Presentation from Richmond CCG, Healthwatch Richmond, Hounslow and Richmond Community Healthcare, Kingston Hospital, West Middlesex University Hospital and the Richmond GP Alliance on the changes happening to community services in Richmond.
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.
Presented by: David Cozadd, Director of Operations with the Burke Center
Thomas Kerss, Sheriff of Nacogdoches County; Current President of the Sheriff’s Association for Texas
Anne Bondesen, Project Director for the Rural East Texas Health Network (RETHN)
Guidance for commissioners of liaison mental health services to acute hospitalsJCP MH
This guide describes what ‘good looks like’ for a modern acute liaison service. It should be of value to Clinical Commissioning Groups (who will be commissioning secondary services, both specialist mental and acute).
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.
Guidance for commissioners of acute care – inpatient and crisis home treatmentJCP MH
This guide is about commissioning services for people with acute mental health needs. It explains the purpose, characteristics and components of acute care so that commissioners can commission good quality services that are therapeutic, safe and support recovery.
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.
Presented by: David Cozadd, Director of Operations with the Burke Center
Thomas Kerss, Sheriff of Nacogdoches County; Current President of the Sheriff’s Association for Texas
Anne Bondesen, Project Director for the Rural East Texas Health Network (RETHN)
Guidance for commissioners of liaison mental health services to acute hospitalsJCP MH
This guide describes what ‘good looks like’ for a modern acute liaison service. It should be of value to Clinical Commissioning Groups (who will be commissioning secondary services, both specialist mental and acute).
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.
Guidance for commissioners of acute care – inpatient and crisis home treatmentJCP MH
This guide is about commissioning services for people with acute mental health needs. It explains the purpose, characteristics and components of acute care so that commissioners can commission good quality services that are therapeutic, safe and support recovery.
This is our Business Plan for the next year; 2017-18.
In health, as in other sectors, innovation and adoption at scale is increasingly driven by interdisciplinary research, synergies between industries, and a step-change in end-user (citizen, consumer, patient) engagement in the process. Seeing the wood from the trees, making connections, spotting opportunities, and understanding how to get traction requires a breadth of perspective and strong roots into, and across, that landscape.
Academic Health Science Networks (AHSNs) connect horizontally across research, industries, commissioners, providers and users; and network vertically between policy formulation, system design, operational coal-face and end-user experience. That role takes us across all parts of the NHS, into industry, local government and other public agencies, into universities, charities, start-ups, and into funders. And up and down the system; from the role of the GP receptionist in improvement and innovation; to dialogue with policy makers and regulators about refining system design to support adoption and spread of innovation.
Networks which are open to, and embrace, the diverse perspectives of these stakeholders will, in turn, help the systems and members which they support be open to the adoption and spread of innovation.
That is what we, Wessex AHSN, aspire to. We hope you find this spirit reflected in our business plan.
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
Guidance for commissioners of older people’s mental health servicesJCP MH
This guide is about the commissioning of mental health services which can improve the mental health and wellbeing of older people.
This guide has been developed by a group of older people’s mental health professionals, people with mental health problems, and carers. The content is primarily evidence and literature-based, but ideas deemed to be best practice by expert consensus have also been included.
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
Guidance for commissioners of rehabilitation servicesJCP MH
This guide is about the commissioning of good quality mental health interventions and services for people with complex and longer term problems to support them in their recovery.
A Co-response Model Mental Health and Policingcitinfo
Presented by: Mary C. Pyche, MSW, RSW Health Service Manager
Mental Health Mobile Crisis Team (MHMCT)
Susan Hare, BScOT, Program Leader, Crisis Supports, Capital District Mental Health Program
Constable Angela Balcom, Halifax Regional
Police, MHMCT dedicated police officer
Guidance for commissioning public mental health servicesJCP MH
Public mental health services (updated August 2013)
This is the second version of the public mental health guide. It has been revised and updated to include new sources of data and information.
The guide is about the commissioning of public mental health interventions to reduce the burden of mental disorder, enhance mental wellbeing, and support the delivery of a broad range of outcomes relating to health, education and employment.
Guidance for commissioners of mental health services for people with learning...JCP MH
This guide is about the commissioning of mental health services for people with learning disabilities, enabling them to live full and rewarding lives as part of their local communities.
This guide is aimed at all commissioners responsible for mental health services for people with learning disabilities including young people in transition to adulthood. The guide will also be helpful for providers of mental health services and for family carers.
This guide describes what we know about mental health services for adults with learning disabilities, and what effective and accessible services look like based on current policy, the law and best practice.
