Department of Human Services Breakout session 2 Plenary 10.55 – 11.45 Elizabeth Wilson Victorian...

Department of Human Services

Breakout session 2

Plenary 10.55 – 11.45

Elizabeth Wilson

Victorian Travelling FellowPeninsula Health

5th May, 2005

Whole system care, and the older patient journey

Department of Human Services

Patient Flow Collaborative Whole System Care: The Older Patient Journey

ELIZABETH WILSONPENINSULA HEALTH5TH MAY 2005

Whole System Care :Whole System Care : The Older Patient Journey The Older Patient Journey

Overview:Goal of Victorian Travelling FellowKey drivers for change in the NHSNew/redesigned roles—pilot projectsExtended rolesStrategies to decrease ED pressureStrategies to keep elderly at homeThe way forward

Whole System Care :Whole System Care : The Older Patient Journey The Older Patient Journey

Victorian Travelling Fellowship 2004/5

• Goal:

Examine new roles of Assistant Care Practitioner and extended health care worker & their potential for:

introduction to Victoria in areas of shortages

decreasing inappropriate presentations to ED

use to assist the elderly to stay at home

Whole System Care:Whole System Care: The Older Patient Journey The Older Patient Journey

Extended/blended/new roles

Decrease inappropriate ED attendances

& LOS in ED & wards

Assist elderly to stay home

with decreased confusion re care


Actual

Examine new/blended/expanded

roles

Identify successful strategies to decrease inappropriate attendances

to ED & decrease LOS in ED

Identify successful strategies for helping

the elderly stayat home

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Victorian Travelling Victorian Travelling Fellowship 2004/5 Fellowship 2004/5

Actual

Examine new/blended/expanded

roles

Identify successful strategies to decrease inappropriate attendances

to ED & decrease LOS in ED

Identify successful strategies for helping

the elderly stayat home


Key in Drivers for Changes within NHS:

NHS Plan for health care reform 2000

Increasing demand for healthcare

(European Working Time Directive) Exacerbating shortage of nurses as nurses extend to take up Drs’ roles


NHS Plan 2000 Consultation showed that public wanted: More and better paid staff using new ways of working Reduced waiting times and high quality care centred on patients Improvement in local hospital and surgeries

NHS seen as 1940’s system working in 21st Century Lack of national standards Old-fashioned demarcation between staff and barriers between services Lack of clear incentives and levers to improve performance Over-centralized with disempowered patients


NHS 2000 Budget Allowed for growth in real terms by 1/3 in 5 years

More beds, hospitals, doctors, nurses

Modernization of premises, equipment and systems Investment to be accompanied by reform National Standards with regular inspection by independent Commission

for Health Improvement National Institute for Clinical Excellence to ensure access to cost

effective drugs not dependent on address Modernization Agency to spread best practice Earned autonomy with devolvement of power to local health services once

modernization progresses and organizations work well for patients


For the first time: Social services and NHS to come together and pool resources Modern contracts for GP’s and hospital doctors Nurses and allied health staff –opportunity to extend roles Patients will have a real say in NHS NHS access to private facilities

By 2004 GP appointments available within 48 hours 1000 specialist GP’s taking referrals from GP’s Long waits in ED’s will have endedBy 2005 Max wait for OP will be 3 months and for inpatient treatment, 6

months


Older people use NHS more than any other group

NHS Plan will provide for: free nursing home care a 900m BP package by 2004,of new intermediate care

services to allow older people to live more independent lives national standards for caring for older people to ensure that

ageism is not tolerated breast screening for all women 65 to 70 years old personal care plans for elderly people and their carers


Initiatives to support NHS Plan 2000

1)Shift of balance of power 2)National Service Frameworks including:

3)Agenda for Change/New Ways of Working



1)Shift of balance of power i)Patients and staff to be at heart of NHS PALS and PPI

ii) Local Primary Care Trusts to have role of running NHS and improving care in their areas


• System of patient and public involvement in health in England. This replaced Community Health Councils and comprised following bodies and duties

• The Commission for Patient and Public Involvement in Health (CPPIH)• Local Authority Overview and Scrutiny Committees (OSC)• Independent Complaints Advocacy Services (ICAS)• Patient Advice and Liaison Service (PALS)• The Patient’s Forum• A new duty to on the NHS to involve and consult the public

• The aims and objectives of this strategy are quite simple; by modernising to improve the way we work and run our services we aim to improve the patient experience and patient journey through the Trust. Patient and public involvement needs to be carried out at two levels. This is at an individual level and at a collective level.


