QNI Workshop

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QNI Workshop Sept 09
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Transforming Community Services What Are Our
Aims?
Consistently excellent and personalised services
for people
High Quality Care
Empowered communities that achieve best health
outcomes
Enabled staff to lead transformation
Improving Services
Developing People
Reforming Systems
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What have we done so far?

• Summer 09
• World Class Commissioning TCS Master classes
• Sept/Oct 09
• Procurement roadmap for commissioners
• Dec 09
• Revised National Community Contract
• Jan/Feb 10
• Estates Strategy Guidance

• Nov Dec 2008
• Currency and Pricing Options
• National Standard Contract
• Social Enterprise A guide to the right to
  request
• Jan 2009
• WCC Resource Pack Community services
• Enabling New Patterns of Provision
• Feb/Mar 2009
• Guidance Business Readiness for PCT Separation
• Spring 2009
• Guidance on community information models
• June 09
• Quality framework for community services
• Six Service Transformational Guides

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What do we need to do?
Transformation through Social Movement?
Values

• Appeal to hearts as well as minds
• Engage our values and commitment
• Make us ambitious for change
• Help us feel part of a movement where our
  ambitions are clear, our actions allow our
  ambitions to be realised and
• Enable us to achieve and demonstrate our
  achievement
• Use stories to engage and inspire us to be the
  best
• Make change happen

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The Challenge To deliver the
best..Quality, Innovation, Productivity and
Prevention
Patchy evidence, slow dissemination of innovation
and best practice slow adoption variation in
service quality, productivity, health outcomes

• HSMC literature search for evidence
• Quality Framework
• Transformation Guides
• TCS Innovation and Leadership Awards
• NHS Institute leadership and social movement
• NHS Institute Productive Community Hospital and
  Community services
• QNI programme

Focus on clinical/service improvement areas Get
the basics right Present the evidence and
signpost the policy Develop high impact
changes Develop people - transformational
attributes Focus on quality and productivity
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Ambition Action Achievement The TCS Guides
Based on a framework of ambition, action and
achievement Clearly setting out your
ambition Taking action to deliver the ambition,
using the best available evidence Demonstrating
and measuring achievement
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Ambition 1 Getting Basics Right Every Time
Action Ensure that the basics are in place to
deliver high quality services and improved
productivity

• Organisations need to have robust infrastructure
• to enable teams to
• Know about local health needs and plan services
  accordingly
• Create effective health and care partnerships
• Implement new services/approaches
• Improve access and availability
• Improve care planning and case management
• Have appropriate information and technology
• Have relevant education and training

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Ambition 2 and 3 make everywhere as good as the
best
Action making changes where there is research
evidence and/or professional consensus of high
impact on improving quality and productivity
Actions Health, Wellbeing and Reducing
Inequalities
Philosophy that promoting health and well being
and reducing health inequality are key roles
for all community practitioners Full use of
teachable moments opportunities to tackle
lifestyle factors when people are
receptive Knowledge of the range of
interventions which promote positive behaviours
Extending the impact on health outcomes through
joint working with local partners Making use of
local health data and their determinants to
target and plan work
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Action Children, Young People and their Families

• Ensure all staff conversant with, contribute to
  and audit safeguarding arrangements across
  organisations to ensure systems are effective
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• Enable the voices of children and young people
  themselves and also their families to be heard
  and ensure that they are central to planning and
  evaluation
• Use creative ways of implementing public health
  programmes, such as the Healthy Child Programme,
  to build the foundation for future health
  reducing later costs
• Adapt the hours that community services are
  accessible to suit family needs (fathers and
  young people) and develop new ways of engaging
  families who find it difficult to connect with
  traditional service arrangements
• Offer services in a range of settings and through
  different media acceptable to children, young
  people and families,
• Work with commissioners to develop services so
  that children, young people and families where
  there is illness or disability can choose to be
  cared for at home at all stages of their illness
  or disability

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Action Acute Care Closer to Home

• Identify common local reasons for hospital
  attendance or admission. Work in partnership with
  other organisations to provide a joined up
  (network) approach to acute care closer to home.
  
• Identify new service solutions to unnecessary
  attendance at A E and hospital admissions..
  This may also include community staff in AE
  and/or partnership approaches to improving
  out-of-hours care involving the ambulance trust
  and out-of-hours provider.
• Deliver new and innovative service solutions in
  community settings/homes. Eg include IV drug,
  chemotherapy and blood transfusion therapy,
  anticoagulation (RAT-near patient testing) or out
  patient services such as those for
  musculoskeletal, diabetes and heart failure.
• With advancements in tissue viability, more
  complex wound care can now be provided in the
  community setting aligned to the dermatology care
  pathway.
• Use technology as a virtual means of getting
  specialist advice or a second opinion from a
  specialist nurse, allied health professional, GP,
  or consultant.

