r. binks healthcare policy long term conditions experiences of yorkshire

33
Healthcare Policy in the Area of Long Term Conditions: Experiences of Yorkshire Rachel Binks Nurse Consultant, Critical and Acute Care Airedale NHS Foundation Trust

Category:

Documents


0 download

TRANSCRIPT

Page 1: R. binks healthcare policy long term conditions experiences of yorkshire

Healthcare Policy in the Area of Long Term

Conditions: Experiences of Yorkshire

Rachel Binks

Nurse Consultant, Critical and Acute Care

Airedale NHS Foundation Trust

Page 2: R. binks healthcare policy long term conditions experiences of yorkshire

Long term conditions

consume -

50% GP appts

64% OP appts

70% IP bed days

70% NHS spend

Our Context

Long term conditions -

much more common

as we age

By 2034 –

5% population >85yrs

x2.5 increase

(compared with 2009)

Page 3: R. binks healthcare policy long term conditions experiences of yorkshire

Diabetes

Complex

Common

Costly

Controllable, but

poorly managed

(process and

outcomes)

Our Context

Page 4: R. binks healthcare policy long term conditions experiences of yorkshire

“…DH position: further efficiency savings in

the NHS will continue after 2015, with the

total savings rising from £20bn to a

possible £50bn by 2019-20…

…A startling admission of the long term

impact on public services of the global

financial crisis and ensuing (double dip)

recession…

…The translation is an NHS that has

barely managed 1% productivity per

annum let alone 5% each year for EIGHT

YEARS…”

John Appelby

Kings Fund

The big picture …

Page 5: R. binks healthcare policy long term conditions experiences of yorkshire
Page 6: R. binks healthcare policy long term conditions experiences of yorkshire

Important relationships

Page 7: R. binks healthcare policy long term conditions experiences of yorkshire
Page 8: R. binks healthcare policy long term conditions experiences of yorkshire

NHS Outcomes

Framework

• The NHS Outcomes Framework reflects

the vision set out in the White Paper and

contains a number of indicators selected

to provide a balanced coverage of NHS

activity.

• Its purpose is threefold:

Page 9: R. binks healthcare policy long term conditions experiences of yorkshire

Purpose

1. to provide a national level overview of how well

the NHS is performing;

2. to provide an accountability mechanism

between the Secretary of State for Health and

the NHS Commissioning Board for the effective

spend of some £95bn of public money; and

3. to act as a catalyst for driving up quality

throughout the NHS by encouraging a change

in culture and behaviour

Page 10: R. binks healthcare policy long term conditions experiences of yorkshire

A complex

Structure

but

many

outcomes

that we can

influence with

telemedicine

Page 11: R. binks healthcare policy long term conditions experiences of yorkshire

Long Term

Conditions

Reducing time in

hospital

Emergency

admissions that

should not need

admission

Helping people

recover

Page 12: R. binks healthcare policy long term conditions experiences of yorkshire

Domain 2

• Enhancing

quality of life

for people

with LTCs

Page 13: R. binks healthcare policy long term conditions experiences of yorkshire

Domain 3

• Helping

people to

recover

from

episodes

of ill health

or

following

injury

Page 14: R. binks healthcare policy long term conditions experiences of yorkshire

Long Term Conditions Compendium of Information

(3rd Edition, 2012)

“It is clear that the NHS, as currently

configured for long term condition care, is

not sustainable in the face of the projected

increase in comorbidity and level of need”

Page 15: R. binks healthcare policy long term conditions experiences of yorkshire

Long Term Conditions

Compendium of Information

• The Department of Health has published

the third edition of the ‘Long Term

Conditions Compendium of Information’.

• It is aimed at commissioners as well as

health and social care professionals, to

provide the evidence for improving care

and outcomes for people with long term

conditions (LTCs).

Page 16: R. binks healthcare policy long term conditions experiences of yorkshire

Whole System

Demonstrator Programme

• This document contains the latest

statistical data on long term conditions,

links to the LTC QIPP (quality, innovation,

productivity and prevention) workstream

and provides data from the ongoing

evaluation of the Whole System

Demonstrator Programme on telehealth

and telecare, which supports the delivery

of 3 Million Lives.

Page 17: R. binks healthcare policy long term conditions experiences of yorkshire

LTCs a priority

• It also showcases examples of innovative projects across the country where organisations and communities are pushing the boundaries to deliver improvements in LTC care.

• The information and evidence captured in this third edition of the compendium continues to reinforce why a focus on LTCs should be a priority.

