Regional Home Oxygen Service Events: Southwest Monday 18th September 2006

1
Regional Home Oxygen Service EventsSouthwest
Monday 18th September 2006
2
Home Oxygen ServiceService Delivery Update

• Jeannette Howe
• Head of Pharmacy
• HOS Programme Director
• Scott Lawlor
• Contract Manager

3
Home Oxygen ServiceScope of presentation

• New arrangements
• Initial problems and response
• Governance
• PCT roles and responsibilities
• Contract management
• Performance
• Financial

4
Home Oxygen ServiceNew arrangements

• Change sought by clinicians patients
• Improvements to patient care
• Integrated service
• Access to latest equipment
• Cylinder, concentrator and for first time
  ambulatory oxygen liquid oxygen
• One specification for all England

5
Home Oxygen ServiceNew arrangements

• Clinical assessment
• Properly determine patient needs
• Home oxygen order form (HOOF)
• Ordered by consultants specialist
  practitioners, as well as GPs
• Worked closely with stakeholders
• Development of a specification for service that
  patients clinicians wanted to see

6
Home Oxygen ServiceNew Supplier Regions

• Air Products
• NW, Yorkshire Humberside, East and West
  Midlands, North London, Wales
• Allied Respiratory
• South London, South East
• BOC
• Eastern, South West (from 1 Oct)
• Linde
• North East

7
Home Oxygen ServiceService categories

• Short burst oxygen therapy (SBOT)
• Long term oxygen therapy (LTOT)
• Ambulatory
• Urgent

8
Home Oxygen ServiceNew financing approach

• Cost Per Diem
• 1 route replaces 5 funding channels
• Outcomes - better data
• Number of patients
• Service provided
• Monthly cost of service provided to each patient

9
Home Oxygen ServiceProblems in early February

• Multi-factorial
• Huge volumes of orders
• Many incomplete or inaccurate HOOFs
• Advanced orders for patients not needing
  immediate supply
• Difficulty prioritising orders
• Order/help lines overwhelmed
• Community pharmacist withdrawal

10
Home Oxygen ServiceResponse to problems

• Immediate action to stabilise service, working
  with SHAs
• Re-instate FP10, engaged community pharmacies
• Communications
• Strengthened project governance
• Assessment of suppliers capacity capability,
  inter-dependencies
• Revised transition plans
• Renegotiated with some suppliers
• Strengthened performance management tools

11
Home Oxygen ServiceProgramme Governance
Structure
9 Aug 2006 - Version 1.3
12
Home Oxygen ServiceGovernance roles

• National role
• Programme owner
• Service specification
• High level complaints/ SUIs
• Contractual support eg notices, audits,
  changes, variations, breaches
• Performance management reports (KPIs).
• NHS - HOS Regional leads
• Performance management reports (KPIs).
• Supplier liaison
• Escalate to national lead for clinical/
  contractual assistance
• Liaise with other HOS Regional leads (for same
  supplier) if required
• NHS - PCT level leads
• Implement and manage at local level
• General management as is done today
• Reconciliation and authorisation of invoices
• General complaints/ SUIs

13
Home Oxygen ServiceGovernance protocols 1

• Important to ensure contractual compliance across
  all regional contracts
• A national service specification
• Limit local variations in service delivery to
  patients
• Address cost implications
• Consistent approach to contract management

14
Home Oxygen ServiceGovernance protocols 2

• Current agreed protocol for discussion at
  national level
• PCTs raise with SHA HOS Implementation Team
• Suppliers raise with DH CCMU Joint Supplier
  Forum
• Final Decision - DH HOS Programme Board
• Revised as transition complete revised NHS roles

15
Home Oxygen ServicePCT roles responsibilities

• Continuing management responsibility for local
  HOS, in line with national requirements
• Financial management
• Performance management
• Complaint/SUI management
• Know the service specification, contract terms,
  pricing bands

16
Home Oxygen ServicePCT roles responsibilities

• Support remaining transition
• Disengagement of pharmacies
• Decommissioning headsets
• Commissioning or supporting PbC of clinical
  assessment service
• Work with the regional supplier lead
• Escalation to SHA/national level

