inspiration to · 2017. 6. 2. · of the whole slidepack in 5 minutes read only the heading of each...
TRANSCRIPT
inspiration to
implementation
Delivering Equity and Excellence:
AHPs leading, working and changing together; making a difference for people
National Learning Event - London
22nd February 2011
2 2
This document is designed
to be read on screen
To get an overview of the whole slidepack in 5 minutes
read only the heading of each slide
(look for further detail on each slide at points you are particularly interested in)
Executive summary Slides 3–4
Process and notes from speaker presentations Slides 5–54
Speaker slides Slides 55–75
3 3
Executive summary
4 4
An informative and inspiring day, exploring
what the changes mean for AHPs
220 Allied Health Professionals met at the Inmarsat Centre in London
to understand the implications of the White Paper for AHP
services, explore how the AHP community can work together in
taking these ideas forward and develop their own leadership and
local service delivery as part of this.
A series of presentations set out the important role for AHPs in providing
clinical leadership, forming productive partnerships with service users,
demonstrating compassion and being central to delivering long term and
more realistic outcomes for patients.
Delegates were encouraged to take a highly proactive stance to
understand the detail of commissioning, take a full part in consultations,
build influential relationships with GP consortia, think radically and
creatively about how to add value and develop integrated services and to
promote the great work of AHPs as a whole.
Demonstrating self confidence, offering mutual support and making good
use of networks will be really important during the challenging transition
The event was well evaluated. Delegates found it both informative and
inspiring Executive summary
5 5
Process and notes from speaker presentations
6 6
Bev gave a warm welcome, emphasising the
importance of creative collaboration and
networking
Bev welcomed the audience - a huge privilege to
meet policy makers and shapers
Sit back, listen, think, question, work out what it
means for our patients
We’ll talk about GP consortia, influence - how we
are going to get the voice of the AHP contribution
heard. It is integral to sustainable and affordable
healthcare.
We can only achieve together by collaborating and
building a network. Find people who can help us
sustain that – ‘creative collaboration’
Share AHP common value of contribution to patient
care.
Working in groups of 3:
What is working well and what
am I hoping for from today to
make the coming year a success?
Think about what we need
to do next, to build on
what we hear today
7 7
Thank you all for choosing to come
I want to talk about the principles of white paper, where it represents an
opportunity, to recognise that it does involve change which by its nature
is difficult and presents challenges. Our objectives is the best healthcare
system anywhere in the world.
Three principles:
o Shared decision making with patients – we support that as a system
(not just through our individual practice). This involvement is likely
to lead to better experience and outcomes.
o Focussed on outcomes – we do need to measure and manage
performance. But don’t confuse measures of inputs and processes
with outcomes. Real enthusiasm around the country for this.
o If we want to deliver better outcomes – we need to take decisions
and resources to the front line. This has been the controversial part.
Functions and therefore form of organisations should move.
The Secretary of State explained the three
key principles of the white paper,
8 8
We are working together with local government to make sure people get
the service they need. For the NHS, resources at the front line will rise
by 3% in real terms. (albeit in context of previous rises of 5-7%).
We will need to do better and redesign services together
AHPs are often regarded as the integrators of care.
Looking at greater personalisation – patients want better integration
(personal health and social care budgets)
And more integrated care is likely to deliver better results
At the moment – it isn’t by results but payment by activity
National tariff should shift to payment by outcomes
…emphasising the need to deliver more by
redesigning services,
9 9
Commissioning Groups want to start redesigning clinical services along
care pathways.
o Start to bring a range of providers together across hospital and
community. The primary/secondary divide needs to be broken
down and integrate community services with specialist services
o Creates a need for multi-disciplinary planning and commissioning,
seeing new structure and it creates opportunities (eg for self
referral such as Hackney early years SLT
o These kinds of innovations are empowering patients and are
enthusiastically supported by GPs
I’ve seen many examples of patients getting access to and responding
to AHP services such as music and arts therapy and podiatry. We
should be looking for avoidable mortality events (a measurable
outcome)
I can see more opportunities for integration such as 111 which will
give a more integrated gateway. More important that we integrate
services behind it such as urgent care. (which is currently confused
and disjointed.)
…breaking down barriers, integrating care,
10 10
Delivering healthcare services is about Multi Disciplinary Teams working
together. Commissioners will be looking for services that create that
kind of connection.
There will be new providers (charities, voluntary sector, private sector) –
from commissioning point of view, we will be asking - does this deliver
quality of service we’re looking for? Does it include quality, accessibility,
integration and results?
