Planned Care Working Group

Planned Care Working Group
Meeting One
Introductions
Chair: Steve Parker
National Experts Supporting the Group
Mr. Gavin Marsh - A senior
orthopaedic surgeon and a leading
medical adviser to the CQC
independent reviews. Mr Marsh
provides clinical leadership for a
range of national transformational
and quality improvement
programmes alongside chairing
international spinal conferences.
Working Group
Project
Team
Professional
Reference
Group
Public
Groups
Clare Evans - An experienced
surgical nurse who pioneered the
nurse practitioner role and
established preoperative clinics
improving urgent and elective
surgical pathways in London and
Bristol.
2
Overview of My Life A Full Life (MLAFL) and Whole Integrated System
Redesign (WISR)
What is WISR?
The Whole Integrated Systems Redesign (WISR) is a project to examine the current provision of health and care services on the Isle of Wight, the challenges in
delivering them and then to set out options to reshape them. The purpose of the redesign is to make sure health and care services on the Isle of Wight make best
use of available resources and continue to deliver excellence for years to come. ​A consortium has been appointed to lead on this work.
How does this fit into the My Life a Full Life programme?
The WISR project is being carried out through the My Life a Full Life (MLAFL) programme. MLALF is a collaboration of organisations, including the CCG, the IWC,
the IWNHS Trust and One Wight Health (a GP membership organisation), who work in partnership with the voluntary sector to fundamentally change and
improve the lives of people on the Island. My Life A Full Life aims to provide for people’s individual needs to enable them to take control of their lives and plan for
their future health and social care needs. This work is currently based on the partners’ five year vision for integrated health and social care on the Island.
Which services will WISR redesign?
The redesign will build on the current new models of integrated care already being developed on the Isle of Wight and will reflect other development work in
health, public health, social care and the voluntary sector which is already in progress. The innovative solutions will need to ensure the delivery of high quality,
sustainable, integrated health and social care. This must be consistent with safe standards of care, national requirements and be clinically and financially
sustainable.
In order to undertake the redesign effectively, performance data, changing demographics and public and professional stakeholder views have been analysed to
determine six focus areas. These areas are:
Urgent
Care
Frailty
Mental
Health
Planned
Care
Women’s
and
Children’s
Long-term
conditions
These will be supported by five cross-cutting themes; vulnerability, the ‘island’ premium, sustainability of services, on/off island and workforce development.
Case for Change Overview – 2024/25
If health and care services continue to be delivered in the way they currently are then by the year 2024/25, the forecasting shows that the below story is likely to
occur:
1
2
The increasing elderly population
is driving increased health and
care activity overall. The demand
pressure from the aging
population is greater on the
Island than across England.
5
3
Along with increased levels of
activity, this activity is likely to be
more complex with an increased
number of patients/service users
with co-morbidities.
4
All health and care providers
face significant activity and
capacity challenges. This is not
just challenging for the Trust but
also for GP’s, carers and
district nursing.
The challenge faced by social care
is particularly severe – with a
demand pressure for an
additional 106 front line staff.
The increase in activity across the whole system is likely to lead to a vicious cycle and reduces the proper
flow of patients/service users through the system, and is likely to have a huge impact in the quality of
services provided to patients on the Island.
Inpatients
Outpatients
A&E
Inpatients +2,418 (14%) spells
Outpatients +17,516 (13%) Attendances
Admissions +1,698(17%)
12 additional Consultants and 10 additional other clinical staff
Non-admissions +2,294(4%)
26 additional nursing and midwifery staff
1.5 additional Consultants
40.2 to £40.9m deficit
£0.8 to £0.9m surplus
4
Case for Change Overview – 2024/25 (cont.)
Community Teams
Mental Health
Adult Social Care
+51,572 (20%) contacts
+5,628 (5%) contacts
+14,779 (25%) care weeks
96 additional community staff
12.7 additional mental health staff
106 additional front line staff
£0.1 to £0.3m surplus
£2.75 to £2.8m deficit
£28.2m to £36.8m net budget requirement
£37.9m
deficit forecast for the
IoW NHS Trust by 2024/25
£13.7m
deficit forecast for the IoW
CCG is by 2024/25
£51.6m
the combined financial shortfall across
health by 2024/25
£32.4m
additional budget required for
Adult Social Care by 2024/25
£6.7m
additional budget required for
Childrens Social Care by 2024/25
£39.1m
additional budget required by 2024/25
for social care
5
Working Group Dates
The below timetable for Working Group meetings makes use of existing group meetings that are already diarised. The last two sets of meetings will be confirmed
once membership lists are known on the 18th April.
