110614 tim warren presentation
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Tim Warren Presentation
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110614 tim warren presentation
- 13. Our approach
- 18. Quality Alliance Board PersonCentred Delivery Group Safe Delivery Group Effective Delivery Group Quality Infrastructure Delivery Group Efficiency and Productivity Strategic Oversight Group NMAHP Quality Council Delivering Quality in Primary Care National Planning Forum Chief Executives Health Management Board
- 22. Reshaping Care: Scotland 65+ Health and social care expenditure (07/08 total=£4.5bn)
- 28. The aim is to delay the onset and slow the progression and impact of chronic disease The Extent and Aim of Anticipatory Care
- 30. People are already self managing
- 33. Co morbidity – more than one long term condition (PTI practices, ISD) Co-morbidity
- 34. Health conversation as marker of quality
- 36. quality alliance conversation individual teams organisations systems health literacy consultation skills support / assets in the community policy strategy
- 44. I can read it, but I don’t understand it ..
- 45. 26.7 per cent may face occasional challenges Scottish Survey of Adult Literacy, Scottish Govt August 2010 http://www.flickr.com/photos/pchweat/2331900663/
- 48. The outer circle – Boys Brigade
- 49. The outer circle - Trinity Academy
- 51. Patient Portal ALISS Access to Local Information to Support Self Management
- 65. More info (on resource sheet) www.aliss.org ALISS Open Innovation Process (see 6 ideas and materials used) http://alissproject.wordpress.com/
Editor's Notes
- 4 things: 1 quality strategy, what it is, 3 ambitions 2 SG self management programme – how it evolved 3 current sm activity 4 future ideas 4 things: 1 quality strategy, what it is, the 3 ambitions 2 SG self management programme – how it evolved 3 current sm activity 4 some ideas for future
- The Quality Strategy is a development of Better Health Better Care – an extension of work that has already delivered real improvements. But we know we can make an even greater impact if we better align our policy, planning and performance activity and focus these around quality.
- This is an unashamedly ambitious commitment - to provide the very best service we can for every patient every time, so that our NHS is amongst the very best in the world. In preparing for this new approach we have listened carefully to what patients, carers and people delivering healthcare services across NHSScotland - have said that they want. They want a caring and compassionate health service; they want to see real partnership between patients, clinicians and others; they want services to be provided in a clean and safe care environment, with improved access and continuity right though their journey and of course they want to have confidence in the quality and effectiveness of any treatment.
- Our approach to quality is based upon the Institute of Medicine’s six dimensions of quality. These six dimensions will focus the way we measure healthcare quality to ensure we deliver the right care safely, at the right time, and in a way that is built around the particular needs of the individual
- It’s helpful to look at service provision as it currently stands in cost terms. Figures for 2007/08 show us that: £4.5bn was spent in total on health and social care for people aged over 65 Nearly 2/3 of this spend was in hospital or in care homes. Emergency admissions to hospital alone accounted for 1/3 of the total spend – about £1.4bn. This huge area of unplanned/reactive activity often delivers poor outcomes for the patient and with better community provision there is scope to reduce the pressure on this area and deliver better outcomes.
- Some lines about using language which is easily understood, many health care interactions are far too medical – self management is simply making sure staff and systems are capable of helping people to help themselves. Importance of not separating out anticipatory care from self management – all approaches are about helping people to help themselves, raising awareness of how best to care for themselves, manage their condition and have the confidence and knowledge to know where to get support. Developing Keep Well – Mainstreaming Keep Well, now have health and social care – better integration of healht and social care Support for the voluntary sector -
- Scottish Government have developed a strategic partnership with the Long Term Conditions Alliance Scotland, which sets out agreements made between the two organisations. This is emblematic of our commitment to the voluntary sector.
- Self management touches every single topic you are discussing today. The Quality Strategy focuses on person centred approaches – which is includes promoting independence and confident management of long term conditions. People living with symptoms of post polio syndrome, lymphoedema and allergy, all need to understand as much as possible what their condition is and how best to live well. What make things worse or better – action to take when there are changes in symptoms, recognising worsening – that’s all self management. Developing the knowhow on self management will come not only from health professionals, but from friends, family, internet, other people with same condition. The forum on the Scottish Post Polio Network is good example of mutual support and some hints being shared between members on sources of support.
- We know from public feedback that managing alone without proper information or support is a difficult struggle. This picture shows how little time is spent with health professionals. A person with, for instance diabetes, or asthma or epilepsy will see a health professional for about 15 – 20 minutes per month, and actually - this would be pretty generous in some surgeries. This adds up to just 3 hours per year of professional contact.
- There is an increasing problem with co morbidity – meaning having more than one condition, and of course chronic pain and depression are also recognised as being long term conditions. This graph from ISD shows the prevalence of comorbidy. Looking at the top bar – which is CHD. The white part of the bar shows the number of people with just CHD – just one condition, in pale blue are people with CHD plus one other condition and the dark blue is 2 or more. You will see that only 8% of people with Coronary Heart Disease only have that one condition - 67 % have CHD plus at least another 2 conditions. So these are the major reasons we are gathered here today – these graphs and population pyramids show us how important it is that our systems of caring for people get away from disease silos and separate registers. We will never be able to offer continuous, coordinated care if we organise our systems according to conditions. We need staff who are educated in the generic skills required to help people live well with long term conditions.
