www.hertsdirect .org Commissioning for Health Improvement - Achieving Health Improvement Liz Fisher Health Improvement Manager Elaine Allan Matron Practice Standards Clinical Support Services
Jan 08, 2016
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Commissioning for Health Improvement - Achieving Health Improvement
Liz FisherHealth Improvement Manager
Elaine AllanMatron Practice StandardsClinical Support Services
www.hertsdirect.org
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It started with a CQUINProposed by Public Health to drive MECC
Supported the PH Outcomes Framework
- reducing premature mortality
QIPP savings
Agreed and supported by the emerging CCGs
Financial reward
Built on existing relationships:
Acute Trusts x 2
Community Provider
Mental Health Trust
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Key MECC Ambitions:
–Promoting a healthy weight
–Reducing the harm from alcohol
–Reducing the harm from smoking
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The Costs to Hertfordshire
Smoking: NHS costs: £54 million PA – 1,500 deaths per year in Hertfordshire > 10% SATOD
Wider economy in Herts: £275 million PA
Obesity: NHS Costs in Hertfordshire: £ 84 million PA and likely to double by 2050
Alcohol: Increasing and higher risk drinking: 22.9%
Compared to England average: 22.3%
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The Challenges Ahead:
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Commissioning – Measurable Outcomes
East and North Herts Hospital Trust: Organisational Commitment and Leadership
Training and development
Implementation – delivery and expansion
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The CQUIN
• Training and practice – all frontline staff to be trained
• 50% of all new outpatients to receive brief intervention advice (smoking, alcohol and weight)
• AUDIT C – 50% new patients to complete AUDIT C(Score >20 to be referred to drug and alcohol team)
• Weight concerns - signposted to community providers
• All smokers to be offered a referral to HSSS
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Success is: 1Trust
3 Hospitals
700 Clinics
322 staff trained
> 18,000 Brief Interventions
Signposting to lifestyle services
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Success is:
• > 18,000 Brief Interventions
• 364 patients referred to drug and alcohol services(HDARS – 50% increase in alcohol referrals)
• 607 patients signposted for weight management
• 733 patients referred to stop smoking services
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What Joe said:
“ I was worried why the nurse was asking – but she was trying to help me understand why drinking and smoking were important….I have tried to stop smoking a few times, but doing that questionnaire (AUDIT C) made me about it more seriously and I am definitely going to sort out the drinking before I try again”
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What Sally said:
“I was waiting for my appointment for my Crohn’s disease when I was asked about smoking; this must be a new thing, because I can’t remember being asked before and it must be important for the hospital to ask me about it. You (the stop smoking service) have got in touch very quickly...... do you know I really feel brave enough to have a go now”
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Lessons Learnt
• Data collection – nightmare!
• Matching referrals to outcomes
• Following up patients – impossible
Next StepsImproved data collection (Infloflex)
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Next Steps: Supporting Hertfordshire’s HWb Strategy 2013-2016
• New challenging CQUIN for 13/14 – whole trust
• Improved data collection – Lifestyles (Infoflex)
• Improved referral pathways – opt out approach (NICE)
• Healthy lifestyle volunteers
• Ambition – completely Smokefree hospital site by NSD 2014
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And when you think you are winning…….
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A new target or something we should be doing anyway?
• Asking patients and giving advice and education about smoking was already embedded in practice in Outpatients
• Staff felt health advice and promotion was important
• Staff felt they already carried this out
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Getting Ready
• Staff meetings
• Training in groups and using e-learning tool
• Getting new promotional leaflets in the departments
• We designed a sticker as we had found it worked with smoking
• Collecting the data - more paperwork. BUT how would we know what we had achieved
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Getting Everything Together
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Concerns from Staff
Before we started I thought it would be difficult to ask about alcohol and patients would get upset but I can honestly say I have had none of that since
MECC’ing started
Clinical Support Worker
Sometimes space is difficult to ensure
privacy
The Drs have no interest or awareness
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Findings from Staff
• People happy to engage in conversation
• What constitutes a unit of alcohol ? Many people don’t know
• People want more information about alcohol
• People reluctant to accept referral for smoking
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What MECC means to me……
Gives opportunity and time to chat to any patients that need
support and advice – Sister
It raises awareness of
health promotionStaff Nurse
I like the patient contact –
Dental Nurse
It highlights the good work being carried out in outpatients
Matron
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What’s next in the Trust
• Review how we are doing, listening and learning from staff involved
• Revisit and more training, keep things fresh
• Working with Occupational Health make sure MECC with staff.
• Looking at how we increase patients accepting smoking referrals, ‘opt out’ rather than ‘opt in’ approach.
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I know
I could make some changes
I can help
help you to make them