Fire service as an asset: providing telecare support in the community Webinar...NHS Improving Quality
Guest speaker: Steve Vincent - West Midlands Fire Service & Simon Brake from Coventry Council
Hosted by: Bev Matthews, Long Term Conditions Programme Lead, NHS England
Learning Outcomes:-
To better understand the role that the Fire and Rescue service can provide as a community asset to support health needs Enhancing the quality of life for people by supporting them to stay in their own home, even in a crisis
LTC Year of Care Commissioning Model
Lesley A Callow, Delivery Support Manager - Long Term Conditions Year of Care Commissioning Model
NHSIQ
Fionuala Bonnar, Year of Care Programme Manager
LTC Year of Care benefits:
Improved outcomes and wellbeing:
Patients receive care that is better managed, more seamless across different care services and more needs focused.
Reduction in acute admissions to hospital; and shorter lengths of stay when these are required.
Clinical professionals contribute to a more holistic service for patients by working within an integrated patient-centred care plan
Local health and Social Care economies:
Provide care that delivers value for money and is better managed by integrated teams.
Incentive to improve services for patients
Improved joint working and shared responsibility for outcomes
LTC year of care commissioning early implementer sites workshop held on 1 December 2014. Featuring Dr Martin McShane, Rob Meaker and Renata Drinkwater.
Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient C...NHS Improving Quality
Speaker slides from the national conference, 'Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life', 17 March 2016
NHS England and partners have published six Quick Guides to bring clarity on how best to work with the care sector. They can be accessed at www.nhs.uk/quickguides
Want to find out how the care sector can support local systems in the run up to winter? Want to break down barriers between health and care organisations? Want to find out how Leicester has achieved a 60% reduction in care home admission costs? Want to finally break down the myths around sharing patient information and assessments? Want to use other people's ideas and resources?
Webinar outcomes:
Introduction to the care homes quick guides
Two examples of models referenced in the guides:
- Angela Dempsey, Baker Tilly on the Quest4care tool
- Dawn Moody on MDT working and a model implemented in a CCG
Guest Speakers: Nicola Spencer and Emily Carter - NHS England
Fire service as an asset: providing telecare support in the community Webinar...NHS Improving Quality
Guest speaker: Steve Vincent - West Midlands Fire Service & Simon Brake from Coventry Council
Hosted by: Bev Matthews, Long Term Conditions Programme Lead, NHS England
Learning Outcomes:-
To better understand the role that the Fire and Rescue service can provide as a community asset to support health needs Enhancing the quality of life for people by supporting them to stay in their own home, even in a crisis
LTC Year of Care Commissioning Model
Lesley A Callow, Delivery Support Manager - Long Term Conditions Year of Care Commissioning Model
NHSIQ
Fionuala Bonnar, Year of Care Programme Manager
LTC Year of Care benefits:
Improved outcomes and wellbeing:
Patients receive care that is better managed, more seamless across different care services and more needs focused.
Reduction in acute admissions to hospital; and shorter lengths of stay when these are required.
Clinical professionals contribute to a more holistic service for patients by working within an integrated patient-centred care plan
Local health and Social Care economies:
Provide care that delivers value for money and is better managed by integrated teams.
Incentive to improve services for patients
Improved joint working and shared responsibility for outcomes
LTC year of care commissioning early implementer sites workshop held on 1 December 2014. Featuring Dr Martin McShane, Rob Meaker and Renata Drinkwater.
Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient C...NHS Improving Quality
Speaker slides from the national conference, 'Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life', 17 March 2016
NHS England and partners have published six Quick Guides to bring clarity on how best to work with the care sector. They can be accessed at www.nhs.uk/quickguides
Want to find out how the care sector can support local systems in the run up to winter? Want to break down barriers between health and care organisations? Want to find out how Leicester has achieved a 60% reduction in care home admission costs? Want to finally break down the myths around sharing patient information and assessments? Want to use other people's ideas and resources?
Webinar outcomes:
Introduction to the care homes quick guides
Two examples of models referenced in the guides:
- Angela Dempsey, Baker Tilly on the Quest4care tool
- Dawn Moody on MDT working and a model implemented in a CCG
Guest Speakers: Nicola Spencer and Emily Carter - NHS England
Presentation slides Frailty: building understanding, empathy and the skills t...NHS Improving Quality
Frailty: building understanding, empathy and the skills to support self-care
Guest speaker:Dr Dawn Moody, Director - Fusion48
An opportunity to learn about some innovative approaches to making the health and care workforce 'Fit for Frailty'* (*British Geriatrics Society 2015).
Learning outcomes:
To explore the Frailty Fulcrum as a tool for holistic assessment and management of frailty
To hear how Virtual Reality is being used to build empathy for older people living with frailty
To learn about the impact of a county-wide, multi-agency, multi-professional training an toolkit for care professionals working with older people
Resources:www.fusion48.net
Commissioning Integrated models of care
Kent LTC Year of Care Commissioning Early Implementer Site
Alison Davis, Integration Programme Health and Social Care, Working on behalf of Kent County Council and South Kent Coast and Thanet CCG's
Midlands and East GP Forward View access update event July 2017NHS England
A presentation from the GP Forward View update event in July 2017 for Midlands and East, giving the latest information on improved access to primary care.
Integrated data to support service redesign decision making 19 01 2016 finalNHS Improving Quality
Integrated data to support service redesign decision making
Leeds LTC Year of Care Commissioning Early Implementer Site
Tricia Cable, Year of Care Lead
Alison Phiri, Business Intelligence Manager
Mohini Chauhan, Year of Care Commissioning Manager
Learning Disabilities: Share and Learn Webinar – 27 July 2017NHS England
Topic One: Transforming care for children and young people with autism
Guest speakers: Sarah Jackson and David Gill, NHS England and Pat Smith, Autism East Midlands
This webinar looks at some of the challenges seen, such as gaps in provision for children and young people with autism, and will discuss some of the work that is taking place to address these issues.
Topic Two: “The assuring transformation data system” - how to upload data and run reports
Guest speakers: Andy Tookey, NHS England and Judith Ellison and Sarah Freeman, NHS Digital
This webinar is aimed at people who are new to reporting assuring transformation (AT) data or who are unsure how to run reports.
Slides from a lunch and learn webinar hosted by NHS England's Long Term Conditions Team, on the topic of health coaching by lay professionals.
The speakers and Anya de Longh and Jim Phillips.
CYPMH conference 2016 Future in Mind Vision to Implementation
Inpatient CAMHS – The Tier 4 review report 2 years on
Dr Margaret Murphy - Clinical Chair, Secure and Specialised Mental Health Programme of Care, NHS England
Learning Disabilities: Share and Learn Webinar – 25 August 2016NHS England
Topic 1: Co production – a long term relationship and different Conversations
Guest Speakers: Samantha Clark, Chief Executive, Inclusion North
In health & social care we are constantly grappling with how we can work differently and think differently about people who come to our services (willingly and otherwise) needing support. With so many new ways of thinking & working around – co production, person centred approaches, asset based community development, strengths based approaches, community capacity - sometimes it's hard for people who work in services, as well as the people and families they support, to work out what it those mean to their practice. This webinar will focus on the practical values driven implementation of co production – the long term relationship, shifting power but building on all contributions.
Topic 2: Transforming Care and Building the Right Support – the CQC approach to registering services for adults with learning disabilities
Guest Speakers: Theresa Joyce and Sue Mitchell, Care Quality Commission
This webinar will be an opportunity for commissioners to consider the CQC policy on registering providers who apply to deliver services for adults with learning disabilities. The policy is called ‘Registering the Right Support’ and outlines the factors we will consider in both approving and refusing applications for either new services or changes in existing services. We will consider specific issues, such as applications to change the registration of a hospital ward or unit, to register large or congregate services or to increase the size of an existing location. These factors are all important when commissioners are developing their plans under the Transforming Care program, and the webinar will enable discussion and questions about the registration approach and process.
