Integrated care : 3 years of progress and jugular actions needed. Dr. Geraldine Strathdee, National Clinical Director for Mental Health. .

Transcription

1 1 Integrated care : 3 years of progress and jugular actions needed Dr. Geraldine Strathdee, National Clinical Director for Mental Health.@DrG_NHS Kings fund March 2016

2 This talk: Why do we need Integrated care What s the impact on clinical and economic outcomes Where is integrated care happening What will drive it further and faster Can we agree a charter of principles 2

3 Why do we need integrated care?

4 Why does the NHS need to integrate mind and body care..because mental ill health it is very common, & untreated it does not go away. It leads to significantly poorer clinical, rehabilitation & life expectancy outcomes, increased service use & poor economic outcomes : 4500 international scientific references available on request!! Mental ill health is common Primary care : 30-50% of daily workload Acute care 40+ % of A&E breaches 40% acute beds 20-80% acute outpatient clinics Common Conditions Depression & anxiety Substance misuse Children's conditions Psychosis PTSD Medically unexplained symptoms Alcohol & drugs Depression & self harm Dementia Psychosis relapse Co-occurring depression/ anxiety in cancer, stroke, CVD, COPD, liver, ICUs, bariatric clinics, dermatology Outcome impact Premature mortality : years Physical health deaths & Suicides Reduced Quality of life in LTCs Recovery from illness slow Patient safety Crisis and frequent attenders Premature mortality Reduced Quality of life for LTCs Slow or poor Recovery from illness Patient safety Poorer Patient experience Frequent crisis & elective attendances Longer LOS & delayed discharges Prisons & offenders 70-80% especially young men ADHD, ASD Depression Substance misuse PD Psychosis Premature mortality Lifelong poor outcomes

5 Integration of care is essential for step change in England s health care & mental health access Integrated history taking & assessment at registration & in consultations Integrated treatments and care pathways Integrated teams: sessions or skillmix of physical or mental staff or alliance pathways Integrated case conferencing for frequent attenders, admissions, detentions Integrated Workforce training at undergrad, post grad and CPD Integrated National clinical audits & Inquiries, National confidential inquiries, Integrated NICE guidelines, NICE Quality Standards, NICE indicators Integrated research, genome programme, Integrated payment tariffs, CQUINs, and incentive systems for primary, acute, MH Digital Maturity for people & their clinicians to access their own integrated care records 5

6 National context: Prime Minister announced MH as a national priority, Life Chances Jan 11 th 5 Year Forward view & taskforce: Lifespan approach based on HMT deep dive economics Being Born well Best early years Living and working well Growing older well Dying well Building Positive mental health in individuals & communities Prevention of mental ill health Improving access to Integrated Timely Effective care for all new patients Transformation of services to deliver value, better outcomes, quality & personalized Right Care & integration Integrating 6 physical, social, mental health care for individuals and communities

7 BuildinIntegrated NHS Choices information & self management tools 7 NHS Presentation to [XXXX Company] [Type Date]

8 For the 16 mental health care pathways we have commissioned Biopsychosoical integrated care Using every proven implementation strategy to built in sustainability and continuous quality improvement and gathering and publishing PROMs, PREMs, CROMs Right Time Right Care NICE standards for the common crisis conditions & services & pathways Information Physical health Right Outcomes Right Team Right implementation & Continuous Quality improvement Medication PROMs Psychological therapies Right suicide prevention Rehabilitation & Recovery care plans for training/ employment Right carer and social network Crisis & relapse prevention Maximizing digital potential PREMs CROMs Employment Right team - Compassionate, - Coaching, - Coproduction - Recovery focus - Multi disciplinary/ agency Commissioning guidance Baseline national audit Regional implementation teams Workforce plans Data collection plans Clinical dashboards for teams Accreditation networks Digital Maturity plans 5 ALB & Regulation Big Data & innovation plans 8

9 The 5YFV road map for integrated pathways

10 Open Data network new data Nov ations-and-articles/reports/gettingthe-message-on-mental-health/ 10

11 CQUiN for integrated physical care Indicators (Assessment + Intervention) by Setting Setting Count of Cases CQUIN Performance Acute inpatient ward % Child and adolescent mental health ward % High dependency/rehabilitation ward % Low secure unit % Medium or high secure unit % Older adults ward % Other % PICU % Grand Total %

12 Acute care : transforming acute care and care homes & achieving integration through liaison mental health teams & care pathways Liaison mental health teams: 4 components of productive care in A/E 24/7: Acute delirium assessment ward for people with dementia Acute wards where 40% patients have Mental illness LTC clinics in acute care & primary care where 40-70% have untreated depression & anxiety Productivity gains Reductions in 4 hour wait breaches Admissions by 40% into acute hospital wards & care homes: Repeated Attendances for self harm and other conditions Productivity gains 80% go back home with a well organized personal health care package and are not admitted into a care home Productivity gains Increases the discharge rates Reduces LOS Reduces expensive unnecessary investigations and operations 70% people with liver disease, 40% people with cardiac disease, 40% with long disease, 60% with irritable bowel syndrome, 80% in pain clinics Patients get treatment and Repeat OPCs are reduced Unnecessary diagnostics are avoided 12

13 Chris Hilton :Liaison beyond the hospital Integrated Care Programme Monthly multidisciplinary care planning groups for patients with long term conditions Whole systems integration Planning model of care for Early Adopter projects and future Local Hospital Primary care education and supervision Daily GP advice line Integrated mental health in Intermediate Care team (Consultant and RMNs) Palliative Care Hospice and Community Pilot Outpatient clinics for MUS/LTC HIV Mental Health assessments Community dementia Liaison nurse Support for Primary Care Mental Health Workers IAPT & Clinical Psychology Interfaces Integrated long term condition psychotherapy services

14 Primary care mental health : progressing towards integrated care Psychosis: Enhanced psychosis outreach services +3 rd sector MUS: Collaborative care for MUS medically unexplained symptoms e.g. Tavy/Hackney PACS and MCPs Prevention in High risk groups Self assessment and self management Common conditions Repeat attenders & MUS LTCs: Integrated physical & mental treatment in groups for LTCs Common: direct access psychological therapies for depression & anxiety CYP: Intermountain primary care CYP model Perinatal: Integrated perinatal community teams in reaching to acute clinics & PC Long term & severe mental illness Eating Disorders: community teams Registration: e Chat from New Zealand Prevention :Pan city on line digital platforms

15 Cancer & Diabetes: the evidence & best practice case examples of integrated care Diabetes integrated care : Cancer integrated care: 15

16 Fundamental principles & jugular actions for integrated care 1. Integrated care should be the norm, not the exception 2. Fundamental principle : If there is a likely comorbidity of physical & mental illhealth of > than 20%, teams need the skillmix of staff with new competencies 3. The 5ALBs should commit to integrated clinical care pathways & digital maturity in all commissioning guidance & regulation 4. The AOMRCs & professional bodies should move to evidence based integrated care & training 5. A new breed of management leader is needed: logistics & supply chain process engineers to help patients and clinical teams develop efficient pathways 6. Commissioning & economics experts are needed to develop the economic modeling tools to make integrated care a reality If we make as much progress in the next 3 years as we've made in the last 3, England can dump Decartes! 16 1.