*IC refers to Innovation Centre, Newport
Urgent Care
Frailty
Mental Health
Planned Care
Women’s and
Children’s
Long Term
Conditions
Meeting one
Meeting two
Meeting three
Meeting four
28th April
26th May
14th June
28th June
13.00-16.00
15.00-17.30
14:45 – 17.15
12.00 – 14.30
Room M, IC*
Downstairs Boardroom, IC
Room L, IC
Ground Floor, Board Room
3rd May
25th May
14th June
28th June
14.00-16.00
15.00-17.30
12.00 – 14.30
15.00-17.30
Room L, Innovation Centre
Room L, IC
Room L, IC
Room M, IC
11th May
19th May
16th June
27th June
15.00-17.30
12.00-15.00
12.00 – 14.30
15.00-17.30
Downstairs Boardroom, IC
Room L, IC
Ground Floor, Board Room
Ground Floor, Board Room
10th May
26th May
15th June
28th June
12.00-14.30
15.00 – 17.30
12:00 – 14:30
12.00 – 14.30
Room L, IC
Room L, IC
Room L, IC
Room M, IC
10th May
25th May
15th June
28th June
12.00-14.30
12.00-14.30
11:30 – 14:00
12.00-14.30
Downstairs Boardroom, IC
Room L, IC
Seminar Room 1, Education
Centre
Room L, IC
11th May
24th May
16th June
27th June
12.00-14.30
15.00-17.30
15.00-17.30
12.00 – 14.30
Downstairs Boardroom, IC
Room L, IC
Ground Floor, Board Room
Ground Floor, Board Room
18th May:
PRG
7th June
PRG
Assurance Process
30th June
PRG
7th July
6
WISR Board
Process for Service Pathway Redesign
Mar
Apr
May
Jun
July
Future State – 2030
Project Team
meetings
Professional
Reference Group
18th May
Public
Engagement*
W/C 2nd
May
W/C
9th
May
Input into
Operational
Management
Group and WISR
Board
12th May
Working Groups
1
•
•
•
•
Preparation and
Consolidation
Evidence
• Performance data for:
o Primary care
o Secondary care
o Social care
o Community and Mental
Health
o Voluntary Sector
• Demographics
• Stakeholder views
o Professional engagement
event
o Public engagement events
What is the vision?
What could it look
like (including
international best
practice)?
What are the subgroups?
What is the
process over the
next 12 weeks?
What are the
roles?
What are the next
steps?
•
•
•
•
•
•
Prepare possible
vision – what could
it look like?
Identify Working
Group membership
Create templates
for each meeting
•
•
•
•
Prepare data
packs
Collate existing
strategies
Collate best
practice
Check against
Needs Framework
•
•
•
Process map
current
pathways
and
compare
against
future
pathways
Individual Groups:
Plan
What are the
challenges?
How
ambitious are
we going to
be?
How do we
get to the
future state
i.e., what are
the gaps?
Agree
modelling
outputs for
activity,
workforce
and finance
Sign off
plans
•
•
•
•
What will the
future state be?
St Mary’s
•
•
•
Preparation
Preparation
•
4
w/c 27 June
Individual Groups:
Preferred options
What are the
key pathways
within subgroups to
investigate?
Where are we
now?
What existing
work has been
undertaken?
Apply the
needs
assessment
framework
Preparation
7th July
WISR Board
3
Long listing
Preparation
•
16th June
w/c 13 June
w/c 23
May Groups:
Individual
AM: Kick-off (Vision)
•
•
26th May
2
W/C 25 April and W/C 9
May
30th June
7th June
Consolidation
Develop plans
Input modelling
to understand
activity,
workforce and
financial
implications
•
•
•
Prepare overview
document
Develop detailed
implementation
plans
Develop plans for
remaining focus
areas
Services
on/off Island
Partnerships
Community
outreach
Community and
Primary care
Social care
Voluntary Sector
Combine key outputs to build future state
*TBC: These are planned to take place per Focus area per locality.