Transforming Care: Share and Learn Webinar – 31 August 2017NHS England
Helping people with a learning disability to give feedback
Guest Speakers: Ruth Hudson - Insight Specialist, Joe Penrose - Insight and Feedback Officer, Katie Matthews, Aaron Oxford and Thomas Chalk - Learning Disability Network Managers
NHS England’s Insight and Learning Disability Engagement teams recently published their bite-size guide to helping people with a learning disability to give feedback.
The webinar is aimed at staff who do not have much experience of involving people with a learning disability in giving feedback. It is of particular interest to staff working in Patient Experience and Communication and Engagement roles. Most of the services people with a learning disability use are the same services as everyone else, and so it is important they are included in feedback and engagement work. Join the teams on the webinar to find out more about increasing the representation of one of the most seldom heard groups of people.
Population Level Commissioning for the Future
Wednesday 3 December 2014, 1pm – 1.45pm
Dr Abraham George
Assistant Director/Consultant in Public Health
Kent County Council
&
Beverley Matthews
LTC Programme Lead, NHS Improving Quality
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
How will Sustainability and Transformation Plans (STPs) help deliver the Five Year Forward View?
Matthew Swindells and Simon Enright, NHS England, and Julia Ross, North West Surrey CCG
Day One, Pop-up University 7, 10.00
Presentation slides Frailty: building understanding, empathy and the skills t...NHS Improving Quality
Frailty: building understanding, empathy and the skills to support self-care
Guest speaker:Dr Dawn Moody, Director - Fusion48
An opportunity to learn about some innovative approaches to making the health and care workforce 'Fit for Frailty'* (*British Geriatrics Society 2015).
Learning outcomes:
To explore the Frailty Fulcrum as a tool for holistic assessment and management of frailty
To hear how Virtual Reality is being used to build empathy for older people living with frailty
To learn about the impact of a county-wide, multi-agency, multi-professional training an toolkit for care professionals working with older people
Resources:www.fusion48.net
Commissioning Integrated models of care
Kent LTC Year of Care Commissioning Early Implementer Site
Alison Davis, Integration Programme Health and Social Care, Working on behalf of Kent County Council and South Kent Coast and Thanet CCG's
Midlands and East GP Forward View access update event July 2017NHS England
A presentation from the GP Forward View update event in July 2017 for Midlands and East, giving the latest information on improved access to primary care.
Integrated data to support service redesign decision making 19 01 2016 finalNHS Improving Quality
Integrated data to support service redesign decision making
Leeds LTC Year of Care Commissioning Early Implementer Site
Tricia Cable, Year of Care Lead
Alison Phiri, Business Intelligence Manager
Mohini Chauhan, Year of Care Commissioning Manager
Learning Disabilities: Share and Learn Webinar – 27 July 2017NHS England
Topic One: Transforming care for children and young people with autism
Guest speakers: Sarah Jackson and David Gill, NHS England and Pat Smith, Autism East Midlands
This webinar looks at some of the challenges seen, such as gaps in provision for children and young people with autism, and will discuss some of the work that is taking place to address these issues.
Topic Two: “The assuring transformation data system” - how to upload data and run reports
Guest speakers: Andy Tookey, NHS England and Judith Ellison and Sarah Freeman, NHS Digital
This webinar is aimed at people who are new to reporting assuring transformation (AT) data or who are unsure how to run reports.
Slides from a lunch and learn webinar hosted by NHS England's Long Term Conditions Team, on the topic of health coaching by lay professionals.
The speakers and Anya de Longh and Jim Phillips.
CYPMH conference 2016 Future in Mind Vision to Implementation
Inpatient CAMHS – The Tier 4 review report 2 years on
Dr Margaret Murphy - Clinical Chair, Secure and Specialised Mental Health Programme of Care, NHS England
Learning Disabilities: Share and Learn Webinar – 25 August 2016NHS England
Topic 1: Co production – a long term relationship and different Conversations
Guest Speakers: Samantha Clark, Chief Executive, Inclusion North
In health & social care we are constantly grappling with how we can work differently and think differently about people who come to our services (willingly and otherwise) needing support. With so many new ways of thinking & working around – co production, person centred approaches, asset based community development, strengths based approaches, community capacity - sometimes it's hard for people who work in services, as well as the people and families they support, to work out what it those mean to their practice. This webinar will focus on the practical values driven implementation of co production – the long term relationship, shifting power but building on all contributions.
Topic 2: Transforming Care and Building the Right Support – the CQC approach to registering services for adults with learning disabilities
Guest Speakers: Theresa Joyce and Sue Mitchell, Care Quality Commission
This webinar will be an opportunity for commissioners to consider the CQC policy on registering providers who apply to deliver services for adults with learning disabilities. The policy is called ‘Registering the Right Support’ and outlines the factors we will consider in both approving and refusing applications for either new services or changes in existing services. We will consider specific issues, such as applications to change the registration of a hospital ward or unit, to register large or congregate services or to increase the size of an existing location. These factors are all important when commissioners are developing their plans under the Transforming Care program, and the webinar will enable discussion and questions about the registration approach and process.
Transforming Care: Share and Learn Webinar – 31 August 2017NHS England
Helping people with a learning disability to give feedback
Guest Speakers: Ruth Hudson - Insight Specialist, Joe Penrose - Insight and Feedback Officer, Katie Matthews, Aaron Oxford and Thomas Chalk - Learning Disability Network Managers
NHS England’s Insight and Learning Disability Engagement teams recently published their bite-size guide to helping people with a learning disability to give feedback.
The webinar is aimed at staff who do not have much experience of involving people with a learning disability in giving feedback. It is of particular interest to staff working in Patient Experience and Communication and Engagement roles. Most of the services people with a learning disability use are the same services as everyone else, and so it is important they are included in feedback and engagement work. Join the teams on the webinar to find out more about increasing the representation of one of the most seldom heard groups of people.
Population Level Commissioning for the Future
Wednesday 3 December 2014, 1pm – 1.45pm
Dr Abraham George
Assistant Director/Consultant in Public Health
Kent County Council
&
Beverley Matthews
LTC Programme Lead, NHS Improving Quality
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
How will Sustainability and Transformation Plans (STPs) help deliver the Five Year Forward View?
Matthew Swindells and Simon Enright, NHS England, and Julia Ross, North West Surrey CCG
Day One, Pop-up University 7, 10.00
Public Health contribution towards LTC Year of Care Commissioning ModelNHS Improving Quality
Public Health contribution towards LTC Year of Care Commissioning Model
Dr Abraham P. George
Consultant / Asst Director in Public Health
Kent County Council
What is the long term conditions commissioning model?
Midlands and East GP Forward View update event May 2017NHS England
A presentation from the GP Forward View update event in May 2017 for Midlands and East, giving the latest information on what the Forward View is delivering.
Public Transformation Network - Local Government & Social Care Digital | Ceci...Anna Fenston
Presentation on 'Public Transformation Network - Local Government & Social Care Digital' by Cecil Sinclair, Local Government Association from the Local Digital Futures - Working as One: Platforms & Sharing event held on 4 March 2016 in London.
Commissioning for outcomes,
Wednesday 21 January 2015 - 13.00 to 13.45
Hosted by Bob Ricketts CBE, Director of Commissioning Support Services and Market Development for NHS England.
NHSIQ LTC Year of Care Commissioning Programme shortlisted for HSJ Awards 2014:
HSJ Awards Dragon’s Den presentation on enhancing care by sharing data and information
More at: http://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care.aspx
NHS and Liverpool structures, priorities and commissioning workshopInnovation Agency
Presentations at the NHS and Liverpool structures, priorities and commissioning workshop on Tuesday 11 September at The Accelerator Building, Liverpool
Stopping over-medication of People with Learning Disabilities
(STOMPLD) 2016.
Reducing Inappropriate Psychotropic Drugs in People with a Learning Disability in General Practice and Hospitals in 2016.
