mca improvement programme the team compendium programme past
TRANSCRIPT
MCA Improvement ProgrammeThe Team Compendium
Programme Past
Overview• Background: The Need • The Programme: What we planned to do • The Projects: What happened
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• Confirm, challenge and contributions • The Programme: Evaluation & Learning • Summary Recommendations & Next Steps
The Need
Pam Palmer
Drivers• Mental Capacity Act 2005• House of Lords Select Committee Report,
Spring 2014• Government Response, June 2014 – improved
understanding and implementation of MCA• CNO programme – focus on raising awareness
and understanding across the local health and social care community
WHAT DIFFERENCE DID WE INTEND TO MAKE?
OUTCOMES
CNO RequirementsNational Requirements 1: Source: Letter from the Chief Nursing Officer, NHS England, 29/01/2014• Development programme for MCA leaders across the system to understand their local issues and explore best
practice• Increase in patient/carer experience events to ascertain real time feedback• Identification of specific local requirements and consideration of short term secondments/pump prime
initiatives – with CCG Colleagues, provider organisations and local authority partnersNational Requirements 2: Source: Letter from the Chief Nursing Officer, NHS England, 21/07/2014• A. Awareness raising and training activity – of NHS E’s directly commissioned services e.g. primary care,
specialised services; commissioners and providers with responsibility for these • B. BIA Trainers: Re-training health professionals whose BIA status has lapsed. Training additional numbers of
health professionals from provider services.• C. Raising awareness of advance decisions, embedding discussions about patients wants and wishes into
relevant patient pathways; increasing awareness of frontline staff of Lasting Power of Attorneys (LPAs) and deputyships; promoting use of the electronic register (late 2014).
• D. Development of local assurance mechanisms to confirm compliance is in place across the local system; identifying any themes or gaps to be addressed through the national programme.
• E. Identifying and contributing to a repository of best practice including capturing case studies to be shared more widely.
• F. Supporting local networks and groups of professionals to come together to share expertise, ideas and best practice.
• G. Developing and sharing mechanisms to use the commissioning process to improve outcomes for individuals lacking capacity – through joined up working between commissioners and providers which ensures patients at the heart of decision-making
Local Area ResponseExtension of training opportunities to the primary care staff group, and other key professionals – to address key deficiencies across specific areas e.g. Police applications; nursing and care home staff
Promote the role of BIA across partner agencies - to be delivered through a number of market place events
Commission specific BIA training - following an analysis of need - and having confirmed commitment for both the training and future application of skills learnt to support the local community.
Develop an online information resources to provide information and guidance around the development and use of ‘advance decisions’; Lasting Power of Attorney; links to patient pathways etc.
Develop & promote improved user/ carer/ family feedback systems for use in cases where MCA/ DOL has been utilised to improve the understanding of the systems/ processes and the impact upon individuals their carers and family.
Support the development of local MCA forums
Promote the development of local KPIs for integration into existing Safeguarding Adult Board assurance frameworks
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AimTo increase
Understanding about and
implementation of the MCA across our Area*
by adding value to local activity and plans.
* Leicestershire, Lincolnshire and Rutland
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Benefits detail and specifics subject to evaluation advice
• Improved ‘User’ [patient, service user, carer and public] feedback systems: a cycle of ‘real time’ advice into (and feedback from) staff development and service improvement
• Improved quality of service and professional practice: staff sharing best practice and shaping their development opportunities drawing on user-feedback
• Greater compliance across a wider group of professionals: targeting previously ‘hard to reach’ professional groups
• Greater assurance of MCA compliance: creating new and supporting existing Best Interest Assessors, Supervisors and frontline ‘champions’.
HOW WERE WE TO KNOW IF WE HAD MADE A DIFFERENCE?
OUTCOME INDICTATORS
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Realisation of these benefits • Independent evaluation. • Evidenced:
– quantitative and qualitative measures of progress– against a baseline – service and practice improvement case studies– ‘user’ stories– contributions from stakeholders– other illustrations from the Programme.
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Programme
Six ProjectsSix deliverables
Four primary benefits
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First Tranche of Projects • EVALUATION: evaluate MCA Programme (and its
projects) against national and local requirements • User’ EXCHANGE: User’ outcomes (as defined by
the individual) evidently embedded into practice • MCA EXCHANGE forum to sustain and develop a
vibrant, integrated* MCA frontline workforce in Leicester, Leicestershire & Rutland and Lincolnshire *inter-discipline, multi-agency and where possible cross-county
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Second Tranche of Projects• UNIVERAL PORTAL – on hold and was abandonned• LEADERSHIP at all LEVELS Increase profile of and support to
MCA Leaders at all levels across all organisations – with an emphasis upon frontline supervisors
• DOLS BEST INTEREST ASSESSORS - Increase number and distribution of Best Interest Assessors to meet service need
• TARGETED PROFESSIONAL GROUPS - Bespoke face-to-face training sessions and professional development for identified target groups in health and adult care - enhancing professional delivery and User experience across the pathways of care.
HOW DID WE MAKE SURE IT WAS HAPPENING?
