Whittington Health
Dr Katie Coleman, Paul Sinden,
and Whittington Health
5 December 2013
Whittington Health (CCG)
CCG position statement to the trust following publicity on the estates strategy :
•
Whittington Health provides both hospital and community services to Islington residents.
Opportunity to better align services in and out of hospital
•
Success of trust as Integrated Care Organisation (ICO) central to CCG strategy.
•
Support for trust application in 2014 to become a Foundation Trust in order to maintain the ICO
•
Options for the trust in the future:
 Maintain ICO as a Foundation Trust
 Merge with an existing Foundation Trust. Local FTs include UCLH, Royal Free Hospitals,
Homerton, Camden & Islington NHS Foundation Trust
 Merger may risk separation of hospital and community services.
 Acquisition
Whittington Health (CCG)
CCG position statement to the trust following publicity on the estates strategy :
•
ICO provides an opportunity to better align services in and out of hospital
•
Hospital services will change in the future as the ICO moves more services into the community
•
CCG supports service changes with good clinical evidence and improves patient outcomes
•
Assurance that decisions about cost improvements are not at expense of quality and safety
•
Maternity business case to expand capacity
•
Workforce numbers overall are not expected to change at the trust, but composition across
acute/community, specialities, and skill-mix may change in line with service changes
Whittington Health (CCG)
CCG has invested in trust services in line with support set out in position statement
CCG recurrent investment £2m in last 2 years:
• Children’s services – specialist nurses; speech and language therapy; practice nurses, CAMHs
• Adult services – community geriatrician; community equipment; diabetes consultant; audiology
CCG non-recurrent investment £1.7m in last 2years:
• Short-term funding to improve quality and processes
• Winter pressures – additional capacity to cope with additional demand
• Quality standards – Institute for Healthcare Improvement; pressure sores; theatre utilisation
Qualitative focus with the trust:
• Quality of community services – podiatry; physiotherapy; district nursing
• Enhanced recovery
Service developments in 2013/14
(Whittington Health)
 Specialist nurses in community; vitamin drops; speech & language therapists;
immunisations uptake improved; youth health trainers
 Community geriatrician; COPD pathways; closing the prevalence gap; diabetes
year of care
 Quality of Community services – podiatry; physiotherapy; district nursing
 Children’s services – practice nurses and specialist nurses
 Enhanced recovery
Service developments in 2013/14
(Whittington Health)
 Video from Kings Fund
http://www.youtube.com/watch?v=3Fd-S66Nqio
Whittington Health Questions
1. How should hospital and community services be organised to
deliver care to the local community in the future?
2. What are your concerns / hopes for future hospital and
community services?
3. What services do you value in the Whittington?
4. What services do you feel the Whittington needs to provide?
5. Would you like us to do a similar agenda item with other
providers e.g. UCLH, LBI, Camden and Islington Mental Health
Foundation Trust?
Being supported in your community
Paul Sinden
5 December 2013
What are the main aims and objectives of supporting
people in the community?
‘I want to be treated as
a whole person and for
you to recognise how
disempowering being ill
is’
‘I want to have longer appointments with
someone who is well prepared so that I
do not have to tell my story again
Care planning
My goals /
outcomes
‘I want my care to be
coordinated and to
have the same
appointment systems
across services’
‘Better access to
health care through
social services and
vice versa”
‘No clear systems and
processes through all
healthcare services’
Information
‘Person Centred
Co-ordinated Care:
The Islington Way’
‘I want to feel supported
by my community and
get the most out of
services available locally’
‘I want to be listened to
and be heard’
Communication
Transitions
Decision
making
‘Helping people to help
themselves’
Working together: COPD NHS innovation challenge prize 2013
Integrated respiratory consultant across
secondary & primary care
Clinical leadership & support
Incentivised GPs to proactively identify,
diagnose & manage
Supportive self-management
Focus: Early diagnosis & management to prevent further illness & death
Multi-disciplinary partnership: instrumental to introducing & promoting coordination &
integration of COPD care
Emphasis on self-care & lifestyle
Focus on community assets
Education in primary care
Skill-building, networks & clinical champions
OUTCOMES
 25% increase in diagnosed prevalence between 2010 - 2013
 93% increase in referrals to pulmonary rehabilitation between 2010-2012
 72% of people on COPD register now have self management plan
 16% decrease in emergency admissions in 2011/12 vs 2010/11
N19 pilot and community wards
Setting the pilot up:
• Live in N19 area
• Be referred through hospital or social care access pathways
• Need rehabiliative services from reablement, OT, REACH or CRT
• Improve service user experience by one person coordinating support with one person
managing the service user’s care
• Improve outcomes for service users by ensuring right professional input at the right
time
• Reduce emergency admissions and readmissions and emergency department
attendances.
• Evaluation is currently taking place for the pilot initial figures show it has been
positive:
• 84% of service users rated very or fairly satisfied
• 92% of service users felt it was clear who was coordinating their care
Questions
• Where do you see areas of greatest need for funding health services –
community, prevention or for acute problems?
• Tell us why you have given us this answer and what concerns you have?
• What are the problems facing the NHS? What could be the solutions?
When discussing please consider such prompts as:
• Practical issues such as Do Not Attends in appointments
and unnecessary GP or A&E attendance
• How do we support people to be healthier and prevent
lifestyle behaviours which impact poorly on health such as
obesity
• How do we prevent people getting LTCs / support them
when they do
• Strategic issues such as less funds and privatisation.
Supporting people to have the best
wellbeing (self care)
Dr Katie Coleman
5 December 2013
‘Self care’ and what this means
• People being supported to look after themselves.
• ‘self empowerment’ – being empowered by being given the
ability to make choices, to be listened to and to be heard.
• ‘you are disempowered by being ill. You need services which
empower you as you find that you lose your voice’
• Its about care and not medication / medical help. It was felt
this ethos can get lost.
• ‘patients need to not have to be an expert.’ - those patients
who have lower activation levels are intrinsically more scared
and overwhelmed by self care.
• To ensure that patients don’t feel scared – they need
knowledge and to be empowered to make choices.
What are we doing around self care?
•
•
•
Self care review with patients
• Tools and pilots to support self care
PAM:
Care plans can be tailored for each patient and integrated into their care
•
Provides a method to evaluate efforts to increase motivation
•
The degree to which we can support and improve patients’ abilities determines in large
part their health outcomes.
•
Currently surveying our 44 000 patients who have LTC to discover their activation level.
•
•
Self management programmes
Shared decision making
• Helping patients reach a decision – when they hit a crossroads in their health
care,
• Where a simple choice is not possible, rather a number of treatment options
need to be considered.
• Decision Aids
• Clear and easy information to the patients on the condition and the treatment
options. (In depth pathway tools, apps, website, printed out sheets, films).
Questions
Questions:
1.
How can people be supported to stay out of hospital
and be looked after in the community?
2. How can you help support lifestyle change in the local
community?
II.
What support skills do you need to do this?
3.
Do you feel your life and community supports your
health and why? (Please think about non medical factors
such as your social networks, your home and your personal
interests).