The Nuffield Trust's Holly Holder presents on a project in partnership with the London School of Economics to evaluate a whole systems approach to integrated care in North West London.
Greater Manchester's visionary approach to integrated care
Delivered by the Greater Manchester Health and Social Care Partnership
Day Two, Pop-up University 8, 16.00
Working better together: community health and primary careNHS Confederation
This slide pack captures the main points from a workshop on integrated working between primary care and community health services. The workshop was organised by the NHS Confederation Community Health Services Forum in partnership with the National Association of Primary Care, in September 2014
“National Patient Safety Collaborative Programme”
The National Patient Safety Collaborative Programme, launched on the 14th October 2014 will be the largest patient safety initiative ever attempted in the world. Led by the 15 Academic Health Science Networks and supported by NHS England and NHS Improving Quality, they will be undertaking a challenging programme of work over the next 5 years. This session will outline the actions to date and the next steps moving forwards.
Greater Manchester's visionary approach to integrated care
Delivered by the Greater Manchester Health and Social Care Partnership
Day Two, Pop-up University 8, 16.00
Working better together: community health and primary careNHS Confederation
This slide pack captures the main points from a workshop on integrated working between primary care and community health services. The workshop was organised by the NHS Confederation Community Health Services Forum in partnership with the National Association of Primary Care, in September 2014
“National Patient Safety Collaborative Programme”
The National Patient Safety Collaborative Programme, launched on the 14th October 2014 will be the largest patient safety initiative ever attempted in the world. Led by the 15 Academic Health Science Networks and supported by NHS England and NHS Improving Quality, they will be undertaking a challenging programme of work over the next 5 years. This session will outline the actions to date and the next steps moving forwards.
“#CWPZeroHarm”
Cheshire and Wirral Partnership NHS Foundation Trust (CWP) – a provider of mental health and community physical health services – has responded proactively with an initiative to tackle the patient safety challenge posed by Hard Truths. Its #CWPZeroHarm ‘Stop, Think, Listen’ campaign, underpinned by the 6Cs, aims to drive cultural change to deliver improvements in safe care and provide better outcomes. The case study describes how CWP has invested in a number of plans to tackle unwarranted variations in health care by helping staff to deliver continuous improvement. The campaign has already started to make a positive difference – CWP achieved the highest score in the country for ‘overall experience of services’ in the CQC survey of users of its mental health community services.
Directors of communications from 15 Swedish county councils visited London to learn more about the health and care system in England.This presentation is from this visit.
NHS Improving Quality planned and hosted the study tour as a result of close links with Jönköping, one of the councils represented in the delegation. Our guests learned about the important role of communications specialists in transforming healthcare in England, and the leading role NHS Improving Quality has taken in engaging and mobilising staff at scale and pace.
During the study tour it became obvious that many of the challenges and opportunities we face in our health and care system mirror those in Sweden, in particular issues such as emergency care, obesity and smoking, patient safety and working with the media. This was a fantastic opportunity for NHS Improving Quality to strengthen alliances at an international level and share ideas and approaches, and we hope to build on this in the future
A feasibility study to examine the adoption of CBT techniques and their impact on clinical practice in the community pharmacy environment
Led by the AHSN Network
Day One, Pop-up University 8, 11.00
Impact and celebration event - transforming services for the frail and elderl...NHS Improving Quality
North Lincolnshire CCG - transforming services for the frail and elderly. Slides from the impact and celebration event held in London on 24 February 2015.
“Decisions of value – how the NHS can balance quality and finance in decision-making”
NHS decision-makers have to balance the priorities of quality improvement and financial sustainability, in other words they have to deliver value. This balancing act is increasingly challenging as the demands on the NHS change and grow, with more expected within an ever tighter budget. Decisions of Value is a project commissioned by the Department of Health and led jointly by the Academy of Medical Royal Colleges and the NHS Confederation. It has spent six months studying what influences how decisions are made and brings together a large amount of research to show how factors such as relationships, behaviours and environment influence the value delivered, extending beyond Whitehall to the front line.
