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NHS reforms – opportunities and challenges for MS Care

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This presentation by Karen Middleton CBE, Chief Allied Health Professions Officer, explores the narrative for the NHS reforms, the key structures that clinicians need to be aware of and some of the ...

This presentation by Karen Middleton CBE, Chief Allied Health Professions Officer, explores the narrative for the NHS reforms, the key structures that clinicians need to be aware of and some of the main challenges and opportunities they present for MS care.

It was presented at the MS Trust Annual Conference in November 2013.


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NHS reforms – opportunities and challenges for MS Care NHS reforms – opportunities and challenges for MS Care Presentation Transcript

  • NHS reforms – opportunities and challenges for MS Care Karen Middleton CBE Chief Allied Health Professions Officer
  • Summary • Context - the narrative for the reforms • The key structures that clinicians need to be aware of • Key messages • Challenges • Opportunities 2
  • Some NHS facts and figures • 1.3 million staff • £109 billion annual budget • Over 1 million patients treated every 36 hours • 15 million hospital admissions per year • 88 million outpatient attendances • C.12 billion spent on medicines 3
  • Context 4
  • Context – Quality (safe, effective, good experience) ‘In the next room you could hear the buzzers sounding. After about 20 minutes you could hear the men shouting for the nurse, ‘nurse, nurse’ and it just went on and on. And then very often you would hear them crying, like shouting ‘nurse’ louder, and then you would hear them crying, just sobbing, they would just sob and you presumed that they had had to wet the bed. And then after they would sob, they seemed to then shout again for the nurse, and then it would go quiet…’ 5
  • 6
  • Commissioning of services 7
  • First Mandate for NHS England • First Mandate published on 13th November 2012 • Sets out what the Government expects in return for handing over £95bn of tax payers money to NHS England • The NHS Outcomes Framework sits at the heart of this Mandate and the Board is expected to demonstrate progress across the entire framework • In turn, the NHS Outcomes Framework sits at the heart of NHS England’s planning guidance ‘Everyone Counts’, published in December 2012 8
  • NHS Mandate 9 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/127193/mandate.pdf.pdf
  • Tools and levers of the Quality Framework 10
  • NHS ENGLAND Our focus – delivering improved outcomes Domain 1 The NHS Outcomes Framework Domain 2 Domain 3 Preventing people from dying prematurely Enhancing quality of life for people with longterm conditions Helping people to recover from episodes of ill health or following injury Domain 4 Domain 5 11 Ensuring people have a positive experience of care Treating and caring for people in a safe environment and protecting them from avoidable harm Effectiveness Experience Safety
  • How we align these tools and levers will be key to success NHS OUTCOMES FRAMEWORK Domain 2 Domain 3 Domain 4 Domain 5 Preventing people from dying prematurely Enhancing the quality of life for people with LTCs Recovery from episodes of ill health / injury Ensuring a positive patient experience Safe environment free from avoidable harm Duty of quality Duty of quality Domain 1 NICE Quality Standards (Building a library of approx 150 over 5 years) Commissioning Outcomes Framework Provider payment mechanisms Commissioning Guidance tariff standard contract CQUIN Commissioning / Contracting NHS Commissioning Board – certain specialist services and primary care GP Consortia – all other services Duty of quality 12 QOF
  • NHS Outcomes Framework ‘At a Glance’ 1 Preventing people from dying prematurely Overarching indicators 1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare i Adults ii Children and young people 1b Life expectancy at 75 i Males ii Females Improvement areas Reducing premature mortality from the major causes of death 1.1 Under 75 mortality rate from cardiovascular disease* (PHOF 4.4) 1.2 Under 75 mortality rate from respiratory disease* (PHOF 4.7) 1.3 Under 75 mortality rate from liver disease* (PHOF 4.6) 1.4 Under 75 mortality rate from cancer* (PHOF 4.5) i One- and ii Five-year survival from all cancers iii One- and iv Five-year survival from breast, lung and colorectal cancer Reducing premature death in people with serious mental illness 1.5 Excess under 75 mortality rate in adults with serious mental illness* (PHOF 4.9) Reducing deaths in babies and young children 1.6 i Infant mortality* (PHOF 