Self-management in the community and on the Internet - Presentation 22nd Marc...NHS Improving Quality
LTC Lunch & Learn webinar:- 22nd March 2016
Presenter:- Pete Moore, Educator, Author & Pain Toolkit Trainer
As pain is the most daily health problem reported to a GP-
Developing a national pain strategy- reviews from around the world
An overview of the work carried out by NHS England and NHS Improving Quality's Long Term Conditions Sustainable Improvement Team. It puts the case for why person-centred care has to be at the heart of healthcare.
The final poll for the person centred care images captured at the LTC Midlands and East learning event in November 2015. Which captures person centred care the most to you? Access to records or quality for everyone?
Improving the physical health of patients with severe mental health illness ...NHS Improving Quality
Improving the physical health of patients with severe mental health illness in primary care, by Rhiannon England, GP Clinical Lead, City and Hackney CCG
Three Dimensions of Care for Diabetes (3DFD) – diabetes management for people...NHS Improving Quality
Three Dimensions of Care for Diabetes (3DFD) – diabetes management for people with psychological / social needs, by King's College Hospital NHS Foundation Trust, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
2. www.england.nhs.uk
• Introduction and welcome
• Outline of today's workshop
• National update
• EIS future plans and discussion
• Proactive health coaching - followed by EIS
updates and discussion
• Approaches to developing currencies and
payment systems: mental health and NHSE
pricing team updates / approaches - followed by
YoC capitated budget updates from EIS and
discussion
Introductions and outline of today:
3. www.england.nhs.uk
• To hear and learn about other EIS plans for YoC
Commissioning beyond March 2016
• To develop contacts and learning from others to support local
thinking and robust planning around proactive health
coaching
• To update knowledge on national approaches to currency
development and payment – thinking about and discussing
EIS year of care capitated budget approaches
Learning Outcomes:
5. www.england.nhs.uk
LTC Framework
Commitment
to Carers
Frailty
Health Ageing
Guide
Fire Service as
an asset
Care Homes
Quick Guides
Care & Support
Planning
Navigating Health
& Social Care
Self Care
Ambitions for
End of Life Care
Our Declaration
Delivery Models
Planning for Change:
• Capitated Budget
• Contracting
• Simulation Modelling
Patient and
Service
Selection
Planning for Change:
Workforce
Whole Population
Analysis;
Understanding your
population
LTC Dashboard LTC Toolkit
7. www.england.nhs.uk
7
Using behavioural
change to open
minds
o Make a declaration at
www.engage.england.nhs.uk/survey/ltc
-declaration
o Tell your teams about our work
o Encourage them to make a declaration
o Ask them to feed back thoughts and
ideas
o Use our hashtag – #A4PCC – when
you see work that is relevant to
person-centred care for people with
LTCs
o Let us know of any events, activities or
social media opportunities that we can
join forces with you
#A4PCC – Action for Person-
Centred Care
Person
with long
term
condition
8. www.england.nhs.uk
Date Topic Led by and details of session Venue
20 January
12.30pm
Clinical input to care homes
www.nhs.uk/quickguides
Nicola Spencer and Emily Carter
NHS England
Guest speakers:
• Angela Dempsey, - Baker Tilly on
the Quest4care tool
• Dawn Moody – North Staffs on
MDT working and a model
implemented in a CCG
Via WebEx
10 February
11.30am
Health Coaching in the community-
the role of non-clinical staff and
people with lived experience as
coaches
Anya De Iongh & Jim Phillips Via WebEx
TBC Self-management in the community
and on the Internet
Peter Moore, The Pain Toolkit Via WebEx
LTC Virtual Learning Community Lunch & Learn webinars:
Sharing and Learning …
9. www.england.nhs.uk
Date Topic Led by and details of session Venue
11 January
2016
12.30 – 1.30
Developing robust capitated budgets
- Integrated data
- Developing capitated budgets
- The Southend process and experience
Steve Downing, Head of Finance and
Bill Woods, Business Intelligence
NHS Southend
Southend LTC Year of Care
Commissioning
Early Implementer Site
Via Webex
Click here to
register
19 January
2016
12.30 – 1.30
integrated data to support service
redesign decision making:
- The Leeds approach
- How and who...using the integrated
data
- Challenges, lessons learned...what next
Tricia Cable, LTC Year of Care
Commissioning Programme lead,
NHS Leeds
Leeds LTC Year of Care Commissioning
Early Implementer Site
Via Webex
Click here to
register
4 February
2016
10.30 – 3.30
LTC Community of Practice Workshop Please save the date for this workshop -
details to follow
Central
London
11 February
2016
12.30 – 1.30
Commissioning Integrated models of
care:
- The South Kent model of care (what it
looks like)
- Roadmap to delivery
- Contracting models and evaluation.
Alison Davis, Integration Programme
Health and Social Care, Working on
behalf of Kent County Council and
South Kent Coast and Thanet CCG's
Kent LTC Year of Care Commissioning
Early Implementer Site
Via Webex
Click here to
register
LTC Community of Practice webinars:
Scan, Focus, Act …
10. www.england.nhs.uk
• Individual EIS monthly update calls (30 mins)
• Quick updates (national and EIS)
• Your opportunity to raise any issues / request help
• Calls in diary for West Hants, BHR and Leeds
• Dates still to be agreed with Kent and Southend
LTC YoC Commissioning – EIS sites
Dates for Diary
EIS workshops
(10.30 – 3.30, central London, venues tbc):
Monthly project leads forum
2pm – 3.30pm (webex)
18th Jan 2016 Mon 1st Feb 2016
23rd March 2016 Tues 1st March 2016
12. www.england.nhs.uk
• Kent Integrated Dataset - to continue data work
• Funding secured from CCG’s and KCC Social Care
• Kent Integrated Payments Group – to continue work on
capitated payments
• Capitated Payments Workplan drafted
• Additional Programme Management resources under
discussion
• Vanguard and Integrated Care Organisations in East Kent
developing Whole Population Budgets using the dataset
• Public Health to lead evaluation and system modelling work
using the Kent Integrated Dataset
• Further Datasets to be added e.g. children’s services,
police
Kent Post LTC Year of Care Plans
13. www.england.nhs.uk
Report by: Chris Hume Date: 17 December 2015
Progress this month Plans for next month
• 112 out of 202 GP practices have agreed to share data
• Draft implementation plan prepared for 2016/17 shadow
capitated budget for Thanet ICO. Vanguard (Canterbury
and Coastal) and ICO (South Kent Coast ) also looking to
adapt the plan for their use
• Work continuing on key actions from Data Quality
Improvement Plan – reconciling cost data to CCG spend,
data dictionary. New Analyst commenced
• Application made to Integration Pioneer Bespoke Fund for
additional resources to support remaining data collection
(GP data, Acute non-SUS, Continuing Health Care and
IAPT)
• Application prepared to HSCIC to receive IAPT data
• Uncertainty over future of data warehouse resolved – to
be hosted by Maidstone and Tunbridge Wells Trust
• Increase the number of GP Practices flowing data
• Set up local project with Monitor and HSCIC to calculate
prescribing costs
• Continue work with Vanguard and East Kent ICO’s to
develop shadow capitated budgets
• Review preliminary findings from PSSRU analysis of costs
• Continue to implement the data quality improvement plan
• Create Kent wide group on capitated funding
• Commence preparation for post- March arrangements
Risks & Issues Seek (Help needed) and Share (Learning offered)
Timescales for ICO/MCP development by CCG’s mean
capitated budgets will not be produced in 2015/16
Length of time taken to collect GP Practice data leading
to insufficient data to calculate capitated budgets
How to engage CCG commissioners in planning the
implementation of capitated budgets
LTC Year of Care Commissioning Early Implementer Site Update - KENT
14. www.england.nhs.uk
Report by: Leeds EIS • Date: December 2015
Progress this month • Next steps
• Data analysis by practice level using the selection
toolkit and the data packs. They will be shared to all
practices in LSE.
