QIPP: increasing productivity using existing resources

23rd June 2010

College of Occupational Therapists 34th Annual Conference

Aim of Session

• Why QIPP and why now?

• Programme design

– National Programmes

– Regional Programmes

• National Work stream plans for safety

• The role and contribution of AHPs

QIPP

Quality, innovation, productivity & prevention

QIPP QIPP

QIPP

QIPP

“Our best chance lies in focusing on improving quality and productivity, linked together by innovation driving sustained improvements across the system.”

David Nicholson, ‘The Year’, May 2009

The approach to the challenge is a focus on both quality and productivity

The QIPP programme will support the NHS to meet the challenge

Supporting commissioners to commission for quality and efficiency – e.g. through improved clinical pathways, decommissioning poor value care

Provider efficiency – supporting providers to respond to the commissioning changes and efficiency pressures by transforming their businesses

Shaping national policy and using system levers to support and drive change e.g. primary care contracting & commissioning

Care closer to home

More standardisation

Earlier intervention

Empowered patients

Fewer acute beds

Reduced unit costs

Characteristics of a sustainable system:

Areas covered by Quality, Innovation, Productivity and Prevention (QIPP) programme

Twelve workstreams

Commissioning and pathways

Provider efficiency

System enablers

• Safe Care – Maxine Power, DH• Right Care – Muir Gray, DH• Long Term Conditions – John Oldham, DH• Urgent Care – John Oldham, DH• End of Life Care – Sophia Christie, BENPCT• Back Office Efficiency and Optimal Management – Tony

Spotswood, Royal Bournemouth & Christchurch FT• Procurement – Philippa Slinger, Berkshire Healthcare FT• Clinical Support Rationalisation (Pathology initially) –

Ian Barnes, National Clinical Director • Supporting Staff Productivity – Lorraine Foley, NHS Inst• Medicines Use and Procurement - Peter Rowe, Leigh

and Wigan PCT• Primary Care Contracting and Commissioning –

Barbara Hakin, East Midlands, SHA• Technology and Digital Vision - Christine Connelly,

Chief Information Officer

Action to deliver the programme will be needed at every level of the system

Local action – without support

Local action – with support

Regional action – shared work

Regional action – one leads

National action

Other networks

LTCs

Safe Care

Right Care

Back office

EOL Care

Pathology

Digital

Procurement

Staff

Medicines

Primary Care Urgent Care

Tariff

Contract

PBC

Commissioning

Competition

National programmes Enablers e.g.

Assurance and alignment

£15-£20bn savings

The current architecture of our response

There are three main components to the work which need to align

London

S Central

S West

W Mids

E Mids

SE Coast

E England

Y / Humber

N West

N East

Regional plans

Safe Care

Provide support to NHS providers to deliver

improvements in patient safety which result in

efficiency savings

What’s worked?

MRSA Bacteraemia & C. difficile

What have we learned? http://www.mortality-trends.org

Death from falls

A decade

of stability!

851 per year

since 2000

Focus

• Pressure Ulcers

• Falls

• CA- UTI

• DVT / PE

How MANY?

What WORKS?

How will we KNOW?

Reduce Pressure Ulcers by

80%By 2013

Nutrition & Hydration

Surveillance & systems

Continence Management

Keep Moving

•Assessment for all (MUST) •Management plan implemented•Escalation management•Fluid prescription

•Records of intact skin on all•Records of skin breaks on all•Systems for weekly surveillance•Mechanism for data review•MSSA & MRSA in pressure sites

•Assessment for all•Management plan for at risk•Escalation management•Diuretics reviewed•Catheter stewardship•Access to approp equipment

•Turning schedule•High risk environments•Rapid access to equipment •Compression stockings•Prospective falls measurement•Monitor contact risk•Measure VTE prophylaxis

Programme Outline

We own it, we pay for it, keep our NHS safe – act now!

Outcome Measure

•CA-UTI

•Falls

•DVT / PE

Occupational therapy & QIPP

Care closer to home

More standardisation

Earlier intervention

Empowered patients

Fewer acute beds

Reduced unit costs

Characteristics of a sustainable system:

Safe

Equitable

Effective

Patients empowered

Efficient

Quality Healthcare:

Questions to ask?

What are we trying to accomplish?(do we have an aim?)

How will we know if the change we are making is an improvement?

(what are we measuring?)

What changes will we make that will result in improvement?

(what are the 3 or 4 things we need to do to change?)

OT & Stroke (NHS NW)

• 24 hospital teams working together

• Aim = move regional sentinel audit score from 71 to 90 by 2010

• Therapists played an active leadership role from the start

140%

165%

Co-ordinating care?

Mood Assessment MDT Goals

Stroke Services - Warrington

2.96.76

10.216.75

16.8284

20.852.53

47.883.72

18.519.51

1525Average LOHS

Nov 2009-Jan 2010Pre redesign 2008Category

2.96.76

10.216.75

16.8284

20.852.53

47.883.72

18.519.51

1525Average LOHS

Nov 2009-Jan 2010Pre redesign 2008Category

OT within 4 days 73% to 90%

Length of stay 25 to 15 daysMDT work across boundaries

Individuals Lead Change

Stay involved!

• Understand policy

• Understand local strategy

• Set an aim & vision

• Disrupt and move quickly

• Keep leadership up to date

• Measure progress often

• Share data

• Embrace Failure

• Never Give up

“You may never know what results come of your action, but if you do nothing there will

be no result”

Mahatma Gandhi