7
Approach to redesign
Working Groups are set up across the six focus areas (Urgent Care, Frailty, Mental Health, Planned Care, Women’s and Children’s and Long Term Conditions) to
co-produce these recommendations. The Working Groups will meet four times from 26th April to the end of June 2016. The purpose of these are:
INPUTS
•
•
•
•
•
•
•
•
•
•
•
•
Introductory pack from KPMG outlining overall
process and timescales
Overview of the evidence base for change
What good looks like for the specific focus areas
Best practice examples
Initial draft ideas for service change of suggested
pathways produced by the Project Team
Summary of views from Professional Reference
Group Members and from Public Engagement
events
Detailed process map of current versus proposed
pathway
Summary of views from second Professional
Reference Group
High level modelling of proposed pathways
Activity, workforce and finance implications of
proposed pathway redesign
Draft plans for service redesign and
implementation plans for each pathway
Summary of views from relevant Public Groups
OUTPUTS
1
Kick-off for each
individual Working Group
to agree scope and subgroups
•
•
•
•
2
Develop and agree the
hypotheses and key areas to
investigate
•
•
•
3
Agree the preferred options
for pathway redesign
•
•
4
Understand modelling input
and sign-off plans
•
Agreed high level views of subgroups
The associated pathways that the Working Group
proposes to focus on
Agreed roles for future meetings
Refined ideas for service change of suggested
pathway
Test of initial ideas against the Individual Needs
Framework
Clear brief for Project Team to test draft ideas in
the system analytical model
Understanding of gaps required to be filled to
meet proposed service redesign
Second brief to Project Team to test iterated
proposals in the system analytical model
Internal Working Group sign-off of proposed
redesign
Final brief to Project Team to consolidate changes
ready for last Professional Reference Group and
sign off via the WISR OMG
8
Focus Areas
In order to transform Isle of Wight health and social care we need a way of breaking down this highly complicated system into components that facilitate redesign
and enable effective implementation. Each working group will consider care from a provider/care setting perspective, and consider the ‘cross cutting’ themes as key
issues that the WISR needs to address. These cross cutting themes will be supported by the ‘needs assessment’ template as an aide memoire to keep working groups
focused.
Cross cutting themes:
• Vulnerability:
– All population groups, including the vulnerable,
are considered equally.
• The ‘island’ premium:
– Services understand the extra costs associated
with being on an island.
• Sustainability of services:
– Services are provided that clinically, financially
and operationally viable.
• On/off island:
– Consideration of where care can be provided
on/off the island.
• Workforce development:
– Development of staff to match the needs of
the island.
9
Best Practice for MLAFL Whole System Redesign
QUALITY
• Generate process and outcome measures for continuous
evaluation and improvement
•
Adapt international best practice to serve local need. Create
clear objectives which can be properly evaluated and allow
for flexibility for local providers to innovate
•
Sustain a culture of safety, learning and transparency
ACCESS
• Facilitate greater delivery of health care, social care and
voluntary sector services in home, community and primary
care settings through a focus on joint teams and working
between all providers
•
Match the goals and challenges of the organisations
involved and the needs of the local health economy
•
Optimise access and reduce waiting times through greater
standardisation of processes
AFFORDABILITY & SUSTAINABILITY
• Create a sustainable service model that is efficient, effective
and engages the public in self-management
•
Ensure services are financially sustainable and viable.
•
Be sensitive to local governance and political processes to
ensure initial agreement and long-term support
•
Promote learning and development and develop trust and
partnership between the workforce and leadership
COMMISSIONING
Encourage personalisation, choice and control through
diversification of services (supported by personal budgets
where appropriate)
•
•
Use business intelligence with robust data to support decision
making based on fact, and include patients and the public in
service design and decision making
PEOPLE
• Focus services on the individual at all
stages from prevention to treatment.
•
Ensure that the whole health care,
social care and voluntary sector
workforce is deployed to its full
potential
•
Foster and support relationships
between patients, families and
providers
•
Understand cultural similarities and
differences to develop ways of working
to suit all parties
FEASIBILITY
• Ensure financial viability – reduce the impact of diseconomies of scale, with
value for money, an understanding of the costs of care, and robust procurement
•
Develop strategies to ensure the operational continuity of the service being
currently provided whilst the new model of care is being introduced
What are the ‘Wicked Issues’?
Leadership in the care system is committed to safe, sustainable and affordable services.