• Closer working with the self-management group
and Leeds Involving People (LIP) to organise a
workshop involving the self-management patient
forum
• Further engagement in local discussions on models
of care and YoC contribution
• Refresh of data packs for each CCG based on
14/15 data (full financial year 14/15 data expected
in the next few weeks)
• Case study to be finalised based on data packs and
selection toolkit, to be submitted to NHS England
(Sustainable Improvement Team, formerly NHS IQ)
• Demonstration of the Simul8 tool (scenario
generator tool) by Jamie Day (Jan/Feb)
• Self-management/YoC workshop involving self-
management forum (workshop arranged for 13th
January 2016)
• Development of patient stories/patient journeys,
potentially based on ethnography evaluation that
the Sustainable Improvement Team, carried out
• YoC EIS webinar presenting data packs and
carrying out demonstration of selection toolkit to the
wider EIS community
• Further development of Framework for development
of Capitated Budgets and discussion with CFOs
• Development of initial Capitated Budgets for
shadow monitoring
LTC Year of Care Commissioning Early Implementer Site Update - LEEDS
15. www.england.nhs.uk
Report by: Date: As at end Nov 2015
Progress this month – November Plans for next month – December
20th November: we have started running run the
integrated information including Social care, 21
primary care with Health data through the risk
strat tool and re –run the LTC report. This will
be compared to the first time we run. This will
identify any changes in the YOC tariff.
• PI Benchmarking will produce the first set of
dashboards.
• Care-Coordinator project lead assigned.
Risks & Issues Seek (Help needed) and Share (Learning
offered)
Delayed start of Community Recovery
Pathway – may not be able to deliver
outcomes by March 2016.
Not all surgeries have signed up for data
sharing.
Webinar – 11 Jan 2016 from 12.30pm – 1.30pm
Creating robust capitated budgets with Steve
Downing and Bill Woods
LTC Year of Care Commissioning Early Implementer Site Update – Southend
16. www.england.nhs.uk
Report by: Rashid aleem Date: 17/12/2015
Progress this month Plans for next month
• Recruitment of Business Intelligence
personal
* JD written
• Nuffield Report encouraging and
presented at Board Meeting
• Interviews for Business Intelligent
recruitment
* In post by Feb
• CCG is looking to establish a long term
partnership in order to improve automated
reporting across the system (still in
progress)
Risks & Issues Seek (Help needed) and Share (Learning
offered)
• The implementation of a Financial Model
by all parties remains a challenge
Patient Recruitment for H1000
Help around capitated model for Urgent
Care
• Approach NHS England about dual
registration
LTC Year of Care Early Implementer Site Update - BHR
17. www.england.nhs.uk
Report by: Kate Smith Date:as at end Nov
Summary of plans 1516: Progress to date:
Supporting integration and service development:
• Understand how the YoC can help drive service
development and support evaluation of integrated
working
• Information and profiling
• Improve data quality
• Robust costing methodology to feed commissioning
development
• Understand the current resource utilisation profiles
of those with LTCs
• Demonstrate delivery and outcomes of Integrated
Care
Commissioning development:
• Provider development
• Identify models of commissioning that facilitate
delivery of Integrated Care Services to improve
outcomes
Data development
• looking at LTC profiles across federations, costs and
activity within each profile
• presented to clinical lead and being refined to inform
priority areas and further service developments –
cost and activity proportions creating questions of
models
• Local pack structure being developed
• Social care data input - ?Jan
• Working with 7 practices not feeding HHR (on TPP)
• Agreed approach to depression and hypertension
• Considering use of specialist services data,
equipment needs and medicines costs
• Ongoing input into the development of simul8
• Depth interview approach approved and
implementation plan agreed
Risks & Issues: Seek (Help needed) and Share (Learning offered):
• Social Care data integration
• Contracting methodology to support both YoC and
new models of care development
• Resources – capacity and finance
• Local information pack structuring
• Capitated budget structuring
LTC Year of Care Commissioning Early Implementer Site Update – WEST HAMPSHIRE
20. In the UK, 35% of non-elective admissions are
concentrated in just 1% of the population
20
Example from a UK CCG; non-elective hospital admissions, 2013/2014
Note: Hospital spells between 1 April 2013–31 March 2014. Only non-elective admissions (all emergency admission methods; A&E of provider, A&E of other
provider, bed bureau, GP, outpatient, other, visit by consult, transfer from other provider)
Source: Hospital statistics UK CCG
6.2% of population (21,500 people),
100% of the non-elective admissions (31,070)
1% of the population (3,472 people),
35% of the non-elective admissions (10,950)
53% of the non-elective bed days (100,000)
CONFIDENTIAL
0 300,000250,000
30,000
35,000
350,000100,00050,000 200,000150,000
25,000
20,000
15,000
10,000
5,000
0
Non-elective admissions
Capita
21. This 1% is highly transient and needs proactive support
21
Example from a UK CCG
19%
29%
52%
2014/15
100%
Some inpatient care but
no longer in top 1% group
Still part of top 1% group
No inpatient care
(or deceased)
2013/14
Patient group
with highest
use of
non-elective
care
(top 1%)
CONFIDENTIAL
Source: Hospital statistics UK CCG
22. A typical patient in the 1% group “regresses towards the
mean” after a period of high healthcare utilisation
22
Increasing frequency
of A&E attendances
Healthcare cost
per patient
Time
Period of non-elective
activity starts; often
involves repeated
admissions
Integrated care package for
patient in place; healthcare
utilisation stabilises
Patient flagged as high-risk
Secondary prevention
initiatives initiated
CONFIDENTIAL
24. Patient case: “Helena” - in programme 133 days
24
Main gaps
Background
Early resultsActions and planning
Person
• Female, Mid 60’s
• Widow (Lost husband 2
years ago)
Medical history
• Syncope (undiagnosed cause despite attending
specialist syncope clinic)
• Sexual abuse (never disclosed before)
Recent care events
(last 12 months)
• 15 A&E attendances
• 10 hospital admissions
• Anxiety and social isolation
• No confirmed diagnosis and lacking
necessary resources
• Lack of knowledge to recognize
syncope episodes in time
• Contacting GP, as referral for
psychology not done
• Finding local organization which
offers more specialist and
appropriate counselling services
• Supporting patient to approach
organization (through motivational
calls)
• 2 A&E attendances (but no
admissions)
• Now recognizing syncope episodes
and has strategies to remove herself
from situations which she finds
stressful
• Recognized the syncope episodes
related to stress and anxiety and not
physiological
• Has disclosed more distressing
history (son in prison for child
abuse) - coach supporting to
disclose these issues to counsellor
Anxiety and social isolation possible triggers for acute care need
CONFIDENTIAL
25. Patient case: “Peter” - in programme 62 days
25
Main gaps
CONFIDENTIAL
Background
Early resultsActions and planning
Person
• Male, Mid 70’s
• Married, living w wife
• No exercise, does not drink much fluids
Medical history
• Stroke and hypertension
• Cancer of bladder
• Cataract
Recent care events
(last 12 months)
• 9 A&E attendances
• 0 hospital admissions
• No treatment/management plan in
place from GP
• Awaiting consultant appointment
and scan
• Anxious and worries about cancer
returning
• Pain, and lack of knowledge about
symptoms and therefore attends
A&E frequently
• Low confidence and motivation to
follow up with GP
• Arrange GP appointment to review
pain control
• Contact medical secretary to ask for
reduced waiting time for follow up
with consultant after scan
• Discuss symptoms with patient to
identify any gaps in knowledge
• Increase fluids to reduce risk of
urine infection
• Motivation calls to increase
confidence to act proactively
• No further A&E since enrolled in
Proactive Health Coaching
• Reviewed plan and pain control
with GP
• Consultant confirmed no secondary
cancer
• Now talks about his anxieties, and is
able to manage and understand his
physical symptoms better
• Commenced medication to alleviate
symptoms
Now able to manage and understand his physical symptoms better
26. Patients are satisfied and increase their quality of life with
the intervention
26
”I now get a better
access to my GP and
other clinicians”
”The health coach has
been a constant
throughout my ordeal –
the other health care
contacts has changed
consistently”
”Someone who cares, who follows up, who has the time
to listen, who calls when promised and who you can
contact when you need to”
”Other healthcare services
can’t compete with the
frequency of calls from the
health coach”
”The biggest difference is
having contact with the same
person all of the time – very
valuable”
40%
2%
45%
14%
Negative
Positive
Neutral
Significantly positive
Are you satisfied with the support?