While this guide does make reference to autistic spectrum disorders and ‘behaviours that challenge’ (which people with learning disabilities who have mental health problems may also experience), the primary focus of this guide is on people with learning disabilities who have mental health problems.
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
This is our Business Plan for the next year; 2017-18.
In health, as in other sectors, innovation and adoption at scale is increasingly driven by interdisciplinary research, synergies between industries, and a step-change in end-user (citizen, consumer, patient) engagement in the process. Seeing the wood from the trees, making connections, spotting opportunities, and understanding how to get traction requires a breadth of perspective and strong roots into, and across, that landscape.
Academic Health Science Networks (AHSNs) connect horizontally across research, industries, commissioners, providers and users; and network vertically between policy formulation, system design, operational coal-face and end-user experience. That role takes us across all parts of the NHS, into industry, local government and other public agencies, into universities, charities, start-ups, and into funders. And up and down the system; from the role of the GP receptionist in improvement and innovation; to dialogue with policy makers and regulators about refining system design to support adoption and spread of innovation.
Networks which are open to, and embrace, the diverse perspectives of these stakeholders will, in turn, help the systems and members which they support be open to the adoption and spread of innovation.
That is what we, Wessex AHSN, aspire to. We hope you find this spirit reflected in our business plan.
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
Guidance for commissioners of older people’s mental health servicesJCP MH
This guide is about the commissioning of mental health services which can improve the mental health and wellbeing of older people.
This guide has been developed by a group of older people’s mental health professionals, people with mental health problems, and carers. The content is primarily evidence and literature-based, but ideas deemed to be best practice by expert consensus have also been included.
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
Guidance for commissioners of rehabilitation servicesJCP MH
This guide is about the commissioning of good quality mental health interventions and services for people with complex and longer term problems to support them in their recovery.
A Co-response Model Mental Health and Policingcitinfo
Presented by: Mary C. Pyche, MSW, RSW Health Service Manager
Mental Health Mobile Crisis Team (MHMCT)
Susan Hare, BScOT, Program Leader, Crisis Supports, Capital District Mental Health Program
Constable Angela Balcom, Halifax Regional
Police, MHMCT dedicated police officer
Guidance for commissioning public mental health servicesJCP MH
Public mental health services (updated August 2013)
This is the second version of the public mental health guide. It has been revised and updated to include new sources of data and information.
The guide is about the commissioning of public mental health interventions to reduce the burden of mental disorder, enhance mental wellbeing, and support the delivery of a broad range of outcomes relating to health, education and employment.
Guidance for commissioners of mental health services for people with learning...JCP MH
This guide is about the commissioning of mental health services for people with learning disabilities, enabling them to live full and rewarding lives as part of their local communities.
This guide is aimed at all commissioners responsible for mental health services for people with learning disabilities including young people in transition to adulthood. The guide will also be helpful for providers of mental health services and for family carers.
This guide describes what we know about mental health services for adults with learning disabilities, and what effective and accessible services look like based on current policy, the law and best practice.
While this guide does make reference to autistic spectrum disorders and ‘behaviours that challenge’ (which people with learning disabilities who have mental health problems may also experience), the primary focus of this guide is on people with learning disabilities who have mental health problems.
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
Integrated health & social care: service transformation supported by technolo...flanderscare
Wat is de toekomst van zorg op afstand in Vlaanderen? Dat was de centrale vraag van het event van 17 juni. 100 deelnemers dachten hier samen over na. Studiebezoeken aan andere Europese regio's toonden dat daar reeds op grote schaal met telecare en telehealth gewerkt en geëxperimenteerd wordt.
LTC year of care commissioning early implementer sites workshop held on 1 December 2014. Featuring Dr Martin McShane, Rob Meaker and Renata Drinkwater.
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
Presentation by Mike Kenny, Associate Commercial Director, Innovation Agency: The NHS Landscape at Excel in Health: understanding the NHS as a market place on Tuesday 26 February 2019 at Vanguard House, Daresbury.
Using simulation to drive changes in health and care - long term conditions Year of Care model
Bev Matthews and Claire Cordeaux
Presentation from Day 1 of the Health and Care Innovation Expo 2014, Manchester Central
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
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
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
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.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
2. Housekeeping
• Hand up, wait for microphone, introduce yourself -
please keep questions brief
• Photographs being taken & Audio is being recorded
• Feedback and Monitoring Forms – please fill them in
• Get involved - Join Healthwatch Richmond
• Toilets by main entrance
• No fire alarm planned
Welcome
3. Working together for better care
15:00-15:05 Welcome and introduction
15:05-15:20 Why Improve Patient Care?
