Hertfordshire VanguardComplex Care Premium WebEx
12th October 2016
Michelle Airey, Recruitment
and Integration Manager HCPA
Paul Fenton – Programme Manager –
vanguard CCG
The presenters
Structure•The WebEx has 3 parts, including some polls and videos.
Questions •Please post any questions in the Chat room through the WebEx•Between each part, we will go through the questions posed in the Chat room
Afterwards•This WebEx is being recorded and will be uploaded onto YouTube•Slides will be uploaded onto Slideshare•An Evaluation survey will be sent out afterwards
Hertfordshire
Development
Delivery and Impact
Hertfordshire
Development
Delivery and Impact
50 vanguards across the country6 focusing on Care homes
“One in six people aged 85 or over are living permanently in a Care Home. Yet data suggest that had more active health and rehabilitation support been available, some people discharged from hospital to care homes could have avoided permanent admission.”
NHS Five year Forward View, October 2014
August 2015 = Won the bid to become a vanguard site
Enhanced GP care
Supportive technology
Care Home pharmacist
Care Home Trusted
Assessor
Skilled Care Home staff
Confident StaffUpskilling staff to feel more confident about supporting residents’
health & wellbeing
Multidisciplinary Teams
Support & advice from pharmacists, dieticians,
geriatricians, mental health professional, doctors, therapists &
nurses
Rapid ResponseA range of services including a frailty vehicle delivering
expert care, supported by tams of healthcare professionals, doctors
and nurses
Effective TechnologyGP access to patient
information when they visit them in their care
homes and data analysis
Community linked
geriatric team
End of Life care
Wrap around services
Time
Scale of Integration
Relationships,
Including W
orkforce
2004 2016
East and North Hertfordshire Journey
Wheelchairs
Mental Health
DTOC fines pooled
Better Care Fund
Vanguard / Service
Integration
STP
QUALITYUnique
Partnership Arrangement
Memorandum of understanding
Pick and mix options
StrategicAlliances
Negotiation for Outcomes
Raise standards of quality by sharing best practice
NETWORK EVENTS
WORKFORCE DEVELOPMENTMEMBERSHIP
INFORMATION ADVICE & SUPPORT
Poll - Integration in locality between LA & CCG
Rating Financial Projects Monitoring Commissioning
Fully integratedPartially integratedNot at all
Unsure
Hertfordshire
Development
Delivery and Impact
What is an advanced Pathway?
Champion Expectations
Enhanced GP care
Supportive technology
Care Home pharmacist
Care Home Trusted
Assessor
Skilled Care Home staff
Confident StaffUpskilling staff to feel more confident about supporting residents’
health & wellbeing
Multidisciplinary Teams
Support & advice from pharmacists, dieticians,
geriatricians, mental health professional, doctors, therapists &
nurses
Rapid ResponseA range of services including a frailty vehicle delivering
expert care, supported by tams of healthcare professionals, doctors
and nurses
Effective TechnologyGP access to patient
information when they visit them in their care
homes and data analysis
Community linked
geriatric team
End of Life care
Wrap around services
The Project
The Problem
Mandate
Project Team Analysis
Development
Engagement Delivery
Support
Evaluation
Problem• Staff Pressure• Unplanned admissions• Transfer Delays• Poor Outcomes
Mandate
What can we deliver in Hertfordshire to reduce use of services, bridge the gap in
funding between regular funding and CHC and keep residents in their home?
Building a Project Team
Project manager
Commissioning from Local Authority
Integration Manager across
LA and CCGContracts
Manager LA
Quality Lead- CCG
Providers Association
Analysis
Collect baseline
data
Review baseline
data
What is a complex patient?1. Dementia2. Falls Prevention3. Nutrition4. Wound Management5. Health Care - End of
Life, Continence, Neurological and Respiratory
Development Timeline
Characteristics
Develop training
Develop Job descriptions
Develop exercise
Programme
Develop finances
Contracts and Payments
ContractTraining
Payment
Claiming Criteria
Payment Schedule
Monitoring
Admission
HCS Quality
CCG QualityPerformance
Improvement
Poll - Localisation of Champions
Please pick three champions from the list below, that you would consider the most necessary champions for your locality?
•Activities and Wellbeing•Continence and Stoma•Dementia•Diabetes•End Of life Care•Falls•Medication•Neurological•Nutrition•Respiratory•Stroke•Wound Management
Hertfordshire
Development
Delivery and Impact
2014 2017Dec 2015 Jun Sep Dec 2016 Jun Sep Dec
Start engaging Training providers
Start engaging Care Homes
Sign up interested Care Homes
Start reviewing & approving interested Care Homes
Start Care Home contract amendments
Premium starts to be paid
Team meetings start
Start internal training & mentoring
Final Evaluation starts
PreEvaluation
Training
PostEvaluation
Support visitsBeyond the Armchair
Engagement & mentoring
Delivery and Engagement Timeline
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 190
10
20
30
40
50
60
70
80
90
100
Average Falls Risk (Above 50% Attendance)
Average Pre ScoreAverage End Score
CCP Home ID
Falls
Risk
(%)
Internal Evaluation
Impartial Feedback
Service
Pre and Post Course
questionnaires
Impact evaluation for each pathway
Beyond the Armchair Exercise
Behaviour Assessments Engagement
Case Studies
External EvaluationMedeAnalytics
LSE
Safe Responsive Caring Effective Well Led90
91
92
93
94
95
96
97
98
99
100
Example CCP HomeKLOE's PERCENTAGE SATISFACTION GRAPH
Satisfied April 2015 Satisfied April 2016
Champions Trained
126 champions trained
Since April 2015…
22% care homes received training
Complex Care Premium (CCP) Wave 1
Complex Care Premium (CCP) Wave 2
Key:
21 Healthchampions
21 Dementiachampions
21 Woundchampions
21 Nutritionchampions
21 Fallschampions
21 Engagementchampions
Complex Care Framework Outcomes“This programme has enabled all of our staff to gain confidence and knowledge of our clients needs, improving our care standards, resulting in a reduction of ambulance call outs, A&E visits and admissions.”
Mihir Shah, Burleigh House Residential Home
If we consider total A&E attendances per 100 resident population, and perform confidence interval tests, there seems to be some meaningful difference (1 s.d.) between our Wave 1 care homes and those that didn’t receive the training at October 2015 when the training completed.
Training started Training finished
A&E attendances per 100 Care Home population
Community Contacts
Training
• The wave 1 residents show a higher rate of community contacts than the non-wave residents.
• The rate of community contacts has significantly increased since the training commenced to it’s highest level in Oct 2015.
Emergency Inpatient Admission Length of Stay
Training
• This indicator describes how many days on average were spent in hospital as an emergency admission by care home residents who were still in residency.
• Following training, wave 1 residents spent less time in hospital than the non-wave residents.
• Consistent with the fall in rate of admissions during this period.
Mental Health Admissions
Training
• Following the completion of the training, none of the wave 1 residents were admitted to a mental health provider. (From December onwards).
Lessons learnt
Engagement
Managers support
Spread out training
Ongoing support
Levels of learning
Volume of coursewor
k
Building Blocks- Summary
Summary
The Problem
Mandate
Project Team Analysis
Development
Engagement Delivery
Support
Evaluation
The Problem Mandate
Project TeamAnalysis
Development
Engagement
DeliverySupport
Evaluation
Complex Care Framework training model
41
Questions?
Closing
Thank you for your time today.
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