Sw regional peer audit developing quality across services


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  • Employment Range 15 – 55%
  • Sw regional peer audit developing quality across services

    1. 1. The South West of England Regional Peer Audit: Developing quality across services Frank Burbach 1 & Martin Hember 2 1 Somerset Partnership NHS Foundation Trust 2 Avon & Wiltshire Partnership NHS Trust IEPA conference, Amsterdam, November 2010
    2. 2. South West Region E AWP A – S. Glos B – Bristol C – N. Somerset D – B&NES E – Wiltshire F – Swindon F 14 – 35 year old population: 1.18 million 14 PCT Areas 15 EI Teams
    3. 3. Introduction <ul><li>Share with you the process and outcomes of 2 stage audit and review process </li></ul><ul><li>Focus on Peer Review </li></ul><ul><li>Value for Teams and Services </li></ul><ul><li>Value for those commissioning services </li></ul><ul><li>Next steps </li></ul>
    4. 4. Stage 1 : Audit of EI Services <ul><li>The questionnaire was based on the National EI audit of October 2007. </li></ul><ul><li>EI lead clinicians agreed the basic methodology for this audit at a Regional meeting and the questionnaire was finalised by Regional Lead Clinicians. </li></ul>
    5. 5. Stage 1 : Audit of South West EI Services <ul><li>April 09: Questionnaires sent to each EI Team (n=15). </li></ul><ul><li>May – July 09: Data quality analysed and follow-up questions developed. </li></ul><ul><li>August 09: Teams asked to provide clarification of initial data. </li></ul><ul><li>September 09: Final results reported to the Regional EI Network. </li></ul>
    6. 6. Durham Fidelity Criteria <ul><li>Have the capacity to intervene over a period of 3 years with first episode psychosis (FEP) cases. </li></ul><ul><li>Be accessible to the full age ranges from 14 to 35 years (acknowledging that services to under-18s may be provided from a separate CAMHS EI team). </li></ul><ul><li>Have systems in place to cover out-of-hours and weekends. </li></ul>
    7. 7. Durham Fidelity Criteria (continued) <ul><li>Offer active monitoring of individuals who are considered at high risk of psychosis or with suspected FEP for a minimum of 6 months </li></ul><ul><li>Have caseloads of no more than 15 FEP cases per case manager </li></ul><ul><li>Have a strategy for early detection and engagement of high risk and suspected FEP cases </li></ul>
    8. 8. Durham Fidelity Criteria (continued) <ul><li>Monitor DUP & other key outcomes incl. engagement rates, relapse rates, hospital readmission, suicide and para-suicide, education and employment functioning. </li></ul><ul><li>Have a caseload of between 91% and 100% of its target </li></ul><ul><li>Employ a multidisciplinary staff mix </li></ul>
    9. 9. Fidelity to the various criteria based upon responses provided to the survey
    10. 10. Questions Arising from Survey <ul><li>How are teams counting ‘watching brief, assessment and active cases? </li></ul><ul><li>How can caseloads of less than 15 be reported considering size of caseload / number of care coordinators? </li></ul><ul><li>How did teams define an “Early Detection and Health Promotion Strategy”? </li></ul>
    11. 11. Questions Arising from Survey <ul><li>How could we explain the large variation in employment outcomes? </li></ul><ul><li>Is the way in which data is collected influencing the reported outcomes? </li></ul><ul><li>How were teams defining ‘multidisciplinary’ and are they ‘stand alone’ services? </li></ul><ul><li>How robust are arrangements for 14 – 18 year olds? </li></ul>
    12. 12. Stage 2: Peer Review <ul><li>Commissioned Oct 2009 </li></ul><ul><li>Commissioner led Review </li></ul><ul><li>Completion February 2010 </li></ul><ul><li>Final Peer Review Report March 2010 </li></ul>
    13. 13. FIVE STEP PROCESS STEP 1 – Lead commissioners work together to pull the process together locally STEP 2 – Working group established within each area to plan and prepare for the reviews STEP 3 – Site visits to review local intelligence and hold discussions with key stakeholders STEP 4 – Rapid feedback reports presented to host teams as a basis for agreeing issues, learning and recommendations STEP 5 – Final Reports submitted to host sites within 4 weeks of the site visit for local dissemination and action
    14. 14. Review Teams Established <ul><ul><li>South Gloucestershire/North Somerset </li></ul></ul><ul><ul><li>Bristol Teaching/Bath & North East Somerset </li></ul></ul><ul><ul><li>Swindon/Wiltshire </li></ul></ul><ul><ul><li>Somerset/Gloucestershire </li></ul></ul><ul><ul><li>Devon/Bournemouth & Poole Teaching </li></ul></ul><ul><ul><li>Torbay Care Trust/Dorset </li></ul></ul><ul><ul><li>Cornwall & Isles of Scilly/Plymouth </li></ul></ul>
    15. 15. Key Principles <ul><li>Focus on local systems: Primary Care Trust & EI Team boundaries. </li></ul><ul><li>Led by service commissioners. </li></ul><ul><li>Partnership approach </li></ul><ul><ul><ul><li>People who use services </li></ul></ul></ul><ul><ul><ul><li>Carers </li></ul></ul></ul><ul><ul><ul><li>MH Charities and Housing </li></ul></ul></ul><ul><ul><ul><li>Early Team Staff </li></ul></ul></ul><ul><li>Build on partnerships to develop local improvement plan </li></ul>
