Louise Restrick: Whittington Health


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Louise Restrick: Whittington Health

  1. 1. Whittington Health Whittington Health Louise RestrickIntegrated Consultant Respiratory Physician Whittington Hospital and NHS Islington
  2. 2. Whittington Hospital Whittington Health NHS Haringey NHS Islington • Acute general teaching hospital – Beds (inc ICU, maternity and children) – Operating teams and facilities – Clinical skills, knowledge and experience • Provide care for inner city population of ~300,000 – Multi-ethnic population – High levels of deprivation – Smoking p g prevalence ~35% • Not co-located with PCT or London Borough – Work with >2 PCTs/Boroughs
  3. 3. Whittington Health Whittington Health• Integrated Care Organisation• Merger of Whittington Hospital, NHS Haringey g g g y and NHS Islington community services• 4000 staff and budget of £260m• Covers ~500,000 population• One organisation p g providing local healthcare from g home to hospital and hospital to home• Working with General Practice and Social Care 1st April p 2011
  4. 4. Aims Whittington Health High “value” health care: better outcomes value per pound spent • I Improved health outcomes d h lth t • Improved patient experience • Reduced costs …from start to end of each patient’s pathway…working with General Practice, Social Careand Local Authorities
  5. 5. Outcome domains – shared responsibility Whittington HealthPreventing people from dying prematurely NHS and PHEnhancing quality of life for people with care NHS, SC and PHneedsPreventing deterioration and helping recovery NHS, SC and PHfrom episodes of ill-health or injuryEnsuring people have a positive experience of NHS and SCcareTreating and caring for people in a safe NHS, SC and PHenvironment and protecting them from harmImproving population health and tackling health PHinequalities
  6. 6. Whittington HealthInformation needed• Agreed measures of health outcomes• Data on health outcomes and unwarranted variation• Measures of patient experience• Individual and disease group patient pathway costs• Value comparisons for interventions p eg QALYS, life-years lost/saved• What residents want from local health care
  7. 7. Improving Health Outcomes Whittington Health Michael Porter 2011 UCLP/Monitor Conference• Achievable• Right Care Doing the right things and doing things right Value Hierarchyy – Long Term Conditions – Urgent and Emergency Care g g y – End of Life Care – Safe Care
  8. 8. Reducing total costs Whittington Health Michael Porter 2011 UCLP/Monitor Conference • Good outcomes as efficiently as possible – A l i value hierarchy Applying l hi h – Reducing clinical errors • Cost reduction is the wrong goal – save money on the wrong things • N dt f d Need to fundamentally change h t ll h how we d li deliver care to release costs • R d Reduce total cost over cycle of care t t l t l f
  9. 9. Whittington Health
  10. 10. Clinical philosophy Whittington Health• Know costs of health care – Risk stratification• Use value framework• Long-term conditions and co-morbidities focus – Smoking alcohol drugs obesity … Smoking, alcohol, drugs, – Not just getting someone home thinking about preventing the next admission…. – Advanced care planning• Working with patients – Co-Creating Health• Holistic needs assessments – Learning from social care (and palliative care) Behaviour change for clinicians?
  11. 11. Challenges to Integrating Care Whittington Health• Resources used merging 3 organisations• Creating Whittington Health culture & philosophy from 3 different organisations• Using current tariffs including PbR and QOF• Identifying and minimising financial and clinical g governance risks• Enabling Whittington Health professionals to lead/engage with transformational change g g g• Engaging GPs• Engaging Social Care g g g
  12. 12. Whittington HealthCommissioning• GP leadership• Across health and social care – Reablement – B ndled tariffs Bundled – Personalised budgets• C Commissioning* i f i i i * informed b J i t St t i N d d by Joint Strategic Needs Assessment• E Engagement with H lth and W ll B i B d t ith Health d Well Being Board• CQINS that support JSNA* ‘Process of assessing health needs of a population, then planning, securing andmonitoring the best possible range and quality of health services and health improvementservices for that population given resources available.’ Nuffield Trust 2010
  13. 13. Health professionals Whittington Health … and social care• Working for Whittington Health – Consultants – Hospital nurses and allied health professionals – Community teams – Community nurses – IAPT and Stop Smoking teams d St S ki t• Working with Whittington Health – GP Commissioners – GPs and Practice Nurses – Social Care Public Health and other Local Care, Authority teams
  14. 14. What motivates clinicians? Whittington Health  (Improving) quality of care for patients  Mastery of (an) expertise ? Pay  Quality of working day  Peer opinion and respect  Affirmation from patients and families
  15. 15. Enablers for clinical leadership, Whittington Healthengagement and commitment Peer Time Ti Evidence E id Pressure P
  16. 16. Whittington HealthAligning with General Practice • Make the case for improved patient care ‘Just moving the blocks round’ ‘Removing’ district nurses from GP surgeries • Financial levers/barriers GPs commissioning care GPs providers of care • Work more enjoyable… • Peer pressure … relationships
  17. 17. Enablers of Integrated Care Whittington Health Islington joint health and social services NHS Islington track record in re-ablement re ablement  DH demonstrator site for COPD post-discharge re-ablement Consultants working across hospital and community  Respiratory, cardiology, diabetes, rheumatology integrated physicians already providing training and support – Rotational posts Whittington Hospital and NHS Islington and Haringey already Co-Creating Health Site  Diabetes and respiratory UCLP commitment and support it t d t
  18. 18. Enablers of Integrated Care Whittington Health• Common IT system – Shared real-time patient information – Shared outcome and costs data and responsibilities• Innovators given time – Clinical leadership of transformational change & population care given same priority as direct clinical care in job plans• Ed Education ti – Opportunity to train integrated clinicians• C lt Culture and L d hi d Leadership – GPs – WISH, formal roles on the board? – Working across organisational and professional boundaries
  19. 19. Whittington Health