Health & Social Care: Service Transformation in Greater Manchester

Leila Williams Director of Service Transformation

Dr Chris BrookesMedical Director for Healthier Together

2011 - 2013

2007 - 2012

2004 - 2012

People can expect services to support them to retain their independence and be in control of their lives, recognising the importance of family and community in supporting health and well being

People should expect improved access to GP and other primary care services

Where people need services provided in their home by a number of different agencies they should expect them to planned and delivered in a more joined up way.

When people need hospital services they should expect to receive outcomes delivered in accordance with best practice standards with quality and safety paramount – the right staff, doing the right things, at the right time.

Where possible we will bring more services closer to home

For a relatively small number of patients better outcomes depend on having a smaller number of bigger services.

Planning such services will take account of the sustainable transport needs of patients and carers.

This may change what services are provided in some local hospitals, but no hospital sites will close

“The future health and social care system will look substantially different and improved quality of health care for Greater Manchester residents will be underpinned by the following key principles of a new

system:

• Healthier Together is a review of health and social care and is part of a wider public service reform, seeking to improve outcomes for all Greater Manchester residents.

• The overall aim is to improve the quality of treatment in and out of hospital under integrated care, primary care and hospital care.

• The Healthier Together programme is clinically led, and is managed by the Service Transformation team which is accountable to Greater Manchester’s 12 CCGs.

Multidisciplinary Care

Identification of Long Term Conditions

Best care pathways Medicines optimisation Integrated care teams

GP as co-ordinator of care

Involvement in Care

Access to care records Promotion of self care

Primary prevention People die in the place of their

choosing

Access and Responsiveness

Digital technology; range of access mediums

Continuity of care Increased access to primary

care services

Increased out of hospital services

Locally based enhanced services

Smooth primary/secondary care interface

Inter-practice referrals

Quality and Safety

Primary Care Strategy Themes:

Middleton Demonstrator Site

GM Integrated Care Programme

• This element of the programme is jointly led by each Clinical Commissioning Group (CCG) and Local Authority

• We are describing new out of hospital standards and service models, and the associated and necessary activity and financial shift, as part of the public conversation and engagement process on whole system reform, commencing January 2014

• We will support all 10 localities models to overcome the challenges of integrated care implementation, including:

• Models of Contracting and Reimbursement• Competition and Collaboration• Workforce• Information sharing and new technology deployment

• 10 models of integrated care will be in shadow operation by 1st April 2014 and in full operation, backed by the HM Treasury approved CBA by 1st April 2015.

v

PARTNERSHIPS

1) Leadership sign-up to new models of integrated working

2) Partnerships between NHS, local authority and 3rd sector organisations formed

3) Local programme governance arrangements established

SCOPE

4) Population to be included agreed

5) Outcomes to be delivered agreed

6) Budgets to be included identified

MODELDEVELOPMENT

7) New models of care developed and tested

8) Practice, ideas and challenges shared with other localities, working together where this makes sense

9) Investable propositions developed that will enable budgets to be moved to support new model of working

COMMISSIONING & IMPLEMENTATION

10) Approach to sharing investment and risk agreed by commissioners and providers

11) New models of care implemented

12) Outcomes continually measured, assessed & evaluated, making changes as required

Enablers: IT, workforce, estates, contracting models, service user engagement, primary care development

Process for establishing new models of Integrated Care in Greater Manchester

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Out of Hospital Standards - ExampleQUALITY AND SAFETY STANDARDS

All providers of health and social care (like hospitals and local authorities) will: o Have ways to ensure high quality services are delivered o Publish how well they are doing against a set of standards o Learn from incident reporting, complaints and peer review

All commissioners (who buy services on behalf of a population) of health and social care will expect high quality services and will investigate unexpected variations in care All commissioners and providers of health and social care will work together to identify people whose circumstances make them vulnerable and as far as possible, protect them

from avoidable harm All members of the health and social care workforce will have the right skills and experience to deliver high quality care

THE STANDARD WILL DELIVER THE FOLLOWING OUTCOMES WHAT THIS WILL MEAN FOR YOU

People will feel confident that care and treatment is delivered to agreed safety and quality standards

People will receive consistent, high quality care People will have a positive experience of care and support

THE STANDARD MAY BE MEASURED IN A NUMBER OF WAYS

More consistent outcomes across Greater Manchester in primary care Better reporting of incidents, near misses and errors that is timely and transparent Better GP patient satisfaction survey results More people and carers who are satisfied with their experience of care and support

services More people able to access their own records More people reporting they feel safe in the care they receive Better Friends and Family test results Better staff satisfaction and reduced staff turnover rates In development: Specific Greater Manchester primary care data measures and benchmarking tool which

will include GP practice level measures

You can access information regarding the quality of

your health and social care services You can compare your health and social care services

to services elsewhere in Greater Manchester You know the care you receive is safe Your health and social care services communicate with

you openly and honestly and admit when they’ve got it wrong

You can access high quality care wherever you live In Greater Manchester

You are given information and have the knowledge about any medicines you take, their purpose, how to take them, and potential side effects

