East Midlands High Impact Change Model (HICM) Event 4 October 2018, - - PowerPoint PPT Presentation

East Midlands High Impact Change Model (HICM) Event

4 October 2018, 09:30-13:00 Yew Lodge Hotel, Kegworth

Purpose of the Event

• To discuss and share innovative practice in

implementing the model

• To explore some of the opportunities and

barriers to using various aspects of the model

• To contribute towards a refresh of the model

for 19/20

Local Context / East Midlands Journey

Ruth Lake - Regional Admissions Avoidance and Discharge Network Chair, ADASS East Midlands

East Midlands Regional Overview

Ruth Lake Admissions Avoidance and Discharge Network Chair

East Midlands Journey

Engaged Improving HICM Progress Home First Being able to tell our story

Delayed Transfers

2 4 6 8 10 12 14 16 All Jul 17 All Jul 18 ASC Jul 18

Average Daily DTOC Bed Days / 100 000

National

High Impact Change Progress

HICM * * * *

HF / D2A

* TA Not yet started Plans in place Established but not fully Fully established Mature * Exemplary

Regional AA&D Priorities

• Reducing avoidable admissions to hospital and long term care
• Maximising the impact of social work at the acute front door
• Maintaining / improving DTOC
• Progress on HICM
• Supporting best practice
• Meeting national expectations (LOS, BCF)
• Being prepared for winter
• IPC
• Care Homes

National Overview of DTOC/Patient flow

Liz Sargeant - Clinical Lead, Emergency Care Intensive Support Team

MC1

Slide 9 MC1 LOGOS

MacGregor, Calum, 12/09/2018

Behind every Delayed Transfer of Care, there is a person, in the wrong place at the wrong time A ‘delayed transfer of care’ occurs when a patient is ready to leave a hospital or similar care provider but is still

• ccupying a bed.

DTOC – the story so far

DTOC has been a persistent problem over many years (national reports into DTOC since early 2000s) More recently….

• National Audit Office Report (2015) - Discharging older patients from hospital

– 5% muscle strength that older people can lose per day of treatment in a hospital bed – £820m gross cost to the NHS of older patients in hospital beds who are no longer in need of acute treatment.

• National Strategy to address DTOC

– Care Act (2014)

• Legislation outlining LAs duty in relation to assessing people’s needs and their eligibility for

publicly funded care and support – BCF National Conditions (New condition 4 (2017)

• Requirement for Social Care to work with NHS to implement High Impact Change Model to

manage delays in transfer of care (expectations published)

• iBCF monies

– NHS Five Year Forward View Next Steps

• Mandate for NHS to work with Social Care to reduce DTOC

– CQC Local System Reviews (interface of Health and Care) – Increased collaboration centrally between national partners

• Delayed Discharge Programme Board - Strategic (DHSC, NHSE/I, LGA, ADASS, MHCLG,

CQC, BCST

• Discharge Steering Group - Operations (NHSE/I, DHSC, LGA ADASS, BCST, MHCLG)

• There has been significant improvement in DTOC over the past 18 months

– in the face of persisting challenges (workforce, finances/austerity, commissioning complexity)

• By far, the most critical and important work has come from YOU

(frontline colleagues)

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 1,000 2,000 3,000 4,000 5,000 6,000 7,000

% of occupied consultant-ld beds Number of delayed days

Joint Social Care NHS Total Ambition

Underpinning the data are numerous examples nation-wide, of health and care colleagues going above and beyond the call of duty, working together to ensure patients are not delayed unnecessarily in hospital – THANK YOU!

DTOC – the story so far

Despite the significant progress…

• 4500 patients still in hospital every day (who don’t need

to be there)

• we have to keep up the work nationally, locally and

individually. Nationally - a focus now beyond DTOC to reducing delays through out the entire patient journey

• Ambition to reduce DTOC to 4000 beds by the latter part
• f 2018
• Ambition to reduce extended length of stay
• Provide support to local systems

DTOC – the story so far

National Support

Providing support to systems so that people get the right care, right place and right time and encouraging the development of home first principles Programmes

