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Suzanne RastrickChief Allied Health Professions OfficerHealth Education Wessex - 24 April 2015

“It’s the Patient, stupid…….”(with apologies to James Carville, 1992)

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Patient Choice….

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The Policy Case for Commissioning AHP Services in England…...• The NHS Mandate

• The NHS Outcomes Framework

• Patient Choice

• The Five Year Forward View (October 2014)

• The Forward View Into Action: Planning For 2015/16 (Dec. 2014) & Supplementary Information For Commissioner Planning 2015/16 (Dec. 2014)

• ‘Intelligence’ Based Commissioning Models & Approaches

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NHS Outcomes Framework – 5 Domains

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What does this mean for patients

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NHS Commissioning Assembly…• “….as clinical commissioners we need to understand

the outcomes that matter most to people in our communities – these “citizen outcomes” should guide our decisions….”

Gateway ref 01801

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Commissioners are sighted on what “citizens” want.

Adapted from: Legatum Institute (2014) Wellbeing and Policy

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How should providers respond to delivering these “citizen outcomes”?• Ensure those with Board leadership roles fully understand the

AHP workforce in their accountability• Approach workforce planning strategically in conjunction with

CCG or Sub Regional NHSE commissioners & LETBs• Move away from easy stereotypes of just more ‘doctors and

nurses’ to ensure workforce has richness and depth of competencies that deliver ‘citizen outcomes’

• Using Organisational Development approaches to fully engage with the existing AHP workforce & their professional bodies to develop both responsive services & multi professional leadership

• Share, spread & celebrate AHP innovation

NHS Five Year Forward View

• The NHS Five Year Forward View was published on 23 October 2014

• One of its great successes was that it is a shared vision for the future of the NHS across six national NHS bodies

• The challenge is now implementation; we know: • It will not be easy• We need to learn from the past • We’re going to need a different

approach

• AHPs are up for it!

The future NHS

The core argument made in the Forward View centres around three ‘gaps’:

Radical upgrade in prevention

• Back national action on major health risks• Targeted prevention initiatives e.g. diabetes • Much greater patient control• Harnessing the ‘renewable energy’ of communities

Health & wellbeing

gap1

New models of

care

• Neither ‘one size fits all’, nor ‘thousand flowers’• A menu of care models for local areas to consider• Investment and flexibilities to support implementation

of new care models

Care & quality gap

2

Efficiency & investment

• Implementation of these care models and other actions could deliver significant efficiency gains

• However, there remains an additional funding requirement for the next government

• And the need for upfront, pump-priming investment

Funding gap

3

Principles of the New Care Models programme

Clinical Engagem

ent

Patient Involvem

ent

Local Ownershi

p

National Support

• The programme will be developed with a co-design approach – built with patients and the health and care system

• It will seek to identify replicable standards, tool and methods so that scale can be reached;

• It will use the transformation fund to maximise progress and pace through centralised support, especially in technical areas as well as leadership support and development for those local health and social care systems;

• The national package of support to prototype sites will be offered with an agreed Memorandum of Understanding and mutual commitment to delivery on the ground, and a commitment to value for local people

• It will establish an evaluation process to support testing and rapid learning

• It will share early and continuous learning with the whole national health and care system through a wider community of support.

New Models of Care

Initially the new models of care programme will focus on:

• Multi-agency support for people in care homes and to help people stay at home

• Using new technologies and telemedicine for specialist input • Support for patients to die in their place of choice

Enhanced health in care homes

• Coordinated care for patients with long-term conditions • Targeting specific areas of interest, such as elective surgery • Considering new organisational forms and joint ventures

New approaches to smaller viable

hospitals

• Integrated primary, hospital and mental health services working as a single integrated network or organisation

• Sharing the risk for the health of a defined population• Flexible use of workforce and wider community assets

Integrated primary and acute care

systems

• Blending primary care and specialist services in one organisation• Multidisciplinary teams providing services in the community • Identifying the patients who will benefit most, across a population of at

least 30,000

Multispecialty Community Providers

First cohort Vanguard sites

Care model Applicant

PACSWirral University Teaching Hospital NHS Foundation Trust

PACSMansfield and Ashfield and Newark and Sherwood CCGs

PACS Yeovil Hospital

PACS Northumbria Healthcare NHS Trust

PACS Salford Royal Foundation Trust

PACS Lancashire North

PACs Hampshire & Farnham CCGPACS Harrogate & Rural District CCG

PACS Isle of Wight

Care model Applicant

MCP Calderdale Health & Social Care Economy

MCPDerbyshire Community Health Services NHS Foundation Trust

MCP Fylde Coast Local Health Economy

MCP Vitality

MCPWest Wakefield Health and Wellbeing Ltd (new GP Federation)

MCP NHS Sunderland CCG and Sunderland City Council

MCP NHS Dudley Clinical Commissioning Group

MCP Whitstable Medical Practice

MCP Stockport Together

MCP Tower Hamlets Integrated Provider Partnership

MCP Southern Hampshire

MCP Primary Care Cheshire

MCP Lakeside Surgeries

MCP Principia Partners in Health

Care model Applicant

Care Homes NHS Wakefield CCG

Care Homes Newcastle Gateshead Alliance

Care Homes East and North Hertfordshire CCG

Care Homes Nottingham City CCG

Care Homes Sutton CCG

Care Homes Airedale NHS FT

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• 2012 CAHPO asked by Sir Bruce Keogh to establish if there was a case of need to improve adult rehabilitation services in England

