Idea Transcript
Thames Valley Strategic Clinical Network & Clinical Senate: The Road to 2020
Contents Introduction: What is the Thames Valley Strategic Clinical Network?
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Partnership wheel
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1. Commissioning guidance
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2. Cancer network
8
3. Children’s network
14
4. Diabetes network
18
5. End of Life network
22
6. Long Term Conditions
25
7. Maternity network
28
8. Mental Health, Dementia and Neurology network
32
9. Stroke network
38
10. Vascular network
40
11. Clinical Senate
42
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Introduction: What is the Thames Valley Strategic Clinical Network and Clinical Senate?
Milton Keynes Banbury
Bicester Witney
Acute Trusts: 4
Aylesbury Oxford High Wycombe
Abingdon Swindon Slough Newbury
Reading
Bracknall
GP Practices: 274
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Thames Valley Population:
Mental Health Trusts:
Community Hospitals:
2.4 million
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The Road to 2020 Cancer
Diabetes 80%
Reduce smoking prevalence to
of cancers staged
10.8% (a 30% reduction)
Additional
450 4 50
1,400 people
fewer lower limb amputations across Thames Valley
surviving s cancer for 10 years or more
Mental Health, Dementia & Neurology 5,000 more people with Serious Mental Illness (SMI) receiving physical health checks
Stroke Strok ke
100% of all acute hospitals in Thames Valley have all-age Mental Health Liaison services in A&E and inpatient 90% of wards individuals with dementia to have patient-centred care & support plans
Maternity
850 additional patients in TV experiencing stroke symptoms will be taken to a HASU for the first 72 hours of their stay in hospital
Every GP practice in Thames Valley meeting 40% achieving the three treatment targets
Long Term Conditions and End of Life
(EoLC) - 10% increase across Thames Valley of death in place of usual residence
(LTC) - 80% of patients having care & support planning consultations
Children
200 fewer strokes in TV s
4,400 more newly diagnosed d patients rreceiving e structured patient education
3,000 1,300 more women n to o be seen by Perinatal Mental Health services in TV Reduce stillbirths by 20% (4.1 per 1000 in TV)
more children m seen in MH s services in Thames Valley Th Children with Eating Disorders seen
within 4 weeks/ 1 week for urgent cases
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Partnership wheel
He In Be ter st na Pr tio ac n tic al e
alt
atc
h
NHS England Specialised Commissioning
Patients
NHS England National Clinical Leadership
Third Sector
NHS England Medical Directorate
Public Health England & Local Authorities
TVSCN & Senate
Sustainability & Transformation Plans
Academic Health & Science Network
Provider Trusts
NHS England GP Forward View
Clinical Commissioning Groups
Primary Care
Acad e inno mia & vatio n
NHS England Assurance
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hw
Commissioning guidance Vision Building on previous iterations of the TVSCN Commissioning Guidance, we created an intuitive, user friendly website version of previous guidance to commissioners, to ensure a comprehensive capture of benchmarking information across the patch, linked to national and local priorities. The commissioning guidance not only described ‘what’ commissioners should focus on, but also ‘how’ to go about achieving this. It linked to best practice guidance, showed quality and financial savings where available, and linked directly to reports delivered by the networks on current status and recommendations.
NEW: Prevention section covering
Targeted advice tackling unhealthy behaviours
The web portal has allowed a more accessible method of showing how the priorities would inform and align to the strengthened two year CCG operational planning process (September-December 2016) as well as Sustainability & Transformation Plans (STP). Due to the further enhancements to the website we have developed stronger partnerships with arm’s length bodies to provide commissioners with a more comprehensive offering. As a result, the public health interventions relating to individual clinical networks now provide calculation and scale of challenge and opportunity. Customised data packs are also provided at a CCG and practice level to quantify potential gains.
More in-depth content
Improved patient pathways
Healthier workplace • Quantified scale of challenge/opportunity on interventions and redesign • Detailed breakdown of national strategies and priorities • Customised data packs per CCG and practice level
PPrevention ti
Screening S i Sessions
Users
1,357
916
Pages / Session New Session
2.44
67.50%
Dynamic experience... Engaged users
Avg. Session Duration
00:02:27 Pageviews
Assessment & Diagnostics
M t Management & Treatment
3,315
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Cancer network Vision Ensuring optimal provision of diagnosis, treatment, care and outcomes for all cancer patients in Thames Valley by increasing early diagnosis, improving outcomes and providing high quality services.