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Action Services for People with Long Term
Conditions

• Use a proven tool like the combined predictive
  model to risk stratify your local population.
• Support and enable people to undertake
  appropriate and effective self-directed care and
  take greater responsibility for managing their
  own health
• Use case managers as key workers to work
  proactively with those with very high intensity
  needs (VHIUs) and those with complex care needs.
  Develop shared care plan with realistic goal
  setting.
• Invest in telehealth and telecare to empower
  patients to take control and maintain their
  health needs, under the guidance and support of
  the case manager.
• Develop personalised care plans using joint care
  planning/ integrated assessment and join up multi
  disciplinary working along the care pathway.
• Engage service users and carers as a means of
  offering choice and personalisation. This will
  include encouragement to participate in expert
  patient programmes and with personalised budgets.
  This should include participation on stakeholder
  forums and working groups

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Action Rehabilitation Services

• Work towards a philosophy of rehabilitation and
  reablement for all providing a clear vision and
  strategy for rehabilitation services.
• Build and develop multidisciplinary and
  inter-agency teams to deliver local
  person-centred rehabilitation.
• Redesign the care pathway promoting high quality,
  productive services which will ensure that all
  individuals have a safe, efficient and effective
  service, which achieves and maintains maximum
  health and independence.
• Promote and enable self-care, providing support
  for families and carers throughout the service
  users journey.
• Invest in services that will maximise an
  individuals potential to return to work,
  providing alternative pathways (e.g.
  volunteering) for work related activities where
  this is not practical.

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Action End of Life Care

• Ensure teams know about Quality End of Life Care
  markers (DH), SHA and PCT strategic end of life
  care plans in accordance with the National End of
  Life Care Strategy and Next Stage Review.
• Use an established systematic framework such as
  the Gold Standards Framework or Liverpool Care
  Pathway in order to optimise care delivery
• Ensure that all patients are who are approaching
  the end of life are identified early and
  sensitive conversations are had about death and
  dying, choice and personalisation with patients,
  carers and families.
• Provide all patients with a key worker/ case
  manager and care plan and where appropriate
  document advance wishes and preferences for care.
  Make sure that all practitioners (including other
  relevant organisations) are aware of these
  preferences, subject to the consent of the
  patient.
• Ensure that care for those approaching the end of
  life is accessible, responsive and available
  twenty-four hours a day.

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Ambition 4 Transformational Practitioners and
Inspiring Leaders who are
Health promoting practitioners focusing on
health, well being and addressing health
inequalities Clinical innovators and expert
practitioners enabling increasingly complex care
to be provided at home Professional partners in
an expert to expert relationship with patients
and in building teams across organisations Entrep
reneurial practitioners exploring business
opportunities including expanding social
enterprises and other innovative
approaches Leaders of service transformation
individual, organisational and across
systems Champions of clinical quality using new
techniques and methodologies to embrace
continuous improvement
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Ambition 4 Transformational Practitioners and
Inspiring Leaders
Actions
Leadership Board Development Organisational
Development Business skills
Developing new Provider organisations
Education of community practitioners Training and
Development
Developing current and future community staff
Mobilising People 6 transformational attributes
Creating a transformational movement?
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Action Next steps for the TCS programme
Phase 2 from April 2009 Co-production and local
leadership are key Emphasis on
Quality and productivity QUIPP NHSI
Productive Quality Framework Contracts

• Implementation
• Guides/QF
• Innovation Leadership Teams
• QNI partnership
• Consultation Quality Indicators
• Leadership/social movement

Workforce Careers Education Development Leadershi
p

• Partnerships/Interfaces
• Primary care
• Transforming Adult Social Care
• Children YP services
• WCC and PBC

Transforming Commissioning WCC/PCT PBC Joint
Strengthening System Enablers Strengthening
measurement (Informatics, IT) Strengthening
provision, social enterprise,
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Ambition QNI Networks Key Part of the Social
Movement

• We have the best opportunity to clinically own
  and deliver change in community services for many
  years
• Change will be delivered by you the people
  providing care working with individuals families
  and communities
• Change will need to be delivered in a difficult
  economic climate
• Clinical leadership with business skills is
  central
• Community services can contribute significantly
  to improving peoples experience and improving
  productivity through more care where people want
  it as near to home as possible
• Early wins could include reduction of excess bed
  days for older people, improved prevention and
  management of pressure ulcers, LTC and EoL care
  pathways that reduce hospital admission,
• Community services are uniquely placed to major
  on prevention and the evidence base is improving
• Action??
• How can DH QNI and you work together to implement
  the TCS Guides, to build a social movement to
  achieve our aims for improved health and care for
  local communities

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Achievement
We deliver high quality care
and improved health outcomes for all