Initiatives to support NHS Plan 2000 2) NATIONAL SERVICE FRAMEWORKS 2.i) NSF OLDER PEOPLE Standards:

“Rooting” out age discrimination Person-centred care Intermediate care General hospital care Stroke care Falls care Mental health care Promoting an active healthy life


• A TOOLKIT FOR OLDER PEOPLE’S CHAMPIONS

Next 2 yearsNext 2 years

PARTNERSHIPS FOR OLDER PEOPLE PROJECTS

60M bp RING FENCED FOR INITIATIVES to be tested and evaluated over the next 2 years WHICH:

• PROVIDE PERSON CENTRED INTEGRATED CARE FOR OLDER PEOPLE

• ENCOURAGE INVESTMENTIN PREVENTATIVE APPROACHES, WHICH PROMOTE HEALTH, WELL-BEING AND INDEPENDENCE FOR OLDER PEOPLE

Available for local authorities to make joint application with PCT’s, District Council, NHS,voluntary and independent sectors


Initiatives to support NHS Plan 2000 2) NATIONAL SERVICE FRAMEWORKS 2.ii) LONG TERM CONDITIONS (CDM)Standards Person centred service Early recognition followed by prompt diagnosis and treatment Emergency and acute management Early and specialist rehabilitation Community rehabilitation and support Vocational rehabilitation Equipment and accommodation Personal care and support Palliative care Support to family and carers Care during admission to hospital or other health or social care

setting


Chronic Disease Management Levels of SupportChronic Disease Management Levels of Support

Case Management

DiseaseDiseaseManagementManagement

Supported Self CareSupported Self Care

Level 3Highly Complex Members

Level 2High Risk Members

Level 1 =70-80%Chronic Care Management

Population Wide Prevention


Case Management for people with CD and older people “20% population require 80% care”

• Castlefields-Improving chronic care in General Practice

A managed care approach –nurse and social worker

Dr David Lyon –GP Outcomes– 1000 bed days saved pa

GP home visit requests reduced by 30% over 2 years

• Unique Care

• Kaiser Permanente-Evercare

• LOPSDP


• Expert Patient Programme —US originated—principally a user led self-management programme for creating expert patients.

Outcomes —early days but 23% reduction in CHD deaths and 10% fall in cancer deaths in 6 years



3)Agenda for Change/New Ways of Working (All initiatives supported by Modernization Agency) Draws together teams of experts to act as catalysts for significant

and sustained improvement in every healthcare setting.Teams included: The Leadership Centre The National Primary and Care Trust Development Programme The National Primary Care Development Team The NHS Clinical Governanne Team Support Team Service Improvement Team (and the National Institute of Mental Health) The Redesign Team The New Ways of Working Team


Underlying principle of Redesign of Workforce

Patient at centre of care rather than traditional work practices, professional boundaries and staff preferences dictating care


• Changing Workforce Programme

Purpose:To improve services to patients & the working

lives of staffNational programme to help those in services

to redesign roles Education & collaborations nationwide


CONSULTANT PRACTITIONERS

ADVANCED PRACTITIONERS

SENIOR/SPECIALIST PRACTITIONERS

PRACTITIONERS

ASSISTANT/ASSOCIATE PRACTITIONERS

SENIOR HEALTHCARE ASSISTANTS/TECHNICIANS

SUPPORT WORKERS

INITIAL ENTRY LEVEL JOBS

MORE SENIOR STAFF 9

8

7

654

3

21


Role redesign:• Individuals can take on different tasks or the task can

move between different levels of skill\• Can encompass four types of changes:

Moving task up or down traditional unidisciplinary ladder Expanding breadth of the job AH/RN Increasing the depth of a job CNC Combining tasks in a different way


• Re-designed & New Roles Pilot Projects

Investigations Technician

AssistClinical Pr.