Why is it needed? Cancer is the most common cause of premature death (15 years old in Thames valley population to meet 30% reduction target by 2020
236,574
Total reduction in number of smokers
110,720
Achieving 30% reduction in smoking prevalence by 2020
Source: QOF 2015/16 for patients aged 15 or over who are recorded as current smokers and ONS population projection
Improving urological cancer services in Thames Valley In 2013, the Cancer Peer Review process identified that there were serious concerns with the Thames Valley service configuration for specialist surgery for prostate, bladder and kidney cancer. The peer review team raised specific concerns with operations being carried out across two locations: Royal Berkshire Hospital (RBH) and Heatherwood and Wexham Park (HWP) rather than one location as recommended in the Improving Outcomes Guidance (IOG) for urological cancer. The review also highlighted problematic working relationships within the Berkshire Specialist Urology Multi-Disciplinary Team (SMDT).2 The Thames Valley SCN established a project to develop a service model for specialist prostate, bladder and kidney cancer surgery in Thames Valley that was compliant with the targets outlined by the peer review team. In order to carry this out, the SCN successfully did the following:
Developed case for changing the current service configuration
Facilitated mediation to improve working relationships within the SMDT
Effectively repatriated radical cystectomy services to RBHT
Improved data collection, both retrospective and current
Appointed impartial external clinical advisor
Developed clinical quality metrics to measure and assess impact of repatriation
By April 2014, the Berkshire-wide compliant cystectomy service was in place. The SMDT established a working environment that operated at a level beyond professional cordiality and dedication to improvement. Surgeries now take place at one location (RBH), and the change has been a success in terms of both collaboration and ensuring patient care. An audit of pre- and post-repatriation shows the following results:
Pre
Post
30
22
65.1
69.6
100%
68%
0%
32%
9.8 days
8.9 days
30 day mortality
7%
5%
90 day mortality (excluding 30 day)
0%
0%
Sample size Average patient age Surgical technique Open Robotic Average length of stay
Pre- and post-repatriation audit results
1
Achieving World-Class Cancer Outcomes: A Strategy for England 2015-2020, http://www.cancerresearchuk.org/sites/default/files/achieving_worldclass_cancer_outcomes_-_a_strategy_for_england_2015-2020.pdf (last accessed 15th December 2016)
2
Peer Review Visit Report for Royal Berkshire Specialist Urology MDT.
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The future for the cancer network Demand on cancer services is increasing due to the steady rise of both new diagnoses and the number of patients who survive. Whilst the workforce has absorbed these increases so far, service quality has dropped which has been reflected in the increasing delays in delivering test results to patients. Across the country, more than a third of radiologists are aged 50 or over, and around a quarter will be approaching retirement age in the next ten years.3 The cancer network is planning to undertake an assessment of the Thames Valley workforce to understand the current situation, and develop plans to manage the recruitment and retention of fully-trained staff.
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Guidance Summary: National Reports Focused on Cancer 2014-2015.
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Children’s network Vision
Why is it needed?
The aim for Thames Valley is to create an environment where children and young people have the opportunity to grow up happy, safe and healthy within resilient families. Good mental health is a vital part of that. The vision is for children and young people to grow up resilient, have good mental health and if they need help know how to access high quality, timely services.
The impact of mental wellbeing problems in the early years is highlighted by the evidence that 75% of adults with mental ill health will have started to experience issues before the age of 18 years old. Despite this evidence, as a health service we may be reaching as few as one in four children and young people with problems that could be helped.
50% of lifetime mental illness (excluding dementia) starts by age 14
Started mental illness
Not started mental illness
The onset of lifetime mental illness1
In addition to the ethical and moral reasons for better services, there is also a powerful economic impetus given that children with serious conduct disorders are twice as likely to leave school without any qualifications, three times more likely to become a teenage parent, four times more likely to become dependent on drugs and 20 times more likely to end up in prison; the monetary cost to the health service, the benefits system and the justice system is high.2 The Future in Mind report3 articulates how we need to set about tackling the problems to create a system that brings together the potential of the internet, schools, social care, the NHS, the voluntary sector, parents, and children and young people themselves.
1
Kim-Cohen J, Caspi A, Moffitt TE et al. Prior Juvenile Diagnoses in Adults With Mental Disorder: Developmental Follow-Back of a ProspectiveLongitudinal Cohort. Arch Gen Psychiatry. 2003;60(7):709-717; Kessler RC, Berglund P, Demler O et al. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602; Kessler RC, PG Amminger, Aguilar-Gaxiola S et al. Age of Onset of Mental Disorders: A Review of Recent Literature. Curr Opin Psychiatry. 2007 July; 20(4): 359-364.