New providers should be working together with other providers of
services to ensure that the services patients and commissioners are
looking for is available to them.
This is a real opportunity because it is shaped by you. There are many
people who have the ability to decide what services are required.
Its getting rid of top down management systems which have been telling
you what to do and giving you and your colleagues opportunity to shape
services.
…and shaping new services in
collaboration with other providers
11 11
How can local provider services respond proactively and
continue to develop planned services with confidence?
The new pathfinder consortia are identifying staff who will
support and transfer. The plans are all about clinical service
design. If you’re in the hospital – the different services are
increasingly getting together to shape decisions about what
service looks like and integration of that service.
Year of care pathway introduced in tariff – started by Cystic
Fibrosis trust. They felt they could capture a tariff capturing full
range of care for a whole year across all providers
…before responding to questions from the
audience #1
12 12
What measures are being taken to prevent fragmentation and
duplication of community care services (particularly for older
people or those with learning disabilities)?
There has been overlap (and confusion) between health and
social care – particularly in SLT. Resolving that is important.
Michael Gove will publish green paper – illustrating how we want
to deliver a much clearer care package
For older people – want much stronger relationship between
hospitals and social care
£150million next year to support rehab in community. Also
£650million specifically about linking health and social care –
things such as home adaptation, telehealth, rehab). Will see
personal budgets for social and health care.
Your PCT has on average £3 per head for eg community
equipment, home adaptations, rehab. There are 2900 people in
hospital who could be discharged.
Questions and answers #2
13 13
How will the concept of any willing provider impact on provision?
Not new - applied up until Sept 2009.
Should stimulate innovation and new capacity – particularly for
charities and voluntary sector. Will mean degree of
contestability between providers. Will enable us to benchmark
prices nationally. Will often simplify process for purchasing
services
Competitive tendering actually designed to pick just one
provider – we’re saying if you can meet requirements (quality
and NHS Tariff, and integration) - anyone can have a standard
contract with a national tariff price to offer services. Does
transfer some of risk into hands of providers.
Questions and answers #3
14 14
What one thing should I do after today to make the most of impending
changes?
Make sure you and your colleagues know what part you play in care
pathways for patients. And make sure to contribute to development of
new pathways. QIPP depends critically on breaking down hospital
/community barrier.
How are joint working agreements between NHS and Local Authorities
likely to be affected?
Expect there to be pooled budgets between NHS and Social Care.
Expecting LAs to play a bigger role through Health and Wellbeing Boards
(as well as leading on public health)
Sometimes commissioning will be done by LAs. Sometimes they will look
to other organisations to do it. eg we encouraged charities in SLT to put
together commissioning support organisation. So GP Consortium doesn’t
need own commissioning expertise. Neurological, Mental Health and
communications charities are looking at providing commissioning
support. You may well find commissioning support organisation based in
LA or Commissioning Consortium who bring all that expertise together.
Questions and answers #4
15 15
How can we ensure AHP services are not commissioned in isolation but
are part of a package (in relation to mental health)
Fragmentation wont support outcomes and patients for services. Need to
get rid of obstacles – tariff has been one. Having the tariff in hospital
and not in the community has been unhelpful.
It’s the production line mentality which breaks it into bits of procedures
Also about making sure resources are there – if we get it right, fewer
managers, admin staff and more clinical/frontline staff. Need for every
bit of resource we’ve got to be delivered to the front line.
Clinically led, designing things around patients in a more integrated way.
Questions and answers #5
16 16
I started getting involved 11 years ago – wouldn’t have been ‘one of me’
sitting at the front.
I was a head teacher for 25 years – 5 years too long – [I suffered] total
burnout. I assumed it couldn’t happen to me but assumptions can be misleading
We might assume that change is unnecessary but change is the law of life
Some health care professional have assumed that powerlessness is
synonymous with illness (esp in mental health and in older people)
First experienced work of AHPs on psychiatric wards in the 90s
o Individualised support lacking
o Opportunities were missed
o Even the creative flexible professions seemed restricted
by inflexible policies and protocols
o Patients could feel dumped rather than included in their care
BUT things have changed.
o Impressed by the positivity within the web survey
regarding how to improve care
o Flexibility is key – focus on skills rather than status
o Service users and carers as equal partners
o Innovation important in change
Bill gave a personal perspective on the impact of
the professions embracing change…
‘There is no better
experience for the heart
than reaching down and
lifting people up
– that’s what AHPs do’
17 17
There are of course other needs - hope belief, spirit
I was able to express feeling in writing and song…
Where did my hope come from?
o It actually came from a cleaner - we used to sit in the
cloakroom – they included and involved me in their
conversations
o Slowly I began to come round to the feeling that wellness
was possible – I call that compassionate ordinariness (It
doesn’t matter how well qualified you are)
o Its about what you can do for the spirit of patients just by
being nice
o What does love mean (by 4-8 year olds). ‘I just helped him
cry’
…before sharing in song the impact of kindness
on his own recovery
‘The virtue of
caring with…the
value of caring
about …the limits
of caring for’
‘Let the difference
you make today
count in all our
tomorrows’
‘Vision without action is a daydream.