• 1. Enhanced – 14 system reviews across 9 areas to really understand why

transfers of care remain a challenge

• 2. Targeted – Tailored Peer Reviews to meet the needs of the system
• 3. Universal – HICM regional events, Learning from CQC events, Why not

home, Hospital Discharge/Home First Practitioner Events Tools (Links included)

• Better Care Exchange / Bulletins
• LGA Guidance documents
• Webinars
• DTOC Improvement tool (NHS Improvement)
• Quick Guides (NHS Improvement)
• HICM (see next slide)

• It was developed by national partners in 2015 to promote a

new approach to system resilience and year around planning for timely discharge

• The model identifies eight system changes which will have

the greatest impact of reducing delayed discharge Why refresh the HICM

• To take account to new national guidance, address

persistent implementation challenges and align guidance to reducing extended length of stay, improving patient flow and early intervention and prevention agenda.

High Impact Change Model

• We are keen to understand and collect an

evidence base on what works and why some areas are challenged than others.

• We know that local leadership and collaborative

working, investment in workforce and investment do have a role to play.

• We are also keen to explore whether a

combination of national, local and regional support in this area works best

Understanding what works

Trusted Assessment – Overview of national position

John Woods - Social Care Lead, NHS Improvement

MC1

Slide 17 MC1 LOGOS

MacGregor, Calum, 12/09/2018

Trusted Assessments

John Woods Improvement Manager (Social Care)

19 |

Why Have a Trusted Assessor? Trusted Assessor or Trusted Assessment? Do you need a T A? Getting Going / Checklist Myth Busting

Agenda.

Presentation title

20 |

Its number 6 in the 8 High Impact Changes. NHS England, NHS Improvement, The Department of Health and Matt say you should. They will count towards performance targets. The lack of them could effect your budget. None of the above – even if they are true.

Why have a Trusted Assessor

Presentation title

21 |

.

Presentation title

22 |

What is A Trusted Assessor

• A person carrying out an assessment on

behalf of a third party

• A person working for & employed by the

Independent Care Sector (ICS) who’s primary role is carrying out assessments to allow for prompt discharge to care and support in the community inc’ at home

• A person employed by the Health or Social

Care who’s primary role is carrying out assessments to allow for prompt discharge to care and support in the community inc’ at home

• A person employed by Health or Social

Care who’s primary role is associated with managing discharges from hospital and in addition can carry out assessments to allow for prompt discharge to care and support in the community inc’ at home.

• A Trusted Assessor completes a bespoke

and agreed assessment for a specific purpose.

Presentation title

23 |

What is A Trusted Assessment

• Using an assessment that was designed for one

purpose to serve another.

• A assessment carried out during the course of

someone's treatment in hospital that is subsequently accepted and used for a different purpose e.g.

• A physiotherapist or Occupational therapist

assessment used to support acceptance , upon referral of someone into a discharge support service e.g. discharge to assess

• A ward nurse assessment being used to

commission and start a community health package.

• A Dr’s report being used to start an interim

support package from Adult Social Care

• A Trusted Assessment is completed for one purpose

but also used for a second purpose with the agreement of both parties.

Presentation title

24 |

When & Where

• Transfers from hospital to an

existing support package.

• Transfer of patients to an

interim support package e.g reablement or intermediate care.

• New admissions to residential

care & New packages of domiciliary support.

• Care Act Assessments.
• Assessments for occupational

therapy equipment.

• Anywhere else you want to

chase delays out of a process

Presentation title

25 |

How Do you Know a TA is what you need?

Presentation title

Do you have delays in getting assessments e.g. ASC, D2A, HBC

• completed. (not

just DTOC) NO, pat yourself

• n the back and

carry on doing what your doing Yes then go to next question. Why is there a delay? Is it because the process is complicated and drawn

• ut e.g. requires sign offs

from managers off site. If so, consider a process redesign workshop perhaps using process mapping.

Is it because the assessment tool itself is cumbersome and unwieldy? If so hold a redesign workshop. Is it because the assessor’s situation or workload is such they cannot carry out the assessment when required. If so, then you should consider a trusted assessment/assessor.

26 |

How Might you set it up?

