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Transcript of Www.england.nhs.uk Suzanne Rastrick Chief Allied Health Professions Officer Health Education Wessex...
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Suzanne RastrickChief Allied Health Professions OfficerHealth Education Wessex - 24 April 2015
“It’s the Patient, stupid…….”(with apologies to James Carville, 1992)
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Patient Choice….
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The Policy Case for Commissioning AHP Services in England…...• The NHS Mandate
• The NHS Outcomes Framework
• Patient Choice
• The Five Year Forward View (October 2014)
• The Forward View Into Action: Planning For 2015/16 (Dec. 2014) & Supplementary Information For Commissioner Planning 2015/16 (Dec. 2014)
• ‘Intelligence’ Based Commissioning Models & Approaches
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NHS Outcomes Framework – 5 Domains
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What does this mean for patients
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NHS Commissioning Assembly…• “….as clinical commissioners we need to understand
the outcomes that matter most to people in our communities – these “citizen outcomes” should guide our decisions….”
Gateway ref 01801
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Commissioners are sighted on what “citizens” want.
Adapted from: Legatum Institute (2014) Wellbeing and Policy
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How should providers respond to delivering these “citizen outcomes”?• Ensure those with Board leadership roles fully understand the
AHP workforce in their accountability• Approach workforce planning strategically in conjunction with
CCG or Sub Regional NHSE commissioners & LETBs• Move away from easy stereotypes of just more ‘doctors and
nurses’ to ensure workforce has richness and depth of competencies that deliver ‘citizen outcomes’
• Using Organisational Development approaches to fully engage with the existing AHP workforce & their professional bodies to develop both responsive services & multi professional leadership
• Share, spread & celebrate AHP innovation
NHS Five Year Forward View
• The NHS Five Year Forward View was published on 23 October 2014
• One of its great successes was that it is a shared vision for the future of the NHS across six national NHS bodies
• The challenge is now implementation; we know: • It will not be easy• We need to learn from the past • We’re going to need a different
approach
• AHPs are up for it!
The future NHS
The core argument made in the Forward View centres around three ‘gaps’:
Radical upgrade in prevention
• Back national action on major health risks• Targeted prevention initiatives e.g. diabetes • Much greater patient control• Harnessing the ‘renewable energy’ of communities
Health & wellbeing
gap1
New models of
care
• Neither ‘one size fits all’, nor ‘thousand flowers’• A menu of care models for local areas to consider• Investment and flexibilities to support implementation
of new care models
Care & quality gap
2
Efficiency & investment
• Implementation of these care models and other actions could deliver significant efficiency gains
• However, there remains an additional funding requirement for the next government
• And the need for upfront, pump-priming investment
Funding gap
3
Principles of the New Care Models programme
Clinical Engagem
ent
Patient Involvem
ent
Local Ownershi
p
National Support
• The programme will be developed with a co-design approach – built with patients and the health and care system
• It will seek to identify replicable standards, tool and methods so that scale can be reached;
• It will use the transformation fund to maximise progress and pace through centralised support, especially in technical areas as well as leadership support and development for those local health and social care systems;
• The national package of support to prototype sites will be offered with an agreed Memorandum of Understanding and mutual commitment to delivery on the ground, and a commitment to value for local people
• It will establish an evaluation process to support testing and rapid learning
• It will share early and continuous learning with the whole national health and care system through a wider community of support.
New Models of Care
Initially the new models of care programme will focus on:
• Multi-agency support for people in care homes and to help people stay at home
• Using new technologies and telemedicine for specialist input • Support for patients to die in their place of choice
Enhanced health in care homes
• Coordinated care for patients with long-term conditions • Targeting specific areas of interest, such as elective surgery • Considering new organisational forms and joint ventures
New approaches to smaller viable
hospitals
• Integrated primary, hospital and mental health services working as a single integrated network or organisation
• Sharing the risk for the health of a defined population• Flexible use of workforce and wider community assets
Integrated primary and acute care
systems
• Blending primary care and specialist services in one organisation• Multidisciplinary teams providing services in the community • Identifying the patients who will benefit most, across a population of at
least 30,000
Multispecialty Community Providers
First cohort Vanguard sites
Care model Applicant
PACSWirral University Teaching Hospital NHS Foundation Trust
PACSMansfield and Ashfield and Newark and Sherwood CCGs
PACS Yeovil Hospital
PACS Northumbria Healthcare NHS Trust
PACS Salford Royal Foundation Trust
PACS Lancashire North
PACs Hampshire & Farnham CCGPACS Harrogate & Rural District CCG
PACS Isle of Wight
Care model Applicant
MCP Calderdale Health & Social Care Economy
MCPDerbyshire Community Health Services NHS Foundation Trust
MCP Fylde Coast Local Health Economy
MCP Vitality
MCPWest Wakefield Health and Wellbeing Ltd (new GP Federation)
MCP NHS Sunderland CCG and Sunderland City Council
MCP NHS Dudley Clinical Commissioning Group
MCP Whitstable Medical Practice
MCP Stockport Together
MCP Tower Hamlets Integrated Provider Partnership
MCP Southern Hampshire
MCP Primary Care Cheshire
MCP Lakeside Surgeries
MCP Principia Partners in Health
Care model Applicant
Care Homes NHS Wakefield CCG
Care Homes Newcastle Gateshead Alliance