For Planned Care services the “Wicked Issues” that have been identified that require
most focus to meet these commitments are below:
•
Tackling all specialties or services where clinical sustainability of both
elective and emergency activity is an issue (e.g. urology)
•
Managing patients with complex needs
•
Cancer care
•
Optimising quality and patient experience
The National Vision for Planned Care
1. Ease of access
3. Workforce
5. Referral to treatment times
• Wherever possible consultants carry out virtual
• Extending clinical roles to enable
•
clinics whereby they review patient records/images
remotely rather than seeing the patient in person
• Use of ‘one stop shops’ – providing an opportunity
for first new appointment, diagnostic and follow up
to be consolidated into a single attendance
• Clinical workflows are standardised by developing
explicit guidelines based on best practice and IT
systems that cement these practices into everyday
work of staff
• Measures taken to proactively reduce non-clinical
cancellations of operations on the day e.g.
proactive involvement of pathway coordinators
lower-grade staff to take the strain off
routine care and patient management
allowing highly skilled professionals to
only be used for their expertise
• Reduced variation, the ability to
ensure the most appropriate level of
care is provided and appropriate
staffing mix to demand
• Capacity to flex workforce plans
6. Shared decision making
4. Outpatient and diagnostics
An integrated clinical and managerial
diagnostic service that addresses the
interest and challenges of the unit it
serves
• Community diagnostic services are
provided for presentations that
would otherwise involve multiple
appointments in the hospital
• Patients are only referred to
specialists once a full range of test
results are available- negating the
need for unnecessary follow-ups and
repeated tests
•
2. Appropriate location for care
• Increased provision of care in a
primary/community setting
• Multi-disciplinary teams diagnosing patients in the
community via virtual clinics and phone
consultations
• Redefining job roles of clinical teams so they are
empowered deliver care in the appropriate care
setting
• Stratifying patients by risk and creating lowcomplexity pathways for lower-risk
Staff responsible for the referral management
process receive regular mandatory training in areas
such as choose and book, provider elective access
policy, 18 week and cancer waiting time rules
• Ensure frequent decision making, minimisation of
piles of paperwork and reduction of batching/batch
sizes in diagnostics and waiting lists
• Identify any bottlenecks in the system which delay
treatment planning
Demand is managed through exploration of
unwarranted variation and improvement in
communication
• Patients are educated and informed about their care
helping them to leave hospital sooner – set
expectations of when patient is likely to be
discharged and expected recovery times
• Ensuring patients are aware of the tools available to
them to help them make difficult decisions about
their care e.g. Decision Aids
•
7. Follow up and outcomes
•
Wherever possible outpatient follow-up
appointments are carried out virtually/by primary
care professionals
Potential Planned Care Sub Group Areas
Sub Group
Areas
Supporting Evidence and Quotes from Recent Professional and Public Engagement
Clinical
sustainability
of services
• Demand for services may become unsustainable with an increase in demand of 20% in urology, 13% in trauma and orthopaedics, 27%
in ophthalmology and 25% in haematology over the next ten years – suggesting a need to explore alternative delivery models
• 18 week waiting list remains below the trajectory for some services
• Consideration required for whether patients are willing to travel for treatment
• The delivery of acute services faces significant staffing challenges. Over the next 10 years there will be a need to recruit between 25
and 30 consultants, with 40 GPs expected to retire. This creates an unsustainable system from a workforce perspective.
• For some services communication is inconsistent and patients are not properly guided through the system - increasing the availability
of Care Navigators could help
• NHS digital maturity survey states Isle of Wight as having made good progress with regards to their readiness, capabilities and
infrastructure – presenting an opportunity to move to being paper-free at the point of care
Cancer
• There are significant pressures facing the delivery of cancer services. At the end of 2010, around 5 100 people living on the island
were living with cancer up to and beyond 20 years after diagnosis. This could rise to an estimated 9 900 by 2030.
• Mortality from cancer in males is significantly worse than in females for both the Isle of Wight and the England average.
• Rightcare identified the Isle of Wight as poor in the early detection of lung cancer compared to 10 similar CCGs
• Breast cancer prevalence and incidence were identified as areas which require further local exploration by Rightcare
• Cancer remains a major cause of poor health and premature death on the Isle of Wight with lifestyle being a significant contributing
factor
• Travel and cost of transport to mainland hospitals for treatment remains an inconvenience and practical hardship for patients
Workforce
• The delivery of acute services faces significant staffing challenges. Over the next 10 years there will be a need to recruit between 25
and 30 consultants, and 40 GPs will also be retiring. This creates an unsustainable system from a workforce perspective.
• Some specialties are only supported by an individual consultant and/ or a small clinical team. Some of these are also difficult to
recruit to, creating the risk of an inability to provide specialist care on an ongoing basis
• In 10 years time the trust’s combined finances are forecast to deteriorate- with additional staffing required playing a large factor in
this.
