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Breakout session 2 Plenary 10.55 – 11.45

Whole system care, and the older patient journey. Breakout session 2 Plenary 10.55 – 11.45. Elizabeth Wilson Victorian Travelling Fellow Peninsula Health 5th May, 2005. Patient Flow Collaborative Whole System Care: The Older Patient Journey.

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Breakout session 2 Plenary 10.55 – 11.45

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  1. Whole system care, and the older patient journey Breakout session 2 Plenary 10.55 – 11.45 Elizabeth Wilson Victorian Travelling Fellow Peninsula Health 5th May, 2005

  2. Patient Flow Collaborative Whole System Care: The Older Patient Journey ELIZABETH WILSONPENINSULA HEALTH5TH MAY 2005

  3. Whole System Care : The Older Patient Journey • Overview: • Goal of Victorian Travelling Fellow • Key drivers for change in the NHS • New/redesigned roles—pilot projects • Extended roles • Strategies to decrease ED pressure • Strategies to keep elderly at home • The way forward

  4. Whole System Care : The Older Patient Journey Victorian Travelling Fellowship 2004/5 • Goal: Examine new roles of Assistant Care Practitioner and extended health care worker & their potential for: • introduction to Victoria in areas of shortages • decreasing inappropriate presentations to ED • use to assist the elderly to stay at home

  5. Whole System Care: The Older Patient Journey

  6. Whole System Care: The Older Patient Journey +++ Zzz Z>*# ++ *%#$ Q**n?@ Actual ++!#@% Zzz z>*# Identify successful strategies for helping the elderly stay at home Yt$# Examine new/blended/expanded roles Identify successful strategies to decrease inappropriate attendances to ED & decrease LOS in ED !?*%#@ ZZXan d% +++ Q**n?@ +++

  7. Victorian Travelling Fellowship 2004/5 Actual Identify successful strategies for helping the elderly stay at home Examine new/blended/expanded roles Identify successful strategies to decrease inappropriate attendances to ED & decrease LOS in ED

  8. Whole System Care: The Older Patient Journey Key in Drivers for Changes within NHS: • NHS Plan for health care reform 2000 • Increasing demand for healthcare • (European Working Time Directive) Exacerbating shortage of nurses as nurses extend to take up Drs’ roles

  9. Whole System Care: The Older Patient Journey NHS Plan 2000 Consultation showed that public wanted: • More and better paid staff using new ways of working • Reduced waiting times and high quality care centred on patients • Improvement in local hospital and surgeries NHS seen as 1940’s system working in 21st Century • Lack of national standards • Old-fashioned demarcation between staff and barriers between services • Lack of clear incentives and levers to improve performance • Over-centralized with disempowered patients

  10. Whole System Care: The Older Patient Journey NHS 2000 Budget • Allowed for growth in real terms by 1/3 in 5 years More beds, hospitals, doctors, nurses Modernization of premises, equipment and systems • Investment to be accompanied by reform National Standards with regular inspection by independent Commission for Health Improvement National Institute for Clinical Excellence to ensure access to cost effective drugs not dependent on address Modernization Agency to spread best practice Earned autonomy with devolvement of power to local health services once modernization progresses and organizations work well for patients

  11. Whole System Care: The Older Patient Journey For the first time: • Social services and NHS to come together and pool resources • Modern contracts for GP’s and hospital doctors • Nurses and allied health staff –opportunity to extend roles • Patients will have a real say in NHS • NHS access to private facilities By 2004 • GP appointments available within 48 hours • 1000 specialist GP’s taking referrals from GP’s • Long waits in ED’s will have ended By 2005 • Max wait for OP will be 3 months and for inpatient treatment, 6 months

  12. Whole System Care: The Older Patient Journey Older people use NHS more than any other group NHS Plan will provide for: • free nursing home care • a 900m BP package by 2004,of new intermediate care services to allow older people to live more independent lives • national standards for caring for older people to ensure that ageism is not tolerated • breast screening for all women 65 to 70 years old • personal care plans for elderly people and their carers

  13. Whole System Care: The Older Patient Journey Initiatives to support NHS Plan 2000 • 1)Shift of balance of power • 2)National Service Frameworks including: • 3)Agenda for Change/New Ways of Working

