Introduction Linda Binder NHS Improvement

1. Improving cardiac rehabilitation through better commissioningNational project meeting18th May 2011 Introduction Linda Binder NHS Improvement

2. Administration and house-keeping • There is no fire alarm test planned • Breaks, lunch and “facilities” • We will stick to time and it’s important that you stay to the end If you are too hot or cold please let us know • This (half) day is designed to participative so please feel free to ask questions and make comments (usual meeting etiquette) • Evaluation forms • Two flip charts – general queries/specific queries NACR • Lesley and Tina • Roger Boyle’s retirement DVD!!!

3. Agenda • 0930 Registration & refreshments • 10.15 Welcome and introductions • 1020 National update • 1030 Project review: Partnership working: North West London Cardiac and Stroke Network and the North West London Health and Innovation Cluster • 1120 Coffee • 1135 Issues and challenges • 1235NACR sub-project overview Improvement • 1245 NACR A question and answer session • 1300 Lunch & networking (Main Peer Support meeting concludes)

4. National updateProf Patrick DohertyNCL for CR

5. items NICE CR commissioning tool NICE TAG for Heart Failure Issues on reporting QIPP and identifying inequalities in NHS services

6. NICE CR commissioning tool This will replace the 2009 tool which was not fully utilised It will align with the DH CR commissioning specification Use up to date costing approach that will include HRG, PbR and DH CR pack costs

7. NICE TAG for Heart Failure • 26th May first meting • Full HF pathway approach • To include CR for appropriate patients • Work to the DH CR commissioning pack • Consider referral criteria • Clinical outcomes and indicators of success

8. NHS Atlas of Variation in HealthcareQIPP | Right Care  The White Paper, Equity and Excellence: Liberating the NHS, specifies a commitment to prove better value from the resources available to healthcare. This requires the NHS to address variations in activity and spend. Such variations indicate the need to focus on appropriateness of care, and to investigate the possibilities that there is overuse of some interventions and that some lower value activities are undertaken. http://www.rightcare.nhs.uk/atlas/

9. Issues on reporting QIPP and identifying inequality in NHS services Positioning CR programmes for the future: • GPs now refer directly into conventional CR and this is very much the case with HF rehabilitation. It is important to report and evaluate in respect of referring activity. • Knowing the referring ID and practice code will help indentify numbers referred and offered, track referral trends and enable greater accountability in respect of poor referral and inequalities. • Funding for CR is often influenced by the individual organisations involved and reporting the number of patients per practices is becoming increasingly important. • As we move towards GP commissioning it would seem wise to include this type of descriptor as CR may be required to share outcomes at that level.

10. Questions welcomed!

11. Partnership working: NWL Cardiac & Stroke Network (NWLCSN) and NWL Health & Innovation Cluster (NWL HIEC) 18th May 2011 Yvonne Robertson,Lead Director, NWL HIEC Melanie Sheddon, Project Support Officer, NWL HIEC Farah Irfan-Khan, Project Manager, NWLCSN

12. Overview • The NWL HIEC & partnership working (Yvonne Robertson, Lead Director, NWL HIEC) • Cardiac Rehabilitation (CR) in NWL: Programmes, barriers & increasing uptake (Farah Irfan- Khan, Project Manager, NWLCSN) • Potential solutions, proposed interventions & pilot projects (Mel Sheddon, Programme support officer, NWL HIEC) • The future (Yvonne Robertson, Lead Director, NWL HIEC)

13. Health Innovation & Education Clusters (HIEC’s) The NWL HIEC Strengths of our partnership working Reputation Working group Funding Diffusion potential Dedicated resource The NWL HIEC & Partnership working

14. CR programmes across NW London Harrow PCT Harefield Hospital Brent PCT Hillingdon Hospital Harrow MyAction Westminster PCT Hillingdon Brent Hillingdon PCT Ealing Royal Brompton Hospital Kensington Hounslow & Chelsea Hammersmith Ealing Hospital & Fulham Chelsea & Westminster Hospital Imperial College Healthcare West Middlesex & Hounslow PCT

15. NWLCSN Work Plan (2011/12) • Evaluate whether CR programmes are adequately resourced - (Quality) • Identify local barriers to CR uptake - (Quality) • Increase CR uptake across NWL -(Innovation, Productivity)

16. Baseline assessment showed uptake of CR is low Referred to national publications on reasons for low CR uptake Need to identify local barriers to formulate local solutions Identify local barriers to CR uptake

17. Cause & effect analysis ???????????????

18. Common barriers - lack of admin support, underfunding,… The most common causes were related to Patients e.g. language barriers, DNAs, lack of awareness of CR, etc What can we do to increase awareness and benefits of CR amongst patients ……. Findings from cause & effect analysis Communications & marketing!

