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Elderly Care Conference 2016Keynote presentations
Welcome to theElderly Care Conference 201621 April 2016Birmingham
Tweet about the conference#ECC_2016
Professor Martin Green OBEChief Executive Care England
Age Discrimination in an Age of Equality
Browne Jacobson Elderly Care Conference21st April 2016
Claims clubMarch 2016
The Act
The stated aim of the Act is to reformand harmonise discrimination lawand to strengthen the law to supportprogress on equality.
Protected Characteristics‘Protected characteristics’ (formerly referred to as ‘equality strands’) are the grounds upon which discrimination is unlawful. The protected characteristics under the Act are:
age disability gender reassignment marriage and civil partnership pregnancy and maternity race religion or belief (including lack of belief ) sex sexual orientation
Public Sector Equality DutyThe duty covers all of the protected characteristics and will requirelocal authorities to have due regard to the need to:
eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Act
advance equality of opportunity between people who share a relevant protected characteristic and people who do not share it
foster good relations between people who share a relevant protected characteristic and people who do not share it
Public Sector Equality DutyTo advance equality of opportunity, local authorities will need to havedue regard, in particular, to the need to:
remove or minimise disadvantages suffered by people who share a relevant protected characteristic or that are connected to that characteristic
take steps to meet the needs of people who share a relevant protected characteristic that are different from the needs of people who do not share it
encourage people who share a relevant protected characteristic to participate in public life or in any other activity in which participation by such people is disproportionately low
The Reality The funding for older peoples’ care Dementia (an illness that is means tested) The ambition in care plans (process v wellbeing) Local authorities’ social care budget (learning disability vs older
people % of spend) Means testing for older people, not for Children
The Challenge To ensure equality of opportunity To ensure equality of resource access To redress the paucity of ambition in care planning To deliver on the spirit and letter of the law To regulate the system for commissioning
Professor Martin Green OBEChief ExecutiveCare England
@CareEnglandNews@CareEngOfficial
Professor Martin Green
Care England
Dr Joe Taylor
1
1. Integration
2. Bringing care home
3. Workforce issues
2
Mrs Confused –
Bouncing around 15 different settings
3Candesic.com
Billing – all done separately
Mrs Confused bill:• NHS• Mental health• Primary care• LA• 3rd sector• PMI• Mixtures above
Total: ??
Confused as nobody collates receipts together
Patient journey – Mrs Confused – a ‘frequent flyer’
The Future: Care more personalised
customised
Source: Adapted from aruba Networks4
Candesic.com
Hospital Room
Mobile Apps
the patient experience to be
The birth of the mCloud – a centralized, secure
mobile cloud hub – will deliver a 50% increase
in operational efficiencies
Prediction:
By 2025
50% More operational
efficiency
Smart waiting mCloud Room
Mobile technology will help realtime medical information become a reality through the use of mobile software and wearable devices
Prediction:
By 2025
75% Reduction in
patient misdiagnosis
Wearable Virtual
Devices
Assistant
The use of WiFi technologies and a secure
network will allow hospitals to move to a modern way of working
Prediction: By 2025
80% Wireless and
paperless
Wireless ElectronicSpace Records
New technologies will allow for
transformed
Prediction:
By 2025
100Personalised and
Experience Connected
What is etype care?