4.1) ii Neonatal mortality and stillbirths iii Five year survival from all cancers in children Reducing premature death in people with a learning disability 1.7 Excess under 60 mortality rate in adults with a learning disability 2 Enhancing quality of life for people with long-term conditions 3 Helping people to recover from episodes of ill health or following injury Overarching indicators 4 Ensuring that people have a positive experience of care Overarching indicators 3a Emergency admissions for acute conditions that should not usually require hospital admission 3b Emergency readmissions within 30 days of discharge from hospital* (PHOF 4.11) Improvement areas Improving outcomes from planned treatments 3.1 Total health gain as assessed by patients for elective procedures i Hip replacement ii Knee replacement iii Groin hernia iv Varicose veins v Psychological therapies Preventing lower respiratory tract infections (LRTI) in children from becoming serious 3.2 Emergency admissions for children with LRTI 4a Patient experience of primary care i GP services ii GP Out of Hours services iii NHS Dental Services 4b Patient experience of hospital care 4c Friends and family test Improvement areas Improving people’s experience of outpatient care 4.1 Patient experience of outpatient services Improving hospitals’ responsiveness to personal needs 4.2 Responsiveness to in-patients’ personal needs Improving people’s experience of accident and emergency services 4.3 Patient experience of A&E services Improving recovery from injuries and trauma 3.3 Proportion of people who recover from major trauma Improving recovery from stroke 3.4 Proportion of stroke patients reporting an improvement in activity/lifestyle on the Modified Rankin Scale at 6 months Improving recovery from fragility fractures 3.5 Proportion of patients recovering to their previous levels of mobility/walking ability at i 30 and ii 120 days Helping older people to recover their independence after illness or injury 3.6 i Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/ rehabilitation service*** (ASCOF 2B) ii Proportion offered rehabilitation following discharge from acute or community hospital Improving access to primary care services 4.4 Access to i GP services and ii NHS dental services Improving women and their families’ experience of maternity services 4.5 Women’s experience of maternity services Improving the experience of care for people at the end of their lives 4.6 Bereaved carers’ views on the quality of care in the last 3 months of life Improving experience of healthcare for people with mental illness 4.7 Patient experience of community mental health services Improving children and young people’s experience of healthcare 4.8 An indicator is under development Improving people’s experience of integrated care 4.9 An indicator is under development *** (ASCOF 3E) Overarching indicator 2 Health-related quality of life for people with long-term conditions** (ASCOF 1A) NHS Outcomes Framework 2013/14 Improvement areas Ensuring people feel supported to manage their condition 2.1 Proportion of people feeling supported to manage their condition** Improving functional ability in people with long-term conditions 2.2 Employment of people with long-term conditions** * (ASCOF 1E PHOF 1.8) at a glance Reducing time spent in hospital by people with long-term conditions 2.3 i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Enhancing quality of life for people with mental illness 2.5 Employment of people with mental illness **** (ASCOF 1F & PHOF 1.8) Enhancing quality of life for 13i Estimated diagnosis rate people with dementia (PHOF 4.16) 2.6 for people with dementia* ii A measure of the effectiveness of post-diagnosis care in sustaining independence and improving quality of life*** (ASCOF 2F) Treating and caring for people in a safe environment and protect them from avoidable harm Overarching indicators 5a Patient safety incidents reported 5b Safety incidents involving severe harm or death 5c Hospital deaths attributable to problems in care Improvement areas Alignment across the Health and Social Care System Enhancing quality of life for carers 2.4 Health-related quality of life for carers** (ASCOF 1D) 5 * ** Indicator shared with Public Health Outcomes Framework (PHOF) Indicator complementary with Adult Social Care Outcomes Framework (ASCOF) *** Indicator shared with Adult Social Care Outcomes Framework **** Indicator complementary with Adult Social Care Outcomes Framework and Public Health Outcomes Framework Indicators in italics are placeholders, pending development or identification Reducing the incidence of avoidable harm 5.1 Incidence of hospital-related venous thromboembolism (VTE) 5.2 Incidence of healthcare associated infection (HCAI) i MRSA ii C. difficile 5.3 Incidence of newly-acquired category 2, 3 and 4 pressure ulcers 5.4 Incidence of medication errors causing serious harm Improving the safety of maternity services 5.5 Admission of full-term babies to neonatal care Delivering safe care to children in acute settings 5.6 Incidence of harm to children due to ‘failure to monitor’