The project’s findings have recently been published and emphasise the importance of the cultural, rather than structural, changes needed to move towards delivering better value and look at how they rely on having the right relationships, behaviours and environments in place. It presents insights into how people interact in the NHS and the crucial factors affecting how they operate within a particular context. In many cases, it indicates a ‘back to basics’ approach that involves a fundamental understanding of how humans interact and operate. As such, it doesn’t look to define good decisions, but rather gives an insight into the principles of good decision-making.
For more information, please see: http://www.nhsconfed.org/decisions-of-value
Impact and celebration event - implementing the city-wide Mental Health Frame...NHS Improving Quality
Jenny Thornton from Leeds Mental Health Framework discusses implementing the city-wide Mental Health Framework. Slides from the impact and celebration event held in Leeds on 3 March 2015.
Angela Coulter, The King's Fund, and Ben Mearns, Surrey and Sussex Healthcare NHS Trust present on patient engagement and health information technology.
“#CWPZeroHarm”
Cheshire and Wirral Partnership NHS Foundation Trust (CWP) – a provider of mental health and community physical health services – has responded proactively with an initiative to tackle the patient safety challenge posed by Hard Truths. Its #CWPZeroHarm ‘Stop, Think, Listen’ campaign, underpinned by the 6Cs, aims to drive cultural change to deliver improvements in safe care and provide better outcomes. The case study describes how CWP has invested in a number of plans to tackle unwarranted variations in health care by helping staff to deliver continuous improvement. The campaign has already started to make a positive difference – CWP achieved the highest score in the country for ‘overall experience of services’ in the CQC survey of users of its mental health community services.
Directors of communications from 15 Swedish county councils visited London to learn more about the health and care system in England.This presentation is from this visit.
NHS Improving Quality planned and hosted the study tour as a result of close links with Jönköping, one of the councils represented in the delegation. Our guests learned about the important role of communications specialists in transforming healthcare in England, and the leading role NHS Improving Quality has taken in engaging and mobilising staff at scale and pace.
During the study tour it became obvious that many of the challenges and opportunities we face in our health and care system mirror those in Sweden, in particular issues such as emergency care, obesity and smoking, patient safety and working with the media. This was a fantastic opportunity for NHS Improving Quality to strengthen alliances at an international level and share ideas and approaches, and we hope to build on this in the future
A feasibility study to examine the adoption of CBT techniques and their impact on clinical practice in the community pharmacy environment
Led by the AHSN Network
Day One, Pop-up University 8, 11.00
Impact and celebration event - transforming services for the frail and elderl...NHS Improving Quality
North Lincolnshire CCG - transforming services for the frail and elderly. Slides from the impact and celebration event held in London on 24 February 2015.
“Decisions of value – how the NHS can balance quality and finance in decision-making”
NHS decision-makers have to balance the priorities of quality improvement and financial sustainability, in other words they have to deliver value. This balancing act is increasingly challenging as the demands on the NHS change and grow, with more expected within an ever tighter budget. Decisions of Value is a project commissioned by the Department of Health and led jointly by the Academy of Medical Royal Colleges and the NHS Confederation. It has spent six months studying what influences how decisions are made and brings together a large amount of research to show how factors such as relationships, behaviours and environment influence the value delivered, extending beyond Whitehall to the front line.
The project’s findings have recently been published and emphasise the importance of the cultural, rather than structural, changes needed to move towards delivering better value and look at how they rely on having the right relationships, behaviours and environments in place. It presents insights into how people interact in the NHS and the crucial factors affecting how they operate within a particular context. In many cases, it indicates a ‘back to basics’ approach that involves a fundamental understanding of how humans interact and operate. As such, it doesn’t look to define good decisions, but rather gives an insight into the principles of good decision-making.
For more information, please see: http://www.nhsconfed.org/decisions-of-value
Impact and celebration event - implementing the city-wide Mental Health Frame...NHS Improving Quality
Jenny Thornton from Leeds Mental Health Framework discusses implementing the city-wide Mental Health Framework. Slides from the impact and celebration event held in Leeds on 3 March 2015.
