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S79 - Day 1 - 1545 - Building the house of care
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S79 - Day 1 - 1545 - Building the house of care


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

Health and Care Innovation Expo 2014, Pop-up University

S79 - Day 1 - 1545 - Building the house of care

Dr Martin McShane
Jacquie White


Published in Health & Medicine
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  • 1. Building the House of Care January 2014 Martin McShane Jacquie White Ed Mitchell
  • 2. Overview • Context • Principles • Resources • Discussion 2
  • 3. • Context • Principles • Resources • Discussion 3 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Patients(%) Age band (Years) Morbidity (number of ETGs) by age band 0 1 2 3 4 5 6 7+ Number of conditions
  • 4. BMJ 2009;339:b2803 4 A man being treated for heart failure in UK primary care rejected the offer to attend a specialist heart failure clinic to optimise management of his condition. He stated that in the previous two years he had made 54 visits to specialist clinics for consultant appointments, diagnostic tests, and treatment. The equivalent of one full day every two weeks was devoted to this work.
  • 5. Changing the nature of the conversation ….the biggest challenge? 5
  • 6. The soft stuff…is the hard stuff 6 Mindsets and beliefs Values Individual behaviours SOURCE: Scott Keller and Colin Price, ‘Performance and Health: An evidence-based approach to transforming your organisation’, 2010. Needs (met or unmet)
  • 7. Year of Care Costs 7
  • 8. Relationship between number of long-term conditions and cost 8 LTC Year of Care Programme
  • 9. Gearing of investment across the system Public Health Social Care (H&WB Board) Primary Care £200 Comm/MH £500 Specialised £300 Acute £1000 £2000/head of population NHS England CCGs 9
  • 10. NHS Expo Seminar Domain 2 Gearing in activity into acute care 10
  • 11. 11 GP Specialist 1990 Specialist 2014 CARE GAP A c t i v i t y Complexity
  • 12. Quality oflife £1 £10 £100 £1,000 ICU ACUTE CARE 0% COMMUNITY CARE Self-management Long Term Condition Management incl Cancer Third sector provision Primary Care 100% Consultant-led services Specialist teams Specialty Clinic Planned procedures INTEGRATED CARE Locality teams SHIFT LEFT £5,000 Cost of Care per Day Risk profiling 12 COMPLEX CARE PRACTICE ??? Bridging the gap
  • 13. LTC Year of Care Programme Impact of coordinated care
  • 14. Person centred coordinated care “My care is planned with people who work together to understand me and my carer(s), put me in control, co-ordinate and deliver services to achieve my best outcomes” Communication Information Decision-makingCare planning Transitions My goals/outcomes Emergencies 14 What people with LTCs want
  • 15. 1. Engaged, informed, empowered individuals and carers 2. Organisational and clinical processes 3. Health and care professionals working in partnership 4. Commissioning 15 Person Centred Coordinated Care
  • 16. Engaged, informed individuals & carers Commissioning Organisational & clinical processes Person- centred, coordinated care Health & care professionals committed to partnership working Plan Study Do Act The House of Care
  • 17. –Informational continuity –Management continuity –Relational continuity 17 The House supports:
  • 18. The House of Care in value to people/patients: The House supports National Voices ‘I’ statements My goals/outcomes e.g. • All my needs as a person were assessed and taken into account. Communication e.g. • I always knew who was the main person in charge of my care. Information e.g. • I could see my health and care records at any time to check what was going on Decision-making e.g. • I was as involved in discussions and decisions about my care and treatment as I wanted to be. Care planning e.g. • I had regular reviews of my care and treatment, and of my care plan. Transitions e.g. • When I went to a new service, they knew who I was, and about my own views, preferences and circumstances. Emergencies e.g. • I had systems in place so that I could get help at an early stage to avoid a crisis.
  • 19. The House of Care in value to NHS: £1.2bn: Avoid ambulatory care sensitive admissions though e.g. following NICE guidelines (1) £0.8bn: Reduction of hospital admissions for common LTCs through integrated care esp frailty, comorbid (2) £0.8-1.2bn: Reduce use of low value drugs, devices and elective procedures using commissioning analytics and clinician education (3) £0.2-0.4bn: Empower people in supportive self- management (4) £1-1.6bn: Shift activity to cost effective settings e.g. pharmacy minor ailments (5) c.£5.5bn: Incentivised wellness programmes in healthy pop & early stage LTCs inc. smoking cessation, salt ↓, exercise ↑(6) £0.4-0.6bn: Avoidance of drug errors e.g. through electronic records/e-prescribing (7)
  • 20. 20 Community Care Primary Care GenHospitals eral University/ Specialist Facilities Social Care General Hospital ICare The Future: 2014-2019
  • 21. The House of Care - Person centred, coordinated care at three levels: National: What can national organisations and policy makers can do to enable construction of the House of Care at the next two levels. Local: How local health economies ensure that the House of Care involves a whole system approach, including ‘more than medicine’ offers Personal: How the House of Care gives professionals on the front line a framework for what they need to do for patients and ask local commissioners to secure for them
  • 22. CCGs: Building the House at the local, community level What •What are the principles and philosophy behind the care which commissioners wish to provide e.g. National Voices 'I' statements •What is the model to use as framework or providing this care (e.g. the House of Care supporting care planning) Which • Which population of people with LTCs are being addressed (risk stratification approaches, GP disease register, frailty index etc) Where, when, whom • Decide the local model of care i.e. where and when will all the components of the house be delivered for each group of people, and by whom How • Write the specification of how to achieve this including the financial model that will support what needs to be done (tariffs, contracts, incentives etc that match the model of care)
  • 23. Building the House – The House of Care Toolkit • A framework to bring together all the relevant national guidance, published evidence, local case studies and information for patients and their carers. • It includes information on what tools and resources are required to achieve person-centred coordinated care and how these can be effectively commissioned. • Resources are arranged into the four key components of the House with summaries of the impact that could be achieved, based on current evidence and details about where to find additional information.
  • 24. To Enter the House first chose your level: NationalPersonal Local Examples of local examples of good practice that will inform the commissioning of services at a local level . Supporting for professionals, services users and carers to work together to understand, plan and deliver person centred coordinated care. National and international guidance, evidence, tools and resources that will enable the construction of the House of Care at the next two levels.