  • Key work programmes 1. 2. 3. 4. 5. 6. 14 Prevention, early diagnosis and intelligence Community services Acute services Integrated care and support Patients in control Parity of esteem
  • Clinical Senates Clinical senates will help Clinical Commissioning Groups (CCGs), Health and Wellbeing Boards (HWBs) and the NHS CB to make the best decisions about healthcare for the populations they represent by providing advice and leadership at a strategic level. • Engage with commissioners to identify areas with potential to improve outcomes • Mediating with their population about how to implement best practice Purpose • A source of clinical leadership • Proactive role in promoting major service change • Link clinical expertise and local knowledge i.e. on patient pathways • Engage with clinical networks 15
  • 12 Clinical Senates North East, north Cumbria, and the Hambleton & Richmondshire districts of North Yorks Yorkshire & The Humber Greater Manchester, La ncashire and south Cumbria East Midlands Cheshire & Mersey East of England West Midlands Thames Valley London South West South East Coast 16 Wessex
  • Strategic Clinical Networks (SCNs) Established within 12 geographical areas covered by Clinical Senates Help local commissioners to: First SCNs 17 • • • • • • • • • Reduce variation in services Encourage innovation Define evidence-based best practice pathways Operate as engines of change across complex systems of care To maintain and/or improve quality and outcomes Cancer Cardiovascular disease Maternity and children’s services Mental health, dementia and neurological conditions
  • Innovation ‘An idea, service or product, new to the NHS or applied in a way that is new to the NHS, which significantly improves the quality of health and care wherever it is applied.’ 18 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131299
  • Academic Health Science Networks • 15 – designated and licensed • 5 year contracts • Systematic delivery mechanism for diffusion of innovation and best practice and collaboration between partners including industry • Align education, clinical research, informatics, training and healthcare delivery • Improving patient and population health by translating research into practice and developing and implementing integrated health care systems 19
  • AHSNs Academia 20 Industry Oxford Eastern Wessex UCL Partners South London East Midlands West Midlands West of England North West Coast Greater Manchester Yorkshire and Humber South West Peninsula Kent, Surrey and Sussex North East and North Cumbria Imperial College Health Partners NHS
  • Health Education England • National • Local – 13 Local Education training Boards (LETBs or HEELs) Purpose: To support the delivery of excellent healthcare and health improvement by ensuring that our workforce has the right numbers, skills ,values and behaviours, at the right time in the right place. 21
  • HEE advisory arrangement HEE Board MPAB PAF HEEAGs Exec Subgroups, National Advisory Groups, Task/Finish Groups, National Programmes Primary Decision Making Body/ Overarching Governance HEE Advisory & Decision Making Support Bodies Sub Groups, Special Projects & National Advisory Groups Board Recommendations & decision under scheme of delegation 22 * SLT = HEE Exec & LETB MD’s
  • Key messages • Stop looking up for direction and guidance • It really is a commissioning-led system • Understand patient power • You have to be bi-lingual • Clinical care has to be paramount • Clinical LEADERSHIP is critical 23
  • Challenges • Doing more for less – or doing different for less • Transformational rather than transactional change • Generalists versus specialists • Education and training numbers • Reactive versus proactive 24 • Exerting influence – more later!
  • Opportunities • The focus on outcomes • Rehab, rehab, rehab! • Multi-disciplinary approach • Patient voice 25
  • Exerting influence • Put yourself in the shoes of the other person • Avoid perception of self-interest • Respect • Prepare • Build alliances • Tell a story • Private persuasion over public passion • Resilience • Wild Cards - Evidence; humour: sprinkling stardust 26
  • A final great thought from a great inspiration… ”When you are done changing, you are done” Benjamin Franklin 4
  • Thank you Karen.middleton1@nhs.net karen@chpo 28