etype care is a cloud based platform consisting of,••••
Web portal,Ipad app, wearable devices,room and bed sensors
etype care connects and benefits,
••••
care home operators,residentsrelatives,healthcare providers
Operators are able to deliver care more efficiently and make better business decisions,residents to receive higher quality care and have their voice heard, relatives to easily
monitor their loved ones and have peace of mind, and healthcare providers to access the enormous elderly care home market
Key features of etype care
Resident profiles enabling carersto keep track of updates (medical notes and records, social notes,photos, calander, alerts, etc.)Surveys to easily get feedbackfrom residents and relativesWearable integration and big dataintervention
analysis to enable early
Immediate GP access via Skype-like interface to give piece ofmind to relatives and residents
Louise HuntSenior Coroner for
Birmingham and Solihull
Elderly Care ConferenceApril 2016
AIMS OF TODAY Tell you about Birmingham and Solihull
Coroner’s court and its work Overview of the new coroners’ system Conclusions DOLS and the Coroners court Issues with the elderly
NEWTON STREET
BIRMINGHAM AND SOLIHULL CORONER’S AREA Population of 1.3 million 4754 deaths reported 606 inquests 1702 post mortems – 36% 99% deaths completed within 6 months Busy office with Senior Coroner, an Area
Coroner and 5 Assistant Coroners
CORONERS AND JUSTICE ACT 2009 New Chief Coroner HHJ Peter Thornton
QC Putting the bereaved at the heart of the
coroners’ service Consistency across coronial areas Open and transparent service Faster investigations and inquests Compulsory training
INVESTIGATION – THE TRIGGER S1 CJA 09 - the trigger to investigate a death
occurs where a body is within the coroner’s area and there is reason to suspect: Violent or unnatural death Cause of death is unknown Died in custody of otherwise in state detention
S5 CJA 09 the purpose of the investigation is to establish: Who, when, where and how the deceased died Particulars to register the death
S5(2) CJA 09 in certain cases how = by what means and in what circumstances to satisfy Art 2 Human Rights Act 1998
CONCLUSIONS – S10 CJA No determination may be framed in
such a way as to appear to determine any question of:Criminal liability on the part of a named
personCivil liability
STATE DETENTION S48(2) CJA 09 = compulsorily detained
by a public authority within the meaning of the S6 Human Rights Act 1998. Immigration detention centresSecure mental hospitalsPrisonsDeprivation of liberty orders
DOLS - 1 Acid test from Cheshire West case
Mental disorder and lack capacity who are under continuous supervision and control and a lack of freedom to leave
Irrelevant:P’s compliance or lack of objection; the relative normality of the placement
(whatever the comparison made); and the reason or purpose behind a particular
placement Standard authorisation – usually care
homes Urgent authorisations for 7 days
DOLS - 2 Dementia – 75%? Acquired brain injury Severe learning disability 2m people “may…at some point due to
illness, injury or disability”
DOLS - 3 Hospital and registered care homes
(LAs) Supported housing (CoP) Community settings including own
home when deprived of liberty there by the state (CoP)
ITU Hospice Respite care
DOLS - 4 Manage families expectations Natural cause death = paper inquests Unnatural deaths inquest with a jury
Falls in care homesChokingSelf harmDeath following abscondingNeglect Industrial disease
INVESTIGATION – INTERESTED PERSONS S47 Expanded list inc:
Spouse, civil partner, partner, parent, child, brother, sister, grandparent, grandchild, child of a brother or sister, stepfather, stepmother, half brother, half sister.
PR of deceased Medical examiner Beneficiary under a policy of insurance Insurer who issued a policy of insurance Person whose act or omission may have contributed
to the death. Trade union where death was at work or from
prescribed disease. Chief constable where it’s a homicide or related
offence IPCC Appointed Government department Any other person with sufficient interest.
POST MORTEMS The coroner directs whatever
examination is required inc toxicology and histology
IP’s can have a doctor attend a PM CTPM Rotsztein decision 2015 Discontinue with natural COD
INQUESTS Opened as soon as reasonably
practicable R5(2) Completed within 6 months – R8 Fixed date inquests Statements requested within 4 weeks
of opening Case review after 6 weeks Pre inquest review hearing
INQUEST – JURY S7 Inquest must be held without a jury
unlessDied in custody or state detention AND death
is violent, unnatural or of unknown causeDeath resulted from an act or omission of a
police officer in the purported exercise of their duty
Death caused by a notifiable accident, poisoning or disease.
Coroner thinks there is sufficient reason for doing so
NEGLECT Neglect as a rider to a conclusion –
Jamieson 1995 Where there is a Gross failure to provide
basic medical attention to a person in a dependent position which directly causes, or materially contributes to the death
Examples of Gross failuresFailing to put a care plan in place to
prevent pressure sores with high waterlow score
Failing to switch on a non-invasive ventilation machine in a patient who had COPD
REPORT TO PREVENT FUTURE DEATHS = “PFD” Mandatory Applies during the investigation and
inquest Concern that circumstances creating a
risk continue and action should be taken Not restricted to matters causing the
death Responses due within 56 days May be national issues
EVIDENCE Oral evidence Medical records R23 written evidence
All interested persons have to agreeIf statements are provided quickly this allows me to write to the family to agree that the statement is readIf the family agree – witness will be de summonsed
DISCLOSURE All statements of witnesses on the
witness list are disclosed if requested by interested persons
So when writing any statement remember it will be disclosed and read by others including lay people
ELDERLY ISSUES Falls versus collapse Lack of attending Dr to provide COD Pressure sores Alzheimer's and dementia Nursing/care home concerns Safeguarding concerns
THE FUTURE Law Commission consultation on DOLS Proposal that CJA 09 be amended to so
that an inquest is only required where Art 2 ECHR is engaged
Coroners and Justice Act 2009 (Duty to Investigate) (Amendment) BillSecond reading 29/01/16
Medical examiner consultation Watch this space
The role of comissioner/provider in an integrated environment
Rob DyerMedical Director
Torbay and South Devon Foundation Trust.