40%
27%
4%
30%
Yes
No
Neutral
Very
How has your quality of life changed?
CONFIDENTIAL
27. We’ve got positive reactions and support from local GP’s,
community services as well as from York hospital
27CONFIDENTIAL
”Proactive Health Coaching is
making my job much easier”
– Community specialist nurse
”I am pleased finally someone
is looking out for her”
- GP in York
”I hope the service will scale up soon. We
needed you for our mother recently”
- Patient in Health Watch reference group
”This has been needed for a
long time”
- Clinician at York Hospital
”PHC is a great fit with our
strategy to move out care
from the acute hospital to
other proactive services”
- Vale of York CCG
CCG
28. The intervention leads to fewer non-elective admissions,
reduced LOS, better health and higher quality of life
28CONFIDENTIAL
Source: Kings Funds report; HN research articles
Non-elective
admissions
Other cost
effects
Other effects
Patient reported
outcomes
Reduced non-elective
admission
Fewer ER and follow-
up out-patient visits
Reduced other costs,
e.g. ambulance
Shorter LOS for un-
avoided admissions
Reduced excess cost
due to longer LOS
Category
Better health
outcomes etc
Impact
Higher quality of life
1
2
3
4
Tracked in PHC
Not tracked in PHC
“Some of the outcomes demonstrated
as a result of interventions include
improved quality of life; improvements
in clinical indicators (eg, in cholesterol
levels and blood pressure); better
adherence to treatment; improved
lifestyle; reduced symptoms; asking
more questions during meetings with
health professionals; reduced re-
admissions to hospital; fewer visits to
A&E; and fewer nights spent in
hospital”
Summary from Kings Fund report: “An overview of patient activation” and
results from Proactive Health Coaching
Patientactivation
29. Results vary among sites but in most cases a 20–40%
reduction in inpatient care utilisation has been achieved
29CONFIDENTIAL
Reduction in inpatient bed-day utilisation in intervention group vs control group (%)
* Results of yes-sayers vs control group in Zelen design regions
Source: Evaluation of full study population 2010–14, all sites
-5%
-10%
-15%
-20%
-25%
-30%
-35%
-40%
Frequent visitors
-0%
-45%
COPDCHF
Östergötland
Västra Götaland
Uppsala
Stockholm
County council RCT design
Zelen
Traditional
Zelen
Traditional
Evaluation
period
2010–14
2012–14
2013–14
2012–14
Sörmland Traditional 2013–14*
*
*
*
30. A telephone-based case-management intervention reduces healthcare utilization for
frequent emergency department visitors
European Journal of Emergency Medicine, 2013 Oct;20(5):327-34.
• 268 patients followed for up to one year (2010–11) in a single-centre nurse-led
intervention trial to reduce care utilisation for frequent emergency department
visitors
• The intervention indicated that a nurse-led telephone-based intervention
significantly decreased the incidence of hospitalisation, number of bed days and
healthcare costs
Latest results from 12,000 patients published in the
European Journal of Emergency Medicine
A case management intervention targeted to reduce healthcare consumption for
frequent emergency department visitors: results from an adaptive randomized trial
European Journal of Emergency Medicine, 2015
• 12,181 patients identified as frequent emergency department visitors in three
Swedish counties were randomised to intervention or control group and followed for
a minimum of one month and a maximum of two years
• This study indicates a significant overall 12% decrease in hospitalisation incidence for
intervention patients compared to controls. The results improved over time as the
intervention was continuously evaluated and improved.
30CONFIDENTIAL
31. PHC is already implemented in Vale of York and will now be
implemented in three new CCGs during the spring
Three new CGGs will be implemented March 2016
• Vale of York implemented spring 2015
• Wolverhampton CCG, Cannock Chase CCG and South East Staff
CCG will be implemented spring 2016
• One more slot for spring/summer 2016
31CONFIDENTIAL
Evaluation
• Nuffield Trust evaluates the Randomised Control Trial
• The intervention is adopted on the NIHR CRN portfolio which means
that participating trusts will benefit from conducting the research
• Martin Bardsley, Director of research at Nuffield Trust is Chief
Investigator
Other aspects
• Visit from NHS England in York during the autumn 2015
• Case study of PHC in York is distributed to Vanguard CCGs from
NHS England
35. www.england.nhs.uk
NHS Five Year Forward View
“Over the next five years the NHS must
drive towards an equal response to
mental and physical health, and towards
the two being treated together...we have
a much wider ambition to achieve
genuine parity of esteem between
physical and mental health by 2020.”
36. www.england.nhs.uk
The Taskforce is creating a 5 year cross-system all
ages strategy for mental health
Scope • Strategy developed by setting priority outcomes (across life course), supported by
measurable objectives, with annual delivery milestones for each ALB contribution
• 20k online survey participants, content workshops, 100+ written responses to
evidence call-out, on-going expert input from National Clinical Directors and Taskforce
Economic
aspects
Economic work in preparation, focusing on establishing spend and cost baseline for
reform opportunities over 5 years.
• Utilising current spend on MH services more effectively
• Integrated care models primary/secondary/specialised, including access &
waiting time standards
• Wider economic impact of mental health / ill-health on the public purse
Activity • Established framework to co-produce measurable objectives & year-on-year ALB
milestones
• Priority themes set (prevention, access, integrated treatment/care, empowerment)
working in partnership with ALBs signatory to Five Year Forward View
• Coordinating the content provided by Taskforce membership and experts
• Priority outcomes established
• Publication of recommendations and response early 2016 (No 10 Announcements on
Perinatal, Liaison etc)
37. www.england.nhs.uk
What the Taskforce heard, in summary
People want our society to become a place where there is no stigma in
talking about mental health problems and people are confident in seeking
help when they need it.
• People want mental health problems to be prevented and for intervention to be
as early as possible
• People want to quickly access effective evidence-based care and treatment,
when they need it
• People want integrated treatment and care, with their physical and mental health
responded to
• People want to be treated compassionately with hope, dignity and respect
Resulting in three clear strategic themes:
• Prevention - “I know how to achieve good mental health”
• Access - “I can get the right help when I need it, and my physical and
mental health are valued equally”
• Empowerment - “I am treated with hope, dignity and respect”
37
38. www.england.nhs.uk
Approach of the Taskforce
• Transformation is achievable, urgent and necessary
• Prevention focusing on children & young people, employment and
older people
• Access through waiting times, pricing and payment, secure transition
to grow community based support
• Integration of physical and mental health (plus social care) e.g.
