Ageing Well and Digital Programme Skills for Care event, 23 May 2019 - - PowerPoint PPT Presentation

NHS England and NHS Improvement

Health and Social Care Integration- Ageing Well and Digital Programme

Skills for Care event, 23 May 2019 Tom Luckraft and Pallavi Kaushal NHS England

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1.Quick guides 2.Long Term Plan- Ageing well programme 3.NHSmail for Social care providers 4.Interactive discussion 5.Concept testing NHSmail communications

Agenda

Presentation title

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A suite of published Quick Guides can be found at www.nhs.uk/quickguides.

• Improving hospital discharge
• Discharge to assess
• Improving hospital discharge to care sector
• Supporting patients’ choices to avoid long hospital

stays – Patient leaflet, easy-read and policy document

• Sharing patient information
• Better use of care at home
• Health and housing
• Better use of care at home
• Sharing patient information
• Enhancing health in care homes
• Quick Guide: Hospital Transfer Pathway – ‘Red Bag’
• Identifying local care home placements
• Technology in care homes
• Managing care home closures – Management

checklist, stakeholder duties and powers

• Clinical input to care homes
• Sharing patient information

Quick guides

Presentation title

Rapid Improvement guide: Trusted Assessor resources

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NHS Long term Plan

• NHS Long term plan shows how the NHS is

going to be using its new funding of an extra £4.5 billion a year in real terms by 2023/24 to improve staffing and expand needed services.

• The Ageing well element of the NHS Long term

plan focusses on addressing the concerns about funding, staffing, increasing inequalities and pressures from a growing and ageing population.

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What is policy seeking to achieve for older people?

Key outcomes: 1) Care that makes sense to people (and their carers and families) 2) People get what they need, when they need it.

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Three national priorities for older people

• 1. Change in approach to health & social care nationally
• 2. Preventing poor outcomes through active ageing
• 3. Quality improvement in existing acute & community services

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Words matter: be careful using the F-word

• Elderly =adjective: advanced age, old
• Frail=adjective: easily broken, not robust, weak
• Frailty = noun: the quality or state of being frail [and not exclusively biomedical]
• Older: adjective: comparator of old
• Ageing=verb: to grow old a normal phenomenon

The frail elderly = not robust & old: ‘an inevitable end state for everyone’ People with frailty = people with specific needs + preferences Ageing well = growing old positively: many can achieve this

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What’s the national approach?

‘The frail Elderly’

‘An Older Person living with frailty’

A long-term condition

Hospital-based episodic care

Disruptive & disjointed

Late Crisis presentation

Fall, delirium, immobility

Timely identification

preventative, proactive care supported self management & personalised care planning

Community based person centred & coordinated

Health + Social +Voluntary+ Mental Health + Community assets

FROM THIS TO THIS

Frailty is being used here as a paradigm

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System challenges & opportunities

• People with varying

degrees of frailty don’t always get the care they need in the right setting and at the right time- Source: People first, manage what matter, Newton Europe, 2019

• Hospital interventions

for some people with frailty are limited in efficacy

• National audit data (NAIC 2017) suggests intermediate care capacity needs to increase

& improve responsiveness

• Enhanced health support to care homes is not consistently offered across the country

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Social Care

• Wellbeing of older people and pressures on the NHS linked to how well social care

functions

• When agreeing the NHS’ funding settlement government committed to ensure that adult social

care funding is such that it does not impose any additional pressure on the NHS over the coming five years

‘That is basis on which the demand, activity and funding in the Long Term Plan have been assessed’

A tactical approach to managing complex needs nationally 2017-18: introduction of the GMS frailty requirements

• Routine identification of severe (and moderate) frailty
• Annual medication review and falls risk identification
• Sharing frailty information via the Summary Care Record

2019: NHS Long Term Plan

• Ageing well community MDTs for 1.2m people with moderate frailty
• Urgent community response
• Crisis response delivered in 2 hours
• Reablement delivered in 2 days
• Guaranteed offer of enhanced health in care homes

Ageing Well-new model for people with complex needs

• Funding for delivering the three models agreed through the LTP process –

includes central funding agreed specifically to support delivery of the 2 hour / 2 day standards by 2023/24.

