Demonstrating the value of Community Services
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The document outlines a program aimed at demonstrating the value of community services through the establishment of quality indicators and outcome measures. It emphasizes the importance of evidence-based assessments for community services, facilitating national benchmarking, and improving clinical effectiveness. The initiative involves collaboration among various NHS trusts and stakeholders to develop a standard framework for measuring the quality and effectiveness of community healthcare services.
Demonstrating the value of Community Services
- 1. DEMONSTRATING THE VALUE OF COMMUNITY SERVICES Summer 2014 Christina Walters, Programme Director Andrew Barber, Technical Consultant http://www.bridgewater.nhs.uk/demonstratingthevalueofco mmunityservices
- 2. To demonstrate the value of community services The programme will establish a set of quality indicators including outcome measures, which will; • Provide evidence of the effectiveness and quality of community services • Provide a clear picture of the community ‘offer’ • Support meaningful national benchmarking of NHS community services • Contribute to the evidence base on clinical effectiveness to support development and improvement • Provide information in an accessible form on the quality and value • Support meaningful national benchmarking of NHS community services • Underpin the development of currency and payment systems for NHS community services For whom? For providers and the people using services,for commissioners and regulators. Vision 2
- 3. Commissioned in full by… Aspirant Community Foundation Trusts’ Network Because: • 18 trusts who are all on the journey to becomingan FT • Policy gap • National regulatory encouragement • Self funding model works quickly • Wide range of previous work to incorporate • Open invitation to others brings sector and patient benefits Who commissioned this? 3 Initiated by… Bridgewater Community Healthcare NHS Trust & Southern Health NHS FT With: • An imperative to create a range of common measures within a framework to demonstrate the quality of community services • A range of locally developed measures in existence • A summit for potential stakeholders • A business case for funding
- 4. ‘Aspirant foundation trust’ network of community trusts: Aspirant Community Foundation Trust Network (aCFTN): Birmingham Community Healthcare NHS Trust Bridgewater Community Healthcare NHS Trust Cambridgeshire Community Services NHS Trust Central London Community Healthcare NHS Trust Derbyshire Community Health Services NHS Trust Hertfordshire Community NHS Trust Hounslow and Richmond Community Healthcare NHS Trust Kent Community Health NHS Trust Leeds Community Healthcare NHS Trust Lincolnshire Community Health Services NHS Trust Liverpool Community Health NHS Trust Norfolk Community Health and Care NHS Trust Shropshire Community Health NHS Trust Solent NHS Trust Staffordshire and Stoke on Trent Partnership NHS Trust Sussex Community NHS Trust Worcestershire Health and Care NHS Trust Wirral Community NHS Trust Who’s involved? 4 And: Acorns Childrens Hospice Alderhey Barts Berkshire Central and North West London Cumbria Dudley Hospitals Gloucester Care Services Greater Glasgow and Clyde Isle of Man Leiccestershire Partnership Northamptonshire Healthcare North West London Peninsula Community Health CIC Pennine Care NHS FT Pennine Acute Hospitals NHS Trust QNI Royal Wolverhampton Trust Solihull South Warwickshire FT Southern Health NHS FT St Georges Suffolk Community University Hospitals Soiuthampton York Hospital FT And… NHS TDA CQC Monitor HSCIC FTN NHS England NHS Confederation NHS Commissioning Assembly Community Tariff Working Group
- 5. Time Clinical frameworks’ Workstreams Data and Finance interface Engagementof participant trusts Engagementof commissioners National alignment & endorsement Clinical services, teams described Formal links & alignment of programmes Expressions of interest from trusts Links to Commissioning assembly Scoping via networks Agreed series to develop Representation on Programme Executive Developmentof communications Links to Local CCGs Formal links & alignment of programmes Design frameworks Endorsement- at each stage Resources secured for programme Joint programme learning events Representationon Programme Executive Build frameworks – through workshops Joint working to achieve data collection mandate Active participation - at each stage Endorsement- at each stage Endorsement- at each stage Initial validation with peers, networks, experts Joint working to achieve currency mandate Ownership of clinical frameworks with local & national value Incorporation into commissioning frameworks Incorporation into quality metrics & outcomes frameworks Piloting, wider evaluation, revision Sign off for national use Timelines – where are we? 5
- 6. • Community trusts collaborate • Clinically focused steering group • Agree definitions, scope • Agree domains for an indicators and outcomes template • Working groups define indicators and outcomes which map to care • Information requirements reviewed by sector • CIDS, CYPHS • Other assurance/outcome frameworks • Evaluate for utility across sector – quality, benchmarking, service offer • Develop as currency for payment system Clinical evidence base and consistent approaches Needs based quality care with focus on outcomes Clinical information recorded and reported Granular costing based on outcomes not just activity 6Schedule of clinical workshops What is the overall process?