OUTPUTS, INPUTS and RESOURCES
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Programme Phases
Phase 1: PROGRAMME DESIGN Phase 2: PROJECT DESIGN including Baseline and Gap Analysis and Project & Exchange Priorities Phase 3: PROJECT DELIVERY including exchange of advice and learning Phase 4: EVALUATIONPhase 5: PROGRAMME CLOSE exit strategies - Product Adoption - evaluation
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Governing Principles & Priorities• Add new, add value to and/or extend (rather than detract from or
replace) existing SAB and organisational business plans and initiatives• Prioritise effort and investment upon delivering innovations that:
– meet the agenda of (and are ideally delivered to) the whole Area– are integrated across professions and agencies – are evidently based on shared best practice, learning and advice – from ‘users’,
from across county, organisation and profession
• Sustainable impact - create exit strategies for all deliverables with options for adoption of identified components of on-going value
• Show maximum sensitivity to limited capacity: – MCA leaders and practitioners – specialist knowledge and expertise
• Maximise the funds and resources available to us, honouring funding bodies’ expectations i.e. NHS’ Chief Nursing Officer.
HOW DID WE MAKE SURE IT WAS HAPPENING?
OUTCOME MONITORING
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Programme Delivery
(Nicky)
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Programme Board – Overall Programme Steering
Project Director with Project Sponsor for each Project
Projects – day to day Project Management Each having a Project Manager working to a Project
DirectorPatient and
Carer ExchangeStaff Exchange
MCA Leadership at
all Levels
DOLS Best Interest Assessors
Department of HealthNHS England
Wider MCA Staff and Leaders, Patients and the Public
L&L MCA Stakeholders
Incl. SAB
Programme Team – day to day Programme Management
Programme Manager
Evalu
ati
on w
ith a
ctio
n learn
ing
Programme Structure
Targeted Professional
Groups
Staff Learning & Development Exchange
Leadership at All Levels
DOLS Best Interest Assessors
Targeted Professional Groups
4. Evaluation (with action learning) Delivered
Baseline
&Gap
Analysis
Patient, Service User & Carer Exchange
Project&
Exchange’
Priorities
Project Sponsorship Support & Exit Strategy
5. Programme Close
Shadow User Ex’Shadow Staff Ex’
1 Programme Design
2 Project Design
3. Project Delivery
advice, information exchange
MCA Improvement Programme: Design & Delivery Process
Constituent P
rojects
Project Adoption
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Programme Roles
forChallenge and Validation
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Evaluation and Monitoring
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Funding & Financial Monitoring• Non-recurrent finance and all its products time-limited • The total funds for distribution is £471,110 non-recurrent. This
includes both the allocation of 19/1/2014 and 21/7//2014 - £319,742 and £161,368 respectively.
• Allocation across the Programme and Projects will be agreed at Board event
• Financial monitoring by the Nursing and Quality Clinical Lead in liaison with the Programme Manager but reporting to Programme Director.
• Emergency financial and other decisions will be taken by the Programme Director in consultation with the sponsor of the relevant Project (or in their absence, a SAB Chair.
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Other Monitoring 1• NHS England’s monitoring of the Programme will be through the
production of the following items at the end of 2014/15 – A self-assessment summary report for the period 2014/15 which will
include an assessment of the extent to which MCA is complied with within their geographical area (to be discussed and signed off by the local Quality Surveillance Group) with reference to any evidence used to reach this conclusion and any gaps or proposed future activity for 2015/16. This will take into account the views of the commissioners and providers across the local system.
– At least two case studies: one of MCA good practice and one of good practice in implementing the least restrictive option - for sharing through the national programme
– Numbers of health professionals trained as Best Interest Assessors [BIAs] in 2014/15
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Other Monitoring 2/2
• Local monitoring of the Programme– Ultimately through the Evaluation – Exception, end-stage and final closure reports to the
Board• Day-to-day monitoring of Projects
– By the Programme Consultant with all Project Managers and via Programme Team meetings
– Option for acceleration of emergency issues for decision to the Programme Director if required.
Retro-LEAP
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2. OUTCOMES INDICATORS
How did we plan to know whether we
made the difference?
3. INPUTS, PROCESSES &
OUTPUTSHow did we plan to
go about it?
4. OUTPUT MONITORING
What happened? How did we steer
toward the Indicators?
5. EVALUATIONWhat difference
did we make to the Indicators? What
have we learned?
1. OUTCOMES What difference did we plan to
make
Retro-LEAP
NEED
Retro-LEAP
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2. OUTCOMES INDICATORS
How did we plan to know whether we
made the difference?
3. INPUTS, PROCESSES &
OUTPUTSHow did we plan to
go about it?
4. OUTPUT MONITORING
What happened? How did we steer
toward the Indicators?
5. EVALUATIONWhat difference
did we make to the Indicators? What
have we learned?
1. OUTCOMES What difference did we plan to
make
NEED
Recommendations to Board& commissioners
(including next steps, exit)
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Programme benefits
Objectives & deliverables
Board & Team Meetings
Info from Team
Outputs & stakeholders
ProjectBene-
fits
Board & Team Meetings
Info from Team
Board & Team Meetings
Info from Team
