Transcript No Slide Title

Workshop –
Update on Standards for
Integrated Care Pathways
Scottish Personality Disorder Network
SECC, 13 September 2007
Rosie Cameron
National ICP Coordinator
NHS Quality Improvement Scotland
Overview of Presentation
 Summary of consultation comments
 Specific BPD comments
 Restructuring of the standards
 Amendments to standards
 Discussion
Consultation on Draft Standards
Comments on approach
1. Supportive of approach (frequent)
2. ICPs require IT system for sharing information and for
variance reporting (frequent)
3. Implementation of ICPs is a large volume of work, so
should be staged (frequent)
4. ICPs require extra resource to implement (frequent)
5. ICPs are the wrong approach totally in mental health (one
or two)
Comments on document
1. Document difficult to read and too much medical jargon
(frequent)
2. Not clear how references were selected and evaluated
(occasional)
3. Accreditation timescale too short and needs to take into
account local circumstances (occasional)
4. Criteria for initiating ICP need to be clear (occasional)
5. Should promote a stepped care model of care for all
conditions (occasional)
Standards general comments
1. Dividing the pathways into 5 diagnostic groups is not helpful
2. Best not to recommend specific outcome measure tools
3. Importance of comorbidity not tackled (alcohol, drugs,
Learning Disability)
4. Psychological therapies: need a consistent approach
5. Too medical a model is being used
6. Recovery focus does not come through
BPD standards
1. Why “borderline” only
2. Maybe call ICP “challenging behaviour”
3. Not helpful to make & give diagnosis
4. Bring forward appendices into standards
5. No evidence, so there should not be an ICP
Overall Summary
1. IT systems & extra resources needed
2. Too medical
3. Difficult to read / navigate
4. Dividing into 5 ICPs not helpful
5. Concern over being too prescriptive on outcome
tools
6. Length of time to diagnosis
The way forward
 Reflecting on comments from consultation
 Internal work
 Restructuring to address concerns
 Content of standards altered via recommendations
from the subgroup
Assessment
Care
Planning
Care
Delivery
Outcomes
Generic
Schizophrenia
Depression
Dementia
BPD
Bipolar
Generic Mental Health ICP standards
Assessment
Care Planning
Care delivery
Comprehensive
assessment
Person & recovery
centred care
Carers, advocates &
multidisciplinary team
involved
Assessment for
comorbidity
Single care plan
Information given on
condition, signposting &
what next
Vulnerability & risk
assessment
Record pharmacological
treatment decisions
Physical health check
Treat comorbidity
Record symptoms &
diagnosis
Record length & reason
for inpatient stay
Assess suitability for
psychological therapy
Assess risk to women
Outcomes
Service user
needs assessment
& outcome tool
BPD Mental Health ICP standards
Assessment
Care Planning
Care delivery
Comprehensive
assessment
Person & recovery
centred care
Carers, advocates &
multidisciplinary team
involved
Assessment for
comorbidity
Single care plan
Information given on
condition, signposting &
what next
Vulnerability & risk
assessment
Record pharmacological
treatment decisions
Physical health check
Treat comorbidity
Record symptoms &
diagnosis
Record length & reason
for inpatient stay
Assess suitability for
psychological therapy
Assess risk to women
Follow medication
guidance
Follow in-patient
admission guidance
Outcomes
Service user
needs assessment
& outcome tool
Level 4:
National
Local ICP
Level 3:
NHS Board and LA
Level 2: Local
management
teams
Process Standards
Level 1: variance
leading to individual
care redesign
Assessment
Outcomes
Management
of variance /
decision making
Mechanism
for tracking
variations from plan
Care
standards
Care
Planning
Care
Delivery
information
information
Performance
Management
& Governance
Service standards