17
Home Oxygen ServicePCT roles and
responsibilities Financial

• PCT reconciles invoices
• Agrees adjustments with supplier
• Advises PPD, which make adjustments
• PCT spreadsheet to be shared
• Urgent supply charges recognised as a concern

18
Home Oxygen ServiceNational role Performance

• Transition reporting - ongoing
• Key Performance Indicators (KPIs) starting to
  use
• Service levels urgent/ discharge etc
• Call centre response etc
• Supplier annual operational plan
• Clinical audits regular/ ad hoc
• KPIs being further developed

19
Home Oxygen ServiceSupplier role and
responsibilities

• Set out in contract terms and service
  specification
• Delivery of a safe, reliable and integrated home
  oxygen service
• Effective communication/working relationships
  with PCTs, NHS Trusts, GP practices, patients and
  carers
• Service information data to support PCT contract
  management

20
Home Oxygen ServiceWorking with suppliers

• PCT and supplier work together on day-to-day
  issues (eg. complaints)
• Need practical/cost effective contract management
• Economies of scale benefits for supplier and
  PCT
• Various options (eg lead PCT/host arrangements)
• Welcome views

21
Home Oxygen Service

• Thank you
• Any questions or comments ?

22
Working with our Suppliers

• South West Transition Team (AP to BOC)
• Air Products Mike Cockram, Rick Kemp, Chris Lund
• BOC Steve Ellis, David Owers, Victoria Rylott,
  Mark Gregory
• DH CCMU Scott Lawlor, Ralph Fernando
• NHS Jill Loader, Jim OBrien, Joel Hirst

23
PCT HOS Bulletin
24
Local networks

• PCT HOS Leads co-ordinated by
• Jill Loader AGW
• Mike Wilcock Peninsula
• Paul Gardner Dorset and Somerset
• Links to Clinical Networks Respiratory Teams in
  primary and secondary care and other
  stakeholders

25

South West transition 18th
September Update, Tauntonte
26
Air Products / BOC personnel today

• Rick Kemp Regional Medical Manager, Air
  Products
• David Owers Marketing Manager BOC Medical
• Tracey Milligan Respiratory Advisor BOC Medical

27
Agenda

• Principles of transition period
• Communications
• Personnel
• Patient data
• Early transfer of jobs
• Hospital discharge emergencies
• Holidays
• Pharmacies
• Post cutover
• QA

28
Principles

• BOC/AP/DoH project team functioning since 6th
  August
• Clinicians received information on transition
  last week
• Patients will receive letter next week
• Emergency HOOFs 4 hr callouts received by Air
  Products up to midnight Saturday 30th September
  will be actioned by them, even if work goes into
  Sunday. (no handover of emergencies)
• BOC call centre takes SW calls from midnight Sat
  30th September
• Early transfer of some jobs to relieve pressure
  on cutover day and warm up new staff.
• Any remaining outstanding jobs transferred to BOC
  on Sunday 1st Oct loaded into BOC systems.

29
Communications -1

• Letters to Clinicians
• new contact details from 1 Oct
• BOC call centre number 0800 136 603
• BOC fax number 0800 169 9989
• business as usual during transfer
• DO NOT resend HOOFs
• AP BOC will transition service transparently

30
Communications - 2

• PCT generated patient letter cancelled
• Letters to patients to arrive in last week of
  September
• service is the same,
• continue as normal,
• just new number to call from midnight Saturday
• new number to call 0800 136 603
• electricity refunds (up to 30th September) will
  be sent out by AP by mid October

31
Personnel/Vehicles

• Air Products permanent people are being
  transferred (TUPE) to BOC
• BOC also taking on contractors
• BOC will have new fleet of vans equipment

32
Patient data

• 7500 patients currently identified in South West
• Expected total circ. 8000
• Initial transfer of patient records as at 31st
  August
• Transfer of updated records on 22nd September and
  week commencing 2nd October
• All patients have completed consent form (so no
  data protection issues)
• AP / BOC commit to compliance with Data
  Protection Act 1998

