Involving patients in outcomes based commissioning in community services, pop up uni, 10am, 2 september 2015
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Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event. Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being. More information is available online: www.expo.nhs.uk
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Involving patients in outcomes based commissioning in community services, pop up uni, 10am, 2 september 2015
- 1. Involving patients in outcomes based commissioning in community services Dennis Berg, Policy Adviser, Monitor Mark Drury, Head of Public Affairs, Oldham CCG Matthew Smith, Assistant Director Improving Outcomes, Cambridgeshire & Peterborough CCG
- 2. Oldham CCG • CCG in northeast Greater Manchester • Diverse borough with significant health inequalities • 1st wave CCG, authorised without conditions • Triple aim: best care, best health, best value • Key themes: innovation and patient involvement • 8 clusters of around 30,000 patients each
- 3. Community services • Transferredfrom Oldham PCT to Pennine Care under TCS • CCG vision is for more responsive services, led by and wrapped around the GP clusters • Specifications devised to reflect this model • Split into 6 lots – 1 core and 5 specialist • Tenders advertised through Supply2Health (since replaced by Contracts Finder)
- 4. Patient involvement • Delegated scoringof patient experience to patients, worth 12.5% of the overall score – based NHS Patient Experience Framework • Key challenges: – Recruitment and selection for 6 panels of around 6 patients each – Time requirement for patients – Prior knowledge, experience and diversity – Tight time window – Staff support required
- 5. Recruitment and preparation • Approach patients known to the CCG • Match interests to lots (some patients scoringmore than one lot) • Briefing notes explaining the process indetail • Confidentiality agreements, etc. • Sharing hard copies of the patient experience elements of bid submitted to AWARD with scoring criteria
- 6. Scoring • Patients scoredeach question at home • Then facilitated moderation sessionto finalise 1 score for each bid • Core lot also involved a Patient Experience presentation by bidders plus supplementary questions • Finalised scores addedonto AWARD • The scores are the scores • Feedback
- 7. Learning In subsequent tenders we have revisedthe process: • Involved patients more directly in devising the specifications • Reduced the patient experience questions to 6 • Open recruitment (including Oldham 500) to increase diversity • Participants in the Community retender acting as facilitator in subsequent bids.
- 8. Cambridgeshire & Peterborough CCG • Large CCG 913,000 patients, 107 practices • 3 main acute hospitals, 2 main LocalAuthorities • CCG has 8 Local Commissioning Groups leading on local service design, patient and clinical engagement • Financially challenged economy / hospitals / LocalAuthorities • High bed occupancy, high delayed transfers of care, consequent impact on A&E / flow • Urgent & Emergency Care vanguard site
- 9. What did we do? • Developed an Outcomes Framework for Older People Integrated Pathway and Adult Community Services • Outcomes Framework used as the main specificationfor procurement of a new service for older people, integrating community services, end of life care, older people mental health and unplanned acute hospital care, some specific voluntary sector and primary care services • £800m 5 year outcome-basedcontract won by UnitingCare as the Lead Provider (owned by Cambridge University Hospitals FT and Cambridgeshire & Peterborough FT) • New service startedApril 2015
- 11. Structure and link to payment • 7 High level domains • Outcomes • Outcome measures / indicators (mix of proxy measures and ‘true’ outcomes • Technical specifications for each indicator • Payment by Outcomes (PBO) – a percentage of the contract value is linked to achievement of outcomes: • Year 1 - 0% (preparatory year) • Year 2,3 – 10%, year 4,5 – 15%
- 12. How we developed the Outcomes Framework Early engagement 100+ groups – what’s important? Develop ‘wiki’ approach; learning from early patient feedback Domain teams including patient input Full public consultation (Outcomes Fr. Mark 2 and Bidder Proposals) Work with Health Scrutiny Committees / councillors Workshops with stakeholders to test Outcomes Framework Mark 1 2013 Public health-led evidence review Data capture/ baseline work Indicator preparation & phased‘go live’ Final OF Mark 3 issued to bidders Dialogue with bidders & external expert review Work with COBIC on developing OF Autumn 2015 Oct 2014 - Now March – June 2014 Winter 2013/14 Autumn 2013
- 13. What does the Outcome Framework mean for patients and staff? • One way of understanding the benefits of outcomes based commissioning is to consider how it will improve quality of care and provide measurements that give assurance that the quality of care has been achieved. • Both the CCG and UnitingCare have spent time listening to the stories of patients to inform the outcomes framework and service solution • Mrs Smith is a 92 year old woman who lives alone. She has become frailer and sociallyisolated over the previous 6 months following falls and loss of confidence. She is used to being independent and so does not call for any help.A good neighbour has been doing some shopping but she is shortlymoving out of the area.
- 14. What happens to Mrs Smith • GP / MDT identifies frail people such as Mrs S at risk of complications/ avoidable admission. • Mrs Smith is overdue for a medication review and she has now become housebound. • Community matron visits her at home. • Notices Mrs S is unsteady on her feet, appears socially isolated, needs ongoing social care • Referral to physiotherapist for a walking aid and an assessmentof her risk of falling again. • Mrs S referred to a voluntary organisation for befriending and support with shopping,and to an occupational therapist for advice on safer home adaptions • All changes made as part of an individual plan created by Mrs Smith & community matron. • She had consented to the multi-disciplinary team (MDT) way of working and was introduced to the MDT coordinator, who acted as her care coordinator, and who kept in touch until the plan was implemented and then kept in regular contact afterwards. • Mrs Smith feels less isolated, has contact numbers which work, uses her mobility aids and has started to go out again, accompanied.
- 15. Measuring improvement • Mrs S receives a short survey questionnaire which she completes with the help of her new volunteer friend (Domain A patient experience indicators.). Her answers reflecther positive experience;especially the way the team around her appeared well coordinated and informed and involved her in planning. • The community staff feelwell supported,appropriately trained, and work in a ‘learning’ and open organisation with effective IT systems in place (Domain B safety and C organisational developmentindicators). • She did not suffera further fall and felt more confident(falls indicators pathway domain 1.1.3, 1.14), • She was identified as frail and at increased risk of unplanned admission (pathway indicator 1.3.1) • She was seen by the physiotherapist, community matron and occupational therapist within 5 days of referral (routine referral frail person pathway indicator 1.3.2) • She had a Health and care summary and plan available 24/7 (pathway indicator 1.3.3) • She was given lifestyle advice re smoking (healthy lifestyle pathway indicator 1.5.1) • She did not suffera hip fracture (pathway indicator 1.1.7)
- 16. Learning • Early engagement with patients shaped the framework – challenge is to keep engagement to ensure it continues to evolve • Outcomes-basedcommissioning as a concept isn’t always easy for patients / carers to grasp – examples of what it means for individual patients, or stories / vignettes help • Describingoutcomes can become very high level (‘motherhood and apple pie’) or very technical (clinical measures or data definitions for proxy measures) – needs to relate to people’s experience of illness / care • LocalAuthorities can help; interested councillors reviewed our outcomes • Envisage that the challenge will be to answer the ‘so what’ question can the Lead Provider demonstrate what they have done to improve outcomes as a result of measurement eg of patient experience
- 17. Questions?
- 18. Contact details Mark Drury: mark.drury@nhs.net Matthew Smith: matthew.smith4@nhs.net Dennis Berg: dennis.berg@monitor.gov.uk