2
Five Year Forward View for Mental Health. https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf (last accessed 16th December 2016)
3
Future in Mind: Promoting, Protecting and Improving our Children and Young People’s Mental Health and Wellbeing. https://www.gov.uk/government/ uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf (last accessed 16th December 2016)
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There are five core themes: • Promoting resilience, prevention and early intervention; • Improving access to effective support: a system without tiers; • Care for the most vulnerable; • Accountability and transparency, and; • Developing the workforce.
Seeing more children in mental health services In Thames Valley an additional 3,000 children and young people will be able to access evidence-based treatment by 2020/21. Estimated prevalence *
2016/17
2017/18
2018/19
2019/20
2020/21
England
711,674
21,000
35,000
49,000
63,000
70,000
Thames Valley
29,866
881
1,469
2,056
2,644
2,938
NHS Milton Keynes CCG
3,964
117
195
273
351
390
NHS Aylesbury Vale CCG
2,456
72
121
169
217
242
NHS Chiltern CCG
3,824
113
188
263
339
376
NHS Oxfordshire CCG
7,874
232
387
542
697
774
NHS Bracknell & Ascot CCG
1,753
52
86
121
155
172
NHS Slough CCG
2,377
70
117
164
210
234
NHS Windsor, Ascot & Maidenhead CCG
1,652
49
81
114
146
163
NHS Wokingham CCG
1,706
50
84
117
151
168
NHS North & West Reading CCG
1,231
36
61
85
109
121
NHS South Reading CCG
1,593
47
78
110
141
157
NHS Newbury & District CCG
1,437
42
71
99
127
141
* Estimated prevalence of any mental health disorder, aged 5-16 in 2014 (source: PHE Fingertips - Children’s and Young People’s Mental Health and Wellbeing)
Seeing how the service is working The SCN is working with the CYP mental health system to understand not only the number of children and young people being seen, but also if the services are improving.
1. Reduced waiting times A key priority for the SCN is to ensure that the waiting times for children and young people are reducing, and to understand where there are common themes; within Thames Valley, this means focusing attention on the number of CYP with autism. Autism - Waiting times to diagnosis Waits average wait (days)
Q2 2016-17 W Berks 259
Number of patients waiting
Trajectory 2020
Bucks
Oxon
107
128
%
%
%
171
12.3
34
10
54
10
4 - 6 weeks
77
6.4
15
4
22
4
12
3
22
4
157
13.0
27
8
31
6
23
7
25
5
235
68
367
70
8 - 10 weeks 10 - 12 weeks > 12 weeks
795
66.3
MK
awaiting info
awaiting info
%
0 - 4 weeks 6 - 8 weeks
E Berks
100%
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2. Timely intervention for eating disorder interventions The aim is for 95% of children and young people with eating disorders to be seen within four weeks, or one week for urgent cases, and ultimately reduce the number of tier 4 eating disorder admissions. A national minimum data set will be released in April 2017 and will form the basis on which progress will be monitored and a trajectory agreed.
3. Improving experience The SCN needs to hear from children and young people and their carers to understand if the experience is improved, and defining what an improved experience consists of. All CCGs to have in contract with providers a young person’s forum/ group.
4. Referral to acceptance rates Improving transparency and accountability across the whole system to ensure children are referred to the right service at the right time, improving the area’s referral to acceptance rates. This baseline data will be released in the data set.
Improving quality of care during transition from children to adult services Transitioning from children to adult services can lead to poor quality of care and condition management
Outcomes
Greater collaboration across Local Authority, Health & Social Care
Taking learning from... TVSCN supported
Guidelines & process ensures safe transition from paediatric to adult services
with Transition Nursing capacity to implement
For patients aged 13-18 to support readiness for transition to adult services
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Ensures vulnerable patients stay visible in the system
Ready Steady Go is a transition tool system, developed by Southampton Children’s Hospital, and is designed to encourage collaboration between clinicians, patients, and parents to establish the patient’s needs and to communicate these clearly between children and adult long term condition services (e.g. diabetes, endocrinology, cardiology etc). The transition from children to adult services is currently not standardised across the country, and young patients can fall through the gaps when they become the sole point of contact for arranging and attending appointments. Self-management of long term conditions can decline in the late teens; diabetes management in particular can become poor when a young person becomes responsible for managing their own food and medication intake, and emergency presentations of diabetes increase during this time. The TV SCN funded a three year, two phase project to set up a transition steering group, publish a transition policy, and implement Ready Steady Go.