• Joint workforce planning would be a common golden thread running through all

the 3 workstreams.

Urgent Community Response

• Deliver clearly defined crisis response services within two hours of referral across

the country – within five years to avoid unnecessary hospital admission and support same day emergency care

• Deliver clearly defined reablement care within two days of referral to all those judged

to need it across the country – within five years to reduce unnecessary hospital stays

Enhanced Health in Care Homes (EHCH)

• Upgrade NHS support to all care home residents who would benefit by 2023/24,

with the EHCH model rolled out across the country across the next decade as staffing and funding grows

Community Teams

• From 2020/21 have primary care networks assessing local populations at risk and

working with local community services to support people where it is needed most through targeted support

• Support the expansion of the existing community dataset
• Support the commitment to greater recognition and support for carers

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Key LTP Commitments - UCR: 2 new service standards

1.8 a) – All parts of the country will implement and improve the responsiveness of community health crisis response services to deliver the services within two hours of referral in line with NICE guidelines, where clinically judged to be appropriate 1.8 b)– All parts of the country should be delivering reablement care within two days of referral to those patients who are judged to need it 1.8 c) – More NHS community and intermediate health care packages will be delivered to support timely crisis care, with the ambition of freeing up over one million hospital bed days by 2023/24

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Key LTP Commitments - Community Teams

1.9. The £4.5 billion of new investment will fund expanded community multidisciplinary teams aligned with new primary care networks based

• n neighbouring GP practices. Most CCGs have local contracts for

enhanced services and these will normally be added to the network contract. Expanded neighbourhood teams will comprise a range of staff such as GPs, pharmacists, district nurses, community geriatricians, dementia workers and AHPs, with social workers and the voluntary sector. 1.17 Using a proactive population health approach focused on moderate frailty will enable earlier detection and intervention to treat undiagnosed

• disorders. Based on their individual needs and choices, people identified as

having the greatest risks and needs will be offered targeted support for both their physical and mental health needs, which will include dementia and frailty.

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Key LTP Commitments - EHCH: the care home guarantee

1.15 – We will upgrade NHS support to all care home residents who would benefit by 2023/24, with the EHCH model rolled out across the whole country over the coming decade.

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Enhanced Health in Care Homes model

• A programme that will roll out the successful

Care Home Vanguards ‘Enhanced Health in Care Homes (EHCH)’ model nationally to help address variability in access to health care and ensure that all care homes residents receive holistic/integrated care

• The programme will involve the delivery of

enhanced primary care/specialist support in care homes, regular multi-disciplinary team resident reviews, aligned with rehabilitation services where these are provided, and support timely access to out of hours support and end of life care

• Intended key outcome: improving the

provision of care across all care homes. Enhanced Health in Care Homes

III

Case study Analysis of the Wakefield Enhanced Health in Care Homes programme has shown a 27% reduction in ambulance calls from care homes for falls, and a 28% reduction in hospital bed days.

Domain 7 of EHCH framework is around Data and Technology. A key work programme associated with it is the NHSmail for social providers to improve communication between health and social care.

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• Digital Solutions focused om the

individual; enabling excellent medical supervision, with contributions from a truly multidisciplinary team.

• Irrespective of where the person

is located, whether in a hospital, care, home , or as most people are, in their own home.

• However, despite pockets of good

practice, currently information sharing with social care providers to support the person is in the main, still posted or faxed.

• Digital information sharing between

health and social care systems appears to be largely absent.

Integrated Care

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• NHSmail is a secure, centrally funded platform to support

collaborative working across health and care.