Action without vision is a nightmare’
‘I was seen as a
person, not an illness’
18 18
Gabriel highlighted the opportunity for AHPs
in tackling the big public health issues
Great opportunity moving public health teams to the local
authority
Need those navigational skills in the future – hope expertise
from AHPs will come out and help the rest of us make this
important journey towards better integration and services.
We have had perhaps top down dictatorial management
structure – we need to work with AHPs who really know
communities to start addressing problems such as health
inequalities.
Fantastic opportunity for AHPs to up their game on
prevention
o Having physiotherapists actively advocating changes
in our streets and transport infrastructure
o Dietitians working with schools on having fresh fruit
and veg available in workplace and schools
o Really encourage AHPs to come on board and get
really stuck in to this exciting prevention agenda
Huge issue on lifestyle problems – those are our priorities –
we need to help people change their own lives.
‘AHPs are very very
welcome on board’
‘Great opportunity for AHPs to
start addressing some broader
needs and really get involved in
producing change, working
across boundaries in new
imaginative ways’
19 19
Exciting time for professionals working with whole person
No one professional group has whole answer
More people with complex conditions which will give all
professional challenges in how we work
Focus on the person, deliver key outcomes, how we can
become more engaged in delivering that care
Importance of people making rapid recovery after being in hospital – will be
delivered by many people. Can go home rather than nursing home – hugely effective
way of proving post emergency care. Gives improved quality of life.
Number of professional groups expert at working across and through boundaries.
Experts in delivering joined up personalised care
Need to continue to agile working with different groups.
Push boundaries of how we’re going to work collaboratively
Work with people in creative ways to help maintain their independence
For too long system has removed autonomy. About empowering professionals to
work in creative ways.
o Focus on the individual, your local communities and the needs of local
community.
David encouraged delegates to push the
boundaries and work creatively
20 20
Some things never change – constantly hold that
patients still need our services and care
Many of you unclear how system will look in future
All of us facing a tough time, but we do have
some opportunities
DH will have less and less to do
o Will retain parliamentary accountability, public health
system and social care system. Running of NHS will sit
with NHS Commissioning Board (NCB) – small and clinically oriented.
o It will retain some commissioning of some small specialist services
o It will hold the GP consortia to account to ensure it delivers on outcome
framework
o It will devolve most of money to the consortia
We need to influence how those GP consortia work.
Attention must be paid to provider development (any willing provider)
All the providers overseen by CQC and Monitor and must meet their registration
requirements. All will provide care free at the point of need.
Integration of care pathways across NHS and Local Authorities – finally we’re getting
to a structural model we want to see.
Much greater integration between local authority and NHS - through health &
wellbeing boards
Karen explained the new system for health,
Karen’s slides are in the annex
21 21
NCB will be held to account via National Outcomes Framework
integrating NHS, public health and adult social care services
What outcomes are important - Not just about doing operations
on time – but what happens after that. This is where AHPs
uniquely deliver – maximising potential and returning people to
independence.
5 domains – you need to work through outcomes your service
delivers and how they link upwards to these.
You need to understand three things…
o Quality improvement system in NHS
o We have been getting more sophisticated
in what we mean about outcomes
– more about the quality of life that
people have
o Outcomes framework will be underpinned
by NICE standards – crucial that clinicians
take part in consultations
…the increasing sophistication of the
outcomes framework…
‘Delivering true
outcomes is your business’
22 22
We will have more autonomy – in the past we have been restricted by
policies and procedures
AHPs bring strong clinical governance - we feel passionately about the
quality of care we’re delivering. Maximising other’s potential (not
dependency on us)
We will have less resources to deliver more. Demand is rising, drugs
more expensive. So innovative creative solutions will be required.
Assumption sometimes that creativity rests with voluntary sector, not us.
Our contribution can be hidden – its important you talk about it.
There are very few rules
o We maybe quite like having rules but the challenge is now to take
responsibility ourselves
…the scope for AHPs to demonstrate their value
and innovation in a more autonomous
environment...
