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Design for Life

Design for Life. Public Health Support For The Development Of World Class NHS Services In Wales Nigel Monaghan. Designed for Life – A Personal View. What is a hospital? What should a hospital be? What is the Doctor-Patient Relationship? What should the Doctor-Patient Relationship be?

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Design for Life

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  1. Design for Life Public Health Support For The Development Of World Class NHS Services In Wales Nigel Monaghan

  2. Designed for Life – A Personal View • What is a hospital? • What should a hospital be? • What is the Doctor-Patient Relationship? • What should the Doctor-Patient Relationship be? • How do we engage clinical staff in managing their work?

  3. Health and Social Care Quality • “The forgotten area of public health” • Move from “evidence-base decisions” to “service redesign for effectiveness, access and efficiency” • Expectation that public health can solve problems which others cannot solve • Designed for Life has raised expectations and demand.

  4. Traditional Skills • Clinical effectiveness • Cost effectiveness/Efficiency • Audit and evaluation • Outcome measurement “Third Party” Service Reviews “Third Party” Needs Assessment Advice on what should/should not be provided

  5. This Presentation Considers: • The Definition of Public Health • The Commissioning Cycle • Implications of applying 1 to 2

  6. The Challenge: • Advice to improve quality • 22 Local Health Boards • 14 Hospital Trusts • 3 Regional Commissioning Support Units • Health Commission Wales (Specialised Services) • Numerous networks in regions and across Wales • From a small team

  7. Definition Of Public Health • The science and art of preventing disease, prolonging life, and promoting health through the organised efforts of society For commissioning of quality care services what is: • The unique contribution of public health? • The “organising efforts of society” role?

  8. Plan: Review/Revise: Commission/ Contract Commissioning Cycle Monitor: The Commissioning Cycle

  9. Plan: Assess Need Apply Evidence Base Review/Revise: Support Performance Review Commission/ Contract Commissioning Cycle Monitor: Advise on performance indicators The Commissioning Cycle

  10. Our Contribution, Within The Cycle • Evidence of need, effectiveness, inequality etc. • Advice to on service models to inform planning • Advice on methods of contracting • Advice on performance management indicators • Support to reviewing performance

  11. Our Contribution, Evaluating The Cycle • As advocates for better services we have responsibility to make the cycle work. We should ask: • Is the commissioning cycle working? • If not, what is not working? • If no one else is in a position to do something public health may need to fill the gap for now

  12. Doing Our Bit To Make It Work • Evidence and advice produced in easy to use formats • Providing advice on “how to do things” not just “how not to” • Identifying areas where performance management can be improved and how • Identifying and highlighting missing key information and promotion of capture of that information where it is needed when it is needed

  13. Products To Support The Cycle • Interventions not commissioned by diagnostic/procedure codes: • poor effectiveness • little health gain • high cost with lower cost alternatives • Chronic conditions/care pathways • Service review tools and service redesign tools • Key quality indicators

  14. Interventions Not Normally Funded • 50 interventions of: • Poor clinical effectiveness +/- • Poor cost effectiveness +/- • Little health gain • References • Hierarchy of evidence – grading of recommendation • OPCS diagnostic codes plus procedure codes

  15. Abdominoplasty or Apronectomy Blepharoplasty Breast augmentation (breast enlargement) Breast reduction Breast prosthesis removal or replacement Face lift or brow lift Gynaecomastia Hair depilation Hair grafting – Male pattern baldness Hyperhidrosis treatment with Botulinum Toxin Inverted nipple correction Liposuction Mastopexy Pinnaplasty Removal of Tattoos Removal benign skin lesions Removal of lipomata Repair of lobe of external ear Resurfacing procedures: dermabrasion, chemical peels and laser Revision mammoplasty Rhinoplasty Thigh lift, buttock lift and arm lift, excision of redundant skin or fat Grommet insertion Tonsillectomy Cholecystectomy (for asymptomatic gall stones) Circumcision Day case surgery versus inpatient surgery Ganglia Interventions Not Normally Funded

  16. Gastroplasty Gender reassignment surgery Haemorrhoidectomy Laparoscopic surgery for primary inguinal hernia Lymphoedema Varicose veins Caesarean section for non-clinical reasons Dilatation and curettage Hysterectomy for heavy menstrual bleeding Reversal of female sterilisation Lasersurgery for short sight Photodynamic therapy for age-related macular degeneration Apicectomy Dental implants Orthodontic treatments of essentially cosmetic nature Removal of asymptomatic wisdom teeth Autologous cartilage transplantation Complementary and alternative medicine (CAM) for acute low back pain Geriatric orthopaedic rehabilitation unit Hip prostheses Hip resurfacing techniques Internal fixation of fracture of the distal radius and tibial shaft Intramedullary fixation with cephaloconddylic nail for extra-capsular hip fractures Therapeutic use of ultrasound Drug treatment for erectile dysfunction Reversal of male sterilisation Interventions Not Normally Funded

  17. Generic Care Pathway For A Chronic Condition Community Based Secondary Care Based Self/Family Help and Support Rehabilitation Rehabilitation Rehabilitation Palliative Care Primary Prevention Secondary Prevention/ Early Diagnosis Secondary Prevention/ Early Diagnosis Risk Factors/Early Disease Chronic Disease Management Risk Assess /Care Plan/Review Acute Event Tertiary Care Support Services & Diagnostic s Support Services & Diagnostic s Support Services & Diagnostic s Support Services & Diagnostic s Support Services & Diagnostic s Support Services & Diagnostic s

  18. Consultancy Advice • Holistic reviews of services often as part of a partnership • Against service objectives, evidence base, models of care delivery • Identify good and poor performance, perverse incentives, risks • Advise on what should be provided, model of care, outcome and quality indicators, commissioning arrangements

  19. Consultancy/Service Review • QuIP – Support a quality improvement campaign • Diagnostics – Advice on future demand • Cosmetic Surgery – Advice on need for regulation • Child and Adolescent Mental Health Services – advice on holistic model and contracting

  20. Consultancy/Service Review • Musculoskeletal service review – support local service reviews with advice on need and effective models of care • Stroke service review – including stroke units and rehabilitation

  21. In Summary • Because we are a limited resource we intend to: • systematise work so that other domains can understand and support our contribution • prioritise the demands upon us to maximise impact • complete tasks once for the whole of Wales Thank you for listening

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