Page 18: R. binks healthcare policy long term conditions experiences of yorkshire

The Whole System

Demonstrator Programme

• One of the most complex and comprehensive studies the Department has ever undertaken, and has yielded a wide range of very rich data.

• Launched in May 2008. It is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients and 238 GP practices across three sites, Newham, Kent and Cornwall.

• Three thousand and thirty people with one of three conditions (diabetes, heart failure and COPD) were included in the telehealth trial.

Page 19: R. binks healthcare policy long term conditions experiences of yorkshire

The Whole System

Demonstrator Programme

• For the telecare element of the trial people were selected using the Fair Access to Care Services criteria.

• The proposition being analysed was “Does the use of technology as a remote intervention make a difference?”

• As each site used different equipment and had differing populations there is confidence that the results are transferable to other locations.

Page 20: R. binks healthcare policy long term conditions experiences of yorkshire

Findings

• 45% reduction in mortality rates

• 20% reduction in emergency admissions

• 15% reduction in A&E visits

• 14% reduction in elective admissions

• 14% reduction in bed days

• 8% reduction in tariff costs

Page 21: R. binks healthcare policy long term conditions experiences of yorkshire

Benefits for the

Individual

• More effective self care

• Improves quality of life for carers

• Less travel and disruption for routine check-ups

• Retention of dignity

• Increased confidence to manage own health

• Fewer stressful, unplanned hospital admissions

Page 22: R. binks healthcare policy long term conditions experiences of yorkshire

Benefits for Healthcare

Professionals

• Through risk stratification, professionals can identify those people in their practice who have LTCs and could be better supported if telehealth were adopted

• Professionals can be better informed of the status of these people and see less demand on services, with fewer A&E events and unscheduled inpatient episodes

• Professionals see less impact on family members/carers of people with Long Term Conditions (LTCs) as they start to take more control of their own health

Page 23: R. binks healthcare policy long term conditions experiences of yorkshire

Benefits for Healthcare

Professionals

• More regular data means professionals can be better informed of a person’s health status which leads to early intervention and proactive care

• Deploying telehealth-enabled services modernises the way by which large numbers of people with LTCs are treated improving their care, quality of life and the life of their carers

• It makes more efficient and effective use of available clinical teams by reducing unnecessary home visits

• It involves people far more in the management of their own healthcare

• It significantly reduces the incidence of A&E usage and unplanned admissions thus reducing the disturbance on elective planning

Page 24: R. binks healthcare policy long term conditions experiences of yorkshire

Next steps

• The headline findings, with the detail now supported in the paper, provided the impetus for 3millionlives and the drive for industry to work with health, social care and housing stakeholders to develop workable business models to enable telehealth to be delivered at scale and at the right price, and pricing structure, for the public purse.

Page 25: R. binks healthcare policy long term conditions experiences of yorkshire

Next steps

• A further four reports are planned, which will analyse other elements of the telehealth trial, including a separate paper on costs and how telehealth affected quality of life.

• The telecare findings are due to be published at some point in the future. The full BMJ article is available online. *published by the BMJ. Research team lead by the Nuffield Trust. 3ML Press Release

Page 26: R. binks healthcare policy long term conditions experiences of yorkshire

telecare

telecoaching

telemonitoring

teleconsultation

Implementing

telehealth

BMJ 14th July 2012 345; 7, 16, 20

Page 27: R. binks healthcare policy long term conditions experiences of yorkshire

We must have

New ways of

delivering

early

specialist

opinions and

care

Page 28: R. binks healthcare policy long term conditions experiences of yorkshire

so less in here…

Page 29: R. binks healthcare policy long term conditions experiences of yorkshire

The bigger picture …

scale of financial

challenge

growing demand

unmet need

inappropriate

utilisation

stretched capacity

+ traditional

hospital dominated

medical model

designed

by default

=

Page 30: R. binks healthcare policy long term conditions experiences of yorkshire

a system designed by

default

some people seem to

do quite well without

waiting for healthcare

support……

Page 31: R. binks healthcare policy long term conditions experiences of yorkshire
Page 32: R. binks healthcare policy long term conditions experiences of yorkshire

Much more of this

numerous potential use

cases:

• long term conditions

• outpatients

• nursing homes

• employee health & well

being

• early supported discharge

• admission avoidance

• dementia – carer support

• social care

• purely social calling

• specialist networks

Page 33: R. binks healthcare policy long term conditions experiences of yorkshire

Thank you for listening

Any Questions?