• Examples of good innovative practice and service design, but poor adoption and dissemination

• Clinicians and service users - unsure of services available and how to access them

• More recent stakeholder engagement told us:• service not always focused on patient need• lack of focus on outcomes • commissioning structures an obstacle to care

So, what are CAHPO team doing? ……Innovating Rehabilitation

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Rehabilitation Innovation Challenge Prizes• “Open Mind Partnership”

Leicestershire Partnership NHS Trust

Leicester Open Mind in partnership with Fit for Work

- GP referral or Open Mind therapists

- Long-term MSK pain

- Cognitive Therapy and Mindfulness techniques

- Addressing physical, social and mental barriers such as depression and anxiety

• “Fitness for Work Service”

Derbyshire Community Health Services NHS FT

- Self referral or by managers

- Assessment – physical activity, design of the workplace

- Phased return to work and duties where appropriate

- Service also offers MSK pain education and management, advice on equipment and educational resources

- ROI - £5 for every £1spent

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• Publish the economic arguments for rehabilitation• Take forward recommendations from C&YP scoping

project report• Publish commissioning frameworks:

• Self referral and early intervention• Supported self management• Urgent and emergency care review• Older people’s programme• Living with and beyond cancer• Elective care

• Return to work programme• Support development of regional networks

Plans for Rehab Programme 2015/16

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Proposals being taken forward across the United Kingdom

• Independent prescribing by advanced radiographers• Independent prescribing by advanced paramedics• Supplementary prescribing by advanced dietitians• Exemptions from Human Medicines Regulations by orthoptists

Work to date• A case of need for each the above proposals has been developed and approved by

• NHS England Senior Management Teams (June 2014)• Department of Health Non-Medical Prescribing Board (July 2014)

• Ministerial approval to undertake preparatory work for four separate but simultaneously running public consultations (August 2014)

• AHP medicines project board established (September 2014)

• Development of consultations and supporting documents including• Draft practice guidance for each profession • Draft outline curricular frameworks for training programmes• Impact assessments for each proposal• Consultation summary documents• Alternative formats e.g. easy read versions

AHP Medicines Project

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AHP Medicines Project - continuedBenefits of proposed changes

• Provision of best care, first time, in the right place through timely access to medicines• Reduced need for additional appointments, onward referral and hospital admissions to

access medicines required• Reducing risks and costs associated with delays in care• Supports new roles and service re-design that is patient-centred and cost-effective• More flexible, responsive and empowered workforce

Current steps• Ministerial approval gained to publish the four consultations in February 2015• Consultations on independent prescribing by radiographers and paramedics are

running for 12 weeks• Consultations on proposals for dietitians and orthoptists are running for 8 weeks• Patient and public engagement events are being held during the consultation period (2

in England and 1 in each of the devolved administrations)• Following close of the consultations, responses received will be collated and analysed • The report on the responses to the consultation will inform a paper by the Medicines

and Healthcare Products Regulatory Agency (MHRA) to the Commission on Human Medicines (CHM), asking them to consider the proposals in light of comments received

• The CHM will then advise Ministers of their recommendations in relation to the proposals

AHPs: data capture is crucial 1 DECEMBER 2014

Suzanne Rastrick Chief Allied Health Professions Officer

NHS England

I was appointed by NHS England in September 2014 as Chief Allied Health

Professions Officer. Throughout my career in the NHS I have welcomed independent

scrutiny of health services, so was pleased to be invited by the Nuffield Trust and the

Health Foundation to chair a QualityWatch roundtable discussion focused on how we

can measure the quality of care delivered by allied health professionals (AHPs).

While the report is retrospective, it suggests that AHPs are not adequately

represented in or by many of the national quality measures which systematically

capture data relating to the activities of medical or nursing colleagues. This results in

an inappropriate impression of the activities of AHPs.

Care spanning many sectors

Most striking for me is the fact that, given the nature and scope of their work, AHPs

are ideally placed to address some of the key challenges facing the health and care

sectors. As we see in the report, their publicly funded employment already spans the

NHS, local government (social care and education), housing, third sector and

independent practice. There is now a real opportunity to develop and build measures

across sectors that reflect both the pattern of actual service delivery for patients and

the outcomes AHPs achieve for them.

Let’s talk about data...

www.qualitywatch.org.uk/blog/ahps-data-capture-crucial

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AHPs are ideally placed to deliver many of the ambitions in the 5YFV • Two fundamentals AHP’s deliver on:

InnovationEntrepreneurship

• Some areas to strengthen:Economic evaluationConsistent outcome dataDeveloping networks to spread excellent practice

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Effectiveness, from a different perspective

Connect…Be Active…Take Notice…Keep Learning…Give…

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NHS England Chief Allied Health Professions Officer’s Conference

#CAHPO15 23 June 2015

The Kia Oval, London

“Insights on Innovation & Entrepreneurship”