• The working age population is decreasing meaning a significant proportion of staff will need to be recruited from elsewhere
13
UK and Global Examples – Planned care
FaceTime/Skype GP Appointments – London, UK
Predictive algorithms for readmission - Israel
London GP clinics are making use of new specifically
designed smart phone and tablet services to provide
immersive consultation to patients virtually. Use of such
virtual products offers enhanced and out of hours
services with minimal clinician impact- drastically
reducing wait times for patients.
A not-for-profit insurer and provider in Israel serving
3.8 million people has developed an algorithm for
predicting patient readmission. In practice clinicians
therefore have access to a list of all their patients
ranked in order of likelihood for readmissions.
Online email consultation - Denmark
Practitioners in Denmark have been required to offer
patients consultations by email. In 2013, the number
of email consultation was equivalent to 11.2% of all
primary care consultations in the country
Maximizing consultant time and low skilled staff Narayana Hrudayalaya Hospital - India
Consultant productivity is maximised through using
their time effectively and the support of lower skilled
staff. Junior surgeons would open and close surgical
procedures while consultants would only do the
most complex part of the operation. Allowing them
to spend one hour on a six hour operation, and often
do two procedures at once.
Planned
care
Point of care testing, Worldwide
Point-of-care testing gives immediate results in nonlaboratory settings to support more patient-centred
approaches to healthcare delivery.
Sensor and microsystem and low-cost imaging
technologies for point-of-care testing combine multiple
analytical functions into self-contained, portable
devices that can be used by non-specialists to detect
and diagnose disease, and can enable the selection of
optimal therapies through patient screening and
monitoring of a patient’s response to a chosen
treatment.
Current developments in point-of-care testing are
addressing the challenges of diagnosis and treatment
of cancer, stroke, and cardiac patients.
.
APPENDIX
Groups
1
Project Team
2
Working Group
3
Professional Reference Group
There will be one project team for each focus area. The purpose of the project team is to tailor best practice for the Isle of Wight and to draft the
redesigned pathways. The project teams will be the ‘working engine’ for each focus area. KPMG will be responsible for developing the data and
gathering information, collating best practice, and writing-up findings. Isle of Wight members will be responsible for bringing local expertise to
the best practice.
There will be one Working Group for each focus area. The purpose of these groups is to develop and agree the vision for their focus area and to
agree the redesigned pathways.
2 Working Group
Additional check and challenge
will be done by medical, clinical
and other care professionals
through a WISR Professional
Reference Group. This will aid the
Working Groups with their draft
service change recommendations
and act as a checkpoint for
recommendations that are put
forward for the later public
consultation.
4
1 Project Team
Public Group
In parallel, a variety of public groups
will also inform the Working Groups
as they draft recommended service
model changes. KPMG and the
Professional Reference Group will be
responsible for understanding the
adjacencies between focus areas.
KPMG will arbitrate between the
public groups and the Professional
Reference Group, should there be
any misalignment.
16
Approach to redesign
A governance structure is included below. Joint reporting to the WISR Operational Monitoring Group (OMG) will be carried out by Working Group
representatives jointly with an OMG member who sits on the Professional Reference Group and a member of the Public.
Further reporting and final sign off at the WISR Board will be carried out by a member of the OMG (the WISR Programme Director) prior to reporting at the
MLAFL Board. Relevant work being carried out by other MLAFL workstreams (e.g. Prevention and Early Intervention) will be reported via the MLAFL Board.
Governance structure
MY LIFE A FULL LIFE BOARD
Reporting
PREVENTION AND EARLY INTERVENTION
WISR BOARD
INTEGRATED LOCALITY TEAMS
Reporting
WISR OPERATIONAL MONITORING GROUP
INTEGRATED ACCESS
Joint reporting*
PROFESSIONAL REFERENCE
GROUP
Membership:
•
Chair: WISR Programme Director
•
KPMG clinical lead
•
KPMG project facilitation
•
System professionals from health
and social care, including the
voluntary sector
WORKING GROUP (x6)
Perspective
and Insight
Membership:
• Chair
• Isle of Wight Subject Matter Experts
• Isle of Wight members of the public
• KPMG SME
• KPMG Project facilitator
Commitment:
•
Attending four workshops
(approx. 2-3 hours in duration
each)
Generation of
Detailed Proposals
Perspective
and Insight
PUBLIC USER AND CARER
ENGAGEMENT GROUPS
These groups will help ensure that the
emerging outputs from the six working
groups make sense from a public and
carer point of view as we strive to
deliver the vision for the Island
underpinned by the ‘I’ and ‘We’
statements.