New Care Model – Intentions
We will• Improve people’s experiences of health and care;• Support people in improving their wellbeing and in managing their own
health;• Shift the focus of our services from reactive to proactive with preventative
interventions at all levels;• Help to reduce inequalities in health and care;• Continue to support and develop a motivated, flexible workforce
Through improved quality of services, reduction in duplication and waste and reduced clinical risk we will• Maintain a financially stable and sustainable health and care system for the
long term.42
Where is Torbay?
EmployeesSDHFT 4500 TSD 1500
TurnoverSDHFT £232mTSD £142m
BedsSDHFT 500TSD 193
EmployeesSDHFT 4500 TSD 1500
TurnoverSDHFT £232mTSD £142m
BedsSDHFT 500TSD 193
Integrated Care Organisation
Acute servicesCommunity servicesAdult health and social care
EmployeesSDHFT 4500 TSD 1500
TurnoverSDHFT £232mTSD £142m
BedsSDHFT 500TSD 193
Integrated Care Organisation
Acute servicesCommunity servicesAdult health and social care
Complexity
DGH9 community hospitals120 services over 70 sites
The Local Multiagency Team
New care model
• Less dependent on bed-based care– Increase in Intermediate care– Increase in community care – GP providers
• New or developing partnerships – Voluntary sector– Care home and domicilary care market
• Changing role of specialist services• Move from specialist to generalist• Greater focus on prevention, well-being and self-
care
Role of commissioner/provider
• We have one commissioning CCG (councils, specialist commissioning)
• Role of CCG with an ICO as it’s main provider• Block contract• The provider has become the commissioner
– Complexity– Risk ?visible– New partners and new risks
New challenges
• Transactional • Poor performance in some areas (CQC)• Financial challenge• Worsening of relationships with CCG• Sustainability and Transformation Plan (STP)• Devon Success Regime• Unstable partners• Multiple regulators (who disagree)
Transforming care in HampshireOur multi-specialty community provider
Overview• NHS Five Year Forward View set out new models of
care needed for sustainable future• Initially 29 ‘Vanguards’ across England to pilot them• Hampshire Vanguard is a Multi-specialty Community
Provider (MCP)• NOT one size fits all: Local variation • MCP is about transforming how care is organised and
delivered to improve out-of-hospital care.• We were awarded Vanguard Status in March 2015
Your health, in your hands, with our help.
What is a Multi-specialty Community Provider?
• An extended team of GPs and specialists offering more straightforward access to a wider range of health and care closer to people’s homes.
• Centred around GP practices and primary care hubs.• Supporting a population based around a natural
community of care.• Enhanced support and promotion of self-care and
prevention.
Your health, in your hands, with our help.
Our MCP in Hampshire:Better Local Care• Our vision is for better health, well-being and
independence for people living in our natural communities of care. For People to take greater control of their own health and happiness and to feel confident about the support they receive when they need it.
• We aim to do this by delivering a step-change towards more accessible and higher capability out-of-hospital care, designed with and by the people living in our communities, and founded on the things that are important to them.
Your health, in your hands, with our help.
Our MCP in Hampshire:Better Local Care• Initially around 30 GP practices working in partnership
with Southern Health NHS Foundation Trust.
• Supporting population of 220,000 in three initial localities (Gosport, East Hants and South West New Forest)
• Supported by 16 local health providers, commissioners, local authority and third sector partners.
• Significant growth across Hampshire since inception (coverage approx 1m people)
Your health, in your hands, with our help.
Listening to our patientsTop themes :
• “I am happy to be seen by a healthcare professional other than my own GP for same day appts”
• “I am happy to travel to be seen somewhere other than my own practice for same day appts, however I have concerns about public transport”
• “I am less confident in pharmacists than my GP or experienced nurses but that is because I don’t understand what pharmacists are qualified to do”
Your health, in your hands, with our help.
Case for changeGP capacity: 1 in 6 GPs in Wessex plan to retire in next 2 years
Access to appts: 1 in 10 people in Fareham & Gosport say they cannot get an appt at a convenient time; 1 in 4 people say their surgery is not open at a convenient time
Long term conditions: The number with two or more LTC is projected to increase from 5 million to about 6.5 million
Demographics: Predicting a national increase of 10% in number of people aged 75+ by 2019
Your health, in your hands, with our help.
Case for changeGP capacity: 1 in 6 GPs in Wessex plan to retire in next 2 years
Access to appts: 1 in 10 people in Fareham & Gosport say they cannot get an appt at a convenient time; 1 in 4 people say their surgery is not open at a convenient time
Long term conditions: The number with two or more LTC is projected to increase from 5 million to about 6.5 million
Demographics: Predicting a national increase of 10% in number of people aged 75+ by 2019
Your health, in your hands, with our help.