Angela Coulter, The King's Fund, and Ben Mearns, Surrey and Sussex Healthcare NHS Trust present on patient engagement and health information technology.
Building the Health Workforce as We Transform the Delivery System, presented by Mary D. Naylor, PhD, RN, Marian S. Ware Professor in Gerontology, University of Pennsylvania School of Nursing
Candace Imison, Director of Healthcare Systems at the Nuffield Trust, presents on how we need the right workforce to transform the delivery system in healthcare.
Bethan George: Creating and using linked data sets Nuffield Trust
Bethan George, Deputy Director at the Waltham Forest, East London and City (WELC) Integrated Care Programme, presents on creating and using linked data sets.
Dr Alisha Davies explores evaluation of the 'Better access, better care, better lives' scheme in Barking, Dagenham, Redbridge and Havering as part of the Prime Minister's Challenge Fund.
Theo Georghiou presents on a Nuffield Trust evaluation project to examine the effectiveness of the voluntary sector in helping to prevent hospital admissions.
Abraham George: Kent Year of Care Programme Nuffield Trust
Dr Abraham George, Consultant in Public Health
Kent County Council, presents on using whole population linked datasets to develop higher value models of care in Kent's Year of Care Programme on long term conditions.
Magnus Liungman: RCTs in complex settings Nuffield Trust
Magnus Liungman and Dr Gustaf Edgren present on the lessons learned from developing a healthcare prevention intervention for frequent emergency department visitors.
Ruth Thorlby: capturing patient and staff thoughts in evaluation Nuffield Trust
Ruth Thorlby, Acting Director of Policy at the Nuffield Trust, presents reflections on the challenges of capturing patient and staff thoughts in evaluations
Laura Eyre and Martin Marshall: Researchers in residence Nuffield Trust
Laura Eyre, Research Associate and Martin Marshall, Professor of Healthcare Improvement at UCL give an inside perspective on moving improvement research closer to practice.
Anna Middlemiss, Public Health Consultant at Wakefield Council and Gaynor Endeacott, Project Manager at Healthwatch Wakefield present on their approach to patient evaluation.
Elizabeth Orton: Leicestershire’s Better Care Fund Nuffield Trust
Elizabeth Orton, Consultant in Public Health and Janine Dellar, Head of Public Health Intelligence at Leicestershire County Council present on evaluating Leicestershire's Better Care Fund programme.
Tom Deblanco: maximising patient engagementNuffield Trust
Tom Delbanco, MD, MACP and Koplow–Tullis, Professor of Medicine, Harvard Medical School present on maximising patient engagement through health information technology.
Cheryl Davenport, Director of Health and Care Integration at Leicestershire County Council, talks about how simulation is helping to evaluate how emergency hospital admissions can be reduced.
This presentation was given by Miriam Taegtmeyer at a meeting of the Overseas Development Institute on the 20 January 2016. In it she discusses the REACHOUT quality improvement approach.
Evaluation of IC initiatives - challenges, approaches and evaluation of Engla...Sax Institute
This presentation from Nicholas Mays, Professor of Health Policy, Director, Policy Innovation Research Unit, Department of Health Services Research & Policy focuses on the challenges, approaches and evaluation of England's Pioneers.
Lesley Strong and Hazel Carpenter: integrating community and social care serv...The King's Fund
Lesley Strong and Hazel Carpenter discuss how Kent County Council, Kent and Medway NHS and Social Care Partnership Trust, Kent Community Health NHS Trust and the clinical commissioning groups have been working together to join up community health and social care services in the county.
Components of integrated care include: a system of risk stratification to determine which high-risk patients the multidisciplinary team are going to work with; co-located, mobile and flexible teams; a single assessment process with assistive technology at the core; and health and social care co-ordinators appointed in some localities.