  14. Whole System Care: The Older Patient Journey Initiatives to support NHS Plan 2000 • 1)Shift of balance of power i)Patients and staff to be at heart of NHS PALS and PPI ii) Local Primary Care Trusts to have role of running NHS and improving care in their areas

  15. Whole System Care: The Older Patient Journey • System of patient and public involvement in health in England. This replaced Community Health Councils and comprised following bodies and duties • The Commission for Patient and Public Involvement in Health (CPPIH) • Local Authority Overview and Scrutiny Committees (OSC) • Independent Complaints Advocacy Services (ICAS) • Patient Advice and Liaison Service (PALS) • The Patient’s Forum • A new duty to on the NHS to involve and consult the public • The aims and objectives of this strategy are quite simple; by modernising to improve the way we work and run our services we aim to improve the patient experience and patient journey through the Trust. Patient and public involvement needs to be carried out at two levels. This is at an individual level and at a collective level.

  16. Whole System Care: The Older Patient Journey

  17. Whole System Care: The Older Patient Journey Initiatives to support NHS Plan 2000 • 2) NATIONAL SERVICE FRAMEWORKS 2.i) NSF OLDER PEOPLE Standards: “Rooting” out age discrimination Person-centred care Intermediate care General hospital care Stroke care Falls care Mental health care Promoting an active healthy life

  18. Whole System Care: The Older Patient Journey • A TOOLKIT FOR OLDER PEOPLE’S CHAMPIONS

  19. Next 2 years PARTNERSHIPS FOR OLDER PEOPLE PROJECTS 60M bp RING FENCED FOR INITIATIVES to be tested and evaluated over the next 2 years WHICH: • PROVIDE PERSON CENTRED INTEGRATED CARE FOR OLDER PEOPLE • ENCOURAGE INVESTMENTIN PREVENTATIVE APPROACHES, WHICH PROMOTE HEALTH, WELL-BEING AND INDEPENDENCE FOR OLDER PEOPLE Available for local authorities to make joint application with PCT’s, District Council, NHS,voluntary and independent sectors

  20. Whole System Care: The Older Patient Journey Initiatives to support NHS Plan 2000 • 2) NATIONAL SERVICE FRAMEWORKS 2.ii) LONG TERM CONDITIONS (CDM)Standards Person centred service Early recognition followed by prompt diagnosis and treatment Emergency and acute management Early and specialist rehabilitation Community rehabilitation and support Vocational rehabilitation Equipment and accommodation Personal care and support Palliative care Support to family and carers Care during admission to hospital or other health or social care setting

  21. Whole System Care: The Older Patient Journey Chronic Disease Management Levels of Support Case Management Level 3 Highly Complex Members Disease Management Level 2 High Risk Members Level 1 =70-80% Chronic Care Management Supported Self Care Supported Self Care Population Wide Prevention

  22. Whole System Care: The Older Patient Journey Case Management for people with CD and older people “20% population require 80% care” • Castlefields-Improving chronic care in General Practice Amanaged care approach –nurse and social worker Dr David Lyon –GP Outcomes– 1000 bed days saved pa GP home visit requests reduced by 30% over 2 years • Unique Care • Kaiser Permanente-Evercare • LOPSDP

  23. Whole System Care: The Older Patient Journey • Expert Patient Programme —US originated—principally a user led self-management programme for creating expert patients. Outcomes —early days but 23% reduction in CHD deaths and 10% fall in cancer deaths in 6 years

  24. Whole System Care: The Older Patient Journey Initiatives to support NHS Plan 2000 • 3)Agenda for Change/New Ways of Working (All initiatives supported by Modernization Agency) Draws together teams of experts to act as catalysts for significant and sustained improvement in every healthcare setting. Teams included: The Leadership Centre The National Primary and Care Trust Development Programme The National Primary Care Development Team The NHS Clinical Governanne Team Support Team Service Improvement Team (and the National Institute of Mental Health) The Redesign Team The New Ways of Working Team

  25. Whole System Care: The Older Patient Journey Underlying principle of Redesign of Workforce Patient at centre of care rather than traditional work practices, professional boundaries and staff preferences dictating care

  26. Whole System Care: The Older Patient Journey • Changing Workforce Programme Purpose: To improve services to patients & the working lives of staff • National programme to help those in services to redesign roles • Education & collaborations nationwide