diabetes and other long term conditions
Underpinned by:
• Skills of workforce for compassion, dignity and respect
• Empowerment of people to look after their mental health in their own
communities
38
39. www.england.nhs.uk
Findings of economic analysis
Annual spend on mental health is currently ~£34bn p.a., of which ~£19bn is via HMG
• Spend includes ~£15bn of non-HMG activity, primarily driven by carers looking after friends and
family
• National spend on treating dementia, learning disabilities and substance abuse add an additional
~£50bn to this
~67% of spend has little or no national cost data available, significantly limiting ability to
analyse overall cost base
Where data exists, significant variation in spend across services, providers and geographies
• Spend per capita across CCGs varies more than 5x fold, reducing to 1.8x fold after taking into
account underlying need
• Spend per unit across providers of the same service can vary 3 - 4x, with variation in some
services more than 10x fold
Linking spend to activity and outcomes highlights exciting opportunities to improve
effectiveness
• Data shows some CCGs are much more effective than others in their ability to convert money
spent into positive outcomes
• Ongoing publication of cost and activity data is a powerful lever to improve effectiveness, and
closing variation in outcomes
39
40. www.england.nhs.uk
Three economic deep dives
• Prevention approach illustrated by focus on employment support
• 1m people with mental health problems are unemployed, only 8% will be in work after
accessing current Work Programme support
• Suggested opportunity for specific evidence-based interventions integrating employment
and clinical support to improve outcomes
• Whole person care approach illustrated by focus on type 2 diabetes
• £8.8bn p.a. treating Type 2 diabetes, forecasted rise to £12bn by 2030. £8bn-13bn on
long term conditions linked to poor mental health
• Mental health treatment generic and isolated from diabetes pathway, with presence of
poor mental health appearing to drive 50% cost increase - suggested potential reduction
if specialist psychological support in place
• Suggested opportunities to improve outcomes through integrated physical and mental
healthcare for long term conditions
• Access approach illustrated by focus on secure care pathway
• £1.2bn p.a. spend on secure inpatient (low, medium, high adult) with 90% low secure
inpatient stays longer than 5 years in total care. Difficulties finding step-down placement
resulting in 6-9 months delay in discharge
• Suggested opportunities by shifting emphasis to prevention, focusing on high-risk and
over-represented groups e.g. BME men of working age and growing community-based
support to avoid inappropriate admission and support effective discharge
NB Assumptions need further testing against clinical best practice
40
41. www.england.nhs.uk
• We are committed to:
• Reduction in unaccountable wholly block payment models
• Increasing incentives that reward improving outcomes, quality and
access for individuals and across the system
• Getting rid of incentives that reward poor outcomes
• Driving efficiency and increasing public value
• To deliver this we are:
• Exploring how to deliver an effective outcomes focussed payment system
with data we have now to deliver rapid change
• While making it flexible and responsive to new care models and data coming
online
• Including aligning with 5 year forward view models of care and ensuring work
to develop payment models that cross primary and secondary care
• Supporting data improvement that reflects best practice
• With effective clinician and service user drive in the use of outcomes
• We are working towards launching mental health payment guidance by the
end of the year to support Taskforce recommendations
Payment systems for all mental health across
the life course need to support this journey
41
42. www.england.nhs.uk
Strategic Context
Increased Transparency:
• “…the continued use of unaccountable, ill-defined, block contracts by mental
health commissioners is detrimental to patient access to mental health
services” IMHSA Policy Paper
Move towards commissioning based on quality and patient outcomes
rather than historical service provision.
• “payment mechanisms that enable person-centred approaches to care and
parity between physical and mental health. Payment agreements for mental
health services are to be transparent, consider the needs of patients and
ensure accountability”.
Enhancing Quality through Allocative Efficiency
• Using the payment system to incentivise adoption of practice that promotes
sustained recovery, in the most appropriate setting
43. www.england.nhs.uk
Monitor / NHS England’s Objectives for
Commissioners
43
By April 2015 all contracts to be underpinned by an
understanding of need, evidence-based responses to need and
expected outcomes
By April 2016 all contracts to include clear incentives for the
delivery of outcomes, outcome and quality driven payment
models will have been introduced in a limited number of areas
AND have robust data on cost, activity, quality and outcomes
By April 2017 a wholesale shift to outcome-focused contracting
44. www.england.nhs.uk
IAPT Payment
Approach
Developing an Outcomes-
based currency for IAPT
Robert Finnin | Project Manager
Mental Health Clinical Policy & Strategy Unit, NHS England
robert.finnin@nhs.net | 07584 27 55 44 14th January 2016
45. www.england.nhs.uk
• Rewards good outcomes rather than just activity
• Is fair (MONITOR criteria):
• To Patients;
• To Providers;
• To Commissioners;
• To Tax Payers
• Minimises perverse incentives and opportunities for
gaming
• Is efficient and stable
• Incentivises innovation, efficiency and improvement
• Enables Parity with Physical Health Services
IAPT “PbR” Currency Objectives
46. www.england.nhs.uk
Cluster 1
£x
Cluster 2
£y
Cluster 3
£z
IAPT Currency Payment Approach
• Guiding Principle:
• Value of Payment = Cluster Tariff x %’age Outcomes Achieved
• Price per Cluster: Recognition that Complexity of Need drives cost
Cluster 4
£p
51. www.england.nhs.uk
Overview of Currency Model –
IAPT PbR Payment System
Activity:
Appointments in Month
IAPT PbR Tool:
Calculate Payments
Prices & Targets (annually set):
Assessment Only Price
Sub-caseness Price
Cluster Based Treatment Prices
Access & Outcomes Targets
Balance Between Targets
Submitted IAPT MDS
Monthly Payment Calculation:
Each Commissioner to each Provider
Quarterly Reconciliation Payment:
Each Commissioner to each Provider
Business Rules:
Cap or Collar
History File:
Appointments where episode has not
finished
Appointments from previous months,
where episode has not finished
Annual Activity & Finance Plans:
Annual Activity (Monthly Plan)
Finance Envelope (Monthly Plan)
Quality & Outcomes Premium
Activity:
Appointments in Month
IAPT PbR Tool:
Calculate Payments
Prices & Targets (annually set):
Assessment Only Price
Sub-caseness Price
Cluster Based Treatment Prices
Access & Outcomes Targets
Balance Between Targets
Submitted IAPT MDS
Monthly Payment Calculation:
Each Commissioner to each Provider
Quarterly Reconciliation Payment:
Each Commissioner to each Provider
Business Rules:
Cap or Collar, etc
History File:
Appointments where episode has not
finished
Appointments from previous months,
where episode has not finished
Annual Activity & Finance Plans:
Annual Activity (Monthly Plan)
Finance Envelope (Monthly Plan)
Quality & Outcomes Premium
52. www.england.nhs.uk
• “Where there are
commissioners struggling to
secure or efficiently utilise
capacity we should support
them piloting the currency
model in order to stimulate
better provision (coupled with
choice)”
• IAPT as Local Payment
Example
• Published in conjunction with
Monitor
IAPT Local Payment Example
https://www.gov.uk/government/publications/supporting-innovation-
in-the-nhs-with-local-payment-arrangements
53. www.england.nhs.uk
• 2014/15 – IAPT PbR Extended Pilot
• Publication of LPE
• Currency Calculator Developed
• 2015/16 - IAPT Currency Market Assessments
• Provider performance will be assessed against currency
model by central team;
• Infrastructure developed to support a national
implementation
• Develop local prices, business rules and guidance
• Commissioners to develop clear understanding of
local need informed by robust provider clustering.
• 2016/17 - IAPT Currency Road Test
• Shadow Implementation of Currency
• 2017/18 - IAPT Mandatory currency with local prices
• Contractual implementation of IAPT Currency Model
IAPT Currency Timeline
57. Moving towards whole-population budgets
Evidence suggests capitation may be an effective payment approach for helping to implement
new care models and the 5YFV vision.
Monitor and NHS England recognise that capitation departs significantly from existing
payment approaches and we need to support transition.
A whole-population budget is the proposed solution for vanguard sites that have not yet
developed a locally determined capitation approach, or for any site that may choose to follow
in the near future.
WPB is a multi-year payment for the total population covering all in-scope services based on
current spend or cost. Current costs or spend are only the starting point: they will be
adjusted for factors such as the target pattern of care and efficiency to avoid locking in
current costs.
WPB seeks to apportion risk appropriately between the provider and the commissioner,
based on available data.
Our expectation is that all multispecialty community providers (MCPs) and primary acute care
systems (PACS) vanguard sites will develop a whole-population budget spanning several
years for implementation in April 2017, unless they are already developing a locally
determined capitation approach.
58. Choosing the population scope: why whole
population?
We recommend that local areas that have not started developing a new
payment method focus on a whole-population approach.
The population is large enough to mitigate the risks caused by random variations
(ie payment otherwise at risk of being too high/low purely based on external factors)
Larger £ amount, minimise risk transfer to the provider (all other things being equal).