23 23
The key is how we respond - We could bury our heads in the sand, talk about
fragmentation, be defensive about competition OR we need to look at this as
a real opportunity
Want to give you some confidence - we actually have huge amount to build
on – your profile and visibility as a group has gone up over the last five years.
We are exerting co-ordinated influence at the highest levels
We have the Allied Health Boards, the Federation and a really strong brand –
but mustn't talk about our own individual services - but what AHPs can offer
at its broadest level
You need to make the complex world of allied health simple for others
You are in the main autonomous practitioners – that is very good value for
money. Non medical prescribing work – about difference it can make in care
pathway for patients
We can completely redesign some care pathways – the SHA AHP leads (led by
NHS London) are looking at seven key care pathways where AHPs could and
should be playing a greater role (available in Spring). You can use this to
influence commissioners
We are flexible and responsive and adaptive – the modernising AHP report is
available from today – important not to reinvent the wheel.
…to promote the value of the entire profession…
24 24
Leadership with a purpose – about driving up quality of care. Clinical leadership competency
framework and leadership challenges - skills to empower and motivate your patients are very
transferable to management and leadership positions. There will be leadership fellowships.
Have been successful supporting AHPs moving into research – they can illustrate how they can
convert research into practice - success of clinical academic careers work
We do deliver outcomes for patients
o Many announcements on rehabilitation and reablement
o Don’t worry about the definition – just run with it
Don’t wait for the rules – they are not going to come.
Stay networked and engaged – you really need to work together on this agenda. Need to articulate
solutions to complex problems made simple (for GPs, LAs)
o Fascinating how envious non AHP providers are - we’re seen as creative, innovative
independent, entrepreneurial.
o AHPs are seen as having a clear brand. But there is anxiety. Need to articulate what
contribution you can make to GP consortia
o Don’t be afraid to compete
o Tell the story of your brand and relate it to outcomes framework..
o Be the new best friend of your local GPs – you need to understand the issues they are dealing
with. Relate it to the outcomes they will need to deliver
…and to fully engage with the new agenda
25 25
Have been working in low security forensic psychiatry unit.
People there for months/years
Their liberty is restricted and choice is limited
Represented Yorkshire and Humber in leadership challenge
I’ve begun to realise my own leadership skills and how I can
use to influence and change
o Recognising strengths in other people. Raising self-worth
o I value the voice of the service user
Part of regional involvement strategy group has seen big changes
o Using patients on interview panels for recruitment
o Design and development of new low secure hospitals
o How clinicians deliver psychiatric care (20 service user designed standards).
Service users now routinely chair their own meetings
o My future plan – articulating whats important to the patient
o Model pathway for patients – goal to reduce bed stay by 20%
o Encouraging and facilitating service user participation
Sally explained how she had helped to give users a
greater voice in choosing their care
I’ve witnessed
transformation in
patients – the key
message is about
patient choice
26 26
About four years ago – in clinical role with small strategic
component
Realised I could develop that side of role to influence care
AHP leadership challenge was a lifeline – like lighting
a blue touch-paper
My take-home – find a mentor who can really help shape
your development
Met five Chief Execs on one to one basis, attended board meetings.
They were enormously generous to me.
Secondment – worked in QIPP. Experienced lack of integration first hand. Lots of
coaching. I left with a far greater awareness of myself – how to approach the
people I wanted to influence and greater understanding of the system
Currently seconded 2 days per week as health and wellbeing champion.
As AHPs – we often feel we’re not being understood – seek first to understand.
Leadership is an active process. Its also about people and your relationships with
them. Translating the big-picture and making it relevant to front-line.
Martin shared his insights for effective
leadership
‘I left with a far greater
awareness of myself’
27 27
I was operations manager for specialist therapy and before that managing
musculoskeletal service. Part of one of 30 service improvement projects.
How to integrate things into our daily practice quickly. Using MSK service
Don’t wait for someone to come and tell you service isn’t up to scratch
Need to take time to analyse, see problems, to know your service, to talk to
users and know capacity and demand.
Problems with follow-up did not attends and time
spent on admin.
Changed way we were booking (did ring and rebook)
and the way admin team worked with us.
Do need to talk to patients and use patient stories
Go out and show what we can do – don’t keep it to
yourself. Work out how to find way to get agenda
that will improve service across
Susanne explained how a whole team approach had led to service improvements
‘We need to think about
changing the way we work – to
do that we need whole team’
28 28
During lunch, delegates visited the marketplace,
29 29
…before the panel addressed questions
Karen Middleton,
Chief Health Professions Officer,
Department of Health
Edna Robinson,
Chair,
The Big Life Company
Paul Hitchcock, Director,
Allied Health Professions
Federation
30 30
Can we demonstrate how AHP services contribute to health
outcomes?
o Karen: Understand what local populations want to see then
reflect on how your own service is delivering those. Translate
data into information that supports that. Outcomes must be
about quality and show that you can deliver in highly efficient
and productive way. Then you can go with coherent story to
commissioners that you can deliver those outcomes.