    16. 16. Outcomes <ul><li>Reports produced </li></ul><ul><ul><li>what is working well </li></ul></ul><ul><ul><li>examples of innovative practice </li></ul></ul><ul><ul><li>Service strengths and gaps </li></ul></ul><ul><ul><li>key recommendations </li></ul></ul><ul><li>Team and Trust action plans </li></ul><ul><li>Closer working with Commissioners (particularly in 8 PCT areas) </li></ul>
    17. 17. Commissioner’s View <ul><li>“ By listening to and acknowledging examples of best practice and innovations in their own service and the ‘visiting service’, clinicians, managers and commissioners were able to identify elements of service that were essential to retain and those that required development……..The engagement and contribution of people who use EI services and their family carers was a key success feature in the SW EI peer review”. </li></ul><ul><li>Ian Pearson, Commission Manager, Devon </li></ul>
    18. 18. Outcomes 2 <ul><li>March 2010: South West EI Network Event </li></ul><ul><ul><li>overview of peer audit results </li></ul></ul><ul><ul><li>best practice case studies </li></ul></ul><ul><ul><li>workshops (developing common metrics, commissioning, early detection & health promotion) </li></ul></ul><ul><li>Sept. 2010: SW Commissioners meeting </li></ul><ul><li>feedback to the commissioning process. </li></ul><ul><ul><li>Agreed that standardised SW data collection would enable development of quality outcome standards </li></ul></ul>
    19. 19. Outcomes 2 <ul><li>October 2010 South West EI Leads meeting </li></ul><ul><ul><li>agreed parameters for common data collection & discussed how this relates to health quality outcomes </li></ul></ul><ul><li>December 2010 meeting EI leads & commissioners </li></ul><ul><ul><li>common data collection to be agreed. </li></ul></ul>
    20. 20. Data - baseline, annual, discharge <ul><li>DUP (medication; EIS) </li></ul><ul><li>Pathways into care </li></ul><ul><li>Engagement (rates;quality) </li></ul><ul><li>Use of M H A (1 st contact) </li></ul><ul><li>Relapse rates (admissions; CR&HTT; MHA) </li></ul><ul><li>Employment, Education or Training </li></ul><ul><li>Housing stability </li></ul><ul><li>Substance misuse </li></ul><ul><li>Discharge destinations (recovery rates) </li></ul><ul><li>Self harm </li></ul><ul><li>Suicide rates </li></ul><ul><li>Offending rates </li></ul><ul><li>Physical health </li></ul><ul><li>Quality of life </li></ul><ul><li>Satisfaction </li></ul>
    21. 21. Service Improvement Cycle <ul><li>Audit </li></ul><ul><li>Establish baseline data </li></ul><ul><li>Peer Review </li></ul><ul><li>Local Action Plans </li></ul><ul><li>Feedback </li></ul><ul><li>Network Conference </li></ul><ul><li>Leads Meeting </li></ul><ul><li>Commissioners Meeting </li></ul>4. Regional Planning Develop common Data Gathering and metrics 5. Review Data Collection Inform Service Development
    22. 22. What is the added value of the Peer Audit? <ul><li>Commissioners’ involvement highlighted anomalies in the setting of targets (the number of new cases per year), previously assumed to be standard across the region </li></ul><ul><li>Bringing together commissioners, Teams, service users and carers enabled focus on quality and sensible service planning. </li></ul>
    23. 23. What is the added value of the Peer Audit? <ul><li>Face to face meetings enabled more thorough exploration and greater honesty about variation in team practices, e.g. </li></ul><ul><ul><li>age range (esp.14-18; transition arrangements) </li></ul></ul><ul><ul><li>multidisciplinary skill mix </li></ul></ul><ul><ul><li>assessment processes </li></ul></ul><ul><ul><li>health promotion procedures & early detection strategies </li></ul></ul><ul><ul><li>data collection </li></ul></ul>
    24. 24. EI Team View <ul><li>“ The Peer Review was a very positive process; a catalyst. It was the first time in 6 years that we had been able to meet the Commissioners! </li></ul><ul><li>The Commissioner who was involved in the whole process has since continued to work closely with the EI team. We have now agreed an action plan which may lead to the development of an early detection service and an extension of the criteria for EI.” </li></ul><ul><ul><ul><ul><ul><li>Angela Hawke, team manager, East Cornwall </li></ul></ul></ul></ul></ul>
    25. 25. Conclusion <ul><li>If the survey (mainly quantitative data) and Peer Audit (qualitative data) had been part of a research project then there would have been more rigour and the results would have been more reliable. </li></ul><ul><li>However, this process has bought together Clinicians, Commissioners and Managers and is likely to have a greater effect on future service delivery. </li></ul>
    26. 26. Finally <ul><li>“ The product of the EI review process was an improvement plan based on local and regional best practice, designed primarily by clinicians and owned by a range of interested parties, including host organisations, senior managers and NHS commissioners.” </li></ul><ul><ul><ul><li>Ian Pearson, Commissioning Manager, Devon </li></ul></ul></ul>
    27. 27. Acknowledgements <ul><li>SW Early Intervention Teams </li></ul><ul><li>SW Primary Care Trusts </li></ul><ul><li>David Shires and Jo Smith (Former National Programme Leads) </li></ul><ul><li>Kate Schneider RDC Programme Director, Mental Health & Well-Being </li></ul><ul><li>Jo Gajtkowska, RDC </li></ul>
    28. 28. Thank you for listening http://www.swdc.org.uk/mental-health/early-intervention-services/