Whittington Health

WhittingtonWhittington Health

Louise RestrickLouise Restrick Integrated Consultant Respiratory Physician

Whittington Hospital and NHS Islington

Whittington HealthWhittington HospitalNHS Haringey

NHS Islington

• Acute general teaching hospital– Beds (inc ICU, maternity and children) – Operating teams and facilitiesOperating teams and facilities– Clinical skills, knowledge and experience

• Provide care for inner city population of ~300,000– Multi-ethnic population– High levels of deprivation– Smoking prevalence ~35%g p

• Not co-located with PCT or London Borough– Work with >2 PCTs/Boroughs

Whittington HealthWhittington Health• Integrated Care Organisation• Merger of Whittington Hospital, NHS Haringey g g g y

and NHS Islington community services• 4000 staff and budget of £260m• Covers ~500,000 population• One organisation providing local healthcare from g p g

home to hospital and hospital to home• Working with General Practice and Social Care

1st April p2011

Whittington HealthAims

High “value” health care: better outcomesHigh value health care: better outcomes per pound spent

I d h lth t• Improved health outcomes• Improved patient experience• Reduced costs…from start to end of each patient’s pathway

…working with General Practice, Social Care and Local Authorities

Whittington HealthOutcome domains – shared responsibility

Preventing people from dying prematurely NHS and PH

NHS, SC and PHEnhancing quality of life for people with care needs

Preventing deterioration and helping recoveryfrom episodes of ill-health or injury

NHS, SC and PH

Ensuring people have a positive experience of care NHS and SC

Treating and caring for people in a safe environment and protecting them from harm

NHS, SC and PH

Improving population health and tackling health inequalities

PH

Whittington HealthInformation needed

• Agreed measures of health outcomes• Data on health outcomes and unwarranted variation• Measures of patient experience• Individual and disease group patient pathway costs• Value comparisons for interventionsp

eg QALYS, life-years lost/saved• What residents want from local health care

Whittington HealthImproving Health Outcomes

• Achievable• Right Care

Michael Porter 2011 UCLP/Monitor Conference

Doing the right things and doing things rightValue Hierarchyy– Long Term Conditions– Urgent and Emergency Careg g y– End of Life Care– Safe CareSafe Care

Whittington HealthReducing total costs

• Good outcomes as efficiently as possibleA l i l hi h

Michael Porter 2011 UCLP/Monitor Conference

– Applying value hierarchy– Reducing clinical errors

• Cost reduction is the wrong goal – save money on the wrong thingsN d t f d t ll h h d li• Need to fundamentally change how we deliver care to release costsR d t t l t l f• Reduce total cost over cycle of care

Whittington Health

Whittington Health

• Know costs of health careClinical philosophy• Know costs of health care

– Risk stratification• Use value frameworkUse value framework• Long-term conditions and co-morbidities focus

– Smoking alcohol drugs obesitySmoking, alcohol, drugs, obesity …– Not just getting someone home thinking about preventing

the next admission….– Advanced care planning

• Working with patients– Co-Creating Health

• Holistic needs assessments– Learning from social care (and palliative care)

Behaviour change for clinicians?

Whittington HealthChallenges to Integrating Care

• Resources used merging 3 organisations• Creating Whittington Health culture & philosophyCreating Whittington Health culture & philosophy

from 3 different organisations• Using current tariffs including PbR and QOFUsing current tariffs including PbR and QOF• Identifying and minimising financial and clinical

governance risksg• Enabling Whittington Health professionals to

lead/engage with transformational changeg g g• Engaging GPs• Engaging Social Careg g g

Whittington HealthCommissioning

• GP leadership• Across health and social care• Across health and social care

– ReablementB ndled tariffs– Bundled tariffs

– Personalised budgetsC i i i * i f d b J i t St t i N d• Commissioning* informed by Joint Strategic Needs AssessmentE t ith H lth d W ll B i B d• Engagement with Health and Well Being Board

• CQINS that support JSNA

* ‘Process of assessing health needs of a population, then planning, securing and monitoring the best possible range and quality of health services and health improvement services for that population given resources available.’ Nuffield Trust 2010

Whittington HealthHealth professionalsand social care

• Working for Whittington Health

… and social care

– Consultants– Hospital nurses and allied health professionals– Community teams– Community nurses

IAPT d St S ki t– IAPT and Stop Smoking teams• Working with Whittington Health

GP Commissioners– GP Commissioners– GPs and Practice Nurses– Social Care Public Health and other LocalSocial Care, Public Health and other Local

Authority teams

Whittington HealthWhat motivates clinicians?

(Improving) quality of care for patientsMastery of (an) expertise? PayQuality of working dayPeer opinion and respectAffirmation from patients and families

Whittington HealthEnablers for clinical leadership, engagement and commitmentengagement and commitment

E idTiPeer PEvidenceTime Pressure

Whittington HealthAligning with General Practice• Make the case for improved patient care

‘Just moving the blocks round’‘Removing’ district nurses from GP surgeries

• Financial levers/barriersGPs commissioning careGPs providers of care

• Work more enjoyable…• Peer pressure

… relationships

Whittington HealthEnablers of Integrated Care

Islington joint health and social servicesNHS Islington track record in re-ablementNHS Islington track record in re ablementDH demonstrator site for COPD post-discharge re-ablement

Consultants working across hospital and communityConsultants working across hospital and communityRespiratory, cardiology, diabetes, rheumatology integrated

physicians already providing training and support– Rotational posts

Whittington Hospital and NHS Islington and Haringey already Co-Creating Health SiteDiabetes and respiratory

UCLP it t d tUCLP commitment and support

Whittington HealthEnablers of Integrated Care

• Common IT system– Shared real-time patient information– Shared outcome and costs data and responsibilities

• Innovators given time– Clinical leadership of transformational change & population

care given same priority as direct clinical care in job plansEd ti• Education– Opportunity to train integrated clinicians

C lt d L d hi• Culture and Leadership– GPs – WISH, formal roles on the board?

Working across organisational and professional– Working across organisational and professional boundaries

Whittington Health