Post on 22-May-2015
transcript
Healthcare Policy in the Area of Long Term
Conditions: Experiences of Yorkshire
Rachel Binks
Nurse Consultant, Critical and Acute Care
Airedale NHS Foundation Trust
Long term conditions
consume -
50% GP appts
64% OP appts
70% IP bed days
70% NHS spend
Our Context
Long term conditions -
much more common
as we age
By 2034 –
5% population >85yrs
x2.5 increase
(compared with 2009)
Diabetes
Complex
Common
Costly
Controllable, but
poorly managed
(process and
outcomes)
Our Context
“…DH position: further efficiency savings in
the NHS will continue after 2015, with the
total savings rising from £20bn to a
possible £50bn by 2019-20…
…A startling admission of the long term
impact on public services of the global
financial crisis and ensuing (double dip)
recession…
…The translation is an NHS that has
barely managed 1% productivity per
annum let alone 5% each year for EIGHT
YEARS…”
John Appelby
Kings Fund
The big picture …
Important relationships
NHS Outcomes
Framework
• The NHS Outcomes Framework reflects
the vision set out in the White Paper and
contains a number of indicators selected
to provide a balanced coverage of NHS
activity.
• Its purpose is threefold:
Purpose
1. to provide a national level overview of how well
the NHS is performing;
2. to provide an accountability mechanism
between the Secretary of State for Health and
the NHS Commissioning Board for the effective
spend of some £95bn of public money; and
3. to act as a catalyst for driving up quality
throughout the NHS by encouraging a change
in culture and behaviour
A complex
Structure
but
many
outcomes
that we can
influence with
telemedicine
Long Term
Conditions
Reducing time in
hospital
Emergency
admissions that
should not need
admission
Helping people
recover
Domain 2
• Enhancing
quality of life
for people
with LTCs
Domain 3
• Helping
people to
recover
from
episodes
of ill health
or
following
injury
Long Term Conditions Compendium of Information
(3rd Edition, 2012)
“It is clear that the NHS, as currently
configured for long term condition care, is
not sustainable in the face of the projected
increase in comorbidity and level of need”
Long Term Conditions
Compendium of Information
• The Department of Health has published
the third edition of the ‘Long Term
Conditions Compendium of Information’.
• It is aimed at commissioners as well as
health and social care professionals, to
provide the evidence for improving care
and outcomes for people with long term
conditions (LTCs).
Whole System
Demonstrator Programme
• This document contains the latest
statistical data on long term conditions,
links to the LTC QIPP (quality, innovation,
productivity and prevention) workstream
and provides data from the ongoing
evaluation of the Whole System
Demonstrator Programme on telehealth
and telecare, which supports the delivery
of 3 Million Lives.
LTCs a priority
• It also showcases examples of innovative projects across the country where organisations and communities are pushing the boundaries to deliver improvements in LTC care.
• The information and evidence captured in this third edition of the compendium continues to reinforce why a focus on LTCs should be a priority.
The Whole System
Demonstrator Programme
• One of the most complex and comprehensive studies the Department has ever undertaken, and has yielded a wide range of very rich data.
• Launched in May 2008. It is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients and 238 GP practices across three sites, Newham, Kent and Cornwall.
• Three thousand and thirty people with one of three conditions (diabetes, heart failure and COPD) were included in the telehealth trial.
The Whole System
Demonstrator Programme
• For the telecare element of the trial people were selected using the Fair Access to Care Services criteria.
• The proposition being analysed was “Does the use of technology as a remote intervention make a difference?”
• As each site used different equipment and had differing populations there is confidence that the results are transferable to other locations.
Findings
• 45% reduction in mortality rates
• 20% reduction in emergency admissions
• 15% reduction in A&E visits
• 14% reduction in elective admissions
• 14% reduction in bed days
• 8% reduction in tariff costs
Benefits for the
Individual
• More effective self care
• Improves quality of life for carers
• Less travel and disruption for routine check-ups
• Retention of dignity
• Increased confidence to manage own health
• Fewer stressful, unplanned hospital admissions
Benefits for Healthcare
Professionals
• Through risk stratification, professionals can identify those people in their practice who have LTCs and could be better supported if telehealth were adopted
• Professionals can be better informed of the status of these people and see less demand on services, with fewer A&E events and unscheduled inpatient episodes
• Professionals see less impact on family members/carers of people with Long Term Conditions (LTCs) as they start to take more control of their own health
Benefits for Healthcare
Professionals
• More regular data means professionals can be better informed of a person’s health status which leads to early intervention and proactive care
• Deploying telehealth-enabled services modernises the way by which large numbers of people with LTCs are treated improving their care, quality of life and the life of their carers
• It makes more efficient and effective use of available clinical teams by reducing unnecessary home visits
• It involves people far more in the management of their own healthcare
• It significantly reduces the incidence of A&E usage and unplanned admissions thus reducing the disturbance on elective planning
Next steps
• The headline findings, with the detail now supported in the paper, provided the impetus for 3millionlives and the drive for industry to work with health, social care and housing stakeholders to develop workable business models to enable telehealth to be delivered at scale and at the right price, and pricing structure, for the public purse.
Next steps
• A further four reports are planned, which will analyse other elements of the telehealth trial, including a separate paper on costs and how telehealth affected quality of life.
• The telecare findings are due to be published at some point in the future. The full BMJ article is available online. *published by the BMJ. Research team lead by the Nuffield Trust. 3ML Press Release
telecare
telecoaching
telemonitoring
teleconsultation
Implementing
telehealth
BMJ 14th July 2012 345; 7, 16, 20
We must have
New ways of
delivering
early
specialist
opinions and
care
so less in here…
The bigger picture …
scale of financial
challenge
growing demand
unmet need
inappropriate
utilisation
stretched capacity
+ traditional
hospital dominated
medical model
designed
by default
=
a system designed by
default
some people seem to
do quite well without
waiting for healthcare
support……
Much more of this
numerous potential use
cases:
• long term conditions
• outpatients
• nursing homes
• employee health & well
being
• early supported discharge
• admission avoidance
• dementia – carer support
• social care
• purely social calling
• specialist networks
Thank you for listening
Any Questions?