100 likes | 233 Views
The big picture - NYY. North Yorkshire has a population base of 794,532LTC affects a significant proportion of the total population; 176,000 people registered on QOF; 50,000 with Diabetes, COPD and Heart Failure Patients with a LTC are more intensive users of healthcare servicesNHS NYY estimat
E N D
1. Long-term Conditions and Telehealth in North Yorkshire & York
Kerry Wheeler, Assistant Director of Strategy Programme Lead for Telehealth
2. The big picture - NYY North Yorkshire has a population base of 794,532
LTC affects a significant proportion of the total population; 176,000 people registered on QOF; 50,000 with Diabetes, COPD and Heart Failure
Patients with a LTC are more intensive users of healthcare services
NHS NYY estimates a 14% increase in the population by 2020, with more people living longer and an estimated 22% increase in those aged 65+ years / 50% over 85s.
Prevalence of LTC rises with age
Financial challenges in NHS
3. Why Telehealth? An enabler to support implementation of LTC care pathways - fragmented
Emerging (inter)national evidence base
Non-elective admissions increasing by 5-10% a year against a background of reduction in financial allocation; expectation that care is provided in a different way
LTC - frequent cause of admissions to hospital. Example: COPD spend is circa 10 million with 3 million on primary diagnosis;
Rurality of NYY leads to issues regarding access to services and efficiency of service delivery
Push from NYCC significant impact from telecare
Support from the SHA to act as a pioneering site for the region
4. How did we start the Project? April 09 - PBC Consortia approached NYY to implement Telehealth across 4 Localities (Whitby, Hambleton/Richmondshire, York & Selby) as part of phased approach within longer term programme.
June 09 120 units, 2 Suppliers, establishment of project team, internal steering group and executive board
Sept 09 - Commenced implementation through Community Staff. Early evaluation through YHEC showed positive impact
Dec 09 Procurement of 2,000 Telehealth units for full scale roll out across NYY
April 10 Commencement of 3-year contract with Tunstall Healthcare
September 2010 Phase 2 monitoring commenced
5. Which LTC are part of the Telehealth programme? 6,705 Heart Failure patients and 11,505 COPD patients in NYY, with an estimate of 1,000s more undiagnosed.
LTC with trackable vital signs indicative of health deterioration; e.g. COPD exacerbation / reduction in oxygen saturation levels, heart failure decompensation / increased weight through fluid accumulation
Diabetes as a co-morbidity to COPD and Heart Failure
6. Progress over last 12 months...... Commenced work with Clinicians on redesign of care pathways for COPD, Heart Failure and Diabetes July 2010
Telehealth within pathways as a clinical tool (enabler)
Process about system change and selection of appropriate patients, not deployment of units
Pathways completed & signed off by PBC and Commissioning Executive in October 2010 NICE and Map of Medicine compliant
Service specifications and KPIs included in contracts from April 2011
By Locality savings plan based on implementation of pathways and deployment of telehealth
Ongoing clinical engagement across all sectors
7. Progress over last 12 months......
Community Staff all trained and largest referrers clinical advocates
47 out of 100 Practices visited to discuss Project. 85 Practices now with patients on telehealth units
7 Practices referring and directly managing Patients 34 patients in total
As at 20 June 346 live Patients on units, almost 500 referrals
Monthly performance dashboard as at end of May 2011, 54% reduction in non-elective activity (150 patients for 6+ months)
Alert rate to clinicians 3%
Telehealth website nyytelehealth.co.uk
8. Focus during 2011/12 Full deployment of units by March 2012
Key Projects:
Deployment of 1,000+ units to COPD & Heart Failure Patients from York Trust
Deployment of 100+ units from Haxby Group Practice (2nd largest Practice in NYY)
Rapid deployment of T-Health Project within Scarborough Trust 100+ units to Heart Failure Patients
Support to Craven GPCC and Harrogate GPCC on delivery of QIPP plans
Project reports through Central QIPP Board at PCT
Work with LMC on QOF plus GMS/PMS incentives
Work with the Nuffield on independent evaluation of the Project
9. What are the benefits of Telehealth? Alerts clinicians to priority patients / early warning of clinical deterioration
Provides easily accessible, historical, and current trend data and health interview responses, to all clinicians involved in the patients care.
Supports clinical decision making and monitoring during changes in the patients therapy
Patients more in control and confident to manage their own condition leading to improved quality of life
Potential to support Early Supported Discharge Schemes from acute hospitals
10. The common questions clinical engagement What is the evidence for telehealth?
What impact will this have on my workload? (3% crucial)
Will we get paid for the extra capacity required to do this shift in workload?
How do I select the right Patients and set alert limits?
What are the costs for this? (either upfront or post PCT funding)
11. Commissioning Telehealth... Clinical engagement pre-procurement
Dedicated management support to take Project forward
Clear reporting/governance for Project to Board
Identify clinical champions
Good Comms/PR essential mixed messages
Telehealth clinical tool to facilitate service change
Prove not just another short term initiative
Patience!