Presentation title

MAP THE STAKEHOLDERS INVITE STAKEHOLDERS TO A CO-DESIGN MEETING N.B. – IF YOUR ASSESSMENTS ARE FOR THE INDEPENDENT CARE SECTOR THEY MUST BE INCLUDED, AND IT MAY BE BEST TO GO TO THEM E.G. THE LOCAL CARE FORUM. EXPLAIN THE PROBLEM AND SEEK CONSENSUS ON A SOLUTION.

THE MEMBERS OF THE GROUP FEEL CHANGES OTHER THAN TA COULD IMPROVE

• MATTERS. –

EXPLORE THESE OPTIONS FIRST THE MEMBERS OF THE GROUP WANT TO EXPLORE TA.

27 |

Next Steps

Presentation title

Can you access funding to develop a scheme.

No then look to see what existing posts might lend themselves to the role. Yes what’s the size of the problem = how many staff.

Look at the TA guidance and draw up a set of agreed principles. These will form the framework for your design team. The stakeholders nominate a small design team to come up with a workable solution to bring back to the larger group.

28 |

Checklist

• Consider the strength and maturity of

relationships and trust between local health and social care commissioners and providers, and agree any steps to be taken to support improved trust and relationships as part of plans to develop and implement a trusted assessment service

• Bring all stakeholders together to begin

the co-design process

• Establish a set of common/shared
• bjectives for the trusted assessment

service

• Consider how others have developed

the service as part of your discussions

Presentation title

29 |

Checklist

• Agree what kinds of assessment will be

included in the service

• Co-design a streamlined process end

to end

• Agree who can be a trusted assessor
• Agree competencies and put in place

training requirements

• Build clear frameworks and a feedback

loop/hotline into the model

• Agree metrics to be used to monitor

how the service is operating and its impact

• Agree where the service can be put in

place quickly

Presentation title

30 |

Myth busting – trusted assessment is:

• Not about forcing trusted assessment on systems
• If your system does not have delays in discharge

caused by delays in assessment you may not need to develop a trusted assessor approach.

• Not about forcing trusted assessment on providers
• A provider cannot be forced to take a trusted

assessment and in any event, they should be part of its development or it will not work.

• Not necessarily about costing more
• In fact, trusted assessment could be free if you

use existing resources, or relatively inexpensive if you share the costs between several

• rganisations
• Not about moving costs from health to social care or

vice versa

• Trusted assessment is not meant to change the
• utcome, just to speed it up.
• Not about denying people a full assessment
• The assessment should be as detailed as is

necessary to reach the next stage.

Presentation title

31 |

Myth busting – trusted assessment is:

• Not about slowing up the process
• Trusted assessment is meant to speed up

the process. If it does not, it is being done wrong.

• Not about moving people home from hospital

without the right support and without their consent or a best interest’s decision

• The laws and guidance still apply as they

did before.

• Not about transfer of responsibility
• If a trusted assessment is carried out on

an organisation’s behalf, that

• rganisation is still responsible for both

the assessment and the outcome.

• Not about discharging people from hospital

before they are clinically ready

• A trusted assessment comes in when the

system needs speeding up, but not sooner than is appropriate.

Presentation title

32 |

Myth busting – trusted assessment is:

• Not illegal
• Trusted assessment is referenced in The

Care Act 2014

• Supported by The Care Quality

Commission.

• Not only for hospital discharges
• It can be used in lots of areas including

making eligibility determinations.

• Not really that hard
• If the wills there it’s doable and you can

put in safeguards.

• Not going to change the world
• It’s good but not that good.

Presentation title

33 |

Summary

• Be clear what problem you are trying to solve
• Have you got delays in assessments due to

resource

• Where and what’s the impact
• Co-Design your solution
• Involve those involved in design and decisions
• Keep your options open – e.g. assessment or

assessor

• Clarity of purpose
• Be clear which assessments are included, who

can do them etc.

• Who will run the service
• Integrate & Expand
• Make them part of the team and provide a

feedback loop both ways

• One assessor or area is ever enough
• Record and Evaluate
• You will have useful data to help with mkt

development and ensure the service is performing.