33
Early transfer

• Early transfer of some jobs (1 or 2 days)
• warms up new BOC staff
• adds extra resource in SW over last 3 days
• covers downtime of staff transfer
• Examples
• new Std (3day) HOOFs from Wednesday
• cylinder refills from Thursday
• next day hospital discharge HOOFs from 5pm Friday

34
What do you need to do pre 1st October?

• Clinicians
• nothing
• AP will pass HOOF faxes to BOC and will copy
  clinician with explanation
• BOC will process provide normal acknowledgement
• orders will be delivered within 3 days as normal
• address special patient concerns to Karen Stacey
  and/or Tracey Milligan
• Patients
• nothing
• AP take SW refill orders removal requests as
  normal
• informing patient BOC will deliver
• AP will pass orders to BOC
• BOC will deliver within 3 days as normal

35
Planned Hospital Discharge HOOFs

• Next day cutover 5pm Friday
• AP will call to determine requirement
• If Saturday, AP will deliver
• If later than Saturday, AP will pass to BOC
• BOC will call to confirm delivery date

36
Emergency HOOFS/Call-outs

• AP responsible for fulfilling all emergencies
  received up to midnight Saturday 30 September
• i.e. call received 2359 will be actioned by AP
  through Sunday morning.
• More AP technicians transferred into SW region to
  provide call-out cover
• these staff will also aim to mop up as many
  outstanding jobs as possible on Saturday allowing
  SW engineers to hand over vans etc.
• BOC responsible for fulfilling all emergencies
  received after midnight

37
Patient holidays in South West

• Holiday orders for SW beyond September are
  already being passed to BOC
• Delivery collection of equipment covered by
  agreed BOC/AP process.
• Communicating to patients whose holiday straddles
  transfer period end
• AP will inform them before they go so they have
  the BOC number for post 30th September

38
Pharmacies

• AP and BOC will work together to promote the
  disengagement of the pharmacy chain
• AP/BOC/DoH agreement to speed up the
  disengagement from AP pharmacies
• AP pharmacy supplies already reduced to much less
  than 10 pre-HOS volume
• AP will stop supplies 30th September, letter sent
  to all their pharmacies last week
• they have option to open BOC account
• BOC supplied pharmacies can continue to order
  cylinders post 1st October until stabilisation
  achieved

39
Post cutover

• HOOFs all types
• AP identifies HOOF from SW region
• AP uses current out of region process
• (i.e faxes back to sender giving correct supplier
  to contact)
• emergency hospital discharge HOOFs will be
  phoned back to reinforce this.
• Calls
• AP will identify SW patients
• if call relates to AP issue, AP will handle
• if call relates to new orders, AP will provide
  BOC freephone number
• note if BOC receives calls ahead of the cutover
  they will advise patient to call AP.

40

• Any Questions?
• www.airproductsmedical.com
• www.vitalair.co.uk

41

• Q A

42
Managing service quality

• Dr Ian Spencer

43
Context

• early operational problems
• serious untoward incidents
• adverse media coverage
• erosion of public and political confidence
• need to better understand the quality of the home
  oxygen service

44
Objectives

• To achieve
• a common understanding of service quality by all
  stakeholders
• clarity of reporting frameworks
• clarity of responsibilities
• shared experience and learning

45
Clinical governance

• A framework through which all NHS
  organisations are accountable for continuously
  improving the quality of their services and
  safeguarding high standards of care by creating
  an environment in which excellence in clinical
  care will flourish.
• Donaldson and Scally

46
(No Transcript)
47
(No Transcript)
48
Why focus on quality?