1. Set up a transition steering group The TV SCN Transition Nurse created a transition steering group that began in February 2015 and meets every two months to map transition pathways, write policy, and ensure that new specialities are complying with those policies.
The feedback for the trial has been very positive:
“The RBFT Transition Plan means there are clear guidelines to allow us to safely transfer patients from paediatric to adult services…I have found the Transition Nurse to be a very valuable resource.” Epilepsy Clinical Nurse Specialist
“The RBFT Transition Nurse has provided a wealth of information, support and advice.” CHC Paediatric Nurse Assessor
“The appointment of the RBFT Transition Nurse has resulted in an explosion of joint working with the Local Authority, health and social care in the west of Berkshire.” Special Educational Needs (SEN) Team Manager
2. Publish a transition policy The policy was completed in January 2016, published on the SCN website, and will be used for rolling out the transition principles across the Thames Valley area.
3. Implement Ready Steady Go The TV SCN Transition Nurse based in RBFT identified 60 patients with a long term condition aged 13-18 who attended one of eight clinics and worked with them to implement the Ready Steady Go system. The progress of the project was measured against a Commissioning for Quality and Innovation (CQUIN) Indicators: Indicator
Target
End of Q2 audit results (16/17)
Patients to have a transition plan in their notes
50%
83%
Patients to have a named transition worker documented in their notes
50%
73%
CQUIN indicators for the Transition Project
The scheme has reduced instances of missed appointments and encouraged attendance at adult clinics, helped vulnerable patients to stay visible in the health and social care system, ensured correct and needed diagnostic procedures to take place, and ensured adult services had a better understanding of patient needs.
The future of the network The network plans to continue its work by creating a system that is transparent, accountable and competent, and that always has the child and their family at the centre of everything it does. This system will be run by a resilient and competent workforce who not only know how to identify a child’s presenting issues but also respond in good time and prevent escalation to crisis services. The staff will know what interventions to use, who to call and how to access further help when needed, so that a child, with the right support can develop the tools and resilience needed for better mental health and wellbeing, and take these with them into adult life. The system will also be built on good practice examples, and will create learning and development environments that will bring about long-term, sustainable cultural change.
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Diabetes network Vision
Why is it needed?
To deliver a step-change in diabetes care for the patients of Thames Valley through prevention, patient education and delivery of diabetes care standards. By 2020, the network plans to have every GP practice in the area reaching the target of at least 40% of patients achieving the three treatment targets (controlled blood pressure, controlled cholesterol level, controlled long-term blood sugar level) on a regular basis.
In Thames Valley just under 1,000 people will die early from type 2 diabetes; a disease which has been shown to be preventable in many cases. At present, we have 42,000 people with diabetes whose HbA1C (long-term blood sugar) isn’t controlled; 30,000 whose cholesterol isn’t controlled; and 30,000 whose blood pressure isn’t controlled. Type 2 diabetes also accounts for 9% of the total NHS spend. The National Diabetes Audit (NDA) is an annual national clinical audit, which measure the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards. Thames Valley outperforms the national rate for audit completion, with 94% of TV GP practices completing the audit compared to 81% across England, which means that the data on which the network can base improvements is strong.
Three treatment targets By 2020, at least 40% of patients with diabetes in every GP practice in Thames Valley will receive the three treatment targets on a regular basis. Achieving this ambition will mean that 54,343 people in Thames Valley will have their diabetes better controlled, which will improve outcomes and reduce complications. CCG
No of practices submitted
Average CCG performance %
Percentage of practices achieving less than 40%
No of people required to reach 40%
NHS Aylesbury Vale
19
44.4
26
4780
NHS Chiltern
34
44.8
12
7724
NHS Oxfordshire
68
38.8
66
14195
NHS Milton Keynes
24
38.8
58
5562
NHS Bracknell & Ascot
15
44.2
13
2866
NHS Slough
16
42.6
31
5164
NHS Windsor, Ascot & Maidenhead
16
42.0
50
2859
NHS Wokingham
13
37.8
62
3337
NHS North & West Reading
10
37.5
80
2472
NHS South Reading
15
37.1
60
2751
NHS Newbury & District
10
34.0
80
2633
Total
54343
Note: For patients