A service improvement focused on frailty using an R&D approach, pop up uni, 3...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
New Care Models - the story so far, pop up uni, 2pm, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
Sharing and Learning Together to Deliver High Quality End of Life Care for AllNHS Improving Quality
Sharing and Learning Together to Deliver High Quality End of Life Care for All
Presentations from the Sharing and Learning Together to Deliver High Quality End of Life Care for All event held on
Tuesday 24 June 2014, Congress Centre, London, WC1B 3LS
#nhsiqeolcare
Involving patients in outcomes based commissioning in community services, pop...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Making Seven Day Services a reality, pop up uni, 2 pm, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Social Prescribing | Swindon | Building Health Partnerships SEUK2014
Swindon have piloted a social prescribing scheme to support individuals being discharged from secondary mental health services. This presentation was given as part of an action learning day on social prescribing hosted by Swindon Building Health Partnerships group. For more information about the Building Health Partnerships programme www.socialenterprise.org.uk/buildinghealthpartnerships
Effectiveness of the current dominant approach to integrated care in the NHSNuffield Trust
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Lisa Annaly, Head of Provider Analytics at the Care Quality Commission, discusses lessons learned from the CQC as they have worked to monitor care quality over time.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Monitoring quality of care: making the most of dataNuffield Trust
Chris Sherlaw-Johnson, Senior Research Analyst at the Nuffield Trust, introduced the Monitoring quality of care conference and gives an overview of some of the approaches that we've been using at the Trust to identify where care quality has been improving, especially for frail and older people.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
New Models of General Practice: Practical and policy lessonsNuffield Trust
Nuffield Trust policy researchers Rebecca Rosen and Stephanie Kumpunen present findings from our upcoming report on large scale general practice models.
1. Evaluating a whole systems approach to
integrated care in North West London
Nuffield Trust & London School of Economics
22 June 2015
Holly Holder (holly.holder@nuffieldtrust.org.uk)
Project team: Matthew Gaskins, Holly Holder, Judith Smith and Gerald Wistow
3. Methodological challenges
• How do you evaluate such a large and complex programme?
• In such a multi-level programme, which level do you
investigate?
• How do you evaluate something that is constantly changing?
4. What is the Whole Systems Integrated Care (WSIC)
programme vision?
Vision
• Care is coordinated around the individual
• Care is provided in the most appropriate setting
• Funding flows to where it is needed
Aims
• People will report a better quality of life
• Quality of care will improve
• Better care will be delivered at lower cost
• Providers will operate more effectively
• Professional experience will improve
5. WSIC process and delivery
• Develop accountable care partnerships (ACPs)
• Use a capitation payment model that incentivises providers
to work together and focus on population outcomes rather
than activity
• To have GPs at the centre of organising and coordinating
care within the ACPs
• To make patients equal partners in all aspects of design
6. North West London
• 2 million population
• 8 local boroughs
• 8 clinical commissioning groups
• £4+ billion annual health and
social care spend
7. A complex provider landscape
Mount Vernon
Harefield
RNOH
Hillingdon
Northwick Park
Ealing
West Middlesex
Central Middlesex
Hammersmith
Charing Cross
St Mary’s
Chelsea and
Westminster
Royal
Brompton
Royal Marsden
Imperial
London
North West
Western Eye
St Charles
• 10 acute and specialist
hospital trusts
• 2 mental health trusts
• 2 community health
trusts
• 400+ GP practices
9. How is the WSIC programme funded?
• Top-slice of 2.5% of pooled budgets of eight NW London CCGs
and NHSE commissioning budget for NW London
• Programme management team also drives other, related
initiatives: acute hospital reconfiguration, and programmes to
reform primary care and mental health services
• Additionally, all eight NW London CCGs have joined to work as a
collaborative
10. Two levels of operation: pan-NWL level
Adapted from WSIC Integrated Care Toolkit
Governance structures
11. Activities at a pan-NWL level
Tackling the ‘tough nuts’ once at the pan-NW London level...