Better Local Care at a glance
Prevention and self care
Extended Primary Care Team
Improved access
De-layering specialist support
Access Hub
Access Hub, the epicentre of the care model, linked to out of hours service, with care navigators. MSK therapists and pharmacists delivering care in the hubWeb GP
E-consultsApps
WebGP enabling online triage and e-consultations, & use of Apps to support self care
New pathways
of care
Multi-disciplinary team with specialist input, eg for end of life care, mental health, diabetes and wounds and leg ulcer care
Recovery café and
educationRecovery café and patient education supporting people with long term conditions
Carousel clinics providing improved access to specialist care for people with complex long term conditions
Carousel clinics
Your health, in your hands, with our help.
Our MCP in Hampshire
Your health, in your hands, with our help.
East Hampshire 10 practices / 70k patients Semi-rural “new town”
Gosport 11 practices / 80k patients Urban deprived
New Forest 7 practices / 70k patients Rural – older demographic
Some achievements to date• Set up Better Local Care localities – initially three
locations, now expanded to cover much of Hampshire, based around local GPs and their practice populations
• Launch of extended primary care access hubs in the New Forest and Gosport
• Physiotherapy, mental health nursing and respiratory specialist input into GP practices
• Campaign to protect all care/nursing home residents in Gosport from flu
• Care navigators and surgery sign posters piloted in the New Forest and Gosport
Your health, in your hands, with our help.
Some achievements to date• Launch of bespoke team development programme to
bring together extended team including health, care and local community to co produce and deliver new services
• Formal partnership between Southern Health and GP practices in Gosport
• Integration of information systems to ensure professionals in localities have access to the same patient information
Your health, in your hands, with our help.
Three levels of transformation
Your health, in your hands, with our help.
Commissioner reformProvider reformA new model
of carePooling the combined resources for the local population and commissioning services using long term outcome and capitation based contracts
Primary Care and Southern Health coming together to deliver the new model of care that has been co-designed with local people, is seamless across health and social care services and is cost effective
A new care model with better access to care, extended primary care team proactively managing need, and specialist advice and support in the community.
A new model of care
Your health, in your hands, with our help.
A new model, built around natural communities of care
Your health, in your hands, with our help.
Wider primary care at scale
Improved access to care
An extended primary care team
Fewer steps to access specialist support
Prevention and self-managementWe want to put people in control of their own health and wellbeing and we know that, to achieve that, we need to change the dynamic of the relationship between health professionals and patients.
We will adopt a patient activation approach and embrace ‘co-production’ in its fullest sense
Use our clinical systems and the Milliman analysis to profile risk factors and health behaviours in our localities
For patients, we’ll provide viable alternatives that give them the skills, knowledge and means to self-manage
For primary and community care, we need to support practitioners to take a whole person approach in every interaction.
We will support voluntary and community providers to work alongside health
Your health, in your hands, with our help.
Primary Care Sustainability Retain individual identity – registered list Reduced workload Services backed into general practice Working at scale Create new career structure Education, teaching and training – more specialties Partnership model remains, but New Practice Model - employed
Consultants in Primary Care Risk – premises, staff Skill mix
Your health, in your hands, with our help.
Improved access to care
Your health, in your hands, with our help.
Example of new model: Primary Care Access Centre Co-located with MIU in local
hospital Open 8-8 for walk-in or pre-
booked appointments Staffed by GPs,
physiotherapists, clinical pharmacists, nurse practitioner, paramedic, paediatric nurses
Able to read and write to a single shared clinical record
Going live from late summer 2015
multiple points of access that are not integrated
Current model of care:Multiple, disjointed access points
Extended primary care team
Your health, in your hands, with our help.
+
Bringing primary, community and adult social care together, with specialists from local hospitals and third sector organisations, to work as a single extended primary care team: the MCP
Social care services
Older People’s Mental Health Teams
Community Care teams
Single integrated teams based around General Practices
Fewer steps to specialist support
Your health, in your hands, with our help.
See GP
Planned Skype conversation: GP, consultant and patient. Management plan agreed.
Respiratory team review investigations.
Patient sees GP, investigations on site.Investigation
ReferralSeen in OPD to review results
GP sees patientLetter to GP
Example of traditional respiratory care
Example of new model of respiratory care
Provider reform
Your health, in your hands, with our help.
Structures to deliver transformation
Your health, in your hands, with our help.