19. Potential solutions, proposed interventions & pilot projects • Expected barriers: Staffing & underfunding • Common barriers related to patient engagement: • - DNA’s, • - Refusals, • - Lack of knowledge of CR service & benefits • HIEC & NWLCSN identified collaborative working opportunity: • - HIEC & NWLCSN to support NWL services to achieve national target of 85% uptake • - HIEC involvement with NWL CR working group

20. Joint workshops aimed at NWL CR programmes November ’10 workshop: • Strengths & opportunities of existing CR services • The patient perspective • Achievable goals within 12 months • Most popular suggestion - ‘Promote existing services to patients, GP’s, consultants & commissioners’ February ‘11 workshop: • Introduce NWL CR programmes to communications and marketing and how it can be used to improve services • Identify potential communication and marketing interventions to increase uptake of CR • Opportunity to propose projects to pilot marketing implementations

21. Proposed pilot projects Two pilot projects submitted from three programmes: 1) Imperial: • Development of a video clip to target patients prior to discharge who miss out on seeing a CR nurse (e.g. weekends, etc) • Video clip to include: What CR service involves, persuasive and clear information from the Cardiac Consultant and patient perspective on CR 2) Brent & Harrow: - Educating GP’s on the existence & benefits of CR services

22. Progress so far and next steps Progress so far • Project proposals submitted • Initialised scoping exercise and baseline assessments at pilot sites • Pilot site meetings set up to design and plan projects Next steps • Embark on pilot projects and implement interventions • Collect and analyse data • Share learning and sustain changes

23. Engage with HIEC national network Engage with clinical leads Share learning's with NHS Improvement national team Continue working with NWLCSN and identify future priorities for potential partnership working The future

24. For more information: The NWL HIEC: • Yvonne.robertson@chelwest.nhs.uk • Melanie.sheddon@chelwest.nhs.uk The NWLCSN: • Farah.irfan-khan@nhs.net

25. Coffee time!

26. Issues and challenges ……..so just how do we sort this out then????

27. NACR & NHS ImprovementUpdate on PilotProject18th May 2011 National Improvement Leads NHS Improvement

28. Brief Overview

29. Joint work with NACR • Collaboration with NACR to explore, test and evaluate feasibility of modifying the existing national audit dataset and database to capture ‘mandatory’ information requirements of commissioning pack without compromising the integrity of the existing national audit • Provide a ‘one-stop’ database for CR providers (clinical & service performance outcome data)? • Aim – to produce a commissioner-focused report to help gauge progress towards the 4 key outcomes cited in the pack (alongside the clinical reporting and audit) which will enable commissioners to manage performance effectively

30. The Challenge….

31. The Challenge…. • The NACR provides patient based information records in a linear approach i.e. information about a patients clinical progress through CR over time • Commissioners want to know how a CR service performs (not individual patient clinical information) at set points (monthly/quarterly) • Commissioners need to understand how many patients are starting and finishing CR (as well as readmission rates and patient satisfaction) at regular intervals in order to set appropriate costs, monitor throughput, performance and ensure value for money …can we use the NACR database to extract both clinical and performance data?

32. Brief Update

33. Update in brief… • Launch for the pilot sites – meeting today • Extra fields on the NACR database site – only visible to the pilot projects • The NACR Team will support the technical aspects and changes to the fields on the database • NHS Improvement team to work on the ‘how to’ with sites – finding solutions to reporting on performance • Patrick Doherty will work across the provider commissioner interface to translate the commissioning pack requirements into sensible usable practice • The NACR Team will collate regular reports on the progress of the database and the usability of the new fields

34. What next…

35. Next steps… • Funding for the project agreed & finalised (one year) • Sites taking part will have a briefing meeting this afternoon • We will update you at future meetings and through the website • Any solutions that we uncover on the ‘how to’ will be shared as they evolve • Anyone who thinks they might still be interested in taking part – please let us know

36. National Audit of Cardiac Rehabilitation Your queries answered!! Nerina Onion NACR

37. Lunch and Networking

38. Next Steps • Format of future meetings • Meeting dates for remainder of year National meetings 18th May 2011 12th July 2011 20th September 2011 15th November 2011 11th January 2012 Virtual meetings Individual visits per site with NILs Individual conference calls/Web-ex’s • Reminder – Heads of Agreement forms • Evaluation of today