Mick WardHead of Strategic Partnerships and Development (Older People and Disabled People)

Debbie KeoghEye Care Liaison Information Officer

Leeds Vision Strategy Programme Board - Purpose• To act as a strategic partnership across

health and social care

• To provide strategic direction, commissioning and service transformation

• To oversee respective sub groups

Leeds Vision Strategic Group

Disabled People’s Strategic Partnership and Service Development Board

Leeds Ophthalmology

Service Re-Design

Team

Leeds Sight Loss

Services Group

Specific eye care pathway groups as appropriate

Priority Groups Sub Group of the Strategic Commissioning Executive

Leeds Vision Strategy - Priorities• Improving eye health through promoting

eye examinations amongst at-risk groups (including in Super Output Areas, BME populations and older people)

• Developing the business case and service specification for an enhanced community eye care service

Priorities

• Improving the support available for people with sight loss, including reviewing services commissioned by Adult Social Care and providing support at the point of diagnosis

Priorities

• To use a social model approach to challenge the barriers faced by visually impaired people to independence, inclusion and equality

Information Prescriptions

The right information at the right time

• All public services should put the person who uses them at their heart. This applies especially to health and social care because all care is personal.

‘Our health, our care, our say’

• Without information there is no choice. It gives patients the power and confidence to engage as partners with their health service.

‘Better information, better choices, better health’

The future

Everyone with a long-term condition or social care need will be guided to reliable sources of information to allow them to feel more in control, better able to manage their condition and to stay independent.

Problem and solution

Finding the information that you want at the right time can be difficult, although there are many potential sources of information

88% of patients wanted more information to make decisions and choices about their treatment or care

61% thought that being given more information about their health conditions would make a big difference

...tailored to help people with long term conditions and carers receive information they need to manage the condition.

…signposts to sources of information about health and care – eg Tel nos, website addresses.

…include helpful and relevant information, for example about conditions and treatments, care services, benefits, and support groups.

…will be given to people by their health and social care professionals

Information prescriptions

Informed and empowered

people

What is an Information Prescription?

…and you have an ongoing care need…

…your care professional willgive you this…

Well if you have a visit from someone about your care…

…so you will know where to get more information,

get more help and advice……

…or meet others in the same situation…

…so you’ll know all about it and can take charge!

…and you’re diagnosed with a

condition

…your doctor willgive you this…

Well if you go to your doctor…

…so you can find out about your condition, where to get help or meet others with the

same thing…

……and find out how to look after

yourself…

..so you’ll know all about

it and can take charge!

Information Prescription content

Benefit advice

Social care servicesManagement of

conditions

Support groups

Information Prescription content

Example of an Information Prescription

Benefits

Patients, carers and social care users

• Access to the information needed to help people understand and manage their care

• Given at an appropriate time, throughout the care pathway

• Increased understanding helps people feel in control and independent

• Allows everyone access to quality information, by making the delivery of information routine and available to all

• Supports everyone to receive information through accessible formats, tailored to their needs

• Help people to access the support they need, not just those who know their way around the system

Professionals and services• Allows professionals to give people relevant,

timely information quickly and easily

• Increased understanding to help people feel in control and stay independent

• Supports care planning, choice and self care

• Improved self care can reduce visits to GPs and hospital admissions, as well the length of stay in hospital

• Provides a complete package of care for people, centred around people rather than services

• Provides an integrated tool for health and social care staff, centred around people rather than services

The process for Information PrescriptionsInformation

ContentIdentify sources of information people

people need to access

AccessMade available through range of

channels

PrescribingA template in an

appropriate format

PersonalisedProcess

Specific to thecondition, place and point on care

pathway

DirectoriesEstablish links to

the content

InformationPrescriptions

Understanding the impacts and benefitsDeveloping the process and national policy

Realising behaviour changes

Information Prescriptions available nationallyfor people with long term conditions

Development

Piloting Evaluating

PatientsSocial Care Users

CarersProfessionalsOrganisations

ContentDirectoriesTemplateIssuing

Accessing

DevelopingTesting

Implementing

ImpactBenefits

Effectiveness

2007

2008

Pilot sitesCancer (general): Durham

Head, neck, lung and gynaecological cancer: Nottingham

Young people’s mental health: South Staffordshire

People over 65 mental health: Cambridgeshire

Dementia: Isle of Wight

Alzheimer’s dementia: Suffolk

Neural and physical conditions: North Tyneside

Sight loss: Leeds

Dementia: Leeds

Diabetes: Darlington

Adult mental health outreach: South Essex

Whole systems approach: Manchester

Depression, anxiety: Doncaster

Deaf and hard of hearing: Oxford

Cystic Fibrosis: Birmingham

Non-surgical cancer treatment: Birmingham

Psychosis/Schizophrenia, Bi-polar/Manic depression: London

Paediatric pharmacy: London

Complex cancer care: London

Diabetes, Asthma, Arthritis: London

Pilot evaluation findings for patients/users/carers

76% agreed that they were more confident in managing

their condition66% agreed that they felt more in control of

what was happening

Carer views similar overall

to those of patients and

service users: some

reported improvements to

the quality of their own day

to-day life

89% of users agreed that the information was useful, including all cancerpatients and 91% of those living in more affluent areas but only 76% of those living in disadvantaged communities or who received a light-touch IP.

73% agreed that they were more confident in asking questions

Pilot evaluation findings for professionals

41% of the issuing sample wanted to offer more information (especially in mental health and LAs)…

…notably about how the condition progresses, contact details for charities/voluntary and support groups

Two thirds said that IPs could help provide better care and it gave them better opportunities to explain how to use information

70% of those issuing agreed that theycould continue with this new way ofworking.