PROJECT TEAM (x6)
Membership:
•
KPMG Project facilitator
•
Professional lead
•
Commissioning or management lead
Commitment:
•
1 day/week ring fenced
*Working Group reporting to the OMG will include
representation from the Professional Reference Group
and a member of the Public
17
MLAFL Engagement and Support to WISR Working Groups
1
MLAFL Project Support
MLAFL is being asked by WISR to provide named individuals to support each of the 6 Working Group areas for the duration of the redesign. This
will mean that the implementation of proposals generated can be picked up immediately by the MLAFL team. It will also enable Working Groups
to have clearer insight of the existing plans within MLAFL that can support proposed changes during discussions.
2
MLAFL Workstream Support
3
List of MLAFL Workstream Leads
As each Working Group develops its proposals, there will be a clear need for specific support from other workstreams in MLAFL. For example, the
use of technology to help deliver improved service change will require insights and support from the “Information & Technology, Information
Governance and Estates” workstream. Workstream support will also allow Working Groups to create proposals that are consistent with strategies
for service change that have already been generated within the key MLAFL workstreams of “Prevention and Early Intervention”, “Integrated
Access” and “Integrated Localities”.
Prevention and Early Intervention
Anita Cameron-Smith
One Leadership and One Empowered Workforce
Jacqui Skeel
Integrated Access
Ian Lloyd
IT, Information Governance and Estates
Gavin Muncaster; Kevin Bolon
Integrated Localities
Chris Smith
Strategic Commissioning, Contracting and One Island £
Gillian Baker; Loretta Outhwaite
Whole Integrated System Redesign
James Seward
Organisational Integration and Form
Chris Mathews
Evaluation and Measurement
Sharon Kingsman
18
Individual Needs Framework
What is the Individual Needs Framework?
RAG Status Definition
• The Whole Integrated System Redesign (WISR) programme has developed an
Individual Needs Framework to appropriately assess new models of care. This is
provided on the next page, it has been approved by the WISR board and is
consistent with the 4 tests and 12 questions in the Programme Assurance
requirements. These views on need have been determined using the MLAFL ‘I’ and
‘We’ statements, prior reports and stakeholder meetings across the health and
social care system.
RAG Status
Definition
Red
No evidence provided to demonstrate how the requirement
would be fulfilled
Evidence demonstrates that proposed changes are on the
right trajectory towards achieving the requirement
Evidence is provided that demonstrates how the requirement
would be fulfilled
• It includes five overarching criteria with 17 underpinning sub-criteria against which
new models of care will be assessed. For each of the 17 sub-criteria, high-level
requirements have been provided.
Definitions for the Individual Needs Framework
Amber
Green
Component
Care
Detail
•
The use of care refers to both care and support.
Current
financial
envelope
Demographic
change
•
This refers to the next two financial years (FY16/17 and
FY17/18).
•
•
How will it be used?
Inequalities
in care
• It will enable the Working Groups to self-assess their emerging new care models
and pathways and remove or amend from the outset any proposed service designs
that will not meet the expected requirements.
Minimum
amount of
resource
•
This refers the changes in the sizes of various age
groups within the island population, for instance
increases in elderly people, a declining working age
population, and reducing birth rate.
This refers to the provision being provided equitably to
all groups, including those with protected
characteristics.
This refers to the need to achieve a balance of
resources across both current and new services, in
terms of ensuring that any new or redesigned services
do not draw necessary resources away from existing
services which will continue to be delivered.
Parity of
esteem
Services
•
This refers to mental health being given equal priority
to physical health.
•
This includes care, support and advice services.
• In order to assess the emerging new models of care, the models will each be
graded against each of the high-level requirements, being assigned Red, Amber or
Green RAG status by the Working Groups during the design phase. The definitions
for Red, Amber and Green RAG status are presented overleaf as well as definitions
to assist in understanding and using the Individual Needs Framework.
• An Evaluation Criteria document will also be provided to assist Working Groups to
use the Framework.
• It will highlight the models and pathways requiring further development in the
Working Groups.
• It will support Professional Reference Group and Public Stakeholder Group
members to challenge Working Group recommendations against the Individual
Needs Framework criteria and level requirements.