Questions and Answers Panel #1
31 31
How as AHPs do we influence commissioning of specialist
services?
o Karen: NCB will be issuing outcomes framework – need to
influence that. Also influence NICE commissioning guidance
o Edna: Also getting to know GPs – although smaller number of
people for specialist services. Need to connect using
technology. Huddle for comfort.
o Paul: (Through) Health and Wellbeing Boards primarily based
in local government with local politicians. Many of specialist
services will be particularly talked about at election time
Questions and Answers Panel #2
32 32
How can I support professional bodies locally?
o Paul: Future environment - lots of lobbying and influence.
Need to continue to have national voice. Get involved in eg
primary care commissioning network
o Wherever a decision happens, AHP needs to be in there on
that decision making
o That only opens the door – you need to knock on the doors.
o Use the available resources - we need feedback on them.
o I also need new stories – to support the deep factual stuff
we’re doing
Questions and Answers Panel #3
33 33
How is the Commissioning Board going to monitor consortia
(GPs will need expert guidance)?
o Edna: Consortia will be accountable to Commissioning Board.
(public accountability, management of resources).
o Having clinicians in charge locally is a good concept. You
have responsibility to make a compelling offer.
Questions and Answers Panel #4
34 34
We are incredibly privileged in the West – we need to be less
obsessed about micro-things.
The sum of all the parts is very exciting – tricky idea that we
give it all to group of volunteers rather than professionals
Risk we disinvest in important societal hopes (Citizens Advice
Bureau punch well above their weight)
I’m seriously committed to clinical engagement - its an art
rather than a science. We’re creating a non-branded way of
connected
We do have Health Care Provider commissioning network
which you are a part of - you should get active in that to put
forward your connective BIG voice
Does require a level of corporate behaviour – clinicians will
have to do tough things (deny drugs according to guidelines)
Edna examined some of the risks of the NHS
creating its own ‘Big Society’,
‘You should get active
in that to put forward
your collective
big voice’
Edna’s slides are in the annex
35 35
Have you seen system from wide point of view – other industries pride
themselves in their end-product (satisfying customers)
We need good people who understand processes as much as clinical competence
You do need to understand processes.
Don’t see it as a right to be invited (to discussion with commissioners)
Challenge for Chief Exec is to assist in true devolvement of decision making.
Means taking some risks and allowing some mistakes
Don’t become obsessed with who has been invited to be in the structure – stay
focussed on consortia
BUT system fails many of the people every day – less than 5% of NHS works from
Friday night to Monday morning!
Get an organisational coherence around your offer
We will get you together to help you look at your transitional issues – its your
transition, your pride, your relationships. Equally it is the public’s NHS.
…the importance of understanding processes and
not becoming obsessed by organisational structure
‘I’m really excited that the consumer is going
to take over the NHS for the first time’
36 36
Delegates reflected on how best to network
and influence commissioning…
37 37
We have to be braver about what we do – apprehensive about
becoming social enterprise but have to face head on.
Edna - Organisation is only a form – but such a big form in NHS.
Kind of need to dissemble and rebuild in own image.
Edna really refreshing - great
…feeding back some of their ideas
38 38
A difficult environment to operate in - the argument
and debate will go on around us.
Would like to look at lessons from history:
2004/5 in the NHS – last time faced a real and significant
financial problem. Deficit of £1Bn. People rushing around
trying to save money – some sensitive, some brutal and quite short term.
At the same time, government launched Foundation Trusts, Practice
Based Commissioning, payment by results etc. People marched against
changes in service.
Leadership lost the plot/reason why we were here at that time – we got
excited about technical aspects of change. Had a damaging effect on the
services for our patients – we have to focus on patients.
Ara Darzi came in – patient pathways, redesign of services. Quality as
the organising principle. Having a real definition – experience, safety
and effectiveness. That definition is now in the Bill – quality is the
organising principle. Can’t trade effectiveness against patient experience
and you can’t trade safety against effectiveness. Real purpose.
David set the context for change in the NHS
over the last few years,
39 39
In May 2009 – I sat down with the NHS management board to look at the future.
Became clear that financial position wasn’t going to be there in the future.