Presentation title

34 |

• john.woods2@nhs.net / john.woods.consulting@gmail.com
• Rapid Improvement Guide
• https://improvement.nhs.uk/resources/rapid-improvement-guide-trusted-assessors/
• Trusted Assessments - Essential Elements
• https://improvement.nhs.uk/resources/developing-trusted-assessment-schemes-essential-

elements/

• Quick Guides
• https://www.nhs.uk/NHSEngland/keogh-review/Pages/quick-guides.aspx
• Better Care Exchange
• https://future.nhs.uk/connect.ti/system/login?nextURL=%2Fconnect%2Eti%2Fbettercareexch

ange%2Fview%3FobjectId%3D9820976#9820976

Further Information / Help

Presentation title

35 |

Questions

Presentation title

36 |

They do it in Linc’s

Presentation title

This Photo by Unknown Author is licensed under CC BY

Care home trusted assessor (CHTA)

Working together to improve transfers from hospital to care homes Melanie Weatherley Chair, Lincolnshire Care Association (LinCA) melanie@walnutcare.co.uk

What does a Care Home Trusted Assessor do?

Support for busy Care Home Managers

An independent, experienced individual who is there to support the Care Home

Manager to facilitate timely discharge

Ask the questions and gather the information needed Make sure the check lists have been done Report back in an agreed format

Available at the hospital when the resident needs them

Support for the Discharge Team

Able to respond as soon as a placement is agreed Liaison between hospital and care home on an equal footing

Support for the Health and Social Care System

Reduced cost of delays – human and financial

Who can be a Care Home Trusted Assessor?

Experience of Managing Residential Care must have done pre-admission assessments Preferably with nursing experience Able to interpret hospital notes Able to work with the discharge team, But stay independent Excellent Communicator Professionally Curious Able to build trust – integrity is essential Part time or full time

Why have a Care Home Trusted Assessor?

People need to be home as soon as they are ready, Delayed transfers of care cost money Lack of trust and understanding between partners Getting to hospital can be challenging for busy

managers

CHTA can be a way of working together to speed up

the process

Developing the Care Home Trusted Assessor Role

Key factors of our success to date – OWNERSHIP brings TRUST

Assessor is answerable to (ideally employed by) the Care Home Sector Service is available to all, but not mandatory Care Home documentation is used where appropriate CHTA must not place individuals Independence from all parties – individual care homes can be challenged if appropriate

Recognising the importance of the information collected

Granular level information about delays Trends spotted in a timely manner (end of the week not the quarter)

Statistics in first full year

439 referrals 340 Assessments Completed 304 discharges Total days saved 735 Total Savings £400K (Net)

Consultation – future of High Impact Change Model (HICM)

Liz Sargeant - Clinical Lead, Emergency Care Intensive Support Team (ECIST) Mala Mistry - Advisor, Local Government Association

• HICM was introduced in 2015 as a

improvement toolkit to help health and social care systems consider a implementing a series of Changes in order to reduce DTOC and improve patient flow.

• This year, there is a ambition to refresh the

model to better links with emerging national agendas on improved patient flow, community support and reducing length of stay.

Introduction

HICM Refresh Questionnaire

• Below is a link for the HICM refresh

questionnaire, This is a further opportunity for you to provide feedback as a means of informing the refresh of the HICM. It should take around 10 mins to complete.

• For reference the HICM can be found here

http://survey.euro.confirmit.com/wix/p1866998059.aspx

• To find out how you use the model and your views on how

this could be improved?

• To find out what has been most useful / least useful when

implementing the model and considering the impact it has had

• To find out what you what you think the gaps are in the

current model and how you think it should be improved and why The views from this workshop will directly feed into collecting the evidence base for revising the current HICM.

Purpose of the workshop

Stage 1

Spend 20 minutes considering the following questions

• Q1. How do you use the HICM and what is missing?
• Q2. What Change has had the most / least useful in

improving patient flow and why? Use prompt questions provided that are on the tables

Stage 2

Spend 20 minutes considering the following questions

• Q3. How do you think the HICM could be

improved? Please make use of the prompt questions for this question provided on each table.

Next Steps

• Understanding the key themes from each of the

nine HICM refresh workshop

• Set up of a National Reference Group of

practitioners to act as a sounding board for the development of the refreshed HICM.

• Aim is to publish refreshed model by April 2019