15:20-16:00 A new vision for care that matters to patients
Frail Elderly Work stream
Cardiology Work Stream
16:00-16:50 Panel discussion
16:50-17:00 Summary and close
4. Changing the way we commission
healthcare to achieve the outcomes that
matter to local people
Kathryn Magson
26 November 2015
5. Local doctors, nurses and other
clinicians recognise that the service
established in 1948 is no longer fit for
the 21st century.
The needs of an older, larger
population, in which more and more
people have long term conditions
and illnesses, mean we need to
reorganise the way care is delivered.
In short, we need to deliver many
more services in the community and
make sure all our hospitals are
specialist centres of excellence for
those who really need them.
The NHS is changing
6. 5 reasons for change
1. Quality of care - All patients should get the best possible care, but the quality and
safety of all our health services varies enormously and depends on where and when you
are treated. This costs lives.
2. Changes in what patients need - People getting older and sicker - demand rising
rapidly. Need much more care to be outside hospital.
3. Financial and workforce challenges - We do not have the money or staff to go on
as we are, despite increased funding. There is a national shortage of clinicians in some
key areas and we need to transform workforce.
4. We can provide better care with the same budget - Compelling evidence that if we
spend our money differently, we can get services that are both better and more
affordable. (E.g. stroke, major trauma, cardiac).
5. The need for joined up services - Patients need services that work together and
across professional boundaries.
7. 7
There’s only one pot of money
• The NHS budget has not been cut.
• It has risen slightly above the inflation
rate every year since 2010, but it is not
keeping pace with the rapidly rising
costs of delivering healthcare.
• But the costs of providing care are rising much more quickly
due to innovative but costly new technologies and rapidly
increasing demand from a rising and ageing population. This
means that there is an emerging ‘financial gap’.
8. Case for change – June 2014
The CCG with Richmond Council approved the case for changing the way we
commission community services.
The key issues identified:
• The public’s experience appears to be fragmented and does not focus on
improving outcomes for them. This is a particular problem for elderly people with
complex needs.
• Staff do not feel the way services are commissioned and managed enables them
to do their best for patients; blocks integrated working
• Many GPs, experience the services in a way which is almost random. There is no
logical reason for the extent of variability of access to and engagement with the
current services.
• The current contract is poorly designed and difficult to manage, key performance
indicators (KPIs) focus on inputs and processes rather than improvements to
patient health.
Out of hospital health and social care
9. You said ………..
11
“No help or support given had
to find our own solutions”
“The amount of time you spend on the
phone passed from pillar to post ..
being told it’s not our responsibility”
“If you are in need of help ..
you need it NOW not in 6
months or at certain times
which suit the provider not
the patient”
“I don’t see a light at the
end of the tunnel”
“It’s hard to know the right
person to speak to and there is
no one to pull it all together –
there are even two parts to
physio!
“Technology gives me much
more independence”
“I have to tell the same story
over and over”
10. Outcomes based commissioning (OBC) approach
We want to transform out of hospital health and social care services to
support a more innovative and integrated approach to service delivery
based on outcomes that matter to patients and carers
• Improve patient and carer experience by encouraging whole
person care
• Improve the customer experience for GPs by reducing variability
• Deliver and demonstrate value for money.
• Deliver against our better care closer to home strategy
Out of hospital health and social care
13. Coordinating Providers for 2016/17 contract
Following an extensive assessment process Richmond CCG and Council asked a
selected group of local organisations to come together as a group of ‘coordinating
providers’ to develop and deliver this contract:
• Hounslow and Richmond Community Healthcare NHS Trust;
• Richmond General Practice Alliance;
• Kingston Hospital NHS Foundation Trust; and
• West Middlesex University Hospital NHS Trust
We would like to have a single NHS contract with all of the co-ordinating providers who
will be co-signatories, but one of which will be the host provider. The form of this is for
the providers to propose, but we anticipate some form of joint venture or an alliance with
each party equally represented (rather than a lead provider model for instance).
14. Timeline and process for 2016/17 OBC contract
April
16
Jan 15
FEBRUARY
Mar 15 Jun 15 Oct 15 Jan 16
ISDS and
Draft
Heads of
Terms
release
MCP
Response
OBC
Dialogue
Formal
Evaluation
Mobilisation
(Feb – Mar)
Governance
Qualification
Co-ordinating
providers
submit MOU
demonstrate
collective
agreement
Contract
negotiation
6 weeks
On-going
dialogue
Interim
Checkpoint
Review and
Feedback
Providers
develop
Memorandum
of
Understanding
(MOU)
JUNE
DECEMBER
OCTOBER
AUGUST
Transition
Coordinating provider development – Most Capable Provider Assessment (MCP)