MCP Delivery Unit
PROVIDER STEERING GROUP
LCDG WNF
LCDG GOSP
LCDG P&B
FF1 Etc. FF3 FF2
MCP Board
NHS England New Models of Care Programme
Locality Clinical Delivery Groups
LCDGEH
MCP Sponsor Board
Enabling workstreams
Your health, in your hands, with our help.
Design and implementation of extended primary care team
Putting in place the leadership team and development support
Creating a single health record and shared information
Getting the right estate for the MCP
Developing governance arrangements for the MCP
Ensuring the MCP represents good value for money
Building a social movement for change via effective communications and engagement
Evaluating the impact of the MCP
Challenges encountered Information governance / sharing: Inconsistent IG interpretations have lead to some
information not being shared with all partners Indemnity: In some cases providers’ indemnity policies preventing staff working in
new ways: (eg paramedics working in same day access hub) Transfer of estate: dominant primary care landlord with ability to delay transfers (eg.
Forton Medical Centre, Gosport) Maintaining clinical engagement: especially in new localities – linked to level of
funding allocation for 16/17 Commissioner engagement: some very engaged commissioners but not universally
seen as a priority at all levels Sustainability of primary care / GP federations: In some areas primary care at
breaking point financially and/or in terms of workforce
Your health, in your hands, with our help.
Strengthening leadership and building new teams
• Working in new ways across traditional barriers requires a new, shared culture
• Development programme will build this through:• Senior leadership development
• Developing emerging leaders and teams
• Developing the extended primary care teams
Your health, in your hands, with our help.
New paradigm = new organisation• For the MCP to succeed, a new type of organisation
is needed.• Our current organisations have come together to
determine how this will look.
• Provider board’s clear that future lies with MCP
• Will work with regulators to overcome hurdles of new organisational form
Your health, in your hands, with our help.
The benefits
Your health, in your hands, with our help.
Your health, in your hands, with our help.
For people using services, families, carers and citizens• More straightforward access to a wider range of care via
your local GP practice or primary care hub
• Better outcomes based on what’s important to you
• More advice and guidance to help you make the right choices and manage your own health and care
• Better access to local voluntary and community groups
• More involvement in design of care services near you
• In short, Better Local Care.
Your health, in your hands, with our help.
For health and care professionals
• Being part of developing new services that better meet the needs of local people
• Working as one team with a much wider group of professionals supporting the same people
• Access to team and leadership development and talent management
• More time to support people who need your specific expertise
Your health, in your hands, with our help.
For the health and care economy
• More tailored, better value services co-produced by the people who use them and commissioned based on outcomes rather than activity
• Reduced acute hospital activity (admissions and ED attendance)
• More focus on primary care, education and prevention
• More sustainable services (esp. general practice)
Delivery
Your health, in your hands, with our help.
Natural Communities of Care (NCC)
Andover
Winchester
Stockbridge
Soton
Romsey Eastleigh
Totton
Hythe
Lymington
Alton
Basingstoke
Business Unit 3
Clinical Service Director Juanita Pascual
Head of Professions Susanna Preedy
MCP General Managers Sarah England Kate Smith Vacancy – TBC – Basing/Alton
Burseldon
Business Unit 2
Clinical Service DirectorTBC
Head of Professions Racheal Marsh
MCP General Managers Phil A-HarrisSarah Olley
Ringwood
FordingbridgeBusiness Unit 1
Clinical Service DirectorPeter Hockey
Head of Professions Julia Lake
MCP General Managers Laura Rothery
LR
SO
PAH
KS
SE
VAC
MCP localities (west)
Delivering the new model locallyNewcomer sites JoinedFareham 25 Feb 16Havant, Hayling and Emsworth 28 Jan 16Waterlooville 3 Dec 15Avon Valley Eastleigh, Romsey, Chandlers Ford 3 Dec 15Eastleigh Southern Parishes 14 Jan16Totton 17 Dec 15Waterside and Hythe 11 Feb 16Andover 14 Jan 16 Winchester 14 Jan 16 Winchester Rural South 14 Jan 16Alton 10 Mar 16 Basingstoke 10 Mar 16Southampton City 17 Dec 15
Programme management officePaul Streat
Director of Provider Development
Alison FowlerProgramme
manager
Jane DruceEvaluation
co-ordinator
Dominic LodgeCommunity
Development lead
Claire LittleExecutive assistant
General managers
Paul Streat Tel: 07817998310 [email protected] Fowler Tel: 07342 064786 [email protected] Druce Tel: 07827 823894 [email protected] Lodge Tel: 07785 433768 [email protected] Little Tel: Claire.li
Transforming care in HampshireOur multi-specialty community provider