer 2014, a confidential registration option for innovations which are in development (being developed by industry, frontline staff and other innovators both at a national and international level).24
  • 25. Specialised Services Innovation Portfolio (2) • This will have significant value for NHS England’s commissioners because as a result of this new information, commissioners will be able to: • Understand the potential beneficial impact on patient outcomes, quality, safety, patient experience or efficiency from innovations; this may include any change over costs or related costs in future financial planning. • Identify promising innovations for additional support where appropriate to further strengthen or speed up development plans for promising innovations as appropriate. • Connect innovators to staff in other parts of NHS England who may have access to support or funding opportunities or working on similar/related innovations. • Identify gaps in services and encourage these to be bridged by the development of innovation 25
  • 26. Participate in the Innovation Portfolio: Page - 26
  • 27. Specialised high cost drugs All specialised PbR-excluded medicines and devices are: • Prioritised nationally • Commissioned and funded (where applicable) directly by NHS England • Commissioned as directed by Secretary of State following NICE Technology Appraisal or in accordance with other national policy • Potential for national procurement tenders – e.g. home Parenteral Nutrition, Pulmonary Hypertension Homecare, Anti Retro-Virus drugs 27
  • 28. Specialised Services Quality Dashboards
  • 29. Introduction • A programme to work with clinical reference groups to create clinical quality dashboards that are: • Clinically meaningful • Demonstrate service quality • Visually intuitive • Statistically robust • Can be used to explore areas or excellent or poor service • Can be near time and rapidly refreshed 29
  • 30. Analytical Methodology • Spine Charts (alerts / alarms) Used standard (Spiegelhalter) SPC methodology as per CQC / Dr foster etc • SPC sparklines Increase the amount of relevant information presented contain national mean, variation and trend 30
  • 31. • Are you different? • Do you know why? • What does it mean? • Are you comfortable being different? • A dashboard is the opener for a conversation, it is not a test. • Have the conversation openly and in the spirit of appreciative enquiry • Don’t argue about the data and ignore the message Approach: questioning variation 31
  • 32. Initiation • Programme initiated in July 2012 • 20 specialised service clinical reference groups (CRGs) engaged 32 BMT Burns Cardiac Surgery Cardiology Clinical Genetics Cystic Fibrosis Haemophilia HIV Hyperbaric Oxygen Immunoglobulin therapy Major Trauma Mental Health NICU PICU Paediatric Cardiac Surgery Paediatric Neurosurgery PET CT Radiotherapy Renal Spinal
  • 33. Measures creation • Measurement ambitions understood • Definitions created and refined 33 Measure Number Theme Measure Name of KPI Numerator Denominator CFS04 Domain 3: Helping people to recover from episodes of ill health or following injury Reduce infection risk Percentage of patients admitted who are admitted to a single room/cubicle Number of patients who are initially admitted to a single room/cubicle during period (admission in period) Number of CF patients admitted during period CFS05 Domain 3: Helping people to recover from episodes of ill health or following injury Reduce infection risk Percentage of patients admitted to a ward staffed by CF specialist staff (as defined by national specialist service specification) Number of patients admitted to a ward staffed by CF specialist staff during period Number of CF patients admitted during period CFS09 Domain 3: Helping people to recover from episodes of ill health or following injury Physiotherapy patient contact time: outpatients Number of routine CF appointments at multidisciplinary clinic where patient was seen by physiotherapist Number of routine outpatient CF appointments at the multidisciplinary clinic Total number of appointments in CF out patient clinics during period CFS10 Domain 3: Helping people to recover from episodes of ill health or following injury Dietician patient contact time: outpatients Number of routine CF appointments at multidisciplinary clinic where patient was seen by dietician Number of routine outpatient CF appointments at the multidisciplinary clinic Total number of appointments in CF out patient clinics during period
  • 34. Data collection • Remit for Pilot – collect data from Trusts • Data requirements and online data collection tools shared 34
  • 35. Q3 Pilot out turn • First data return 20th January 2013 • Dashboards shared with providers 1st February 2013 for validation • Dashboards shared with commissioners 8th February 2013 • 651 Dashboards populated, for 16 CRGs, 22 services 35 BMT Burns Cardiac Surgery Cardiology Clinical Genetics Cystic Fibrosis Haemophilia HIV Hyperbaric Oxygen Immunoglobulin therapy Major Trauma Mental Health NICU PICU Paediatric Cardiac Surgery Paediatric Neurosurgery PET CT Radiotherapy Renal Spinal
  • 36. 36 Example Trust
  • 37. 37
  • 38. Pilot outcome • The pilot programme has demonstrated that Specialised Service Quality Dashboards can be produced. • They provide data on variation in a service to the national CRGs and other stakeholders that is not available through an alternative route. 38 This information is now presented to the Paediatric and Neonatal Governance Committee on a quarterly basis along with the other CQUINs set to show areas of development within the Trust’s Neonatal service with actions delegated out where necessary. Issues surrounding the number of in-utero and ex-utero transfers were discussed at last Directorate Management Meeting (9th October). The reports highlight other Trusts that may be providing care in a different way where we could seek advice and support to improve our level of care. Lead Nurse for Children and Neonates and Named Nurse for Safeguarding Children