Care Homes East and North Hertfordshire CCG
Care Homes Nottingham City CCG
Care Homes Sutton CCG
Care Homes Airedale NHS FT
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• 2012 CAHPO asked by Sir Bruce Keogh to establish if there was a case of need to improve adult rehabilitation services in England
• Examples of good innovative practice and service design, but poor adoption and dissemination
• Clinicians and service users - unsure of services available and how to access them
• More recent stakeholder engagement told us:• service not always focused on patient need• lack of focus on outcomes • commissioning structures an obstacle to care
So, what are CAHPO team doing? ……Innovating Rehabilitation
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Rehabilitation Innovation Challenge Prizes• “Open Mind Partnership”
Leicestershire Partnership NHS Trust
Leicester Open Mind in partnership with Fit for Work
- GP referral or Open Mind therapists
- Long-term MSK pain
- Cognitive Therapy and Mindfulness techniques
- Addressing physical, social and mental barriers such as depression and anxiety
• “Fitness for Work Service”
Derbyshire Community Health Services NHS FT
- Self referral or by managers
- Assessment – physical activity, design of the workplace
- Phased return to work and duties where appropriate
- Service also offers MSK pain education and management, advice on equipment and educational resources
- ROI - £5 for every £1spent
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• Publish the economic arguments for rehabilitation• Take forward recommendations from C&YP scoping
project report• Publish commissioning frameworks:
• Self referral and early intervention• Supported self management• Urgent and emergency care review• Older people’s programme• Living with and beyond cancer• Elective care
• Return to work programme• Support development of regional networks
Plans for Rehab Programme 2015/16
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Proposals being taken forward across the United Kingdom
• Independent prescribing by advanced radiographers• Independent prescribing by advanced paramedics• Supplementary prescribing by advanced dietitians• Exemptions from Human Medicines Regulations by orthoptists
Work to date• A case of need for each the above proposals has been developed and approved by
• NHS England Senior Management Teams (June 2014)• Department of Health Non-Medical Prescribing Board (July 2014)
• Ministerial approval to undertake preparatory work for four separate but simultaneously running public consultations (August 2014)
• AHP medicines project board established (September 2014)
• Development of consultations and supporting documents including• Draft practice guidance for each profession • Draft outline curricular frameworks for training programmes• Impact assessments for each proposal• Consultation summary documents• Alternative formats e.g. easy read versions
AHP Medicines Project
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AHP Medicines Project - continuedBenefits of proposed changes
• Provision of best care, first time, in the right place through timely access to medicines• Reduced need for additional appointments, onward referral and hospital admissions to
access medicines required• Reducing risks and costs associated with delays in care• Supports new roles and service re-design that is patient-centred and cost-effective• More flexible, responsive and empowered workforce
Current steps• Ministerial approval gained to publish the four consultations in February 2015• Consultations on independent prescribing by radiographers and paramedics are
running for 12 weeks• Consultations on proposals for dietitians and orthoptists are running for 8 weeks• Patient and public engagement events are being held during the consultation period (2
in England and 1 in each of the devolved administrations)• Following close of the consultations, responses received will be collated and analysed • The report on the responses to the consultation will inform a paper by the Medicines
and Healthcare Products Regulatory Agency (MHRA) to the Commission on Human Medicines (CHM), asking them to consider the proposals in light of comments received
• The CHM will then advise Ministers of their recommendations in relation to the proposals
AHPs: data capture is crucial 1 DECEMBER 2014
Suzanne Rastrick Chief Allied Health Professions Officer
NHS England
I was appointed by NHS England in September 2014 as Chief Allied Health
Professions Officer. Throughout my career in the NHS I have welcomed independent
scrutiny of health services, so was pleased to be invited by the Nuffield Trust and the
Health Foundation to chair a QualityWatch roundtable discussion focused on how we
can measure the quality of care delivered by allied health professionals (AHPs).
While the report is retrospective, it suggests that AHPs are not adequately
represented in or by many of the national quality measures which systematically
capture data relating to the activities of medical or nursing colleagues. This results in
an inappropriate impression of the activities of AHPs.
Care spanning many sectors
Most striking for me is the fact that, given the nature and scope of their work, AHPs
are ideally placed to address some of the key challenges facing the health and care
sectors. As we see in the report, their publicly funded employment already spans the
NHS, local government (social care and education), housing, third sector and
independent practice. There is now a real opportunity to develop and build measures
across sectors that reflect both the pattern of actual service delivery for patients and
the outcomes AHPs achieve for them.
Let’s talk about data...
www.qualitywatch.org.uk/blog/ahps-data-capture-crucial
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AHPs are ideally placed to deliver many of the ambitions in the 5YFV • Two fundamentals AHP’s deliver on:
InnovationEntrepreneurship
• Some areas to strengthen:Economic evaluationConsistent outcome dataDeveloping networks to spread excellent practice
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Effectiveness, from a different perspective
Connect…Be Active…Take Notice…Keep Learning…Give…
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NHS England Chief Allied Health Professions Officer’s Conference
#CAHPO15 23 June 2015
The Kia Oval, London
“Insights on Innovation & Entrepreneurship”