Finalise
selection
of co-
ordinating
providers
and notify
existing
providers
of
decision
and
process
Publish MOI
to providers
setting out
overall terms
and process
to April
2016,
including
requirement
for providers
to submit
Governance
Qualification
MOU
APRIL
Contract
Award
FEBRUARY
Contract
Start
Date
APRIL
15. A.
Population-
wide
outcomes
A5: I want
appropriate
care to be
there when I
need it
A1: I want
to belong,
feel that I
belong and
feel normal
A2: I want to
be able to live
as productively
and
independently
as possible
A3: I want to
feel in control
and be able to
cope
A4: I want
the services
to work
together for
me and
keep me
well
B. Carer-
specific
outcomes
B1: I want
support for
me as well as
the person I
care for
B2: I want it
to be easier
for me to
care
= Outcome relating to impact of care on
quality of life
= Outcome relating to experience of care
Outcomes framework for mental health
16. 11
Our local plans link in with and support the wider
change programme for the NHS across south west
London:
• Primary care will be central to delivering changes
• Hospitals must deliver round the clock care, led
by senior doctors
• We need to separate planned operations from
emergencies
• We need to improve mental health services
South west London commissioning collaborative
17. What will this mean for local people?
• A coordinated approach to care – a group of providers delivering a
coordinated service across organisational boundaries and care
settings
• Care will be personalised and focus on people’s wellness reflecting
the value delivered by care rather than the activity undertaken
• Achievement of better outcomes through more integrated, person-
centred care and providing better value for money
22. A new vision for care
that matters to patients
Dr Kieran O’Flynn,
GP, Richmond GP Alliance
23. A new vision for the future
• Currently care is very disjointed and involves lots of
different professionals
• Hospital is one of the worst places to be if you are
frail
• Once you’re in, you can’t get out again
• People want to be at home
• Right care by the right person, right place, timely
24. Keeping well
• Identification of patients at high-risk of admission
• Benchmarking
• Shared electronic record, so ALL professionals see
the same information
• Voluntary sector
• Carers
• Family and friends
25. When things change
• Rapid Assessment and Treatment Team (Flying RAT)
• Aligned to Richmond Response Rehabilitation Team
• Doctor and multidisciplinary team to assess and keep
patients in their own home
• Intravenous antibiotics and fluids
• Community team manage the patient with their own GP
• Single electronic record
26. When people end up in hospital
• Discharge out of A&E (ED) home with RRRT
support
• Hospital In-reach Team (HIT squad)
• Use single electronic record and Benchmarking to
inform management
• Early Facilitated Discharge
27. Nursing Homes
• Variable users of services
• Increased collaboration and support to nursing staff
to promote management decisions
• Telemedicine
• Single GP per nursing home?
• Rescue medicines insitu
• Sharing knowledge and expertise with nursing staff
re End of Life Care
29. Cardiology and caring for the patient in the
community
Context
In Richmond, almost 32,000 of the
GP registered population have a
heart condition including
congestive heart failure
• Hypertension
• Ischemic heart disease
• Atrial fibrillation
National prevalence models
suggest that there are large
numbers of people with
undiagnosed long-term conditions
in Richmond borough – for
example, up to 2,700 people with
undiagnosed coronary heart
disease.
How can we tackle this and how
will my experience of Cardiology
care improve?
• Through accessing the right
care when you need it.
• Designing care around the
needs of the patient
• By targeting patients most a risk
of cardiovascular disease.
• By delivering consistent care
pathways
30. Let’s look at two examples
Example 1: Heart Failure Care
What will the new model offer Richmond
patients that ‘s new?
• Rapid access to diagnostic tests
local to you
• Triage of patient referrals by GP’s,
supported by Consultants to make
sure patients enter the most
appropriate and effective treatment
pathway as soon as possible
• Specialist nursing dedicated to
delivering care to patients in the
community and outside of a hospital
setting.
Example 2: Atrial Fibrillation
The new model will:
• Diagnose atrial fibrillation in all
patients before the age of 65, this
helps in the prevention of strokes.
• Deliver care that is based within the
community and local to you.
