Transcript Slide 1

Commissioning for Health Improvement Achieving Health Improvement
Liz Fisher
Health Improvement Manager
Elaine Allan
Matron Practice Standards
Clinical Support Services
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It started with a CQUIN
Proposed 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:
1
Trust
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 Steps
Improved 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
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Sometimes space
is difficult to ensure
privacy
The Drs have
no interest or
awareness
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 highlights the good
work being carried
out in outpatients
Matron
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It raises
awareness of
health promotion
Staff Nurse
I like the patient contact
–
Dental Nurse
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
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I can help
help you
to make
them