Long Term Conditions Commissioning PlansLong Term Conditions Commissioning Plans

Dr Adrian Mairs

LTCANI Meeting 13th August 2012

Dr Adrian Mairs

LTCANI Meeting 13th August 2012

LTC Service TeamLTC Service Team

Reports to Commissioning Programme Board Sponsor Joint PHA/HSCB Chair Linked groups

Cardiovascular Commissioning Group & Network Stroke Strategy Implementation Group Respiratory H&W Group Neurological conditions Sub-group NIVASC

RemitRemit

Regional commissioning guidance– Framework for local plans

Annual commissioning plan Review TDPs Clinical linkages / partnerships PPI

ScopeScope

Cardiovascular services / Framework Diabetes Respiratory services / Framework Neurological conditions All ages

Commissioning DriversCommissioning Drivers

PfG TYC: integrated care, “shift left”, diagnostics McKinsey Quality 2020 Strategy NICE Service Frameworks PPI

Programme for Government (PfG)Programme for Government (PfG)

Enhance access to life-enhancing drugs for conditions such as rheumatoid arthritis, cancer, inflammatory bowel disease and psoriasis and increase to 10% the proportion of patients with confirmed ischaemic stroke who receive thrombolysis

Identify and evaluate the current baseline of patient education and self management support programmes that are currently in place in each Trust area

TYC - LTCTYC - LTC

Self care & prevention – partnership working Personalised care plans - home based mx. Named contacts for patients Use of information systems to support care pathways Medicines management – community pharmacy Admissions protocol Telehealth

McKinseyMcKinsey

Quality & productivity improvements Better management of LTCs Reduced LoS Enhanced /effective home & community

services Shift to lower cost settings

NICE Technology Appraisals (TAs)NICE Technology Appraisals (TAs)

For each Technology Appraisal, the HSC Board will submit a Commissioning Plan to the Department within 15 weeks

TA 236 - Acute coronary syndromes: Ticagrelo TA 244 - Chronic obstructive pulmonary disease: Roflumilast TA 248 - Diabetes (type 2): Exenatide (prolonged-release)

NICE Clinical Guidelines NICE Clinical Guidelines For each Clinical Guideline endorsed by the Department, the HSC Board will submit a Board Response to the Department within no more than 15 weeks CG 36 - Atrial fibrillation CG 87 - Type 2 Diabetes – Newer Agents (update of CG66) CG 101 - Management of chronic obstructive pulmonary disease in adults

in primary and secondary care (partial update) CG 105 - The use of non-invasive ventilation in the management of motor

neurone disease CG 119 - Diabetic foot problems - inpatient management CG 126 - Stable Angina CG 130 - Hyperglycaemia in acute coronary syndromes CG 134 - Anaphylaxs CG 137 - Epilepsy

Commissioning ContextCommissioning Context

Programme for Government Commissioning Plan Direction Commissioning Plan TDPs Population Plans

Commissioning Plan DirectionCommissioning Plan Direction

AAA Screening – June 12 Thrombolysis: increase to 10% - March 13 Telemonitoring: 400k monitored pt. days –

March 13 Unplanned admissions:↓ 10% - March 13 Performance indicators

Unscheduled Care SpecificationUnscheduled Care Specification

Proactive Mx of LTCs 10% ↓ unscheduled hospital admissions ↓ LoS

Local economies• Practice registers / risk profiling• Regular primary care review• Patient education & self-management• Integrated community teams• Escalation procedures• Medicines management• Tele-monitoring

Commissioning PlanCommissioning Plan

Specific Targets By March 2013, increase to 10% the proportion of

patients with confirmed Ischaemic stroke who receive thrombolysis

By March 2013, achieve 400,000 Monitored Patient Days (equivalent to approximately 2,200 patients) from the provision of remote tele-monitoring services through the Tele-monitoring NI contract.

Commissioning Plan - LTCsCommissioning Plan - LTCs

Key Deliverables Implement COPD Integrated Care Pathway Expand provision of insulin pumps to children &

adults with Type 1 diabetes Identify & evaluate current baseline of patient

education & self management programmes in place in each Trust area

Self Management / Patient Education Programmes

Baseline Audit

Self Management / Patient Education Programmes

Baseline Audit

Wendy Thornton

Public Health AgencyMonday 13 August 2012

Wendy Thornton

Public Health AgencyMonday 13 August 2012

1. Background1. Background Key commitment (priority 2) in PfG 2011-15Key Commitment

Milestone 2012/13

Milestone2013/14

Milestone2014/15

Enrol people who have a long term (chronic) condition, and who want to be enrolled, in a dedicated chronic condition management programme (DHSSPS)

Identify and evaluate the current baseline of patient education and self management support programmes that are currently in place in each trust area

Health & Social Care Board / Public Health Agency should work with key stakeholders to develop and secure a range of quality assured education, information and support programmes to help people manage their long term conditions effectively, alongside full application of the Remote Telemonitoring contract

People with a long term condition will be offered access to appropriate education, information and support programmes relevant to their needs, including innovative application of connective health

2. Key characteristics?2. Key characteristics?Patient Education Programmes

Self Management Programmes

Support Groups

KEY CHARACTERISTICS

Part of care pathway Referral from health

professional Likely secondary care

setting Time limited Condition specific Clinically/health professional

led Robust QA mechanisms

KEY CHARACTERISTICS

Not currently part of care pathway (but ideally should be?)

Likely self referral Likely primary or community

care setting Time limited Fully or partially peer led Holistic approach Can be either generic or

condition specific QA mechanisms less robust

perhaps?

KEY CHARACTERISTICS

Not part of care pathway Likely community care

setting Ongoing – not time limited Peer led Unscripted & informal Focuses on social aspect Lack of QA mechanisms

Examples include.... Cardiac & pulmonary rehab programmes Various diabetes education programmes

Examples include....CH&S – “Taking Control” programmeArthritis Care – “Challenging your Condition”

Examples include....Various respiratory support groups

3. Audit scope3. Audit scope

Specific programmes only (not support groups) Programmes for patients only (not carers) Physical AND mental health programmes LTCs – key 4 - diabetes, asthma, COPD, heart

failure, plus others... Includes Condition Management Programme

(CMP) – DEL/Trust partnership programme Includes Trust and I.S provided/funded

programmes

4. Methodology4. Methodology

Questionnaire (in form of Excel spreadsheet)

Distribute to Trusts & IS orgs during Autumn 6 weeks timeframe for completion Info collated and analysed by PHA/DHSSPS LTC Regional Implementation Steering

Group