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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