Radiography

Endoscopists

CombinedClerical,PSA, tec

Assistant CarePractitioner

Intermediate Care

Practitioner

AssistantPharmacy

Pract

New/Re-designed

roles


Points of Difference UK/Australia:

• UK—phased out Div 2 nurses over a decade ago Health Care Workers have had expanded roles New roles based around competency Health, Social Services and Higher Education sector funded by same

level of Government

• Australia more “regulation” conscious Nurse Practitioners –specific requirements and registration with NBV Some hesitation around competency-”safe haven” of regulations Federal/State split of responsibilities


Blended/Extended roles

Emergency Care Practitioner --Ambulance attendant/ED nurse

Nurse consultants— on Reg roster Night nurse practitioners---hospital at night Surgical/anaesthetic assistant( nurse)

Pathway to Audiology

Foundation Degree in Health & Social Foundation Degree in Health & Social CareCare

Generic introduction to health and

social care

Fd Level 1 Fd Level 2 Post Fd career

Associate Practitioner: Orthopaedic Intermediate Care

Associate Practitioner: Children & Families

Associate Practitioner: Mental Health or LD

Associate Practitioner: Generic acute care

Pathway to Nursing

Pathway to Occupational Therapy

Pathway to Physiotherapy

Pathway to Podiatry

Pathway to Social Work

New roles in the workforce

Application to year 2 and 3 of BSc(Hons)

in chosen profession

Co

mm

on

Learn

ing

: IPL

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www.hciu.soton.ac.uk

http://www.hciu.soton.ac.uk/






Decreasing inappropriate attendances to Decreasing inappropriate attendances to ED, & LOS in ED & wardsED, & LOS in ED & wards

Appropriate presentations to EDDecreasing LOS in ED/wards

Consultants admit direct to

ward under relevant unit

Nurse led Minor Injuries

Units

Nurse led Walk in Centres

No/clerk triage unless

Very busy

Admitting team located in MAU all shift

Surgical assessment units

Nurse ConsultantsED/med/surg

Physio Practitioner/consultant

.

Keeping the Elderly &/or Keeping the Elderly &/or chronically ill at home.chronically ill at home.

.

Keeping the elderly at home

Care (case)Management

Expert patient programmes

(chronic disease)

EmergencyPractitioners

Assistant Care Practitioners supportingtraditional allied health,

nursing & carer functions

Consultant Practitioners

Allied health &/or nurseled clinics

Issues supporting changesIssues supporting changes

Strong Leadership from Gov’t & NHSResources for change management & role re-design trainingWhole system change--communicationMultiple collaboratives to support pilotsSupportive unions & colleges

OutcomesOutcomes• (Winter 2004/5 DHS Report)

2000/1 2002/3 2004/5Flu vaccine uptake over 65’s 65% 72%GP within 2 working days 75% 99+%

Patients spending 4 hours or less in ED (Including WIC / MIU from 2003/4 ) 77% 97%Cancelled Operations/% booked 3.4% 1.3 %

Population facts (Aus)Population facts (Aus)

ABS(2001)Population trends for the 21st Century

The Way ForwardThe Way Forward

Australia• N3 ET National Nursing and Nurse Education Taskforce (Recommendations from 2002 National review of Nurse Education including scope of practice of nurses and others)

Victoria• DHS/VQC-Patient Flow Collaborative/HDM/HARP• Debates re blended training at TES• DHS Nursing Policy Branch/NBV –scope of practice issues

Health Services• Complex Care Team• RAD teams• Streamline clinic—nurse prompted analgesia, investigations• Direct admissions ED to RAPCS• Physio specialist in ED –Rosebud • Proposed expanded role of Div 2 nurses• Development of advanced practitioner roles

Key IssuesKey Issues

• Patient at centre of care

• Thinking outside the square

• Breaking down barriers between traditional roles

Questions

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Department of Human Services Breakout session 2 Plenary 10.55 – 11.45 Elizabeth Wilson Victorian...

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