Whittington Health

Dr Katie Coleman, Paul Sinden, and Whittington Health

5 December 2013

Whittington Health (CCG)

CCG position statement to the trust following publicity on the estates strategy :

• Whittington Health provides both hospital and community services to Islington residents. Opportunity to better align services in and out of hospital

• Success of trust as Integrated Care Organisation (ICO) central to CCG strategy.

• Support for trust application in 2014 to become a Foundation Trust in order to maintain the ICO

• Options for the trust in the future: Maintain ICO as a Foundation Trust Merge with an existing Foundation Trust. Local FTs include UCLH, Royal Free Hospitals,

Homerton, Camden & Islington NHS Foundation Trust Merger may risk separation of hospital and community services. Acquisition

Whittington Health (CCG)

CCG position statement to the trust following publicity on the estates strategy :

• ICO provides an opportunity to better align services in and out of hospital

• Hospital services will change in the future as the ICO moves more services into the community

• CCG supports service changes with good clinical evidence and improves patient outcomes

• Assurance that decisions about cost improvements are not at expense of quality and safety

• Maternity business case to expand capacity

• Workforce numbers overall are not expected to change at the trust, but composition across acute/community, specialities, and skill-mix may change in line with service changes

Whittington Health (CCG)

CCG has invested in trust services in line with support set out in position statement

CCG recurrent investment £2m in last 2 years:• Children’s services – specialist nurses; speech and language therapy; practice nurses, CAMHs• Adult services – community geriatrician; community equipment; diabetes consultant; audiology

CCG non-recurrent investment £1.7m in last 2years:• Short-term funding to improve quality and processes• Winter pressures – additional capacity to cope with additional demand• Quality standards – Institute for Healthcare Improvement; pressure sores; theatre utilisation

Qualitative focus with the trust:• Quality of community services – podiatry; physiotherapy; district nursing• Enhanced recovery

Specialist nurses in community; vitamin drops; speech & language therapists;

immunisations uptake improved; youth health trainers

Community geriatrician; COPD pathways; closing the prevalence gap; diabetes

year of care

Quality of Community services – podiatry; physiotherapy; district nursing

Children’s services – practice nurses and specialist nurses

Enhanced recovery

Service developments in 2013/14 (Whittington Health)

Video from Kings Fund

http://www.youtube.com/watch?v=3Fd-S66Nqio

Service developments in 2013/14 (Whittington Health)

1. How should hospital and community services be organised to deliver care to the local community in the future? 2. What are your concerns / hopes for future hospital and community services?

3. What services do you value in the Whittington?

4. What services do you feel the Whittington needs to provide?

5. Would you like us to do a similar agenda item with other providers e.g. UCLH, LBI, Camden and Islington Mental Health Foundation Trust?

Whittington Health Questions

Being supported in your community

Paul Sinden5 December 2013

What are the main aims and objectives of supporting people in the community?

‘Person Centred Co-ordinated Care:The Islington Way’

Care planning

Information

Communication

Decision making

Transitions

My goals / outcomes

‘I want to have longer appointments with someone who is well prepared so that I do not have to tell my story again

‘I want to feel supported by my community and get the most out of services available locally’

‘I want to be listened to and be heard’

‘Helping people to help themselves’

‘I want my care to be coordinated and to have the same appointment systems across services’

‘Better access to health care through social services and vice versa” ‘No clear systems and processes through all healthcare services’

‘I want to be treated as a whole person and for you to recognise how disempowering being ill is’

Working together: COPD NHS innovation challenge prize 2013

OUTCOMES 25% increase in diagnosed prevalence between 2010 - 2013 93% increase in referrals to pulmonary rehabilitation between 2010-2012 72% of people on COPD register now have self management plan 16% decrease in emergency admissions in 2011/12 vs 2010/11

Integrated respiratory consultant across secondary & primary care

Clinical leadership & support

Incentivised GPs to proactively identify, diagnose & manage

Supportive self-management

Emphasis on self-care & lifestyle Focus on community assets

Education in primary careSkill-building, networks & clinical champions

Focus: Early diagnosis & management to prevent further illness & death Multi-disciplinary partnership: instrumental to introducing & promoting coordination &

integration of COPD care

N19 pilot and community wards

Setting the pilot up: • Live in N19 area• Be referred through hospital or social care access pathways • Need rehabiliative services from reablement, OT, REACH or CRT

• Improve service user experience by one person coordinating support with one person managing the service user’s care

• Improve outcomes for service users by ensuring right professional input at the right time

• Reduce emergency admissions and readmissions and emergency department attendances.

• Evaluation is currently taking place for the pilot initial figures show it has been positive:

• 84% of service users rated very or fairly satisfied • 92% of service users felt it was clear who was coordinating their care

Questions

• Where do you see areas of greatest need for funding health services – community, prevention or for acute problems?

• Tell us why you have given us this answer and what concerns you have?

• What are the problems facing the NHS? What could be the solutions? When discussing please consider such prompts as:

• Practical issues such as Do Not Attends in appointments and unnecessary GP or A&E attendance

• How do we support people to be healthier and prevent lifestyle behaviours which impact poorly on health such as obesity

• How do we prevent people getting LTCs / support them when they do

• Strategic issues such as less funds and privatisation.

Supporting people to have the best wellbeing (self care)

Dr Katie Coleman 5 December 2013

• People being supported to look after themselves. • ‘self empowerment’ – being empowered by being given the

ability to make choices, to be listened to and to be heard. • ‘you are disempowered by being ill. You need services which

empower you as you find that you lose your voice’ • Its about care and not medication / medical help. It was felt this

ethos can get lost. • ‘patients need to not have to be an expert.’ - those patients who

have lower activation levels are intrinsically more scared and overwhelmed by self care.

• To ensure that patients don’t feel scared – they need knowledge and to be empowered to make choices.

‘Self care’ and what this means

• Self care review with patients

• Tools and pilots to support self care• PAM:• Care plans can be tailored for each patient and integrated into their care

• Provides a method to evaluate efforts to increase motivation

• The degree to which we can support and improve patients’ abilities determines in large part their health outcomes.

• Currently surveying our 44 000 patients who have LTC to discover their activation level.

• Self management programmes • Shared decision making

• Helping patients reach a decision – when they hit a crossroads in their health care, • Where a simple choice is not possible, rather a number of treatment options need to be considered. • Decision Aids • Clear and easy information to the patients on the condition and the treatment options. (In depth

pathway tools, apps, website, printed out sheets, films).

What are we doing around self care?

Questions:

1. How can people be supported to stay out of hospital and be looked after in the community?

2. How can you help support lifestyle change in the local community?

II. What support skills do you need to do this?

3. Do you feel your life and community supports your health and why? (Please think about non medical factors such as your social networks, your home and your personal interests).

Questions