Service Transformation Sue Thomas Florence Nightingale Scholar Winston Churchill Fellow CEO Wilmington Healthcare Commissioning
Aims • To give an overview of the current NHS and drivers that impact on MS services • To put MS services into the context of the NHS today • To highlight how service transformation can improve care • To provide thoughts on which areas of your own services might be useful to explore
The Long Term Plan for England
National Action Plan on Neuro Conditions (Scotland)
National Action Plan on Neuro Conditions (Scotland) General Standards for neurological care and support 1. Leadership and governance 2. Partnership working 3. Staff education, training and information 4. Diagnosis 5. Assessment of needs 6. Treatment and management 7. Person- centred care
Patient Care – as we know it multiple organisations, with multiple contracts Source MS Trust
Transforming and integrating care In a traditional patient pathway c are is provided by multiple organisations, with multiple contracts The NHS is now implementing the Long Term Plan for health and social care, where all providers will need to work together as a partnership under one contract, providing care more effectively and more GP efficiently . Hospital Trust Independent imaging providers Community Trust Mental Health Social services Ambulance Trust Traditional patient pathway for MS https://www.england.nhs.uk/long-term-plan/
Main influencers on care Workforce Money Integration Technology
GIRFT "Not everything that counts can be counted ; and not everything that can be counted counts ." “Getting it right first time” www.gettingitrightfirsttime.co.uk • Using data to improve clinical practice • Identifying cross cutting themes and facilitating people working together. Implementation teams operating across 7 regional hubs provide a management structure to facilitate changes and support clinicians to working together in teams. There are currently 46 clinical leads across the workstreams driving forward changes. • By tackling variations in service delivery across and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as the reduction of unnecessary procedures and cost savings • Clinical leads: Geraint Fuller and Adrian Williams • National development of data • Local visits to present audit
Understanding services What types of services do you work in? • Neuroscience centres • Neurology centres with in- patients • DGH Neurology centres without in-patients • DGH with visiting neurologist Source Binleys database 2018
Greater Manchester Hub and Spoke Services Pennine Acute Trust Rochdale Infirmary Royal Oldham Fairfield General North Manchester Bolton Royal Central Greater Manchester Manchester Neurosciences Centre @ Salford Royal &Trafford Wigan, Wrightington Stockport and Leigh Tameside East Cheshire University Hospitals (Macclesfield) South Manchester
Is the MS pathway the same across the area? Richmond MS Pathway
STP ‘s – plan on a page Integrated Care Systems • ICS is an evolved version of the STP • Are these also a potential for MS improvement?
Moving from organisaiton to place based care by 2021
Workforce The workforce challenges in the NHS in England now present a greater threat to health services than the funding challenges – Kingsfund report Nov 18 1 – NHS Trusts face 100,000 staff shortage 1 – 40,000 shortfall in nurses 2 – 20,000 shortfall in mental Health Staff 2 – 10% paramedic vacancy 2 – 700 less GPs PA 1 – 50% district Nursing Posts 2 – Brexit - 12.5 per cent of which is non-British and 5.6 per cent of which is from the EU. • Brexit has created additional risks in both the short and medium term. Already, a net inflow of nurses from the • EU into the NHS has turned into a net outflow: between July 2017 and July 2018, 1,584 more EU nurses and health visitors left their roles in the NHS than joined. Since we cannot instantly train the extra staff that we need, which is to import the staff we need from overseas • 1 https://nhsproviders.org/media/3431/workforce-project-initial-analysis-of-issues-facing-the-provider-sector.pdf 2 https://www.kingsfund.org.uk/sites/default/files/2018-11/The%20health%20care%20workforce%20in%20England.pdf
GP Contract 2019 and Directed Enhanced Services (DES)
Information technology empowering patients
Creating efficiency Highest average CCG cost £2,809 Lowest £991 [Average Cost for a Non-Elective Admission, by CCG] £3,000 £2,000 Average Cost £1,000 £0 CCG
Gathering intelligence
Wessex MS admissions Kipps C, Thomas S, Matthews D (2016) Wessex Strategic Clinical Network Intelligence Report
Sue’s Summary - 10 point plan for transforming your service : 1. Understand the data national and local 2. Understand costs 3. Check on variation 4. Understand their local strategic plans 5. What is the patient pathway, what outcomes are needed in your area? 6. DMD delivery how can you support the wider agenda on variation? 7. Promote the self-care agenda 8. Workforce – understand capacity 9. Engage the voluntary sector 10. Use the MS Academy for support
Thank you Sue.Thomas@wilmingtonhealthcare.com 07801 143122
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