• Available since year 18/19 to Care Providers after completing the

Entry Level of the Data Security and Protection Toolkit (DSPT).

• Using NHSmail can improve the care of patients/residents
• by supporting their timely discharge back to the place they

call home.

• the ability to email discharge information can also improve

medicines management for patients.

• improve communication between health and social care

settings, supporting integrated and person-centred care.

• a safe and secure method for exchanging patient identifiable

data between healthcare professionals, GPs, pharmacies, hospitals and social care providers.

• Online information including NHSmail registration routes, offer

with add on features, benefits and social care case studies on the NHS Digital website

• In case organisations wish to continue using their in house email

systems, there is an expectation for systems to be secure. See here for more details on the secure email accreditation process.

Secure email- NHSmail

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NHSmail Benefits

Hospital Nurse prints details of change of care and treatment Hospital Nurse collects print out Faxes print out to care providers Care professional collects print out Adds detail to care provider system (often computerised) Both professionals pay to dispose of confidential fax.

20-30 minutes per care record/discharge summary

Hospital Nurse copy and paste changes in care and treatment to email. Sends Care providers attach

• r copy/paste details

from email to care plan

2-3 minutes per care record/discharge summary

Using an all too familiar method of information transfer Replacing this method with NHSmail

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NHSmail used for….

Presentation title

sharing of sensitive information with local authorities such as Deprivation of Liberty (DOLS) applications, housing bidding and enquiries, safeguarding incidents and enquiries, change of circumstances for example, financial assessment, changes in need. sharing information relevant to police and probation services receipt of discharge summaries and admission notes from local hospitals sharing of referrals, community psychiatrist nurse (CPN) reviews and care planning with mental health trusts or receipt of referrals to the acquired brain injury and neuro- rehabilitation unit sharing of GP patient records and referrals funding enquiries with clinical commissioning groups (CCGs) ambulance service – observations and safeguarding

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Baseline:

• >1% (approx.141) social care providers have completed IG Toolkit - DSPT predecessor

(April 2018). DSPT annual update is required. 2018/19 year end report: Aim: 10% of care providers to be DSPT compliant by 31 March 2019. (DSPT reports were made available from July 2018).

• 2018/19 Year end report: 3,334 (12.3%) care providers achieved DSPT compliance;

5.016 (18.4%) initiated DSPT.

• 342 (1.3% of total) care providers have an active NHSmail account through National

Administration Service (NAS)

NHSmail/DSPT uptake 2018/19- national

All All All All All All All All All DSPT registered 335 430 501 566 782 888 1131 1398 5016 DSPT entry level achieved 11 20 51 93 2261 DSPT standards met achieved 20 31 33 39 92 112 135 239 1073 1000 2000 3000 4000 5000 6000 Number of care provider organisations

Data Security and Protection Toolkit uptake by Social Care Providers- 2018/19

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Di Digi gital tal In Inte tegr gration ation ro road admap map fo for care re pr prov

• vide

iders rs

GP system- EMIS, SystmOne access Advanced Care Planning Shared care records, Local Health care records exemplars Tele-triage, Skype for audio/video conferencing Summary Care records Instant messaging

• n Skype

NHSmail

Standards met/exceeded DSPT compliance

Entry level DSPT compliance

Digital Maturity of Care Providers

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• Contractual requirement for those providers operating under a NHS

Standard Contract to complete the DSPT.

• The Department of Health and Social Care recommend that all social

care providers complete the DSPT as they will hold, process or share personal data.

• DSPT is aligned with GDPR compliance.
• Long Term Plan (LTP) - section 1.15: Care home staff will have access

to NHSmail, enabling them to communicate effectively and securely with NHS teams involved in the care of their patients.

• The LTP also commits to upgrading support to all care home residents

by 2023/24 through the Enhanced Health in Care Homes (EHCH) model – which includes secure email access within the ‘Data, IT and Technology’ care element of the model.

