Mark Fleming

Healthcare Improvement Scotland

and

NHS Ayrshire and Arran

Session structure • Why we did not develop national ICPs

• A step by step guide to developing care pathway standards in mental health for local use.

• Using pathways to actively involve users and their carers/relatives in care provision.

• Supporting Care Pathway developments locally.

• Learning from successful care pathway developments and implementations.

Why no national ICPs???? • Local leadership

• Local Development and Ownership by staff and service users

• Local process mapping

• Local Understanding

• Local Training needs

• Local eHealth systems

• Local Governance

• Local implementation

• Local Information sharing protocols

• Local Improvement reporting

Delivering For Mental Health 2006

Standard 6

NHS QIS will develop Mental Health ICP standards and Accreditation Model.

NHS Boards will develop and implement from 2008

ICP Definition

An explicit agreement by a local group of staff and workers, both multidisciplinary and multiagency, to provide a comprehensive service to a clinical or care group on the basis of current views of good practice and any available evidence or guideline.

It is important that the group agree on communication, record keeping and audit.

There should be a mechanism to pick up when a patient has not received any care input specified by the pathway so that the omission can be remedied.

The local group should be committed to continuous improvement of the integrated care pathway on the basis of new evidence of service developments or of problems in implementation.

Integrated Care Pathway

A tool to compare planned care

with care actually given

National Standards for Mental Health ICPs

How Did we Develop the ICP Standards?

• 18 months exercise

• Evidence reviews

• Clinical and Improvement leadership

• Nationwide Consultation/Feedback process

• Involved 150 clinicians, users and carers.

• Launch event

ICP Standards - Process standards (how ICPs are developed)

generic

condition specific

- Care standards (content of ICPs)

- Service improvement standards (how ICPs are

implemented)

Main Process Standards Stakeholder involvement

Process mapping

Leaders and project managers identified

Recording and sharing of information

Referral systems developed

Care Standards Service user at the centre of care planning

Comprehensive assessment

Risk management

A service user rated measure of needs (eg Avon)

Use evidence based interventions

Measure outcome

Support implementation of ICPs

Describe systems for reporting and acting on

variances

Drive service redesign and continuous quality

improvement

Service Improvement Standards

A step by step guide • How to Guide is embedded in ICP standards

• Laid down a foundation for service improvement.

• ICP Toolkit – www.icptoolkit.org

• ICPUS/SPA – ICP workbook. http://www.icpus.org.uk/wp-content/uploads/2007/08/icpus_workbook_2007.pdf

Key Principles of How to Guide • Clinical and management Leadership.

• Stakeholder involvement

• Process Mapping

• Close links to Governance and Quality

• Staff Communication, Training needs and Skills Development.

• Data collection, sharing, and analysis to develop good information.

• Systems for variance analysis.

Alignment with Six dimensions of healthcare quality

Patient centred

Safe

Effective

Efficient

Equitable

Timely

Assessment Care

Planning

Care

Delivery

• Social needs

• Recovery approach

• Interventions

• Talking therapies

• Admission/transfer

• Review & follow up

information

info

rmation

Management

of variance /

decision making

Tier 1: local variance

leading to individual

care redesign

Tier 2: Local

management

teams

level leading to

service redesign

Tier 3:

NHS Board level

Performance

Management

Mechanism

for tracking

variations from plan

• Measurement

of outcomes

Values base/Evidence base/good practice

Local ICP G

overn

ance

Mental state

Strengths & needs

Risk

Physical & neurological

Specific assessment/outcome

tools

Benefits to service users

ICPs will :

help improve assessment and care planning

ensure care is delivered in accordance with

evidence and best practice

improve recording of care delivered and

outcome achieved

“…the right care and treatment

at the right time…”

Involvement of users & carers in the ICP development process There is a requirement that users and carers are engaged

and involved in the ICP development process

There are a variety of ways of achieving this

May 2007 VOX (Voices Of eXperience) developed good practice guidance in service user involvement

This provides and excellent framework for local teams in developing their ICPs

VOX (Voices Of eXperience) Guidance

It is essential that service user involvement and participation is real and meaningful, and is based on empowering the individual to regain more control over their lives, develop their capacity, confidence and self esteem, allowing and facilitating their participation as citizens in both their own lives, and in helping to contribute positively to improving the lives of others.

Good Practice In Service User Involvement Guidance Notes May 2007

Client and carer focus throughout the standards

Standard 2 :Education and Involvement

Standard 3: Process Mapping involving Users and Carers

Standard 10: Inclusion of user led needs assessment e.g. My View

Focus on recovery, strengths and aspirations as well as needs

Client and carer focus throughout the standards

Standard 21: Measure of needs and outcomes To evaluate recovery from a user or carer

based perspective e.g. My View

Standard 39: Gathering feedback from users and carers about having their care delivered through an ICP

Client and carer focus throughout the standards

Involvement of service user and carer in all aspects of their care and support

A collaborative approach to care which empowers the user and carer to work with staff

Summarised as person centred care planning standard

Supporting Care Pathway Developments Locally • 1 WTE national ICP coordinator

• National mental health ICP Steering Group

• NHS Board ICP Link contacts

• Condition specific networks/discussions

• Training for staff

• Workshops on ICP development

• Facilitation of sessions by national Coordinators

Learning from Success • National ICP Link persons network

• Sharing via National ICP Coordinators

• National ICP conference

• Scottish Pathways Association

• European ICP Conference Glasgow 2013

www.icptoolkit.org

Thank you