• variation in process and outcome common
• practice too often lags behind science
• patient safety has a relatively low profile
• poor quality and performance tolerated
• organisational and professional barriers
• inequality of access to appropriate care
• slow permeation of innovation and good practice
• patient expectations as consumers
• poor information for describing quality

49
A quality service

• leadership and culture
• evidence-based standards
• informed patients/users
• well-trained and motivated staff
• safe processes
• learning from mistakes at all levels
• individual
• team
• organisation

50

• Human beings make mistakes
• because the systems, tasks and
• processes they work in are
• poorly designed.
• Dr Lucian Leape, testifying to the Presidents
  Commission
• on Consumer Protection and Quality in Health

51
(No Transcript)
52
The Bovingdon Stack
53
(No Transcript)
54
Seven steps to patient safety

• Build a safety culture
• Lead and support your staff
• Integrate your risk management activity
• Promote reporting
• Involve and communicate with patients and the
  public
• Learn and share safety lessons
• Implement solutions to prevent harm

55
(No Transcript)
56
Management of complaints

• Need for agreed policy aligning provider and NHS
  complaints procedures
• Avoid confusion agree definitions
• What is a formal complaint?
• Oral and Written complaints
• MP correspondence
• Develop a learning culture
• Keep accurate records Complaints Register

57
Management of complaints

• Align to NHS Complaints procedures
• Acknowledge in writing within 2 working days
• Advise of assistance from PALS
• Keep the complainant informed
• Formal response within 25 working days
• Explain any delays in investigation
• Indicate the right to independent review
• Offer an apology when things have gone wrong
• Indicate what action will be taken to prevent
  recurrence

58
Management of complaints

• Complaints report compiled at agreed frequency
• Confidentiality apply Caldicott principles
• Internal managerial review
• Report to regional HOS steering group
• Report to PCTs joint review
• Analysis of trends
• Identification of lessons learned
• Share learning
• Complaints management included in End of
  Transition Report

59
Management of SUIs

• notification of serious untoward incidents (SUIs)
  from Trusts to SHAs
• local adverse incident procedures
• near miss and patient safety incident reporting
  to the National Patient Safety Agency (NPSA)
  using the National Reporting and Learning System
  (NRLS)
• SHA briefings to DH Patient Safety and
  Investigations Unit
• complaints
• Media Alerts to DH Communications

60
Aims of guidance

• ensure consistency of reporting
• provide timely notification
• enable root cause analysis
• identify the lessons learned so that these can be
  shared more widely

61
A definition

• An incident or accident occurring on health
  service premises, or in relation to a health
  service provided in other settings, resulting in
  death, serious injury or harm to patients, staff
  or the public, significant loss or damage to
  property or the environment, or otherwise likely
  to be of significant public concern.
• Situations highlighting a system weakness (near
  miss), where sharing of lessons learned would be
  likely to help to avoid a future incident
  resulting in a future incident resulting in
  serious harm or damage, should also be reported.

62
SUI criteria include

• media attention actual or likely
• unexpected deaths (inc. suicide, drug related
  deaths)
• patients suffering serious or catastrophic harm /
  or unexpected death during healthcare (including
  screening / radiation errors)
• homicide committed by patient receiving MH care
• allegation of professional misconduct, including
  fraud
• serious damage to NHS property
• serious injury or unexpected death on NHS
  premises
• major breaches of confidentiality
• absconding when detained under the Mental Health
  Act
• an adverse incident affecting people and/or
  business continuity including ward closure due to
  infection

63
(No Transcript)
64
(No Transcript)
65
(No Transcript)
66
(No Transcript)
67
An incident or accident occurring on health
service premises or in relation to health
services provided in other settings, resulting in
death, serious injury or harm to patients, staff
or the public, significant loss or damage to
property or the environment, or otherwise likely
to be of significant public concern.
Situations highlighting a system weakness (near
miss), where sharing of lessons learned would be
likely to help to avoid a future incident
resulting in serious harm or damage, should also
be reported.
60 Working Days (excluding external delays)
3 Working Days
SUI Occurs / Trust informed of SUI
Trust report SUI on STEIS
Trust complete internal inquiry and send copy
to SHA
SUI closed when SHA Director of Clinical
Governance is satisfied
SHA may require immediate/72 hour written
briefing
Contact Details Joyce.lovell_at_ntwsha.nhs.uk
Tel. [phone] Sue.campbell_at_ntwsha.nhs.uk
Tel. [phone]
68
Home oxygen SUIs

• any incident that involves the death of a patient
  where the integrity of the home oxygen service is
  challenged
• any serious failure of service delivery,
  including compromised supply of oxygen
• delayed discharge from hospital or inappropriate
  emergency readmission
• health and safety incidents relating to the use
  of oxygen equipment, including fire
• an incident where the quality of healthcare has
  been significantly compromised this may include
  severe distress to service users and their carers.