- 7. What’s our scope? Our schedule of clinical workshops 7 Theme Workshop month - 2014 Theme Workshop month - 2014 Podiatry COMPLETED – DRAFT IN PREP March Speech and Language Therapy – Adults October Safeguarding and Children in Care/LAC COMPLETED – DRAFT IN PREP April (joint with HV & SN) Dietetics October Health Visiting COMPLETED – DRAFT IN PREP April (2-group event) Occupational Therapy –Adults October School Nursing COMPLETED – DRAFT IN PREP April (2-group event) Dermatology November Physiotherapy – Adults MSK COMPLETED – DRAFT IN PREP May (Adults MSK) Audiology November Respiratory – Adults COMPLETED – DRAFT IN PREP June (Adults) IV Therapy During 2014 Physiotherapy – Adults – Community/ Neuro Rehab/General COMPLETED – DRAFT IN PREP June (Adults ‘non MSK’) Community Dentistry During 2014 Homeless & Vulnerable COMPLETED – DRAFT IN PREP July Prison Health During 2014 Falls COMPLETED – DRAFT IN PREP July Walk in Centres During 2014 Joint children’s therapies session: Occupational Therapy Respiratory Speechand Language Therapy Physiotherapy July (Children) Continence Completed in draft form Diabetes August Wheelchairs Completed in draft form District Nursing September Tissue Viability Completed in draft form Health Improvement / Promotion September Family Nurse Partnership On hold
- 8. WHEELCHAIR SERVICE Service : Purpose (Outcome) Statement: Ref. Title Indicator description Threshold WC01 Referrals screened The percentage of referrals accepted that are screened within two working days of receipt of the referral 95% Responsiveness WC02 Referrals acknowledged The percentage of referrers sent a written or electronic acknowledgement within five working days of the referral being received 95% Responsiveness WC03 Referrals assessed WC03a: The percentage of referrals accepted classed as 'urgent' whose assessment takes place within 10 working days 95% Responsiveness WC03b: The percentage of referrals accepted classed as 'routine' whose assessment takes place within 15 working days 95% Responsiveness WC04 Tissue viability risk assessment The percentage of assessments, including any prior nurse assessments, that include a documented tissue viability assessment tbc Safety WC05 Voucher provision The percentage of service users registered with the service who have been offered a voucher tbc Equity WC06 Wheelchair delivery WC06a: The percentage of service users prescribed a wheelchair who received delivery of their wheelchair within three weeks of their prescription being written (locally held stock) tbc Responsiveness WC06b: The percentage of service users prescribed a wheelchair who received delivery of their wheelchair within six weeks of their prescription being written (standard manufacturer's equipment) tbc Responsiveness WC06c: The percentage of service users prescribed a wheelchair who received delivery of their wheelchair within 12 weeks of their prescription being written (bespoke seating) tbc Responsiveness WC07 Handover certificate signed The percentage of service users who sign a handover certificate to confirm receipt of a handover package (on or after delivery) 100% Safety WC08 Friends and Family test score Friends and Family test score tbc Patient experience Social value WC09 Community Equipment Patient Experience Survey tbc Social value Patient experience WC10 Single point of contact for repairs/concerns tbc Equity Responsiveness WC11 Completion of repairs WC11a: The percentage of repairs completed within 24 hours (for emergency repairs) 95% Timeliness WC11b: The percentage of repairs completed within three working days (for non-emergency repairs) 95% Timeliness WC12 Clinical review WC12a: The percentage of wheelchair and equipment provision for children that is reviewed within one year of provision 95% Timeliness Safety WC12b: The percentage of wheelchair and equipment provision for adults that is reviewed within one year of provision 95% Timeliness Safety Indicator type (max. 2) Wheelchair Service - to address a person's enduring mobility problems through assessment and provision of a wheelchair and associated postural and pressure equipment Outcome: Service users can access a range of environments whilst safety and comfort is maximised Quality Indicators - what do the frameworks look like? Overarching outcome(s)Type of care Thresholds Performance measures: activity, responsiveness, timeliness Descriptive Measures – drawn from evidence base and good practice Social value, equity and inclusiveness measures Quality measures: outcomes,patient experience, PROMS, safety 8
- 9. 9 Process of indicators development Expert workshop group On the day + After the day review and comment DRAFT 1 aCFTN + Other trusts Web site DRAFT 2 DRAFT 3 6 - 8 weeks 4 weeks 8 weeks Open accessreview and comment Sector review and comment
- 10. Community services Group A A1 A2 Group B B1 B2 B3 Group C C1 Provider Common care, risk stratified or population groups Commonly applicable Quality indicators & Outcome measures y x z Local services/te ams – to which they apply Local LocalNational National How do we get products for national use? Can A1 – C1 be used as Currency for Commissioning? From our clinical workshops
- 11. • It represents a move away from how services have been commissioned in the past • To date, the basis for commissioning services predominantly input based, paid for through cost and volume, block or a combination of both • Often put on the “…too difficult…” pile BUT… • CQUIN schemes provide incentives for providers through an agreed framework • Outcome-based service specifications Commissioning outcomes 11
- 12. • What do we mean by an outcome? • How can we evidence outcomes? Quantifying and agreeing outcomes 12
- 13. • What do we mean by commissioning based on outcomes? • How might this be different to current commissioning? • What are the barriers to including commissioning arrangements based on outcomes? • And how do we link payment to outcomes? Or is it still on block…? Commissioning outcomes 13