  • 39. Revised Data Collection Method • Revised submission template developed following feedback from providers on original online data collection tool. 39 Please email completed templates to : GEMCSU.SC-Questions@nhs.net ITEMS in GREY: please select from drop down ITEMS in BLUE: please type value ITEMS in YELLOW: will auto populate Organisation Code: (please select from drop down list) Provider Name: Unit Name (if applicable): Contact email (this will be used for any queries relating to your submission): Ref Reporting Period Numerator Denominator Value Comments PNS04 Mean time from request for a CT scan for an urgent indication to completion time of scan Q2 1314 0 PNS10 Proportion of staff with paediatric training and neurosciences training Q2 1314 0 PNS11a Proportion of patients refused admission due to lack of beds either delaying admission or requiring admission to another centre Q2 1314 0 PNS11b Proportion of patients refused admission due to lack of beds either delaying admission or requiring admission to another centre Q2 1314 0 PNS12 Proportion of transfer delayed beyond 3 hours Q2 1314 0 PNS17 Rate of patients and carers responding to experience surveys (note may be >100% with patient and carer responses) Q2 1314 0 PNS02 Proportion of patients aged 1 - 16 years who die within 30 days of first tumour operation 2013/14 0 PNS05 Number of deaths within 30 days of any paediatric neurosurgical procedure or neuroradiological interventional procedure 2013/14 0 PNS06 Proportion of children dying within 30 days of a significant head injury (Codes A31 and / or A05, A06) 2013/14 0 PNS09 Proportion of paediatric patients who require a second shunt operation within 30 days of the first 2013/14 0 PNS15 Proportion of shunt infections within 30 days of insertion 2013/14 0 RA4 YEOVIL DISTRICT HOSPITAL NHS FOUNDATION TRUST Paediatric Neurosurgery Specialised Service Indicator Data Please check you have completed all relevant data before submitting Please input 'NULL' where there is no data available
  • 40. Q1 2013/14 - • 651 dashboards • 25 CRGs or constituents • 186 providers 40 Specialised Service Submissions Q1 2013/14 BMT Adults 20 BMT Paediatrics 5 Clinical Genetics 18 CF Adults 22 CF Paediatrics 22 Cardiology 34 Haemophilia 35 Hyperbaric Oxygen 5 Immunoglobulin 34 Mental Health – CAMHS 41 Mental Health – Deaf Services 5 Mental Health – Eating Disorders 20 Mental Health – Gender Identity Services 5 Mental Health – Low Secure Services 91 Mental Health – Medium Secure Services 40 Mental Health – Perinatal Services 11 NICU 78 Paediatric Neurosurgery 11 PET_CT 11 PICU 19 Radiotherapy 39 Renal Dialysis 38 Specialised Burn Care – Adults 10 Specialised Burn Care - Paediatrics 10 Spinal Cord Injury 7
  • 41. Where next? • Engaging and developing metrics with new tranche of CRGs • Utilisation in the specialised services strategy service delivery focused plans • Public facing – aim June 2014 • US collaboration being discussed 41 Adult Critical Care Congenital Heart Services Hepatobiliary and Pancreas Renal Transplant Specialised Orthopaedic Services Specialised Spinal Adult Neurosurgery Fetal Medicine Metabolic disorders Specialised Dermatology Specialised Pain Specialised Urology Cardiac Surgery Haemoglobin- opathies Paediatric Cancer Services Specialised diabetes (all ages) Specialised Respiratory Vascular Disease Complex Spinal Surgery Heart and lung transplantation Pulmonary Hypertension Specialised Endocrinology Specialised Rheumatology
  • 42. Using outcomes to influence the commissioning of specialised services • Pulmonary thromboendarterectomy • Very complex surgery to remove blood clots and related material from the pulmonary artery of people with chronic pulmonary thrombo- embolic disease (repeated episodes of blood clots travelling to the lung) • 115 patients per annum • ?Continue with current single centre or identify second centre 42
  • 43. Using outcomes to influence the commissioning of specialised services • Transplant services – heart, lung, pancreas, small bowel • Use CUSUM plots – tool that monitors change detection • Identify bad runs of activity in real time • Any issues in transplantation have been shared across the service 43
  • 44. Using outcomes to influence the commissioning of specialised services • Multi-systemic conditions • Rare, often genetic conditions that affect many body systems • Patients see numerous clinicians in an uncoordinated way • Patient groups have influenced the development of ‘carousel’ clinics that bring together patients and all the relevant clinicians into the same room; comprehensive treatment plans are developed with the patient for local care management 44
  • 45. Using outcomes to influence the commissioning of specialised services • Pseudomyxoma peritonei • Very rare, mucus-producing tumour, which spreads to compress the abdominal organs • ‘Sugarbaker’ technique – extensive removal of affected tissues and organs followed by heated chemotherapy • Excellent 10-year survival in selected patients • 200 patients per annum • Originally single centre, now two centres 45
  • 46. Using outcomes to influence the commissioning of specialised services • Adult extra corporeal membrane oxygenation (ECMO) • Supports adults with severe potentially reversible respiratory failure by oxygenating the blood through an artificial lung machine. • Single centre until December 2011; international trial • Tendered and now have five expert centres 46

×