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Individual Needs Framework
The framework below includes the consolidated set of individual needs and high-level requirements against which future new care models should be developed.
Sub-criteria
High-level requirements
Need criteria
•
Individual experience
•
Does it provide sufficient information to empower individuals to be active participants in the design, choice and delivery of
their care*? Does it provide the highest standard of care in the most appropriate setting? Will individuals know what to
expect from the service they receive?
•
Diversity of provision
•
Does it maintain or improve current quality of provision? Does it go beyond statutory services* to involve a range of
traditional and non-traditional services (including volunteers) as partners? Does it recognise parity of esteem*?
•
Technology
•
Does it identify an appropriate use of technology for both individuals and staff, data sharing and collaborative working?
•
Safety
•
Does it evidence a proposed design that maintains or improves safety of care delivery?
•
Distance, time and cost to
access services
•
Does it provide an appropriate balance between quality of care and distance to access services? Does it reduce waiting
times, admissions and referral to treatment times?
•
Clearer and fairer access
•
Does it provide a single point of access to services, with better signposting using a clear directory of services available?
Does it provide care for individuals moving between care settings? Does it reduce inequalities in care*?
•
Out of hours access
•
Does the proposed model or pathway ensure that service users are safely and appropriately cared for out of hours?
•
•
Clinical sustainability
Value for money
•
Does it align clinical staffing, clinical processes and infrastructure? Is there sufficient capacity to meet demographic change*?
•
Does it provide a spectrum of services that are financially and operationally viable*? Is it achievable within the current
financial envelope*? Does it offer opportunities for financial efficiency without impacting negatively on outcomes? If
decommissioning is required, have long term implications been considered?
•
Volume and productivity
•
Has it appropriately considered the minimum amount of resource needed to safely and effectively deliver new and current
services*? Does it ensure there is no unnecessary or duplicated activity?
•
Location
•
Does it consider when services must be provided off/on island*?
•
Sustainable workforce
•
Does it develop and train staff to match the needs of the island? Does it encourage empowerment and fulfilment in the
workforce, including opportunities for staff to undertake adaptable roles? Does it identify and support carers?
•
Self-help and selfmanagement
•
Does it promote early intervention and care that supports individuals to stay healthy and spot problems early? Does it
enable individuals to feel in control of managing their own conditions?
•
Leadership
•
Does the system provide clear structures and lines of responsibility and accountability? Are system and organisational
leaders capable of leading change and influencing across boundaries and agencies?
•
Achievability
•
Has the proposal been co-produced with members of the public? How many years will it take to plan, deliver and evaluate
change? Is the suggested change consistent with the requirements of the overall NHS England assurance process?
Quality
Access
Affordability
and
Sustainability
People
Feasibility
•
Regulatory body agreement •
Is it acceptable to all regulatory and oversight bodies, including those in the voluntary sector?
•
Co-dependencies with My
Life A Full Life
Is it consistent with the strategy and work being done in My Life A Full Life, including the one island pound and emerging
organisational forms?
•
*Definitions have been provided on the previous page
20
Quick Wins
Quick Wins are dynamic, solution-focussed projects that are selected and implemented within a twelve week timeframe. During the redesign process with the working groups, ideas
may be generated which may not fall under the longer-term core system redesign itself, but which may still be viable as Quick Win projects.
Quick win ideas will be picked up during the Working Group sessions. If any Working Group members have ideas now for quick wins, they can submit them for consideration. It will
be necessary to prioritise the projects that will be implemented, and to do this there is a proforma to submit ideas and a selection process against key criteria. A first tranche of Quick
Win projects is currently in progress, and the selection process for the next set of Quick Wins (tranche two) is outlined below.
Tranche 2 selection process:
Quick win idea(s)
identified during Working
Group redesign between
26th April and 27th May
Idea owner completes
the standard proforma
Initial filter based on RAG
status
Selected ‘long list’
created and circulated
prior to selection
workshop
Quick wins selected at
selection workshop
Quick win
implementation begins
Tranche 1 projects currently underway
Citizen centric view of health, social care and voluntary services: Further development of a
publically available database which will be the first point of call for members of the public when
wanting to contact/self-refer to available health, voluntary and social care services.
Out of Hours Service Redesign: Trained Emergency Care Practitioners or Advanced Care
Practitioners to staff the out of hours Beacon Centre, with GP support from the Hub and redesign
of the District Nurse end of life care pathway.
Project Benefits: Increased and appropriate use of health, social care and voluntary
sector services.
