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#Post#: 40--------------------------------------------------
How NICE can support the integration of health and social care s
ervices locally?
By: admini5 Date: May 1, 2015, 5:22 am
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Local Councils and CCGs submitting plans to the Government’s
Better Care Fund (BCF) can get inspired by service integration
case studies in the NICE Local Practice Collection
Better integration of health and social care services is a
critical part of delivering efficient user-centred care.
By working together, NHS organisations and local government can
help reduce hospital admissions and ensure that more people
receive high quality care in community settings.
For patients and services users, integrated care means being at
the centre of their own care, and not having to re-state
personal details, symptoms or needs several times, or falling
between gaps in disparate services or suffering from
uncoordinated visits to different services.
For local Clinical Commissioning Groups (CCGs) and Councils,
integrated care is likely to mean the realignment or redesign of
services and sharing of some budgets.
NICE has an important role to play in supporting local
organisations to integrate their service delivery, and in
particular to support CCGs and Councils in the process of
submitting plans to the Government’s £3.8bn Better Care Fund.
“NICE is well placed to be the first port of call for any local
NHS organisations or Councils looking to provide integrated
care,” says Professor Gillian Leng, NICE’s Deputy Chief
Executive.
“Our evidence-based guidance and quality standards set out what
high quality care looks like across a variety of providers and
settings. What’s more, we provide a variety of resources and
support to help drive change at a local level.
“For example, our Local Practice Collection brings together
hundreds of case studies highlighting projects happening around
the country to improve the quality of care commissioned and
provided.”
Eighteen examples in NICE’s local practice collection highlight
projects already underway where integration of services has led
to improvements in quality and productivity:
1. Alcohol Care Teams: to reduce acute hospital admissions and
improve quality of care: Royal Bolton Hospital NHS Foundation
Trust and the British Society of Gastroenterology
A multi-disciplinary Alcohol Care Team worked across hospitals
and primary care to develop a coordinated approach to alchohol
treatment and prevention, including organising systematic
interventions and access to specialist advice and treatment. The
initiative address alcohol-related problems more effectively,
reducing hospital re-admissions and discharge times, and
improving patient outcomes.
2. Improving the quality of care for patients with type 1
diabetes: dose adjustment for normal eating (DAFNE) : Department
of Health
DAFNE is a five-day structured education programme for adults
with type 1 diabetes, providing knowledge and skills for dietary
carbohydrate management and insulin-dose adjustment.
Introduction of the training programme showed a significant
improvement in patient safety and a reduction in adverse events,
such as hypoglycaemia. There were also sustained improvements in
patient quality of life and treatment satisfaction, due to fewer
hospital visits and admissions.
3. Improving the quality of care for men with lower urinary
tract symptoms: shared decision making: South Norfolk Healthcare
Community Interest Company
This programme focused on the quality of decision-making between
clinician and patient, by providing feedback to individual
clinicians, supported by educational materials that were based
onagreed quality markers from NICE guidelines. The initiative
reduced time delays that oftenresult from incorrect disgnoses
and referrals, as well as increasing patient safety by improving
assessment in primary care.
4. Stratified cancer pathways: redesigning services for those
living with or beyond cancer: NHS Improvement
This initiative improved after-care services by matching the
level of support to the patient's individual needs and
preferences. This included supporting patients to self-manage
their own health and wellbeing once treatment had been
completed, and acute after-effects had subsided. This released
outpatient resources, allowing patients with complex needs to
access specialist teams, and enabled patients to address their
own unmet needs.
5.Safety Express: a national pilot to deliver harm free care
:QIPP Safe Care Programme: Salford Royal NHS Foundation Trust
and University of Central Lancashire
This programme required organisations to address high-level
factors - leadership and safety culture, 95% reliable clinical
care, and support infrastructure - that influence the delivery
of harm-free care, defined as absence of pressure ulcers, falls,
urinary tract infections, and venous thromboembolisms. The NHS
thermometer was used to monitor patient harms, and showed
significant reduction in all four harm areas.
6. Home administration of intravenous diuretics to heart failure
patients: increasing productivity and improving quality of care:
British Heart Foundation
A pilot programme assessed safe and effective ways for
specialist nursing teams to administer intravenous diuretics to
heart failure patients, at home or day care settings. Home-based
treatment was reported to be less disruptive for the patient and
enabled discussion of wider treatment and condition-management,
improving patient and carer experience.
7. Reducing hospital admission rates for people with diabetes: a
systematic approach to improving primary care outcomes: NHS
Greenwich
This initiative used the established NICE Into Practice guide to
provide a structured programme of cardio-metabolic risk
management and improve the health outcomes of high risk
patients, particularly those with diabetes. By effectively
implementing NICE guidelines, and systematically improving
patient outcomes in primary care, the programme aims to reduce
hospital admissions.
8. Management of patients with stroke: REDS (Reach Early
Discharge Scheme) :CNWL NHS Camden Provider Services
The Stroke REDS team provides intensive home-based
rehabilitation to stroke patients who are suitable for early
discharge, before supporting transfer to the REACH community
team for long-term rehabilitation. The initiative improved
patient outcomes and safety by reducing the length of stay in
hospital, promoted patient independence at home, and supported
effective transfer of care.
