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Whittington Health
WhittingtonWhittington Health
Louise RestrickLouise Restrick Integrated Consultant Respiratory Physician
Whittington Hospital and NHS Islington
Whittington HealthWhittington HospitalNHS Haringey
NHS Islington
• Acute general teaching hospital– Beds (inc ICU, maternity and children) – Operating teams and facilitiesOperating teams and facilities– Clinical skills, knowledge and experience
• Provide care for inner city population of ~300,000– Multi-ethnic population– High levels of deprivation– Smoking prevalence ~35%g p
• Not co-located with PCT or London Borough– Work with >2 PCTs/Boroughs
Whittington HealthWhittington Health• Integrated Care Organisation• Merger of Whittington Hospital, NHS Haringey g g g y
and NHS Islington community services• 4000 staff and budget of £260m• Covers ~500,000 population• One organisation providing local healthcare from g p g
home to hospital and hospital to home• Working with General Practice and Social Care
1st April p2011
Whittington HealthAims
High “value” health care: better outcomesHigh value health care: better outcomes per pound spent
I d h lth t• Improved health outcomes• Improved patient experience• Reduced costs…from start to end of each patient’s pathway
…working with General Practice, Social Care and Local Authorities
Whittington HealthOutcome domains – shared responsibility
Preventing people from dying prematurely NHS and PH
NHS, SC and PHEnhancing quality of life for people with care needs
Preventing deterioration and helping recoveryfrom episodes of ill-health or injury
NHS, SC and PH
Ensuring people have a positive experience of care NHS and SC
Treating and caring for people in a safe environment and protecting them from harm
NHS, SC and PH
Improving population health and tackling health inequalities
PH
Whittington HealthInformation needed
• Agreed measures of health outcomes• Data on health outcomes and unwarranted variation• Measures of patient experience• Individual and disease group patient pathway costs• Value comparisons for interventionsp
eg QALYS, life-years lost/saved• What residents want from local health care
Whittington HealthImproving Health Outcomes
• Achievable• Right Care
Michael Porter 2011 UCLP/Monitor Conference
Doing the right things and doing things rightValue Hierarchyy– Long Term Conditions– Urgent and Emergency Careg g y– End of Life Care– Safe CareSafe Care
Whittington HealthReducing total costs
• Good outcomes as efficiently as possibleA l i l hi h
Michael Porter 2011 UCLP/Monitor Conference
– Applying value hierarchy– Reducing clinical errors
• Cost reduction is the wrong goal – save money on the wrong thingsN d t f d t ll h h d li• Need to fundamentally change how we deliver care to release costsR d t t l t l f• Reduce total cost over cycle of care
Whittington Health
Whittington Health
• Know costs of health careClinical philosophy• Know costs of health care
– Risk stratification• Use value frameworkUse value framework• Long-term conditions and co-morbidities focus
– Smoking alcohol drugs obesitySmoking, alcohol, drugs, obesity …– Not just getting someone home thinking about preventing
the next admission….– Advanced care planning
• Working with patients– Co-Creating Health
• Holistic needs assessments– Learning from social care (and palliative care)
Behaviour change for clinicians?
Whittington HealthChallenges to Integrating Care
• Resources used merging 3 organisations• Creating Whittington Health culture & philosophyCreating Whittington Health culture & philosophy
from 3 different organisations• Using current tariffs including PbR and QOFUsing current tariffs including PbR and QOF• Identifying and minimising financial and clinical
governance risksg• Enabling Whittington Health professionals to
lead/engage with transformational changeg g g• Engaging GPs• Engaging Social Careg g g
Whittington HealthCommissioning
• GP leadership• Across health and social care• Across health and social care
– ReablementB ndled tariffs– Bundled tariffs
– Personalised budgetsC i i i * i f d b J i t St t i N d• Commissioning* informed by Joint Strategic Needs AssessmentE t ith H lth d W ll B i B d• Engagement with Health and Well Being Board
• CQINS that support JSNA
* ‘Process of assessing health needs of a population, then planning, securing and monitoring the best possible range and quality of health services and health improvement services for that population given resources available.’ Nuffield Trust 2010
Whittington HealthHealth professionalsand social care
• Working for Whittington Health
… and social care
– Consultants– Hospital nurses and allied health professionals– Community teams– Community nurses
IAPT d St S ki t– IAPT and Stop Smoking teams• Working with Whittington Health
GP Commissioners– GP Commissioners– GPs and Practice Nurses– Social Care Public Health and other LocalSocial Care, Public Health and other Local
Authority teams
Whittington HealthWhat motivates clinicians?
(Improving) quality of care for patientsMastery of (an) expertise? PayQuality of working dayPeer opinion and respectAffirmation from patients and families
Whittington HealthEnablers for clinical leadership, engagement and commitmentengagement and commitment
E idTiPeer PEvidenceTime Pressure
Whittington HealthAligning with General Practice• Make the case for improved patient care
‘Just moving the blocks round’‘Removing’ district nurses from GP surgeries
• Financial levers/barriersGPs commissioning careGPs providers of care
• Work more enjoyable…• Peer pressure
… relationships
Whittington HealthEnablers of Integrated Care
Islington joint health and social servicesNHS Islington track record in re-ablementNHS Islington track record in re ablementDH demonstrator site for COPD post-discharge re-ablement
Consultants working across hospital and communityConsultants working across hospital and communityRespiratory, cardiology, diabetes, rheumatology integrated
physicians already providing training and support– Rotational posts
Whittington Hospital and NHS Islington and Haringey already Co-Creating Health SiteDiabetes and respiratory
UCLP it t d tUCLP commitment and support
Whittington HealthEnablers of Integrated Care
• Common IT system– Shared real-time patient information– Shared outcome and costs data and responsibilities
• Innovators given time– Clinical leadership of transformational change & population
care given same priority as direct clinical care in job plansEd ti• Education– Opportunity to train integrated clinicians
C lt d L d hi• Culture and Leadership– GPs – WISH, formal roles on the board?
Working across organisational and professional– Working across organisational and professional boundaries
Whittington Health