OUR JOINT COMMITMENTS

Greater Manchester health and social care commissioners give you the following commitments We will continuously strive to improve the quality of services and ensure that care is safe We will support all health and social care organisations to be open and honest, learning

from their mistakes We will learn from what people tell us about their experience of the care they receive

You give Greater Manchester the following commitments

Hospital Future Model of Care

Dr Chris Brookes

In Hospital – In Scope

• Urgent and Emergency Medicine• Acute Medicine• General Surgery• Children’s Services

Paediatrics is intrinsically linked to Maternity and Neonatal services and so these are also in scope:• Maternity Services• Neonatal Services

GM In Hospital Case for Change

For Greater Manchester to have the best health and care in the

country

GM Vision

Hospital VisionHospital services delivered in accordance with best practice standards with quality and safety paramount – the right staff, doing the right things, at the

right time

Consultant delivered care

Seven day services

Consistent, high quality care across GM

Improved outcomes and experience for patients

Effective use of workforce – right staff, doing the right things at the right time

Sustainable workforce model

Hospital Vision

Greater Manchester Quality and Safety standards were developed to describe how we might achieve the vision.

For example:

Hospital Standards

UEAM01There will be a Consultant in Emergency Medicine present between the hours of 08:00 and 24:00 (16 hours), 7 days per week

CHS08 All general acute paediatric rotas are made up of at least 10 WTEs, all of whom are EWTD compliant

…However, audits of the standards show that not all of our hospitals are achieving the standards

Audit of standards

GM Quality and Safety Standards Audit

Because each Provider is trying to do everything...

• Limited workforce spread thinly across all sites

• Some clinicians are not seeing a ‘critical mass’ of patients to maintain skills

• Variation in cover at evenings and weekends

• Lack of joint working and sharing of best practice

• Inefficient use of our workforce and estate

• Variation in compliance of Quality & Safety Standards

• Variance in patient outcomes• Variation in patient and staff

experience

A single service provided in a number of locations

We need to do something different…

• Deliver care locally for the majority of patients – Local Services;

• Upgrade Local Services so all attain standards;

• Create a smaller number of Specialist Services for the few patients with ‘once in a

lifetime’ life threatening illness and injury delivered in line with GM standards;

• Create Single Services – multi-disciplinary teams responsible for Specialist and Local

Services for a population of GM;

• Work with the Ambulance Service to direct patients to the right place at the right

time;

• Consultant led care delivered to best practice standards, and;

• Effective clinical leadership and decision making.

Future Model of Care

In summary

Future Model of CareLocal Services

Future Model of Care Local Services

Local Emergency Department

• 24/7 Emergency Department

• ~96% of current patients

Local Acute Medical Unit• Consultant led, 12 hours per day, 7 days

per week• Supported by in-reach from Care of the

Elderly professionals

Local Planned General Surgical Service• Low risk elective and day case surgery• ~81% of general surgery procedures

delivered locally

Local Specialist Services• Rapid access clinics• Outpatients• Specialist treatment such as dialysis and

some chemotherapies

• Deliver care locally for the majority of patients – Local Services• Upgrade Local Services so all attain standards

Future Model of Care Specialist Services

‘Once in a lifetime’ conditions include:• Major trauma• Stroke• Emergency surgery• Highest level of Intensive Care

~8% of patients presenting at ED

Create a smaller number of Specialist Services for the few patients with ‘once in a lifetime’ life threatening illness and injury – delivered in line with GM

standards

Specialist Services:• Fewer sites• Serving a larger population• Attainment of standards

Concentration of specialist resources

Future Model of Care Specialist Services

Future Model of Care Single ServicesCreate Single Services – multi-disciplinary teams responsible for Specialist and

Local Services for a population of GM

Sing

le S

ervi

ce

A

Local Services

Local Services Local Services

Future Model of Care Single Services

Future Model of Care Single Services

Single Service A

Local Services

Local Services

Local Services

What is a Single Service?

• One team of staff working across the sites in the Single Service

• One performance framework

• One clinical governance structure

• One training programme

Future Model of Care NWAS PathfinderWork with the Ambulance Service to direct patients to the right place at the

right time

Integrated Primary and

Social Care

Self

Care

NWAS Pathfinder

NWAS have analysed 1000 historic records and found…

Specialist ED ~11%

Local ED~68%

Primary & Community Care

~21%

Future Model of Care NWAS Pathfinder

Future Model of Care Consultant-led wards

Consultant led wards delivered to best practice standards - paediatrics, maternity and acute medicine

Consultant delivered care on wards, 7 days per week;

Delivered to GM Quality & Safety Standards, and;

Effective discharge planning and regular ward rounds – reducing Length of Stay.

Future Model of Care Consultant-led wards

Future Model of Care Clinical Decision Making

Effective clinical leadership and decision making to ensure high quality, efficient care

Ensuring appropriate senior clinical decision makers are present at the

right time at the right place to make the right treatment decisions for patients is central to the model.

Strong clinical leadership teams within each single service will be a

key factor in the success of the model of care.

Future Model of Care Clinical Decision Making

Questions