This can be mitigated with gain/loss sharing
Can more easily use the current contract values as a starting point to calculate the
baseline payment (otherwise difficult to accurately identify the cost of a specific cohort)
Greater incentive for prevention
(otherwise limited to patients already in the selected cohort)
Easier to operate (easier for a provider to identify whether a patient is covered by the whole
population budget or not, and invoice accordingly)
Wholepopulation
59. 7 steps to a whole population payment approach
Enablers
(including leadership; governance; linked data)
59
Steps to
developing
a capitated
payment
approach
Define the
population scope
covered by the
payment approach
Define the service
scope covered by
the payment
approach
Determine the
contractual form
and duration
Determine
the payment
amount(s)
Determine the
provider-to-provider
payment approach
Determine gain and
loss sharing
arrangements
Agree quality and
outcome measures
linked to payment
1
2
3
4
5
6
7
61. Transition to whole population budget
• As well as the above arrangements, you will need a transition approach for gain and loss
sharing and performance and outcome measures
• These arrangements could be put in place during the shadow-testing period, and then sit
alongside the WPB (or locally determined capitation) when the latter is implemented
• Areas could follow a three-stage approach:
• Note: the three areas do not have to progress at the same speed and not all areas will need
to progress to stage 3 with gain and loss sharing.
Three areas Stage 1 Stage 2 Stage 3
Gain and loss sharing:
example
One-sided shared
savings for limited
scope of services
Expand: for example,
two-sided risk share for
broader range of
services
Full accountability for all gains and
losses, or could be used for services
outside the scope of base payment
(eg acute for MCPs)
Performance and
outcomes:
example
Determine baselines
Payment for data
gathering and
reporting
Locally determined
Initial amount rewarding
outcome improvement
Move to a national approach
Target full amount on outcomes
2016/17 2020+
61
62. Proposed methodology: overview (1)
• The projected payment needs to ensure the commissioner carries the demographic and
epidemiological risk while the provider carries the remaining risks (eg efficiency)
• Monitor and NHS England are designing an approach to calculating a whole-population
budget, structured around three elements:
1. Establishing a baseline
2. Forecasting forward
i. Inflation
ii. Efficiency
iii. Pattern of care (new care model)
iv. Population size
v. Care needs
3. Adjusting based on outturn relative to forecast
To forecast forward population size and
care needs, and to adjust based on outturn
of these two factors, it may be helpful to:
1) Use the growth in allocations
published recently in the 5 year
allocations
2) Use the published changes in
primary care allocations to forecast
the primary care component of your
whole population budget
63. Proposed methodology: overview (2)
Following this method, a whole-population budget should:
• use current commissioner spend as a starting point for the calculation
• consider the changes in patterns of care expected from the new care
model
• be benchmarked to incentivise efficiency
We will test examples of such an approach with interested sites from January, to
enable sites to start shadow-testing in April 2016
We are keen to work with you.
64. Step 1: Establish baseline
Monitor and NHS England consider that ‘commissioner spend’ should be the starting
point for the calculations. This could include:
• Monitor and NHS England providing CCGs and trusts with projected 2015/16
baseline acute activity using a standardised SUS script and a forecasting tool as
a basis for forecasting for 2016/17 to 2020/21, starting with ‘a single version of
the truth’
• NHS England providing MCPs and PACS with the 2015/16 baseline and
forecasting tool for acute activity for their GP-registered populations, based on
the same data and method as CCGs
– This is likely to be relevant as an input to setting MCP/PACS baselines
because the baseline and forecasting tool is built up from GP-registered list
populations
65. Step 2: Forecast forward
• The multi-year approach means the baseline payment needs to be forecast forward
over the life of the contract
• CCGs and vanguards with good data and analytical support may be able to forecast
on a population segment basis, to reflect the variable changes in cost associated with
different population groups. Alternatively they could use the changes to the CCG and
primary care allocations that have recently been published that are themselves based
on appropriate capitation formulae
Step 3: Adjust when needed
• Payment should then only be adjusted if change is outside agreed
boundaries:
o segment-specific boundaries, eg if the number of people over 75 grows
by more than X%
o global boundaries, eg if the total impact of all changes would affect
payments by more than X%
• Changes may need to be made to the service scope, utilisation risk share
agreement and the outcome payments during the duration of the contract
67. What’s involved?
67
Shadow testing can begin with desk-based financial modelling. It should then
progress almost to full running of the new payment approach (except for actual
payment of providers under the new payment approach)
67
SHADOW TESTING
Day-to-day operations the
same, dummy invoice
calculation reflects the new
payment approach
Day-to-day operations
reflect the new model,
dummy invoice calculation
reflects the new payment
approach, actual invoice
reflects old payment
approach
May begin
as a
backward-
looking
analytical
exercise
Full
simulation
of end-to-
end
processes
of new
approach
70. www.england.nhs.uk
A methodology to
develop a year of care
capitated budget
Intro and national thinking (YoC Commissioning):
Jamie Day
Followed by sharing of approach by each EIS
71. www.england.nhs.uk
Select
patients for
referral
Assessment
of patient
need
MDT –
develop and
share care
plan
Deliver
services to
patients
Assign to
patient
cohort
Patient
dies or
leaves area
Change to
patient
cohort
Review
contract
and
budget
Set
contract
and
budget
Perform
and
quality
Payment
Patient pathway
Payment
cycle
Generalised patient pathway and the
payment cycle for complex care patients
74. www.england.nhs.uk
EIS updates on approach to
develop LTC YoC capiated
budget and progress towards
implementation
• Southend
• Kent
• West Hants
• Leeds
• BHR
76. www.england.nhs.uk
Date Topic Led by and details of session Venue
11 January
2016
12.30 – 1.30
Developing robust capitated budgets
- Integrated data
- Developing capitated budgets
- The Southend process and experience
Steve Downing, Head of Finance and
Bill Woods, Business Intelligence
NHS Southend
Southend LTC Year of Care
Commissioning
Early Implementer Site
Via Webex
Click here to
register
19 January
2016
12.30 – 1.30
integrated data to support service
redesign decision making:
- The Leeds approach
- How and who...using the integrated
data
- Challenges, lessons learned...what next
Tricia Cable, LTC Year of Care
Commissioning Programme lead,
NHS Leeds
Leeds LTC Year of Care Commissioning
Early Implementer Site
Via Webex
Click here to
register
4 February
2016
10.30 – 3.30
LTC Community of Practice Workshop Please save the date for this workshop -
details to follow
Central
London
11 February
2016
12.30 – 1.30
Commissioning Integrated models of
care:
- The South Kent model of care (what it
looks like)
- Roadmap to delivery
- Contracting models and evaluation.