8-10% growth for NHS over. Thought future would look like very little if any real
terms growth. That’s how its turned out. Remarkably generous in context of rest of
public service.
BUT – we all know medical technology, patient expectations, demography all
significantly affect demand on the services – so standing still is not an option for us
going forward. We would have to deliver £15-20Bn productivity over next 4 years.
Want to do in a way we haven’t done before – never talk about quality without
talking about productivity and visa versa
Coalition government decided to move ahead with dramatic changes – a revolution
in the way that we work
4% efficiency gain on tariff – over 40% saving in management costs
How can we get to a place where implementing the changes also improves quality
for our patients? If you take development of GP consortia, interesting and dynamic
group of people who really want to make services better for patients and have an
enthusiasm and connection with each other.
…highlighting the imperative to deliver significant
gains in productivity and quality,
40 40
Pathfinders - the way we design authorisation process will affect the kind
of consortia we end up with:
o Long Term Conditions – need to give support and empower people –
how well do you care for people with LTC – important test.
o Primary care – excellent at one level but too often poor. What will the
consortia do to improve? Getting people engaged and working on this
right away will strengthen our ability to do it.
o Clinical services in general – concern. Set of GPs huddled together -
how are they engaging with clinicians across whole of the patch –
secondary care clinicians, AHPs, nurses?
o So change authorisation from dull financial analysis into one which is
alive and can affect our patients.
On provider side – over 100 organisations yet to become Foundation trusts –
you need to demonstrate you have a financially and clinically sustainable
organisation. How can we focus on clinical and financial sustainability?
…and to ensure the authorisation process
really improves services for patients.
‘We’re trying to get the implementation of these
changes aligned with improving services for patients’
41 41
Role of Commissioning Board
o How can we create something which is part of agenda of improving
services for patients
o Has to be clinically driven at its heart – there to turn tax payers money
into better outcomes for patients.
o At its heart is the outcomes framework – how will we tackle big killers,
improve experience of our patients, how can we make safety run right
through the service?
What levers does it have?
o Allocate monies directly to consortia (£60-70bn)
o Direct commissioning(£20bn of healthcare) – big scale but also has to work
closely with localities.
o It will design tariff and set out commissioning guidance, outcomes
framework - a substantial organisation.
He explained how the Commissioning Board will
be outcomes focussed and clinically driven,
42 42
Danger in this radical evolution is that we will extend health
inequalities – the marginalised will be even more marginalised.
The unique selling point of the Commissioning Board is that it is
national – responsible for national consistency. Particular
responsibility to bring in marginalised groups.
It will respond to need for improvement in quality through
quality standards and commissioning guidance.
It will revolutionise tariff – payment by results rather than
activity
…giving great opportunity for improvement.
‘A fantastic opportunity for the Commissioning Board
to get national consistency – to really put N in the NHS
in a way we’ve never been able to do before’
43 43
On provider side – reforms are more significant and more long term and more likely to
change services than change on commissioning side
Quality for patients is systemic – its how all of the services fit together (through health
and social care). Integrated care from point of view of the patients is essential.
If you’re a provider where do you fit in?
o If your business model is you increase number of people you treat and you get
more money – that wont thrive in this new world
o If your business is about delivering national targets (getting ticks in the box) - that
wont thrive in the future
o You’ll need to play your part in delivering integrated services – perfectly possible
with some organisations co-operating and some competing
o You need to radically think about what your organisation does and how it does it.
All contracts and tariffs will be around delivering outcomes for patients
Clinicians will be able to work through issues, redesign pathways – your organisation
needs people who are empowered to do that – need to radically decentralise
organisations so that people can make decisions.
It is a revolution - need to think radically about adding value
Providers need to think radically about how
to deliver integrated value added services.
44 44
Not either/or – in most industries, health care systems, there are bits of
both.
Any willing provider – not a great phrase!
We’re not saying – you can set up round the corner and get paid if
patients come
We are saying you have to be registered by CQC, licenced by monitor,
demonstrate you can deliver quality standards required, and have to
persuade commissioners to give you a contract – that’s is an organised
approach.
Sometimes we need external stimulus to make it happen in the right way
(eg home chemotherapy and dialysis) to ensure we really respond to
needs of our patients.
Any willing provider driven by patients seems reasonable provided its
integrated into the whole of services we provide.
Cooperation and competition can co-exist
45 45
AHPs perfectly used to working across boundaries – health social
care housing. That is the type of working we need to deliver
better outcomes for our patients and to be fair you’re already
doing a lot of this.
