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www.hertsdirect .org Commissioning for Health Improvement - Achieving Health Improvement Liz Fisher Health Improvement Manager Elaine Allan Matron Practice Standards Clinical Support Services
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Commissioning for Health Improvement - Achieving Health Improvement

Jan 08, 2016

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Commissioning for Health Improvement - Achieving Health Improvement. Liz Fisher Health Improvement Manager Elaine Allan Matron Practice Standards Clinical Support Services. It started with a CQUIN. Proposed by Public Health to drive MECC Supported the PH Outcomes Framework - PowerPoint PPT Presentation
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Page 1: Commissioning for Health Improvement -   Achieving Health Improvement

www.hertsdirect.org

Commissioning for Health Improvement - Achieving Health Improvement

Liz FisherHealth Improvement Manager

Elaine AllanMatron Practice StandardsClinical Support Services

Page 2: Commissioning for Health Improvement -   Achieving Health Improvement

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Page 3: Commissioning for Health Improvement -   Achieving Health Improvement

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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

Page 4: Commissioning for Health Improvement -   Achieving Health Improvement

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Key MECC Ambitions:

–Promoting a healthy weight

–Reducing the harm from alcohol

–Reducing the harm from smoking

Page 5: Commissioning for Health Improvement -   Achieving Health Improvement

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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%

Page 6: Commissioning for Health Improvement -   Achieving Health Improvement

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The Challenges Ahead:

Page 7: Commissioning for Health Improvement -   Achieving Health Improvement

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Commissioning – Measurable Outcomes

East and North Herts Hospital Trust: Organisational Commitment and Leadership

Training and development

Implementation – delivery and expansion

Page 8: Commissioning for Health Improvement -   Achieving Health Improvement

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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

Page 9: Commissioning for Health Improvement -   Achieving Health Improvement

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Success is: 1Trust

3 Hospitals

700 Clinics

322 staff trained

> 18,000 Brief Interventions

Signposting to lifestyle services

Page 10: Commissioning for Health Improvement -   Achieving Health Improvement

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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

Page 11: Commissioning for Health Improvement -   Achieving Health Improvement

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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”

Page 12: Commissioning for Health Improvement -   Achieving Health Improvement

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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”

Page 13: Commissioning for Health Improvement -   Achieving Health Improvement

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Lessons Learnt

• Data collection – nightmare!

• Matching referrals to outcomes

• Following up patients – impossible

Next StepsImproved data collection (Infloflex)

Page 14: Commissioning for Health Improvement -   Achieving Health Improvement

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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

Page 15: Commissioning for Health Improvement -   Achieving Health Improvement

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And when you think you are winning…….

Page 16: Commissioning for Health Improvement -   Achieving Health Improvement

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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

Page 17: Commissioning for Health Improvement -   Achieving Health Improvement

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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

Page 18: Commissioning for Health Improvement -   Achieving Health Improvement

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Getting Everything Together

Page 19: Commissioning for Health Improvement -   Achieving Health Improvement

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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

Page 20: Commissioning for Health Improvement -   Achieving Health Improvement

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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

Page 21: Commissioning for Health Improvement -   Achieving Health Improvement

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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

Page 22: Commissioning for Health Improvement -   Achieving Health Improvement

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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.

Page 23: Commissioning for Health Improvement -   Achieving Health Improvement

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I know

I could make some changes

I can help

help you to make them