  27. Whole System Care: The Older Patient Journey 4 MORESENIOR STAFF 9 8 CONSULTANTPRACTITIONERS ADVANCED PRACTITIONERS 7 SENIOR/SPECIALIST PRACTITIONERS 6 PRACTITIONERS 5 ASSISTANT/ASSOCIATEPRACTITIONERS 3 SENIORHEALTHCARE ASSISTANTS/TECHNICIANS 2 SUPPORT WORKERS 1 INITIALENTRY LEVEL JOBS

  28. Victorian Travelling Fellowship 2004/5 Role redesign: • Individuals can take on different tasks or the task can move between different levels of skill\ • Can encompass four types of changes: Moving task up or down traditional unidisciplinary ladder Expanding breadth of the job AH/RN Increasing the depth of a job CNC Combining tasks in a different way

  29. Whole System Care: The Older Patient Journey • Re-designed & New Roles Pilot Projects

  30. Victorian Travelling Fellowship 2004/5 Points of Difference UK/Australia: • UK—phased out Div 2 nurses over a decade ago Health Care Workers have had expanded roles New roles based around competency Health, Social Services and Higher Education sector funded by same level of Government • Australia more “regulation” conscious Nurse Practitioners –specific requirements and registration with NBV Some hesitation around competency-”safe haven” of regulations Federal/State split of responsibilities

  31. Whole System Care: The Older Patient Journey Blended/Extended roles • Emergency Care Practitioner --Ambulance attendant/ED nurse • Nurse consultants— on Reg roster • Night nurse practitioners---hospital at night • Surgical/anaesthetic assistant( nurse)

  32. Foundation Degree in Health & Social Care Fd Level 1 Fd Level 2 Post Fd career Associate Practitioner: Orthopaedic Intermediate Care New roles in the workforce Associate Practitioner: Children & Families Generic introduction to health and social care Associate Practitioner: Mental Health or LD Associate Practitioner: Generic acute care Pathway to Nursing Application to year 2 and 3 of BSc(Hons) in chosen profession Common Learning: IPLU1 Pathway to Occupational Therapy Pathway to Physiotherapy Pathway to Podiatry Pathway to Social Work Pathway to Audiology www.hciu.soton.ac.uk

  33. Decreasing inappropriate attendances to ED, & LOS in ED & wards . Admitting team located in MAU all shift No/clerk triage unless Very busy Nurse led Walk in Centres Appropriate presentations to ED Decreasing LOS in ED/wards Nurse Consultants ED/med/surg Physio Practitioner/ consultant Consultants admit direct to ward under relevant unit Nurse led Minor Injuries Units Surgical assessment units

  34. Keeping the Elderly &/or chronically ill at home. . Consultant Practitioners Emergency Practitioners Care (case) Management Keeping the elderly at home Assistant Care Practitioners supporting traditional allied health, nursing & carer functions Allied health &/or nurse led clinics Expert patient programmes (chronic disease)

  35. Issues supporting changes • Strong Leadership from Gov’t & NHS • Resources for change management & role re-design training • Whole system change--communication • Multiple collaboratives to support pilots • Supportive unions & colleges

  36. Outcomes • (Winter 2004/5 DHS Report) 2000/1 2002/3 2004/5 Flu vaccine uptake over 65’s 65% 72% GP within 2 working days 75% 99+% Patients spending 4 hours or less in ED (Including WIC / MIU from 2003/4 ) 77% 97% Cancelled Operations/% booked 3.4% 1.3 %

  37. Population facts (Aus) ABS(2001)Population trends for the 21st Century

  38. The Way Forward Australia • N3 ET National Nursing and Nurse Education Taskforce (Recommendations from 2002 National review of Nurse Education including scope of practice of nurses and others) Victoria • DHS/VQC-Patient Flow Collaborative/HDM/HARP • Debates re blended training at TES • DHS Nursing Policy Branch/NBV –scope of practice issues Health Services • Complex Care Team • RAD teams • Streamline clinic—nurse prompted analgesia, investigations • Direct admissions ED to RAPCS • Physio specialist in ED –Rosebud • Proposed expanded role of Div 2 nurses • Development of advanced practitioner roles

  39. Key Issues • Patient at centre of care • Thinking outside the square • Breaking down barriers between traditional roles

  40. Questions ?

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