Project Benefits: Improved access to out of hours services across the network.
Creating a discharge summary structure: The creation of a single source and format for key
discharge data which will better improve communication between patients and clinicians. The
standardised approach will reduce clinical risk by preventing missed or delayed information.
Stabilisation of delayed transfer of care management: The agreement of roles and
responsibilities relating to discharge, an agreed definition and agreed application of the definition
through the policies and protocols for the discharge process.
Project Benefits: Improved quality of information to patients and reduction in clinical risk.
Project Benefits: Patient needs met quicker, increased service capacity and improved services.
Relocation of Senior Nurses from the Hub: The provision of alternative cover in the Hub, thus
releasing Senior Nurses to provide leadership and patient facing services in localities. Clinical
support will move closer to both the teams and the patient.
Prevention of unnecessary admission for acute back pain needing MRI scan: To improve the
patient experience through easier and quicker access to diagnostics and removing unnecessary
admission. The project will look at ensuring same day diagnostics for acute back pain – specifically
detecting cauda equina cases.
Project Benefits: Senior Nurses providing leadership and patient facing support in localities.
Project Benefits: Reduced time to carry out urgent diagnostics, reduction in
inappropriate admissions.
For further details and to obtain a proforma please contact: Gulcan Telci ([email protected]).
21
Integrated Pathway
Any ideas produced during the redesign process should be aware of the work being done in social care for the Integrated Customer Pathway,
based on the Greenwich Model. Any questions should be directed to Vamsi Pelluri.
22
References
Section
Reference
Case for Change
KPMG activity workforce and financial system model,
Caring for our Island Time to Act
http://www.mylifeafulllife.com/Downloads/WISR/Time%20to%20A
ct/Time%20to%20Act.pdf
Best Practice for
MLAFL Whole
System Redesign
Intentional whole health system redesign:
Southcentral Foundation’s ‘Nuka’ system of care. The
King’s Fund (2015)
http://www.kingsfund.org.uk/publications/commissioned/intentio
nal-whole-health-system-redesign-nuka-southcentral
Hospital collaboration in the NHS: Exposing the myths.
KPMG (2015)
https://assets.kpmg.com/content/dam/kpmg/pdf/2015/03/hospita
l-collaboration-report.pdf
States of Jersey Transition Plan 2011 to 2021: A
proposed new system for health and social services
(2011)
https://www.gov.je/SiteCollectionDocuments/Government%20and
%20administration/R2%20New%20System%20for%20HSSD%20mai
n%20doc.pdf
Helping NHS providers improve productivity in
elective care
https://www.gov.uk/government/uploads/system/uploads/attach
ment_data/file/466895/Elective_care_main_document_final.pdf
Quality and service improvement tools – Flow Reduce
Unnecessary Waits
http://www.institute.nhs.uk/quality_and_service_improvement_to
ols/quality_and_service_improvement_tools/flow__reduce_unnecessary_waits.html
KPMG Digital health heaven or hell
https://home.kpmg.com/xx/en/home/insights/2016/03/digital-healthheaven-or-hell.html
The National
Vision for
Planned Care
23
References
Section
Reference
Best Practice
(Planned Care)
Maximizing consultant time and low skilled staff Narayana Hrudayalaya Hospital - India
http://www.reform.co.uk/wpcontent/uploads/2014/11/Narayana_Hrudayalaya.pdf
Online email consultation - Denmark
https://home.kpmg.com/xx/en/home/insights/2015/09/in-searchperfect-health-system.html
Predictive algorithms for readmission - Israel
https://assets.kpmg.com/content/dam/kpmg/pdf/2016/03/digitalhealth-heaven-hell.pdf
WISR Individual Needs Report and Framework
-
Joint Strategic Needs Assessment
https://www.iwight.com/Council/OtherServices/Isle-of-WightFacts-and-Figures/Joint-Strategic-Needs-Assessment-JSNA
CCG Atlas Opportunity Tool
http://www.rightcare.nhs.uk/
Local Authority Atlas Opportunity Tool
http://www.rightcare.nhs.uk/
Health and Wellbeing Strategy for the Isle of Wight
2013-16
file:///C:/Users/amcewan/Downloads/HWS%2020132016%20(1).pdf
Joint Strategic Needs Assessment: Cancer
https://www.iwight.com/azservices/documents/2552-Cancer-Finalv1.pdf
Potential
Planned Care Sub
Group Areas
24