Looking forward to future:
o We have to be realistic – it will be tough. We’ll have to
reduce running costs of the system by a third. Important that
you feel supported by your organisations in this.
o Think about the remarkable improvements you’ve made for
your patients – it is awe-inspiring. Take confidence from
that. You all know how you can improve those services.
AHPs are perfectly placed to succeed in
this new environment
‘I am absolutely committed to putting outcomes at the centre and
clinicians at the heart of these changes. Have we got the stamina,
ability and ambition to do it?
When you see how you can improve your patient outcomes and
experience – they are the only incentive we need’
46 46
Do you think pathways/integrated working will be reflected in
joint health/social care commissioning?
Integration is really important because evidence shows it
improves outcomes. Essential (particularly for those with LTC)
that we join up services across the board (housing, welfare
payments and health/social care)
NICE have now been given role of doing social care quality
standards as well.
Really hopeful and optimistic about all of this.
Questions and answers with David #1
47 47
Quality issue – trusts have huge amount to report on but still people can
receive poor care – what assurances can you offer?
Clearly important issue. Really need to think about frail, elderly people in
all our hospitals – focussed piece of work needed here.
I chair National Quality Board – we set ourselves challenge – how can we
reassure ourselves that there are not bad things happening as we go
through all this. Commissioned two reports – one on how we assure quality
in the system between now and April 2012 (while existing arrangements
still in place) and how do we assure ourselves of quality going forward
They show some lead indicators - eg services we provider to people with
learning disabilities in primary care. Important to monitor how services are
personalised over the next 2-3 years.
Also setting out a toolkit for your boards to use – whole set of indicators
that give you a clue on what’s happening in your organisation to quality
and service. Evidence shows danger of picking out specific measure VTE
indicator organisations game it (not in a malicious way). Best indicator is
what your front-line staff think of the quality of service they’re providing –
We’re designing a way to temperature check this in your organisation to be
published soon.
Questions and answers with David #2
48 48
I’d like to add my thanks to all speakers and
panel members who have delivered a varied,
informative and inspirational agenda
Thank you Jane for chairing
Huge changes – standing still is not an option
o Influencing at all levels
o Collaboration and networking
o Innovation and creativity
o Using the AHP brand
We will certainly be looking at how we can
build on success of these national conferences
Up to you to take back locally – start to make a
difference
Good luck and be confident!
Sue closed the day, encouraging everyone
to move forward with confidence
49 49
Event review
50 50
Event review [1]
How would you rate the event for ...
Mean scores
Value / outputs = 8.2
Design / running = 8.5
51 51
Event review [2]
Need for integrated planning for
care pathways
Excellent opportunity for
communication and networking
Learning pack and support
provided clarity
The customer is at the heart of
the NHS
Speakers were inspirational
Marketplace very helpful with
excellent presentations
Useful emphasis on the
importance of outcomes
framework and how to use it
Knowledge on white paper detail
Opportunity to learn about what
other organisations are doing
Reiterated role of AHPs in new NHS
More informed about potential
opportunities
Feel more confident about changes
and challenges ahead
Understanding of MDT working and
planning
Working out more on local
implementation
AHPs need to be flexible and
responsive to the changes in policy
What was really useful about this event/what have you learned?
52 52
In priority order:
Not enough time to get to all the marketplace stands – would have liked
all in one place
More workshops/group work/personal learning and reflection
More time for networking
More time to think about how to link up locally
More time for questions and answers
More GPs and nurses present
Questions felt too stage managed – more spontaneous
Too much jargon
Could have spent more time on outcomes framework
More information on specific areas (social care changes, children’s
services, paramedics, ambulance services)
Event review [3]
What would you have liked to be different?
53 53
Event review [4]
Communicate more/link with
GPs/engage with consortia
Need to go back and consider
how to put into practice the 5
domains
Get up to date information and
data on our current activities
Look at ways of cascading
information following this event
Leadership programmes need to
be developed
Support the team/staff through
the changes
Make GPs our new best friends
Find ways of engaging other
providers
Find ways of engaging the
patients more – develop service
user survey
Continue work on marketing the
service
Take time to do focused reading
(eg outcome framework)
Generate more innovative and
flexible service ideas
Develop links with local
authority, public health
What actions you take from this event/what will you put into practice?