  • 25. Organisational and Clinical Processes Person centred- coordinated care Health and Care Professionals committed to partnership working • Integration • Culture • Technology • Care Co-ordination • Care Planning • Information and Technology • Care Planning • Safety and Experience Informed and engaged patients and carers • Self Management • Information and Technology • Group and Peer Support • Care Planning • Carers Commissioning • Service User and Public Involvement • Contracting and Procurement • Needs Assessment and Planning • Joint commissioning • Metrics • Evaluation • Care Planning Build my own house Click on the links below for more information about each component and use this to build your own house • Guidelines, Evidence and National Audits • Workforce and Organisational Structures
  • 26. Enables individuals to make informed decisions which are right for them, and empower them to self- care for their long term conditions in partnership with health and care professionals. It relies on four key components, all of which must be present for the goal, person-centred coordinated care, to be realised – Commissioning – which is not simply procurement but a system improvement process, the outcomes of each cycle informing the next one. – Engaged, informed individuals and carers – enabling individuals to self-manage and know how to access the services they need when and where they need them. – Organisational and clinical processes – structured around the needs of patients and carers using the best evidence available, co-designed with service users where possible. – Health and care professionals working in partnership – listening, supporting, and collaborating for continuity of care. 26 Person centred- coordinated care Back to house
  • 27. Care Planning Professionals working in partnership with people living with long term conditions and their carers, identifying priorities, discussing care and support options, agreeing goals they can achieve themselves, and co-producing a single care plan, that meets their physical, social and emotional wellbeing needs regardless of how many long-term conditions they have. Consultation preparation Research by the Health Foundation has identified elements that can make a consultation between patient and healthcare professional more successful. Key Components • Focussing on receptionist's conversations in general practice • Practice Health Champions • Appointment guides. Back to house Care planning process An ongoing process encouraging an interactive partnership between clinician and patient to support self management of patients and their long term condition. Key Components • Information provided to the patient prior to the appointment • During the appointment achievable goals should are set in partnership. I • Capturing gaps between preferences and care received • Feeding back preferences to inform future planning. Medicines optimisation To ensure the best possible outcomes from medicines for people living with long term conditions. Key Components • Ongoing, open dialogue with the patient and/or their carer about their choice and experience of using medicines to manage their condition • Recognising the patient’s experience may change over time even if the medicines do not. Engaged, informed individuals and carers
  • 28. Engaged, informed individuals and carers Consultation Preparation Resources Right Conversation at the Right Time, The Health Foundation When doctors and patients talk: making sense of the consultation, The Health Foundation Back to care planning
  • 29. Engaged, informed individuals and carers Care Planning Process Resources Shared decision making, NHS England Tools for shared decision making, NHS England Care Planning, Royal College of General Practitioners Deciding together Care planning in long term conditions, NHS Kidney Care , February 2013 %20planning%20in%20long%20term%20conditions[1].pdf Back to care planning
  • 30. Engaged, informed individuals and carers Medicines Optimisation Resources Medicines Optimisation: Helping patients to make the most of medicines Good practice guidance for healthcare professionals in England, Royal Pharmaceutical Society. most-of-their-medicines.pdf Good practice in prescribing and managing medicines and devices, General Medical Council Back to care planning
  • 31. Integration Ensuring care is designed and delivered around the needs of the individual. Integration is particularly important for people with complex care needs. Services should be joined-up to promote improved outcomes for individuals in need of health and social support, enabling them to live not just longer, but better lives. Care is planned with people who work together to understand me and my carer(s), put me in control, co-ordinate and deliver services to achieve my best outcomes Back to house Interdisciplinary working Professionals from different organisations across health and social care and the voluntary sector working closely together ensuring that care feels coordinated to people living with long term conditions and their carers. Key Components • Single point of contact • Professionals talk to each other • Services quick and responsive people are promoted to stay independent and active • Care developed around the individual and not the system Care Transition Ensuring a seamless transition for people with long term conditions between different care settings. Key Components • Transition following discharge from hospital • Transition related to changes in long term care needs • Transition from children's to adult services. Health & care professionals committed to partnership working
  • 32. Interdisciplinary Working Resources Integrated care for patients and populations: Improving outcomes by working together - A report to the Department of Health and the NHS Future Forum, The Kings Fund improving-outcomes-working-together Integrated Care and Support Pioneers programme, NHS IQ care.aspx Integrated Care – Better Care Fund – Local Government Association /journal_content/56/10180/4096799/ARTICLE Integrated care value case toolkit /journal_content/56/10180/4060433/ARTICLE ICASE - Integrated Care Support and Exchange Kings Fund Integrated care: making it happen Back to integration Health & care professionals committed to partnership working
  • 33. Care Transition Resources Lost in transition, Moving young people between child and adult health services, Royal College of Nursing Transitions between children’s and adult’s health services, and the role of voluntary and community children’s sector, VSS POLICY BREIFING .pdf Transition, National Council for Palliative Care Coordinated transition between health and social care, NICE DraftScope.pdf Back to integration Health & care professionals committed to partnership working
  • 34. The House of Care – Build your own house What elements need to be in place for YOUR local population? Commissioning    Organisational and clinical processes        Engaged, informed individuals & carers       Health & care professionals committed to partnership working          Back to house