The Path to IntegrationHealth and Social CareThe Wirral Way2013The Wirral Way
Focus of SessionThe why??andthe how!!The Wirral Way
The WirralThe Wirral Way
Long Term Conditions• 23% of Wirral people have a long term condition• 70% of health and social care spend• 70% Unschedule...
Mrs SmithThe Wirral Way
Our Patients View• To be treated as a whole person• For the NHS and social services to work asone team• LTC needs to be su...
The Wirral Case for Change• Improve support to patients with LTC in their own homes• Reduce care home admissions upon disc...
Making Integrated Care HappenChris Ham (Kings Fund)• Scale and pace• Decade of austerity• 16 steps• Its not the how but it...
Wirral Goals• 20% reduction in unscheduled admissions• 25% reduction in LOS for LTC• 20% reduction in care home use• Impro...
The Aims• A risk stratification tool• Integrated Teams (by October 2013)• Self care and shared decision makingThe Wirral Way
• Project group with all partners set up April 2012• Engagement workshops with key stakeholders• Thematic analysis• R&D ev...
• Integrated LTC Programme Board• Executive level support and sign up• Partnership agreement• AQUA/Kings Fund Integration ...
Risk Stratification Summary ScreenThe Wirral WayRisk Stratification
Risk Stratification cont…Patient ViewThe Wirral Way
PuffellThe Wirral Way
Integrated TeamsModel EssentialThe Wirral Way
Integrated Teams ModelEssential Cont…The Wirral Way
Challenges for Service Redesign• Terminology• Current business processes (mapping exercise)• Referral form• Screening/init...
Referral FormThe Wirral Way
Screening ToolThe Wirral Way
Other Domains• Patient and carer• Culture• Leadership• Workforce• Finance• IT• GovernanceThe Wirral Way
• Culture and challenge to workforce• IT challenges• Finance and funding models requires negotiation• Programme deliverabl...
AnyQuestions??Thank you• Sheena Hennell – Commissioning Manager• 0151 651 0011• Sheena.hennell@nhs.net• Peter Tomlin – Pri...
Quality of Life and DeathEPaCCS Improving End of Life CareElaine BaylissImprovement Manager, Long Term Conditions& Domain ...
The ChallengeTackling a tough problemInnovation meets many ofthe ambitions of theministers vision aroundimproving End of L...
EPaCCS - SupportingDelivery of The Goal• A universal mechanism for care quality and care planningagainst key ‘touch points...
Delivering ImprovedOutcomes• Survey of 77 former PCTs Autumn 201214 have implemented an EPaCCS (9% of all former PCTs)10 a...
Information Across allCare Providers
CMC Case Example29Patient List reportssupport GSFmeetingsPatient consent isrequired prior to otherinformation being added:...
CMC Case ExamplePatient Outcomes• Implemented across 97% of London.• 5273 patient records created• 5025 trained users acro...
Outcomes ContinuedEvidence from an independent economic evaluation of EPaCCS suggeststhat -• There is a correlation betwee...
Strategic Benefits
Adding Value to End ofLife Care and Beyond:EPaCCS deployment –• Has put the individual in control• Is a tangible system dr...
Supporting WiderImplementation• NHS Improving Quality & Health and Social Care Information Centre• National implementation...
In the end, care counts“EPaCCS… is an outstanding example of how a nationalinitiative can be instigated and supported, wit...
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The path to integration: health and social care – Elaine Bayliss

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Quality of Life and Death Electronic Palliative Care Co-ordination Systems (EPaCCS)

Improving End of Life Care – Elaine Bayliss
The Path to Integration Health and Social Care
The Wirral Way

Elaine Bayliss is an Improvement Manager and Domain Lead for End of Life Care and EPaCCS, NHS IQ

Presented at NHS Confed 2013

Published in: Health & Medicine
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The path to integration: health and social care – Elaine Bayliss