54 54
Event review [5]
Good/excellent
Energised
Challenged
Focused
Enth
use
d
Thoughtful
Inspired
What one word summarises how you feel about today
Informed
Concern
ed
55 55
Speaker presentations
56 56
Karen Middleton
Priorities for healthcare
•Patients at the centre of everything we do
•World class clinical outcomes
•Empowering clinicians
The new system
NHS
NHS
Commissioning
Board
Monitor
(economic
regulator)
GP commissioning
consortia
Department
of Health
Public
Health
England
(part of DH)
Social
care
(in local
authorities)
Local authorities (via health &
wellbeing boards)
CQC
(quality
regulator)
Providers
There are three overlapping frameworks for the NHS, public health and adult social care
services
Adult Social Care and NHS: Supported discharge from NHS to social care. Impact of reablement services on reducing emergency readmissions. Supporting carers and involving in care planning.
Adult Social Care, NHS and Public Health: Departmental business plan ‘impact indicators’ and DH contribution to Public Services Transparency Framework.
NHS
Adult social care
Public Health
NHS and Public Health: Preventing ill health and lifestyle diseases and tackling their determinants
Adult Social Care and Public Health: Preventing avoidable ill health or injury, including through reablement services and early intervention.
NHS OUTCOMES FRAMEWORK
Domain 1 Preventing
people from
dying
prematurely
Domain 2 Enhancing
quality of life for
people with long-
term conditions
Domain 3 Helping people
to recover from
episodes of ill
health or
following injury
Domain 4 Ensuring that
people have a
positive
experience of care
Domain 5 Treating people in
a safe environment
and protecting
them from
avoidable harm
NICE Quality Standards (Building a library of approx 150 over 5 years)
Commissioning
Outcomes
Framework
Commissioning
Guidance
Provider payment mechanisms
Commissioning / Contracting NHS Commissioning Board – certain specialist services and primary care
GP Consortia – all other healthcare services
Duty of quality
Duty
of q
uality
Duty
of
qualit
y
tariff standard
contract CQUIN QOF
Duty of quality
1
2
3 4 5
6
7
The quality improvement system in the NHS
What’s on offer for AHPs?
• More autonomy
• Continuing focus on delivering high quality, high value care
• Greater opportunity to empower patients and families to fulfil their potential
• To focus on ‘adding life to years as well as years to life’ across the whole care pathway and across sectors
What’s on offer for AHPs?
• To be more innovative and creative in service redesign
• To work more efficiently with less administrative burden
• Greater focus on public health and the prevention agenda
• Very few rules
A very sound platform to step up from • DH representation – AHPs now feature in most policy
• National Leadership Council representation
• SHA representation and SHA networks
• National Allied Health Professional Advisory Board
• Allied Health Professions Federation
• The AHP Brand
Sell it to me! • We are autonomous practitioners – Self-referral
• We drive up quality and release cash - Service Improvement Project, extension of non-medical prescribing, SHA QIPP work
• We are flexible and responsive – Modernising AHP Careers
YOU WON’T DO IT WITHOUT US!
Sell it to me!
• We lead with a purpose – Clinical Leadership Competency Framework, AHP Leadership Challenges, Clinical Leadership Fellowships, TCS Leadership Challenges
• We convert research into practice – clinical academic careers
• We deliver the true outcomes for patients – 5 domains of the Outcomes Framework, Rehabilitation and Reablement
YOU WON’T DO IT WITHOUT US!
A call to action!
• Don’t wait for the rules
• Collaborate
• Don’t be afraid to compete
• Tell the story of the AHP brand and your service and
relate it to the Outcomes Frameworks
• Be the new best friend of your local GPs
‘At the end of the day,
we must go forward with hope
and not backward by fear and
division’.
Jesse Jackson
71 71
Edna Robinson
72 72
Current government policy relies on creating new ways of
organising informal goodwill and translating it into a
measureable social contribution
Huge financial 'generalisations' may jeopardise investment
in crucial social starter packs that are essential to wider
buy-in
The NHS policy relies heavily on the political hypothesis
that the public trusts doctors more than "managers”
Clinicians will be organised in a way that relies on
unprecedented levels of corporate behaviours
Can the NHS create its own Big Society?
73 73
The public values ‘system slickness’ and takes professional
competence as a given
Self-importance and the rights of professional groups will
be replaced by showing value and not stamping feet
NHS board will need to behave in a non-hierarchical way if
clinicians are to remain connected for the long run
Networking is the new black but few really know how to
do it ....telling is more fun!
PCTs will be replaced by...well...larger PCTs
It’s so last season, darling......
74 74
Usual nonsense about structures replacing action is
alive and well
Provider market place is a great way to focus your energy
Health and social care boards are the dark horse
The new commissioners want to do it alone...make it easy for
them to include you
The National Commissioning Network will help you (me and James)
Transitional network starts today!
Travel the transition with tranquillity
75 75
Think | Act | Succeed
68
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