R. binks healthcare policy long term conditions experiences of yorkshire
Healthcare Policy in the Area of Long Term Conditions: Experiences of Yorkshire Rachel Binks Nurse Consultant, Critical and Acute Care Airedale NHS Foundation Trust
Our ContextLong term conditions Long term conditions - consume - much more common as we age 50% GP appts By 2034 – 64% OP appts 5% population >85yrs 70% IP bed days x2.5 increase 70% NHS spend (compared with 2009)
Our Context Diabetes Complex Common CostlyControllable, butpoorly managed (process and outcomes)
The big picture … “…DH position: further efficiency savings in the NHS will continue after 2015, with the total savings rising from £20bn to a possible £50bn by 2019-20… …A startling admission of the long term impact on public services of the global financial crisis and ensuing (double dip) recession… …The translation is an NHS that has barely managed 1% productivity per annum let alone 5% each year for EIGHT YEARS…” John Appelby Kings Fund
NHS Outcomes Framework• The NHS Outcomes Framework reflects the vision set out in the White Paper and contains a number of indicators selected to provide a balanced coverage of NHS activity.• Its purpose is threefold:
Purpose1. to provide a national level overview of how well the NHS is performing;2. to provide an accountability mechanism between the Secretary of State for Health and the NHS Commissioning Board for the effective spend of some £95bn of public money; and3. to act as a catalyst for driving up quality throughout the NHS by encouraging a change in culture and behaviour
A complexStructurebutmanyoutcomesthat we caninfluence withtelemedicine
Long TermConditionsReducing time inhospitalEmergencyadmissions thatshould not needadmissionHelping peoplerecover
Domain 2• Enhancing quality of life for people with LTCs
Domain 3• Helping people to recover from episodes of ill health or following injury
“It is clear that the NHS, as currentlyconfigured for long term condition care, isnot sustainable in the face of the projectedincrease in comorbidity and level of need” Long Term Conditions Compendium of Information (3rd Edition, 2012)
Long Term Conditions Compendium of Information• The Department of Health has published the third edition of the ‘Long Term Conditions Compendium of Information’.• It is aimed at commissioners as well as health and social care professionals, to provide the evidence for improving care and outcomes for people with long term conditions (LTCs).
Whole System Demonstrator Programme• This document contains the latest statistical data on long term conditions, links to the LTC QIPP (quality, innovation, productivity and prevention) workstream and provides data from the ongoing evaluation of the Whole System Demonstrator Programme on telehealth and telecare, which supports the delivery of 3 Million Lives.
LTCs a priority• It also showcases examples of innovative projects across the country where organisations and communities are pushing the boundaries to deliver improvements in LTC care.• The information and evidence captured in this third edition of the compendium continues to reinforce why a focus on LTCs should be a priority.
The Whole System Demonstrator Programme• One of the most complex and comprehensive studies the Department has ever undertaken, and has yielded a wide range of very rich data.• Launched in May 2008. It is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients and 238 GP practices across three sites, Newham, Kent and Cornwall.• Three thousand and thirty people with one of three conditions (diabetes, heart failure and COPD) were included in the telehealth trial.
The Whole System Demonstrator Programme• For the telecare element of the trial people were selected using the Fair Access to Care Services criteria.• The proposition being analysed was “Does the use of technology as a remote intervention make a difference?”• As each site used different equipment and had differing populations there is confidence that the results are transferable to other locations.
Findings• 45% reduction in mortality rates• 20% reduction in emergency admissions• 15% reduction in A&E visits• 14% reduction in elective admissions• 14% reduction in bed days• 8% reduction in tariff costs
Benefits for the Individual• More effective self care• Improves quality of life for carers• Less travel and disruption for routine check-ups• Retention of dignity• Increased confidence to manage own health• Fewer stressful, unplanned hospital admissions
Benefits for Healthcare Professionals• Through risk stratification, professionals can identify those people in their practice who have LTCs and could be better supported if telehealth were adopted• Professionals can be better informed of the status of these people and see less demand on services, with fewer A&E events and unscheduled inpatient episodes• Professionals see less impact on family members/carers of people with Long Term Conditions (LTCs) as they start to take more control of their own health
Benefits for Healthcare Professionals• More regular data means professionals can be better informed of a person’s health status which leads to early intervention and proactive care• Deploying telehealth-enabled services modernises the way by which large numbers of people with LTCs are treated improving their care, quality of life and the life of their carers• It makes more efficient and effective use of available clinical teams by reducing unnecessary home visits• It involves people far more in the management of their own healthcare• It significantly reduces the incidence of A&E usage and unplanned admissions thus reducing the disturbance on elective planning
Next steps• The headline findings, with the detail now supported in the paper, provided the impetus for 3millionlives and the drive for industry to work with health, social care and housing stakeholders to develop workable business models to enable telehealth to be delivered at scale and at the right price, and pricing structure, for the public purse.
Next steps• A further four reports are planned, which will analyse other elements of the telehealth trial, including a separate paper on costs and how telehealth affected quality of life.• The telecare findings are due to be published at some point in the future. The full BMJ article is available online. *published by the BMJ. Research team lead by the Nuffield Trust. 3ML Press Release
The bigger picture …scale of financialchallengegrowing demandunmet need + traditional hospital dominated medical model = designedinappropriate by defaultutilisationstretched capacity
a system designed bydefault some people seem to do quite well without waiting for healthcare support……
Much more of this numerous potential use cases: • long term conditions • outpatients • nursing homes • employee health & well being • early supported discharge • admission avoidance • dementia – carer support • social care • purely social calling • specialist networks