Views were less positive in primary care (50%) than in acute settings (80%)

Half now spend more time with their patients or service users.

Two-thirds think this is mainly worthwhile

Notably less positive views in primary care, especially among GPs and practice nurses

Pilot evaluation findings Core IP aspects

Aspects• Holistic information provision

• Personalised with professional involvement

• Partnership working – information providers, health & social care

• Involvement of service users in design

• Trustworthy sources – information accreditation

• Integrated into service delivery

• Reduce inequalities – strategies for additional support, and different channels

• IT support for professionals – IP generator

Different delivery models in different settings

• Integrated prescribing/dispensing vs separate

• Light touch vs fully integrate

• Dispensing - by professionals, libraries, telephone, face to face support.

Pilot evaluation findings

Concerns• Lower visibility/impact of light-touch IPs, including for carers• Consistently lower level of impact on patients/users who live in disadvantaged areas – more support needed here• Concerns in Primary Care, especially GPs• Worries over workloads, notably from those with most experience of the IP process• Around 30% wanted more training , especially MH and acute sector non-specialist

Positive findings• Notably in acute settings, such as cancer sites• Professionals generally rated IP ahead of previous information• Information is normally understood, used and found to be useful• Most of those seeing the information thought their health would benefit• Some increased user/carer confidence reported

Information included on Information Prescriptions

Management of conditions, how it progresses Different treatment options and medication Social care – eg carers support, housing support, housing alterations Local health and social care services Voluntary and community sector organisations Benefits and finance Carers information Employment and training Leisure and other

Implementation

National support for local

implementation

National support for local

implementation

Information quality assurance: information

accreditation scheme

Information quality assurance: information

accreditation scheme

Information systems: NHS Choices

Information systems: NHS Choices

Workforce: NHS Employers

Workforce: NHS Employers

Taking forward local

Implementation

Taking forward local

Implementation

Resource packResource pack

Local implementation: Resource pack

Clear guidance on how information prescriptions can be developed efficiently and effectively

Clear guidance on how information prescriptions can be developed efficiently and effectively

Compendium of tools, templates and other technical approaches which were developed by pilot sites and apply to other settings

Compendium of tools, templates and other technical approaches which were developed by pilot sites and apply to other settings

Provides a network of practitioners and professionals with an interest in and experience of information prescribing

Provides a network of practitioners and professionals with an interest in and experience of information prescribing

Showcase pilot insight

Showcase pilot insight

Resource pack includes… • Making the case• User & Partnership working• Staff Engagement and training• Agreeing options and priorities• Project Planning• Agreeing the processes• Communications• Quality Assurance• Monitoring and Evaluation• Measuring benefits• Risk Management

www.informationprescription.info/resource

National support

Information accreditation scheme

• Accredited information producers can feature on information prescriptions

• Patients and public reassured and able to recognise ‘quality’ both on information prescriptions and elsewhere

• People who use health and social care services will be able to make informed decisions about their care

• Health and social care staff better supported to deliver quality information to the people who use their services

• Raising the bar of quality information producers

• Information producers’ reputation enhanced

Promoting within NHS and social care organisations to secure buy in

Promoting within NHS and social care organisations to secure buy in

www.nhs.uk

Support employing organisations, professional & regulatory bodies, education institutions, in addressing education and training/CPD implications

Support employing organisations, professional & regulatory bodies, education institutions, in addressing education and training/CPD implications

Workforce implementatio

n

Summary

• Local implementation can start now, supported by the learning of the piloting programme.

• Resource Pack:www.informationprescription.info/resource

• IAS Draft standard: www.dh.gov.uk/accreditation

• NHS Choices: www.nhs.uk

Summary

We want information prescriptions to become a routine part of care – just like prescriptions for medicines.

Together we need to take this forward based on the learning of the piloting programme

The Role of the Eye Care Liaison & Information Officer (ECLIO)

Debbie Keogh

RNIB Leeds

Information Prescription Resources • Intra-clinic pathway to detect likely beneficiaries

from Information Prescriptions/CVI• Personal Information Form (PIF)• Directory of services/CD• Free access to a dedicated RNIB Information

prescription telephone service• Support from an Eye care Liaison & Information

Officer

The Eye Care Liaison & Information Officer• Front line service for people newly diagnosed

with an eye condition• Patients who are eligible for registration as

Sight Impaired or Severely Sight Impaired• People who are struggling with their vision on

a daily basis• Support for family members/carers

The Eye Care Liaison & Information Officer Objectives• Timely Support• Initial emotional support• Providing Information• Using a person centred approach to visual

disability• Availability• Providing a bridge between health and

community services

Principles

• Equal opportunities for all

• User consultation throughout the stages

• Confidentiality maintained at all times

• Support provided by the ECLIO is ongoing as and when required by the service user

Referrals to the ECLIO• Eye Clinic

• Community Eye Clinics

• Hospital wards (inpatients)

• Voluntary Organisations

• Adult Social Care

• Other Hospital departments

• Self referrals

Referrals from the ECLIO• Adult Social Care – rehabilitation/ OT

• Education Support Services

• Employment Services

• Welfare Rights

• Travel Concessions

• Voluntary Organisations (Local & National)

Involvement (Short term)• First point of contact

• Understanding of the eye condition

• Emotional Support

• Listening

• Safety

• Working together to form a plan of care

• Signposting

Involvement (long term)

• Continuous contact as required

• Information

• Awaiting services or appointments

• Reassurance (Check appointment dates)

• Continuing emotional support

Advocacy

• Changes to appointments

• Confer with Consultants

• Requests for letters of support

The Eye Care Liaison & Information Officer

RNIB Model

Thank You

Key Challenges

• The broader picture on information

• Providing information across the pathway and health and social care

• Signposting Vs supporting access to information