  1. 1. The Path to IntegrationHealth and Social CareThe Wirral Way2013The Wirral Way
  2. 2. Focus of SessionThe why??andthe how!!The Wirral Way
  3. 3. The WirralThe Wirral Way
  4. 4. Long Term Conditions• 23% of Wirral people have a long term condition• 70% of health and social care spend• 70% Unscheduled Admissions• 55% GP ConsultationsThe Wirral Way
  5. 5. Mrs SmithThe Wirral Way
  6. 6. Our Patients View• To be treated as a whole person• For the NHS and social services to work asone team• LTC needs to be supported acrossorganisational boundariesThe Wirral Way
  7. 7. The Wirral Case for Change• Improve support to patients with LTC in their own homes• Reduce care home admissions upon discharge.• Proportion of people aged 65+ discharge direct to residential care:• NW av. 2.5% - Wirral av. 4.5%• Proportion of local authority ASC spend on aged 65+ on res/nursing care:• NW av. 53% - Wirral av. 62%• Reduce demand on the Ambulance Service• Improve hospital flow & timely discharge to improve thepatient journeyThe Wirral Way
  8. 8. Making Integrated Care HappenChris Ham (Kings Fund)• Scale and pace• Decade of austerity• 16 steps• Its not the how but it is a framework with suggestions• Lessons from experiencehttp://www.kingsfund.org.uk/publications/making-integrated-care-happen-scale-and-paceThe Wirral Way
  9. 9. Wirral Goals• 20% reduction in unscheduled admissions• 25% reduction in LOS for LTC• 20% reduction in care home use• Improved patient experience• By 2014/15 compared to baselineThe Wirral Way
  10. 10. The Aims• A risk stratification tool• Integrated Teams (by October 2013)• Self care and shared decision makingThe Wirral Way
  11. 11. • Project group with all partners set up April 2012• Engagement workshops with key stakeholders• Thematic analysis• R&D evaluation strategy• Communication Bulletin• CCG commissioning intention 2013/14The HowThe Wirral Way
  12. 12. • Integrated LTC Programme Board• Executive level support and sign up• Partnership agreement• AQUA/Kings Fund Integration discovery Community• 8 domains for integrated teams• Programme Manager• Domain leadsThe Wirral WayThe How
  13. 13. Risk Stratification Summary ScreenThe Wirral WayRisk Stratification
  14. 14. Risk Stratification cont…Patient ViewThe Wirral Way
  15. 15. PuffellThe Wirral Way
  16. 16. Integrated TeamsModel EssentialThe Wirral Way
  17. 17. Integrated Teams ModelEssential Cont…The Wirral Way
  18. 18. Challenges for Service Redesign• Terminology• Current business processes (mapping exercise)• Referral form• Screening/initial assessment form• MDT specification• Care planning• Core team and roles• EstatesThe Wirral Way
  19. 19. Referral FormThe Wirral Way
  20. 20. Screening ToolThe Wirral Way
  21. 21. Other Domains• Patient and carer• Culture• Leadership• Workforce• Finance• IT• GovernanceThe Wirral Way
  22. 22. • Culture and challenge to workforce• IT challenges• Finance and funding models requires negotiation• Programme deliverablesFuture ChallengesThe Wirral Way
  23. 23. AnyQuestions??Thank you• Sheena Hennell – Commissioning Manager• 0151 651 0011• Sheena.hennell@nhs.net• Peter Tomlin – Principal Manager• 0151 666 4915• petertomlin@wirral.gov.ukThe Wirral Way
  24. 24. Quality of Life and DeathEPaCCS Improving End of Life CareElaine BaylissImprovement Manager, Long Term Conditions& Domain Lead EoLC and EPaCCSNHS Improving Quality
  25. 25. The ChallengeTackling a tough problemInnovation meets many ofthe ambitions of theministers vision aroundimproving End of Life Careand care coordinationA ‘good death’ through crossorganisational improvementenabling a culture change• 1. Office for National Statistics. Place of death indicator by rolling quarter for England, 2007/08 Q4 - 2012/13 Q2