9. Early discharge and intensive community rehabilitation for
stroke patients: Berkshire West PCT
The Early Supported Discharge (ESD) Team facilitates transition
from the intensive rehabilitation received in acute stroke units
to long-term support in the community. The ESD Team provides
multidisciplinary rehabilitation at home after discharge, for up
to six weeks. The programme reduced the average length of stay
by eight days per patient, as well as reducing re-admission
rates and occurrence of adverse outcomes and secondary cerebral
events.
10. Enhanced home-based palliative care for adults: Bournemouth
and Poole Community Health Services
A nurse-led community palliative care unit was established to
provide enhanced home-based care for patients with end-stage
life-limiting illnesses. The unit allowed for complex care
packages to be provided in patients’ homes, and enabled greater
mitigation of risk and crises, which may result in hospital
admissions.
11. Care in the home schemes: British Red Cross
Red Cross volunteers and staff worked in partnership with NHS
services to deliver care in the home schemes that reduce
hospital admissions and re-admissions, and promote timely and
effective discharge.
12.Self care support for long term conditions:Department of
Health
A campaign from the Department of Health was aimed at educating
patients with long-term conditions about their disease,
treatment choices, and care pathways; policies and common core
principles were also introduced to support service redesign. The
initiative has been replicated across the UK, embedding patient
choice and support for self-care as an integral part of care
pathways.
13.Personalised care plans for long term conditions:NHS North
East
People with long-term conditions should be offered a systematic
planned assessment of their overall care, their ongoing needs,
and their forthcoming care. Personalised care planning is
central to improving patient involvement in care and decision
making, leading to enhanced quality of life and patient
outcomes. Personalised care planning has been effectively
implemented in a variety of settings, notably in supporting
patients with diabetes.
14.Self management for chronic knee pain: using group
physiotherapy to teach exercises and coping strategies:Sevenoaks
District General Hospital
Pain-induced limitation of mobility and physical function,
resulting from chronic peripheral joint pain, increases the risk
of exacerbating or developing co-morbidities. NICE guidance
recommends that exercise should be a core treatment of
osteoarthritis. This rehabilitation programme combines
education, self-management, and coping advice with an exercise
regime tailored to address the patient’s needs.
15. Podiatry education to empower patients to self-care:
Community and Primary Services, Sheffield Teaching Hospitals NHS
Foundation Trust
Many common foot problems, typically presented by elderly
patients, can be treated by the patients themselves, once they
have the confidence, skills, and knowledge. Patients identified
as suitable for self-care were invited to attend an awareness
session delivered by a podiatrist, allowing the podiatry service
to concentrate care on high risk patients, such as those with
diabetes, without any detriment to patients discharged to
self-care.
16. Pre-emptive occupational therapy for healthy older people:
College of Occupational Therapists
A programme of preventative occupational therapy for healthy
older people can promote quality of living and health, and
reduce the need for other medical interventions. A pilot
programme has been undertaken to demonstrate promotion of
successful and healthy ageing.
For practical, hands-on support for integrating services locally
NICE has a dedicated field team of implementation consultants.
Our field team works with people at a local level to help inform
them about putting guidance into practice, to keep them up to
date on what is relevant to them from NICE, and to help share
and spread good practice. Each consultant links with social
care, the NHS, local authorities and other organisations in
their area, and gives them a chance to feedback to NICE on
things that we could do better to meet their needs. If you would
like to meet your local NICE implementation consultant please
contact the NICE Field Team.
17. Rapid Response Services: intermediate tier,
multi-disciplinary health and social care service: Care Services
Efficiency Delivery Programme (CSED-DH) in partnership with
Bristol PCT and Bristol City Council
Rapid Response Services are multi-disciplinary teams that work
to provide alternatives to unscheduled hospital and residential
care admissions for older people, typically through at-home
care. The service operates at an intermediate tier between acute
and primary care, and provides an integrated approach across
health and social care.
18. Peer-reviewed referral management: saving money and
increasing quality by improving referral practice: South Norfolk
Healthcare Community Interest Company
Focusing on improving the quality of elective referrals in
primary care, this initiative peer-reviewed GP referral data and
disseminated timely feedback where the referral could be
altered. This resulted in an overall increase in patient safety
and fewer adverse events, due to more appropriate referrals.
Referral waiting times were reduced, particularly for patients
judged to be at high risk of cancer.
Organisations interested in using high quality, authoritative
evidence to plan services locally can also use NICE Evidence
Services, a free online portal providing access to trusted and
accredited sources of evidence across health, public health, and
social care.
#Post#: 41--------------------------------------------------
Re: How NICE can support the integration of health and social ca
re services locally?
By: admini5 Date: May 1, 2015, 5:27 am
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For more information, please visit the following link:
HTML https://www.nice.org.uk/news/feature/better-care-fund
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