• EHCH is one of the services with included within the Enhanced GP

contracts 20/21 onwards.

• Links with Secretary of State’s Digital vision.
• Government’s commitment for hospital trusts to ‘Axe the Fax’ by 2020.
• GP Contract mandate: ‘Axe the Fax’ by 2020.

Programme enablers

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• DSPT Webinars- to assist completion of DSPT are scheduled,

Information on these webinars is available here.

• DSP toolkit guidance (for both entry level and standards met levels):

available on Care Provider (CPA) alliance website.

• Helpline and support
• Register : https://www.dsptoolkit.nhs.uk/Account/Register
• Presentation developed to be used by IG Leads:

https://www.dsptoolkit.nhs.uk/News/25

• FAQs including Training Tool:

https://www.dsptoolkit.nhs.uk/News/9

• DSP Toolkit Support available through: Exeter.helpdesk@nhs.net
• DSPT and NHSmail training materials and resources are available here.
• Whilst all care providers were able to begin the process required to

access NHS mail utilising online support tools, in 2018/19 the implementation support resources were focussed on Wave One areas- 10 established ICS/Devo areas and 4 self selected areas (London, Derbyshire, Norfolk, Cheshire & Merseyside).

• 2019/20 implementation delivery model under consultation with regional

care sector leads.

Implementation support

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System engagement at all levels required for realising NHSmail benefits!!

Call for action:

• Select target geographies to achieve critical mass output in defined areas for system

transformation.

• Identify organisations and health care professionals working with social care providers and

share materials to raise awareness.

• Encourage sector led approach and liaise with social care providers in your region
• Inclusion with the ICS/STP/CCG Digital road maps and integration plans.
• Raising awareness about the programme at various regional conferences, meetings,

roadshows and events with partners across health and social care sector.

• Buy-in and support from the following system leaders will be essential.

Raising the programme profile

Social Care

• Local Authority Social care

contract managers

• Safeguarding leads
• Care Network Forums
• ADASS Regional Leads
• Care Provider Associations
• LGA Care Home

Improvement Advisors (CHIAs) Health sector

• Chief executives/Chairs of Hospital/Foundation

Trusts & Teams

• Discharge Liaison Officers & Teams
• Community services & Teams
• Chief Nurses & Teams
• Medical Directors & Teams
• Operations/Performance Management Teams
• Primary Care Networks
• Transformation Teams
• Local Pharmaceutical Committee

NHSE/I

• CCG Accountable Officers
• EHCH & Digital

Transformation Programme Leads

• STP / ICS Accountable

Officers

• STP / ICS Directors of

Transformation

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Programme communication

Coming soon!! NHSmail for social care providers communication strategy and toolkit

• To raise awareness about and increase

uptake of NHSmail to improve speedier and secured communication across health and social care.

• Materials produced will include
• Infographics
• animations videos
• Posters
• Leaflets
• Newsletters
• user case studies
• video content (including success

stories of existing users)

• A dedicated ‘one-stop-shop’ website of digital resources for social care

providers available from June 2019. Beta site available on the link

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• What support should we provide nationally?
• What support would facilitate change?
• What other issues should we consider?

Discussion

Learning from Challenges

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We would like to test two concepts developed within NHSMail communication toolkit to support the NHS England and NHS Digital Communication Strategy. This toolkit is meant to be non branded for use across Health and Social Care at a national, regional and also adaptable at a local level . What we would like you to consider as you review the two concepts is :

• How you feel about the two options (open question to get the

conversation flowing)

• What do you think it means to you in your role - i.e. Do you think this

applies to you, and if so what do you think you could do about it?

• Which boards are you naturally drawn to?
• If you close the materials and think back to material what do you recall

from the images? We would then like you use red and green stickers to highlight what you like and don't like. This will help us to create a campaign that really is meaningful across Health and Social Care.

Concept testing NHSmail communications

Presentation title