Source: WSIC Integrated Care Toolkit
12. Two levels of operation: local level (Early Adopters)
3
Summary of Early Adopters: What we are trying to do
Brent
▪ MCP model for people over the
age of 65 with one or more
long-term conditions
▪ MCP would be an accountable
partnership of primary,
community, acute and local
authority care providers, led by
a GP Network
Tri-borough (Central London, H&F, West London and Community
Independence Service)
▪ 3 MCP models (early adopters local to each borough) and a PACS
model in the form of the CIS
▪ Provides opportunity to test proactive early adopter model aiming
to keep people well , building on strong voluntary sector provision
of self-care support, alongside more reactive CIS support aimed at
keeping people out of hospital or getting people home quicker
after crisis
Hounslow
▪ MCP model for people aged 16 and
over with one or more long term
condition and people with dementia
▪ Model based on multi-disciplinary
working, care coordination, self-
management and care planning
Harrow
▪ MCP model for people over the age
of 65 with one or more long-term
conditions
▪ Enhancement of primary care with an
expanded range of health
professionals such as senior nurses
and hospital specialists
Hillingdon
▪ PACS model for people over the age
of 65 with one or more long-term
conditions
▪ Services wrapped around the person
to ensure that they receive the right
care at the right place at the right
time
▪ Third sector to community based
support promoting independence and
self-care and reducing social isolation
Ealing
▪ MCP model for individuals over
75 with one or more Long Term
Conditions
▪ Model based on joint care
teams in all localities, care
coordinators and navigators,
multi-professional care
planning, and self-care
Source: North West London Five Year Forward View Vanguard bid
13. The process happening at the local level
WSIC’s ten-step methodology for developing whole systems integrated care
Source: WSIC Integrated Care Toolkit
14. Our research questions
We explored:
• The way in which the WSIC programme is being designed
• Its involvement of local stakeholders in the processes of
design
• The development and early implementation of early
adopter schemes
• The extent to which the WSIC programme appears to be
on track towards its objectives.
15. Our approach: pan-NWL level
• Formative evaluation
• Regular meetings with programme team
• Workshops with Early Adopters and programme team
• Focus group with Early Adopters
• Evaluation steering committee
• Interviews with senior stakeholders (~88)
• Observations of programme team meetings (120 hours)
• Survey of GPs in NWL (39% response rate, n=160)
16. Our approach: local level
• Four case study Early Adopters
• Interviews with key individuals
• Observations of Steering Committee meetings
• Survey with all Steering Committee members (60%
response rate, n=109)
• Workshops with representatives from all Early Adopters
17. How do you evaluate such a large and complex programme?
• Combine breadth and depth
• In-depth interviews with limited number of people
• Workshops and focus groups
• Survey with all Steering Committee members
• Purpose: thoughts on progress, challenges, achievements
• Survey with GPs in NWL
• Purpose: contextual information to explore how easy or difficult it
was going to be to roll out the programme
• ‘What would help you to deliver more integrated care?’
• ‘Have you heard about the programme?’
• Observations and document reviews (governance papers)
• Does what people say match what is actually happening?
18. In such a multi-level programme, which level do you
investigate?
• Identify where change is taking place (in integrated care
projects – macro, meso, micro)
• Monitoring of pan-NWL issues (context: financial,
provider landscape, commissioning; developments and
progress with programme team)
• Monitoring of all Early Adopters
• Case study approach for in-depth exploration of change
at the Early Adopter level
19. In such a multi-level programme, which level do you
investigate? (2)
How we selected the case studies:
• Where is the early adopter based?
• Geography, complexity of health economy, contextual
differences.
• Who is involved in the early adopter?
• Target population characteristics, partners delivering the
intervention, readiness for implementation.
• How will the early adopter be delivered?
• Scale of initiative in terms of quantity, scale of initiative in
terms of quality, extent of social care involvement.
20. How do you evaluate something that is constantly
changing?
• Benefits of a formative evaluation
• Benefits of a realist evaluation approach
• Interviews/surveys at different time points
• Repeat interviews with same individual
• Develop a key contact within the programme team
• Board minutes are an excellent resource
• Keep up to date with local and national developments
21. Methodological challenges
• How do you evaluate such a large and complex programme?
• Take advantage of different methodologies
• Observations
• In such a multi-level programme, which level do you investigate?
• Both organisational and local
• How do you evaluate something that is constantly changing?
• Timing of research
• Approach to evaluation
• Regular contact
• Tracking national and local policy context