Why commission and develop Home Oxygen Clinical Assessment and Follow Up Services (CAFS)?

1. Why commission and develop Home Oxygen Clinical Assessment and Follow Up Services (CAFS)? Helen Ellis, Primary Care Contracting

2. Introduction The journey so far; where we have been Where we need to be Benefits Why do it? Common concerns and obstacles Solutions

3. The journey so far Previous system recognised by all parties to be less patient-friendly and flexible than it could be Patients wanted a modern service with modern equipment options and lobbied accordingly. The principle being a desire for an integrated service with modern equipment and the flexibility to suit each patients needs.

4. Originally CAFs part of the service spec Unfortunately this did not happen in most areas. The NHS and the DH needed to establish how many people were on oxygen therapy – on formal assessment or other data at that point. Fully transitioned last October and all good!

5. Where are we going? The vision – (according to the network) “…………. the development and improvement of Home Oxygen Clinical Assessment and Follow Up services within the NHS improves patient health and wellbeing by providing a cost and clinically effective service for those requiring home oxygen therapy….”

6. Where we got to Huge and valuable support from pharmacists through the transition period and the aforementioned problems. Sorted the South West out with its particular problems and its subsequent later, additional transition. Supplier companies buy outs (and ins) A steady state - an improved service for patients. Policy transition – previously governed by the Pharmacy team, now by the COPD NSF team and Commissioning Department. Commercial Dept keep the contract management role and the NHS manages the day to day running of the contract locally.

7. Benefits of Commissioning CAFS By commissioning clinical assessment and follow up services, the PCT can influence a reduction in: • inappropriate prescribing or over-prescribing of oxygen therapy; • inappropriate hospital admissions (including emergency admissions); • bed days; • ambulance call-outs; • readmission rates; • GP visits; • clinical risk; • service related costs.

8. Benefits of Commissioning CAFS ii the opportunity of meeting A&E 4-hour wait targets; enable appropriate early discharge effective utilisation of available specialist expertise; appropriate use of resources (right patient/place/prescription); choice and flexibility for patients; delivery of key Public Service Agreement targets; the opportunity to advise and inform patients about treatment, thus encouraging and achieving compliance; patient satisfaction; related service cost savings.

9. Why do it? Better patient care Potential and quickly realised cost benefits Real savings (e.g £50k in the first quarter across SLA 2 PCTs) Considered good practice DH guidance recommends Everyone else is!

10. Obstacles and Concerns Lack, or perceived lack, of specialist staff and resources; Lack of awareness of the range of different service models that might be used or adapted locally (including some low-cost or even cost neutral services); Lack of access to information and/or varying awareness of the clinical assessment and review services currently provided in different parts of the country;

11. Solutions Learn from others Share concerns Talk to finance department Build relationships (across secondary and primary, with GPs, and with other teams and initiatives, COPD, Breatheasy etc). Look at what resources available and what is already happening in the patch

12. Questions to be considered to ensure that key features are included What is required to provide an assessment service? How can this be provided? How much will it cost? Will the service be following clinical guidelines and best practice? Will the service be following standard operating procedures?

13. …key features.. Will the equipment used and procedures followed (blood gas testing, spirometry etc) be according to national standards and protocols? Will those operating the service be competent and trained to do so? How will the service, its staff and equipment be audited?

14. ….key features… Assessment service should include screening to identify patients with an O2 saturation of less than 92%. Patients with an O2 saturation of less than 92% to be referred to a formal assessment service for Long Term Oxygen Therapy (LTOT). Formal patient assessment should be undertaken in accordance with the British Thoracic Society (BTS) and NICE guidelines.

15. …key features.. Competencies for spirometry as defined by Association of Respiratory Technicians Physiologists (ARTP) and BTS and Education for Health, Warwick who provide training. National standards to be found for spirometry http://fp.artpweb2.f9.co.uk/ Assessments and follow-ups can take place in a variety of places including secondary and primary care settings, the home.

16. Next steps for PCTs Undertake Local Needs Assessment; Look at what Home Oxygen patients currently receiving, why and how; (Assess the range of home oxygen services being ordered by health professionals and the extent to which this is influenced by any level of clinical patient assessment before these services are ordered.) Consult with patient groups; Develop a forum/network linking in with other related Health Professionals, particularly across secondary and primary services and look at ways to join up services;

17. Next steps 2 Secure support from other areas, for instance Service Improvement and Medicine Management Teams and including COPD colleagues; Learn from other (newly developed) services; Produce a business case ( those who are developing service); Commissioners consider standard service specification(s) with local requirements; Develop performance management tools and ensure training and education needs met;

18. Next steps 3 Look at educational support to GPs and other clinicians in making the best use of the Home Oxygen Service Identify local “champions” (BTS new oxygen champions in all hospitals) Use the Commissioning Framework, and the new forthcoming DH Guidance document (and the tools and guidance within). Utilise the available network of experts who have set up services

19. What is the network? An opportunity to share knowledge and experience A group of ‘champions’, experts made up of clinicians, commissioners, and managers involved in developing and running CAFs

20. The network aims to To support the development of CAFs To encourage quality of care for Home Oxygen patients To act as a reference group to all NHS organisations requiring support with the development and improvement of CAFs

21. Implementation support Sharing of key papers (protocols, job descriptions, service specs etc) Mentoring Presentations at regional events To act as a reference group Encourage and exert influence on PCTs What can the network offer?

22. The guidance What is it? A new DH booklet which builds on the Commissioning Framework acting as a toolkit for those developing CAFs To include key features of a service, models, examples, ‘how to’

23. The guidance What can it offer? A toolkit for commissioners Real examples in all sorts of different areas and models A suite of resources - demonstrable cost savings, Provide leverage

24. Contact Details Helen Ellis helen.ellis@pcc.nhs.uk 07500 126 618