Rethinking outpatient services: Learning from an interactive workshop

Nuffield Trust | August 2018 | Rethinking outpatient services: Learning from an interactive workshop

A new briefing from the Nuffield Trust in collaboration with health leaders across the country looks at outpatients. The authors reflect on how several STPs have outlined plans  to reduce the number of outpatients. Leicester, Leicestershire and Rutland intends to reduce outpatient activity by 30% by removing unnecessary new and follow-up appointments. Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby are aiming to achieve a reduction in consultant-led first outpatient appointments by a fifth. 

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This briefing reveals opportunities to improve the design of services and challenges if some services should be delivered in their current form.

Read the full news item from the Nuffield Trust 

Download the briefing in full here 

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Breast cancer survivors control their follow-up care in Maidstone

NHS England | August 2018 |Breast cancer survivors control their follow-up care in Maidstone

A new case study from NHS England highlights how patients with breast cancer in  are able to control  their own care in Maidstone, Kent.  The Open Access programme enables patients to have access to regular mammograms, support advice and appropriate clinical follow up up to five years following treatment for breast cancer. The programme recognises patients as individuals and that the way in which they want to be supported may change during their recovery, the team introduced an Open Access Programme, based upon a successful model in place at the Royal Marsden Hospital.

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Early results

  • A reduction of 3,000 breast outpatient appointments
  • Patients access suitable clinical appointments and contact their nurse appropriately.

Patient benefits

  • Timely referral to an appropriate clinician (ie surgeon, oncologist, nurse)
  • Appointments aligned to patient need or want
  • Fast access to the Cancer Nurse to answer questions and concerns.

Full story at NHS England 

Achieving the Provision of Integrated Care

This report traces the development and impact of integrated care to date, highlights some examples of successful practice and draws out the key lessons for later-adopters |  National Association of Primary Care

This report suggests that a number of of factors – ageing populations, an increased prevalence of multiple chronic disease and rising expectations of what health care and technology can offer –  combined with limited human and financial resources, have placed health  systems under intolerable and unsustainable strain.

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Image source: http://napc.co.uk

Integrated Care Systems, where health providers collaborate with other community  stakeholders to prevent ill health, provide more comprehensive care closer to home, keep people out of hospital and reduce costs, is seen as the antidote to these problems. This approach is now spreading around the world, taking many different forms from country to country.

This report of a two-day symposium attended by health experts from the UK, USA and Ireland, traces the development and impact of integrated care to date, highlights some examples of successful practice and draws out the key lessons for later-adopters.

Full report:

Achieving the Provision of Integrated Care:  Exploring the development and successful
implementation internationally of new models of integrated care

 

How fixing the NHS’s broken pay system can deliver better outcomes for patients

An NHS bonus: how fixing the NHS’s broken pay system can deliver better outcomes for patients | Centre for Policy Studies

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Image source: http://www.cps.org.uk

This report argues that by introducing greater flexibility into the system, and linking pay more closely with performance and objectives, both NHS productivity and patient outcomes could be improved. It urges the Government, and NHS managers, to make reform of the pay system an urgent priority as part of the new funding settlement.

Full report available here

Developing new care models through NHS vanguards

The vanguard programme, one of NHS England’s attempts to better meet patients’ needs and deliver savings by developing new care models to integrate health and social care services, has not delivered the depth and scale of transformed services it aimed for at the beginning of the programme, according to this report by the National Audit Office.

A key objective of the programme was to design new care models that could be quickly replicated across England. NHS England selected 50 sites to act as ‘vanguards’ which might entail, for example, joining up GP, hospital and community and mental health services in an integrated network or single organisation in one area to improve healthcare for patients.

NHS England’s early planning assumption was £2.2 billion of funding for new care models between 2016-17 and 2020-21, but it used much of the funding to reduce deficits faced by hospitals. Actual direct funding of vanguards was £329 million over three years from 2015-16, with another £60 million spent by NHS England on central support for vanguards. Consequently, with less funding for transformation, the original intention to expand the programme was not realised.

Despite not meeting its original intention to expand the models across the country, vanguards have made progress in developing new care models. NHS England forecasts that vanguards will make net savings. As at April 2018, it estimated that vanguards would secure £324 million net savings annually by 2020-21, which is 90% of the £360 million that had been expected.

Full report:  Developing new care models through NHS vanguards

See also: National Audit Office press release

Digital change in health and social care

This Kings Fund report aims to support  local organisations looking to undertake large-scale digital change. The document states that the future is bright for technology in health and social care, with local care providers digitising under their own steam and initiative.

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The report shares the lessons from five varied case study sites that have made significant progress towards their digital aims. It sets out the lessons learnt and tips for other organisations that are looking to progress their own digital change.

Overview

  • The use of digital technology in health and social care can improve quality, efficiency and patient experience as well as supporting more integrated care and improving the health of a population.
  • Large-scale change involving digital technology, such as adopting electronic patient records (EPRs) and shared care records, is complex and necessitates attention to particular aspects of the change.
  • This report shares practical learning from a series of case studies where significant largescale digital change is happening.
  • Key barriers to successful digital change include the constraints care organisations face in their workforce, tight budgets, organisations’ attitudes towards risk and the relationships that exist between care providers and key stakeholders.
  • Most of the barriers can be mitigated through time and effort and by treating digital projects as change projects, not IT projects. Effective and consistent staff engagement and resource allocation to the project are key factors in success.

The Kings Fund have also produced an interactive map which brings together case studies from across England, highlighting some of the places that are experimenting with and implementing new technologies to achieve better health outcomes or more efficient care.

Full report: Digital change in health and social care

A summary of the report is available here

The five essential components of value-based approaches to health and care

Against a backdrop of financial pressures, growing demand for services and the quest for transformation of local services, the concept of value in the health and care system is one which has gained increasing prominence over recent years. This paper explores how we can spread the adoption of value-based healthcare across all parts of the system and ensure that we maximise the benefits for those who use NHS and wider services | NHS Confederation

This paper explores the central challenge of how to take value-based healthcare to the next stage and embed it across the whole system.

It explores five key characteristics/factors which support the wholesale adoption of value-based healthcare approaches. These are:

  • Learning and adapting through the adoption of innovation
  • Managing risk
  • Making best use of data
  • Thinking about pathways across the whole system
  • Listening to patients.

Full document: Taking the value-based agenda forward: The five essential components of value-based approaches to health and care