31. Panel discussion
Julie Risley, Healthwatch Richmond Chair (Panel Chair)
Dr Kieran O’Flynn, GP, RGPA
Dr Tapesh Pakrashi, Consultant Cardiologist and Clinical
Director for Cardiology, Kingston Hospital NHS FT
Heather Mitchell, Programme Manager
Cathy Kerr, Director of Adult Social Care, LBRuT
Kathryn Magson, Chief Officer, Richmond CCG
Patricia Wright, Interim CEO, HRCH
Dr Graham Lewis, Chair, Richmond CCG
32. Thank you
Please fill in and return your evaluation form
Worktogether4bettercare@nhs.net
Join Healthwatch Richmond
Call: 0208 099 5335
Visit: www.healthwatchrichmond.co.uk
Editor's Notes
A housekeeping slide Please keep all Questions for the Q&A section Please use the microphones - some people rely on the hearing loop and we're recording sound from the event to capture your questions and feedback We're taking photo's please let us know if you don't want us to give us permission to use your photo. There are no fire alarms planned Please fill in monitoring and evaluation forms
We can’t improve community-based services without taking money from elsewhere. This is why the NHS has for several years been trying to move more services out of hospital into the community.
Community-based services are usually more convenient for patients, as well as being cheaper for the NHS to deliver.
There is compelling evidence that we can get improved services that are more affordable for the NHS with the changes to stroke, major trauma and heart attack services in London.
Moving these services to a smaller number of specialist centres has transformed them from among the worst in the country to the best.
JACQUI
Putting patients and carers at the centre of our commissioning. OBC is about commissioning differently to deliver person-centred care which therefore supports the individual participation duty.
Put patients and carers at the centre of our commissioning – from start to finish
Deliver against our better care closer to home strategy (out of hospital care)
The extensive feedback collated for the outcomes frameworks will also inform this year’s commissioning intentions
Collective duty - Example of KLOE A1- service planning, design, procurement
Jane:
Over the last two years we have listened to what patients, carers and people living and working in Richmond have had to say about local health and social care services. Our GPs have told us that they experience wide variation in access to and engagement with current services across the borough. Staff feel constrained by the way services are commissioned working in silos and not in the joined up way they would like. The existing contract focused on inputs and processes rather than benefits and outcomes for patients.
So last year we went out and talked to patients and carers about our community services and this is some of what they said.
There is obviously something wrong with the our current system and we need to make a fundamental change to how we commission if we want to improve things across health and social care and across different providers. We took all of this valuable feedback and insight and used it to develop patient and carer outcomes. – next slide.
Putting patients and carers at the centre of our commissioning. OBC is about commissioning differently to deliver person-centred care which therefore supports the individual participation duty.
Put patients and carers at the centre of our commissioning – from start to finish
Deliver against our better care closer to home strategy (out of hospital care)
The extensive feedback collated for the outcomes frameworks will also inform this year’s commissioning intentions
Collective duty - Example of KLOE A1- service planning, design, procurement
The outcomes based contract will contain a single, integrated, outcomes framework covering the population and services within scope of the contract. The outcomes and indicators within the framework will give commissioners and co-ordinating providers a view of performance across pathways and population groups.
An outcomes framework was designed through engagement with the public, capturing high level outcome categories, more detailed outcome goals, and suggested measures or indicators for these outcomes. This process also used significant engagement work that has been undertaken previously by Richmond CCG and Council.
The outcomes that matter to the public indicated that the providers of community services and out of hospital care should be incentivised to develop a collaborative and consistent approach to care management, which involves the patient, and focuses on the outcomes that are important to them.
In order that the outcomes are suitable and transferable to a contract, it is necessary to commercialise the existing outcomes framework.
From April to May 2015, the CCG evaluated the list of 40 outcomes and developed 12 outcomes which reflected all the key messages drawn from the original framework.
These outcomes were tested and further refined through working sessions with stakeholder groups. The refined outcomes were grouped into four domains and key themes were identified. The domains and key themes can be seen in the table below and the full commercialised list is on the next slide.
Once an initial list of outcomes had been refined and discussed with stakeholders, further sessions were held to determine the appropriate corresponding indicators; considering both existing indicators as well as discussing how new indicators would be formed.
The phasing in and incentivisation of these outcomes is to be further considered, with a focus on developing a framework that would achieve commercial objectives for the OBC
Areas to highlight –
• self care key part of the solution
• 4 providers joining forces in an unprecedented way to design care pathways without org boundaries
• There is a saving requirement, it must be cheaper
• Want to involve patients, carers, third sector partners in the process
• Early stage, options presented today are indicative ideas only and need to go through a process
A housekeeping slide Please keep all Questions for the Q&A section Please use the microphones - some people rely on the hearing loop and we're recording sound from the event to capture your questions and feedback We're taking photo's please let us know if you don't want us to give us permission to use your photo. There are no fire alarms planned Please fill in monitoring and evaluation forms
A housekeeping slide Please keep all Questions for the Q&A section Please use the microphones - some people rely on the hearing loop and we're recording sound from the event to capture your questions and feedback We're taking photo's please let us know if you don't want us to give us permission to use your photo. There are no fire alarms planned Please fill in monitoring and evaluation forms