69
An integrated approach
CG Lead
HOS Lead
Supplier
Comms Lead
70
Action Service suppliers

• report all SUIs immediately to PCT and SHA HOS
  Leads
• written notification within 24 hours
• internal quality management systems
• reports to MHRA should be copied to PCT and SHA
  HOS Leads

71
Action NHS

• establish local enhanced reporting
• SUIs to be notified to SHA HOS and Clinical
  Governance Leads
• critical incidents to be notified immediately
• written report within 24 hours
• establish robust OOH arrangements

72
Action NHS

• SHA HOS Lead to notify DH MPIG
• PCTs to encourage local reporting
• SHAs and PCTs to collate complaints
• local capture of reports to NPSA NRLS
• SHA HOS lead to summarise in SITREP
• review data at local steering groups
• SHA to coordinate reporting streams

73
Action NHS

• Complete the reporting cycle
• report incident
• investigate
• report outcome
• identify root causes
• share learning

74
Action Department of Health

• MPIG lead responsibility for HOS
• liaison within DH
• Patient Safety and Investigations Unit (PSIU)
• Communications Unit
• Ministerial Briefing Unit
• MHRA
• PSIU liaises with NPSA
• emerging trends and learning shared

75
(No Transcript)
76
How are we performing?

• Overview of quality
• Complaints
• Adverse incidents
• Serious Untoward incidents (SUIs)
• MP correspondence
• Compliments
• Key performance indicators
• Meeting the needs of customers
• Ministers, DH, SHA, PCT, patients and carers

77
Does it ever reach the point where the bra is
good enough the way it is?

• none of this really matters, because it all
  comes down to the mechanics of the human touch
  having someone who knows what theyre doing.
  When that happens, you can be wearing a bra from
  the Dark Ages and it wont matter.
• Cassandra, Sunday Times Magazine, 2 April 2006

78
..no credit can be given for predicting rain
only for building arks.Louis V Gerstner,
Jr.Former CEO, IBM
79
(No Transcript)
80
Joined-up Communications

• Ben McClelland
• Assistant Communications Manager
• NHS Primary Care Contracting

81
why (oh why) am I here?!
82
Think conversation

• Communications
• Broad definition
• Not just media, publications also about our
  own communications with each other
• Talking to each other (Think conversation)

83
Common language and definitions

• Consultation seminars
• Need for common language and understanding
  phrases (eg, adverse incident, SUI etc)
• Piece of work in hand coming shortly

84
Communications pathways
85
(No Transcript)
86
(No Transcript)
87
(No Transcript)
88

• At this point, I stopped drawing lines

89
How do we manage communications?

• Cant and shouldnt expect patients to stick to
  what we might like them to do
• Importance of
• Effective relationship management between people
  and organisations
• Effective lines of communication
• Escalation policy
• Sharing information and feedback
• Cooperating in the best interests of patients

90
Media handling

• More people than ever before get their news from
  regional and free media sources
• 1 in 3 adults dont read a national newspaper -
  regionals are read by more women and a wider
  range of income groups
• Local radio TV news is widely consumed and
  often preferred over national programmes
• National media increasingly highlighting local
  problems

91
Media handling

• Cant stop media from doing their job
  legitimate/newsworthy stories will run
• Cant control what users might say to the media
• Can temper a story, provide context and
  information to balance the end result
• Can ensure good channels of communication with
  users to minimise chance they will go to media to
  be heard

92
Websites

• Three websites
• Patients and the public
• Health professionals
• NHS
• All accessible via www.homeoxygen.nhs.uk
• Two phases
• Phase 1 Collate existing information to provide
  basic site containing key info
• Phase 2 Review, consult and develop

93
(No Transcript)
94
Summary

• Many people involved in the HOS, but all working
  together for the benefit of patients
• Communications are key to realising benefit and
  addressing issues effectively
• Forward as one
• Joined-up communications can make the difference
  between success and failure of public confidence
  in the NHS