Alison Davis, Integration Programme
Health and Social Care, Working on
behalf of Kent County Council and
South Kent Coast and Thanet CCG's
Kent LTC Year of Care Commissioning
Early Implementer Site
Via Webex
Click here to
register
LTC Community of Practice webinars:
Scan, Focus, Act …
77. www.england.nhs.uk
• Individual EIS monthly update calls (30 mins)
• Quick updates (national and EIS)
• Your opportunity to raise any issues / request help
• Calls in diary for West Hants, BHR and Leeds
• Dates still to be agreed with Kent and Southend
LTC YoC Commissioning – EIS sites
Dates for Diary
EIS workshops
(10.30 – 3.30, central London, venues tbc):
Monthly project leads forum
2pm – 3.30pm (webex)
18th Jan 2016 Mon 1st Feb 2016
23rd March 2016 Tues 1st March 2016
Brief reminder about how Pts identifies as suitable for YoC . Totals are cumulative so some double counting across bands. 3 in total across kent
Resultat som voice over
TED indicated move away from block contracts; towards more transparent and sophisticated pricing structures
IAPT PbR sits comfortably within this school of thought;
PoE
incentivise adoption of practice that promotes sustained recovery
Monitor
By April 2015 all contracts to be underpinned by an understanding of need, evidence-based responses to need and expected outcomes
By April 2016 all contracts to include clear incentives for the delivery of outcomes, outcome and quality driven payment models will have been introduced in a limited number of areas AND have robust data on cost, activity, quality and outcomes
By April 2017 a wholesale shift to outcome-focused contracting
Drives Quality by rewarding providers for delivering good outcomes rather than just activity;
Is fair (MONITOR criteria):
To Patients (optimises outcomes)
To Providers (covers costs, including surplus) Ensures a level of reward proportionate to the quality of delivery
To Commissioners (optimises payments, helps meet access & recovery targets) Enables Effective Investment in Effective Provision
To Tax Payers VFM + system-wide benefits - reduces benefit payments & increases tax revenues
a nuanced approach, recognition of case complexity, Minimises perverse incentives and opportunities for gaming
Is efficient (i.e. is cost effective to operate); Is stable – mechanism provides an economy that has a measure of predictability
Focus on outcomes, rather than activity removes the need for commissioners to specify how treatments should be delivered; therefore Incentivises innovation, efficiency and improvement
Enables Parity of Mental Health with Physical Health Services
The IAPT payment approach is designed to reward outcomes but recognises the need to balance this with at least an element of activity based payment. The approach therefore has the following features:
Cluster based Pricing - This first feature draws upon the fact that all patients coming into an IAPT service will, as part of their initial clinical assessment, be assessed using the Mental Health Clustering tool. This will be a core element of the payment structure as it is known that there is close correlation between complexity as indicated by the cluster and treatment cost.
Patients allocated to higher clusters are significantly more likely to require high intensity treatment. Therefore cluster based episode prices can be used to incentivise treatment of more severe cases avoiding perverse incentives to “cherry pick” less complex cases.
Assessment: a basic service price for each assessment that the service undertakes - Correct access and timely assessment is a key enabler for IAPT provision and so this is recognised and funded accordingly
The remainder is a price per client for each of the mental health clusters that IAPT services are expected to treat and for; split by an up-front portion and a performance payment based on the overall results achieved by the service.
Activity based Element – ensures that model rewards providers for delivering agreed patient outcomes, without being exposed to undue increases in patient volumes; Over time it is envisaged that the share of payment linked to activity components will decrease and the share linked to outcomes will increase.
Outcomes based payment
Outcomes - a performance payment based on the overall results achieved by the service - this gives commissioners the ability not just to reward providers for achieving or exceeding desired levels of activity, but influence provider delivered outcomes by adjusting the relative level of reward associated with individual performance measures.
The currency in operation – further developments
The point of the currency model is to incentivise improved performance across all 5 outcome domains; therefore, in reality, the commissioner will negotiate improved outcome performance with the provider.
Nominally The Quality & Outcomes Premium would start at 50% of total budgeted payments in year one and increase by x% each year over 5 years to a maximum of y% of total budgeted payments. (x & y to be determined)
Proportion of treatment type by cluster – assumed increased resourcing for higher clusters
Proven increased resourcing for higher clusters
The IAPT payment approach is designed to reward outcomes but recognises the need to balance this with at least an element of activity based payment. The approach therefore has the following features:
Cluster based Pricing - This first feature draws upon the fact that all patients coming into an IAPT service will, as part of their initial clinical assessment, be assessed using the Mental Health Clustering tool. This will be a core element of the payment structure as it is known that there is close correlation between complexity as indicated by the cluster and treatment cost.
Patients allocated to higher clusters are significantly more likely to require high intensity treatment. Therefore cluster based episode prices can be used to incentivise treatment of more severe cases avoiding perverse incentives to “cherry pick” less complex cases.
Assessment: a basic service price for each assessment that the service undertakes - Correct access and timely assessment is a key enabler for IAPT provision and so this is recognised and funded accordingly
The remainder is a price per client for each of the mental health clusters that IAPT services are expected to treat and for; split by an up-front portion and a performance payment based on the overall results achieved by the service.
Activity based Element – ensures that model rewards providers for delivering agreed patient outcomes, without being exposed to undue increases in patient volumes; Over time it is envisaged that the share of payment linked to activity components will decrease and the share linked to outcomes will increase.
Outcomes based payment
Outcomes - a performance payment based on the overall results achieved by the service - this gives commissioners the ability not just to reward providers for achieving or exceeding desired levels of activity, but influence provider delivered outcomes by adjusting the relative level of reward associated with individual performance measures.
The currency in operation – further developments
The point of the currency model is to incentivise improved performance across all 5 outcome domains; therefore, in reality, the commissioner will negotiate improved outcome performance with the provider.
Nominally The Quality & Outcomes Premium would start at 50% of total budgeted payments in year one and increase by x% each year over 5 years to a maximum of y% of total budgeted payments. (x & y to be determined)
The outcome element of the payment approach; The IAPT payment approach is designed to reward outcomes
Ten measures to reflect not only process measures but also clinical and non-clinical service performance. This includes five access targets along with five outcome domains.
Clinical Outcomes – 50%
Patient Satisfaction – 11.25%
Reducing Disability and improving wellbeing – 10%
Employment outcomes – 10% (e.g. 4% back to work with further quality bonus if this figure surpasses 10% back to work)
Patient choice in therapy – 3.75%
5 access measures – 3% each
Treating BME patients
Treating older patients
Accepting self referrals
Meeting waiting targets
Treating specific anxieties
If one outcome is more important locally the commissioner can weight this as a higher proportion of the quality premium
Some elements of the currency model break down to patient level whereas others can only be measured at service level
Utilises Existing infrastructure and process – should not be burdensome – these are measures that already quantified as part of an IAPT episode of treatment
Observing flow of activity, data and finances
Business Rules: Cap & Collar / Minimum Payment arrangements to mitigate financial risk of under/over performance to provider / commissioner respectively
Core role of PbR tool at the national level
Replication of IAPT currency model
High level of configuration
Service targets between Commissioners and Providers - designed to allow each CCG to set their own performance target for each domain, and budget contract value where this is to be used to set the overall level of performance payments.
PbR Lever controls - Warnings, Exclusions, MFF etc.
Output presented as a report set which clearly sets out for each CCG and provider how the payments have been arrived at.
Building from KB points on Monitor initiative: Provide payment examples that highlight innovative payment arrangements to help the sector move toward the long-term objectives. This document details a possible payment approach that can be considered when developing contractual arrangements during 2015/16.
In effect, by publishing this LPE we are encouraging early adoption of the payment design that is being developed.
Payment approach can be considered when developing contractual arrangements during 2015/16
Strengthen existing cost & volume arrangements
AQP
Replace block arrangements
How best to support implementation?
Commissioner Toolkit / Template Service Specification
Commissioner Workshops
Recognise challenges of developing a capitated budget
It is our expectation that all MCP and PACS Vanguard sites will focus on the development of a whole population budget that spans multi years for implementation in April ‘17, unless they are already developing a locally determined capitation approach.
We have identified 7 steps in the development of a capitated payment approach.
We have been clear that measures of quality, outcomes and access need to be build into any capitated budget to embed accountability and ensure it works in the interests of patients
Capitated budgets are new to England and we are still working to develop them to ensure that they support the NHS to change.
A lot of our work is being conducted with Integrated Pioneers and Vanguards:
We are developing criteria for establishing outcome measures that are key to informing payment
We are also working with local health economies that are developing a capitated budget to produce a ‘roadmap’ that can be used by others that are on the journey of developing their own capitated budget.
And; over the coming months we will also be launching a support offer for the wider sector.
We have received a lot of interest about capitated budgets and published a number of resources including a explanatory animation – links to these resources can be found below.
David
Monitor and NHS England consider that ‘commissioner spend’ should be used as a starting point for the calculations
Has the advantage that data is more likely to be readily available in a usable format
Offers the best starting point for engagement between commissioner(s) and providers.
Do we want to say - This approach will mean current deficits will remain with the providers. As such deficit reduction plans will continue to be needed and will have to be included in the final projected payments.
Can also say that the Fund will provide deficit support (rather than CCG contracts for services) in 16/17.