- A few words about how we have developed self management approaches through policy and strategies. The starting off point was an acknowledgement that every health conversation reflects the health and wellbeing of our health service. Every single contact between patients and professionals is a marker of well our health system is serving our citizens. Each contact is a distillation of attitudes, empathy, experience, education, safety, service design, technology, systems working and management of resources. This is where self management begins, it is simply helping people to help themselves – making people aware of sources of support.
- These health care contacts can be expressed like this - as inner and outer circles. The inner circle, in close to the conversation is where empathy and enablement starts. As Professor Stewart Mercer says – you don’t get enablement without empathy – they are intertwined. That is why we have supported his important work on consultation skills and the CARE measure which I will tell you more about in next few slides. A decent level of health literacy is also crucial for anyone trying to negotiate the complexities of the health and social care system – I will describe our work in health literacy. We need to ensure individuals are properly supported – but at the same time we are all supported by others – family, friends, colleagues and people in the community – our local communities are vital sources of support for us all, which can be particularly important for people living with long term conditions.
- Explanation of CARE measure – patients are asked if they understood the consultation – did they get a chance to tell their story – there is link to measure is on the resource sheet
- Explanation of CARE measure – patients are asked if they understood the consultation – did they get a chance to tell their story – there is link to measure is on the resource sheet
- Explanation of CARE Approach – this is package being developed to support the use of the CARE measure – it is a set of workbooks and DVDs of consultations. NHS NES are inviting applicants to pilot the CARE Approach – if you are interested please see resource sheet for information.
- Explanation of CARE Approach – this is package being developed to support the use of the CARE measure – it is a set of workbooks and DVDs of consultations. NHS NES are inviting applicants to pilot the CARE Approach – if you are interested please see resource sheet for information.
- ALISS project’s work with local communities – adult literacy group (CLAN)
- The Scottish Survey of Adult |Literacy, in August 2010, found that 26.7 of people in Scotland “may face occasional challenges”. This means that they may be able to read and write well, but not have ability to understand what they are reading. This large group of people are at great risk of not understanding their health conditions, information on medicine, treatments, procedures, completing forms, understanding appointment cards and consent forms, signage in health care settings. Many conditions require ability to understand complicated instructions – poor health literacy is an considerable risk to safety.
- Teach Back is a simple method of checking understanding and is extremely useful when used appropriately in conversations about health care. Teach Back postcards being printed at the moment - will be tested out soon in Lothian Health Literacy Framework being developed as component of Person Centred Care Ambition of Quality Strategy
- This 12 month project was set up as a way to engage with national youth groups. The Boys Brigade were keen to collaborate on raising awareness of self management and long term conditions. The Boys Brigade have 450 groups in Scotland and 20,000 members, aged between 12 – 18, so were a great place to start. The project has gone well – lots of activities were organised around the theme of healthy lifestyles – summer camps, games and quizzes which encouraged the boys to learn more about long term conditions. All the material developed with the BBs will be shared with other youth groups throughout Scotland.
- This is the group of 4 senior pupils who developed a lesson plan about self management and long term conditions. This activity was part of the ALISS project and had a focus on local community sources of support . The team entered their ALISS project to a European competition called Comenius and really delighted to say they are through to the last round and will present their project in Bremen in Germany later this year. Meantime senior pupils will continue to use their lesson plans with junior pupils, many of whom are living with long term conditions or may be caring for someone with long term condition. Health and Wellbeing stream of C for Exc – teacher in Trinity Ac had remit
- Explanation of ALISS – how do we get all of this information on this poster board collected and distributed so all of us get to hear about it? ALISS is a Scottish Government project which started off as a commitment to provide each CHP with a self management framework. It was quickly decided that another website about local information wouldn’t do – there are too many websites and places to look with associated problems of updating, duplication, not finding what you want. ALISS has developed over the last 2 years into a highly innovative project – successfully collaborating with colleagues in adult literacy groups, art colleges, schools, technical experts outside the health sector. ALISS is designed to capture less formal resources, the sort of very useful but hard to find out about sources of support which most communities have. It is an ambitious project as it is tackling a difficult problem. There were 3 workstreams in ALISS – Health Literacy, Technical Development and Communities. Compliments NHS Inform More information from www.aliss.org Explain about screencasts for further information. A working “Engine” is developed - Grampian Care Data have very helpfully contributed data to allow the team to test the technology.
- And so our plans are to continue to work in close partnership with the Alliance and support their valuable contribution. Early in the new year the Scottish Government will publish a long term conditions delivery plan which will set out a set of actions which will take us further down the road of implementing the strategies. All of you will have an opportunity to contribute to the plan today - I look forward to hearing your ideas. Thank you all for your attention
- Explanation of Links – 6 in deprived areas of Glasgow, 4 in Fife. Complete now but generated great interest.
- Have good information about areas of relatively high cost – hospital emergency admissions and specialist community based services Need more intelligence about primary and community care – primary care team skills and knowledge and patterns of consultation
- Patient Portal a pilot set up in Ayrshire and Arran – aim is to encourage people to use a self management online tool> the Portal built on good work already established in Townhead Surgery in Irvine, where patients are able to renew prescriptions, book appointments etc. Initial focus on COPD and Diabetes but now potential to spread the development over Scotland.
- Thank you for the chance to speak to you all today. During this presentation , I will you a flavour of national developments long term conditions in Scotland. The term long term conditions is now being accepted world wide as a better description of the previous term chronic disease. Even in our small country – there is a fantastic amount of activity - it is a very busy arena with lots happening and dozens of excellent initiatives. I have left a resource sheet which will give you an idea of what else is happening across Scotland.