  26. 26. EPaCCS - SupportingDelivery of The Goal• A universal mechanism for care quality and care planningagainst key ‘touch points’ across the whole pathway -delivers against DH 2008 EoLC Strategy• Meets patients aspirations alongside those articulated by ourpartners campaigning for excellent end of life care• Focus of EPaCCS based on our goal of maximising thequality of care potential and removing the barriers• Harnesses technology – national standardisation /freedom for local configuration
  27. 27. Delivering ImprovedOutcomes• Survey of 77 former PCTs Autumn 201214 have implemented an EPaCCS (9% of all former PCTs)10 are part way through implementation (7% of all former PCTs),17 are planning a system (11% of all former PCTs)• This is a hugeimprovementsince 2010/11when there werejust 8 knownEPaCCS pilot sites.
  28. 28. Information Across allCare Providers
  29. 29. CMC Case Example29Patient List reportssupport GSFmeetingsPatient consent isrequired prior to otherinformation being added:demographics, care plan,carer details,resuscitation status etc
  30. 30. CMC Case ExamplePatient Outcomes• Implemented across 97% of London.• 5273 patient records created• 5025 trained users across both voluntary and NHS organisations• 973 patients have a place of death recorded (over last 31 months) **78% died in the community, 21% in hospital,By contrast 59% patients died in hospital in London in 2010 (ONS).• Of those patients who had a preferred place of death (PPD) documented, **77.4% achieved their PPD• 50% of patients on CMC have a non-malignant diagnosis.• Improvements replicated across mature EPaCCS deployments countrywide
  31. 31. Outcomes ContinuedEvidence from an independent economic evaluation of EPaCCS suggeststhat -• There is a correlation between EPaCCS implementation and thenumber of people being able to die in the community in line with theirwishes with -• An additional 90 deaths occurring in a person’s usual place ofresidence per 200,000 population each year, over and above the underlyingincrease in rates being experienced across England.• An increase in DIUPR of 15,451 +9.5%. (N= 24 sites)• Can save at least £35,910 per 200,000 population each year• Recurrent savings after four years will be over £100k pa and cumulativenet benefit over 4 years of c.£270k for a population of 200,000 peopleSource: Economic Evaluation of the Electronic Palliative Care Coordination System (EPaCCS) EarlyImplementer Sites. NHS Improving Quality. May 2013.
  32. 32. Strategic Benefits
  33. 33. Adding Value to End ofLife Care and Beyond:EPaCCS deployment –• Has put the individual in control• Is a tangible system driver – a ‘disruptive innovator’• Is a key driver and catalyst for workforce and culturechange• Has wider transferability across the LTC landscape(portability of the EPaCCS solution, ITK developments,and the information standard)• Helps reduce inequalities and variation• Has ensured financial benefits are not at the expenseof patient or carer• Facilitates conformance with the national informationstandard for care coordination
  34. 34. Supporting WiderImplementation• NHS Improving Quality & Health and Social Care Information Centre• National implementation guidance and support• Case for change• Economic Evaluation of EPaCCS• Development of interoperability standards and architecture plans• Survey of local activity• NHS Networks - EPaCCS forum• National End of Life Care Intelligence Network, Public Health England• ISB – End of life care co-ordination: core content data set;a national information standard
  35. 35. In the end, care counts“EPaCCS… is an outstanding example of how a nationalinitiative can be instigated and supported, with high qualityevidence in improvement in outcomes.Having run a large EPaCCS programme across the southwest, with many thousands of people currently registered onEPaCCS…… (t)here is much satisfaction to be had in puttingeffort into supporting people to have as good an experienceas possible at end of life, and EPaCCS is a critical part of this.”Dr Julian Abel - Consultant Palliative care
  36. 36. QUESTIONS
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