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QIPP: increasing productivity using existing resources 23 rd June 2010 College of Occupational Therapists 34th Annual Conference

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Aim of Session <ul><li>Why QIPP and why now? </li></ul><ul><li>Programme design </li></ul><ul><ul><li>National Programmes </li></ul></ul><ul><ul><li>Regional Programmes </li></ul></ul><ul><li>National Work stream plans for safety </li></ul><ul><li>The role and contribution of AHPs </li></ul>

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Quality, innovation, productivity & prevention Q IPP QI P P QIPP QIP P QIPP

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“ Our best chance lies in focusing on improving quality and productivity, linked together by innovation driving sustained improvements across the system.” David Nicholson, ‘The Year’, May 2009 The approach to the challenge is a focus on both quality and productivity

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The QIPP programme will support the NHS to meet the challenge Supporting commissioners to commission for quality and efficiency – e.g. through improved clinical pathways, decommissioning poor value care Provider efficiency – supporting providers to respond to the commissioning changes and efficiency pressures by transforming their businesses Shaping national policy and using system levers to support and drive change e.g. primary care contracting & commissioning Care closer to home More standardisation Earlier intervention Empowered patients Fewer acute beds Reduced unit costs Characteristics of a sustainable system: Areas covered by Quality, Innovation, Productivity and Prevention (QIPP) programme

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Twelve workstreams Provider efficiency <ul><li>Safe Care – Maxine Power, DH </li></ul><ul><li>Right Care – Muir Gray, DH </li></ul><ul><li>Long Term Conditions – John Oldham, DH </li></ul><ul><li>Urgent Care – John Oldham, DH </li></ul><ul><li>End of Life Care – Sophia Christie, BENPCT </li></ul><ul><li>Primary Care Contracting and Commissioning – Barbara Hakin, East Midlands, SHA </li></ul><ul><li>Technology and Digital Vision - Christine Connelly, </li></ul><ul><li>Chief Information Officer </li></ul>Commissioning and pathways System enablers <ul><li>Back Office Efficiency and Optimal Management – Tony Spotswood, Royal Bournemouth & Christchurch FT </li></ul><ul><li>Procurement – Philippa Slinger, Berkshire Healthcare FT </li></ul><ul><li>Clinical Support Rationalisation (Pathology initially) – Ian Barnes, National Clinical Director </li></ul><ul><li>Supporting Staff Productivity – Lorraine Foley, NHS Inst </li></ul><ul><li>Medicines Use and Procurement - Peter Rowe, Leigh and Wigan PCT </li></ul>

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Action to deliver the programme will be needed at every level of the system Local action – without support Local action – with support Regional action – shared work Regional action – one leads National action Other networks

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LTCs Safe Care Right Care Back office EOL Care Pathology Digital Procurement Staff Medicines Primary Care Urgent Care Tariff Contract PBC Commissioning Competition National programmes Enablers e.g. Assurance and alignment £15-£20bn savings The current architecture of our response There are three main components to the work which need to align London S Central S West W Mids E Mids SE Coast E England Y / Humber N West N East Regional plans

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Safe Care <ul><li>Provide support to NHS providers to deliver improvements in patient safety which result in efficiency savings </li></ul>

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What’s worked? MRSA Bacteraemia & C. difficile

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What have we learned? http://www.mortality-trends.org Death from falls A decade of stability! 851 per year since 2000

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Focus <ul><li>Pressure Ulcers </li></ul><ul><li>Falls </li></ul><ul><li>CA- UTI </li></ul><ul><li>DVT / PE </li></ul>How MANY? What WORKS? How will we KNOW?

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Nutrition & Hydration Surveillance & systems Continence Management Keep Moving <ul><li>Assessment for all (MUST) </li></ul><ul><li>Management plan implemented </li></ul><ul><li>Escalation management </li></ul><ul><li>Fluid prescription </li></ul><ul><li>Records of intact skin on all </li></ul><ul><li>Records of skin breaks on all </li></ul><ul><li>Systems for weekly surveillance </li></ul><ul><li>Mechanism for data review </li></ul><ul><li>MSSA & MRSA in pressure sites </li></ul><ul><li>Assessment for all </li></ul><ul><li>Management plan for at risk </li></ul><ul><li>Escalation management </li></ul><ul><li>Diuretics reviewed </li></ul><ul><li>Catheter stewardship </li></ul><ul><li>Access to approp equipment </li></ul><ul><li>Turning schedule </li></ul><ul><li>High risk environments </li></ul><ul><li>Rapid access to equipment </li></ul><ul><li>Compression stockings </li></ul><ul><li>Prospective falls measurement </li></ul><ul><li>Monitor contact risk </li></ul><ul><li>Measure VTE prophylaxis </li></ul>Programme Outline We own it, we pay for it, keep our NHS safe – act now! Outcome Measure <ul><li>CA-UTI </li></ul><ul><li>Falls </li></ul><ul><li>DVT / PE </li></ul>Reduce Pressure Ulcers by 80% By 2013

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Occupational therapy & QIPP Care closer to home More standardisation Earlier intervention Empowered patients Fewer acute beds Reduced unit costs Characteristics of a sustainable system : Safe Equitable Effective Patients empowered Efficient Quality Healthcare :

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Questions to ask? <ul><li>What are we trying to accomplish? </li></ul><ul><li>(do we have an aim?) </li></ul><ul><li>How will we know if the change we are making is an improvement? </li></ul><ul><li>(what are we measuring?) </li></ul><ul><li>What changes will we make that will result in improvement? </li></ul><ul><li>(what are the 3 or 4 things we need to do to change?) </li></ul>

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OT & Stroke (NHS NW) <ul><li>24 hospital teams working together </li></ul><ul><li>Aim = move regional sentinel audit score from 71 to 90 by 2010 </li></ul><ul><li>Therapists played an active leadership role from the start </li></ul>1 40% 1 65% Co-ordinating care? Mood Assessment MDT Goals

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Stroke Services - Warrington OT within 4 days 73% to 90% Length of stay 25 to 15 days MDT work across boundaries

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Individuals Lead Change

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Stay involved! <ul><li>Understand policy </li></ul><ul><li>Understand local strategy </li></ul><ul><li>Set an aim & vision </li></ul><ul><li>Disrupt and move quickly </li></ul><ul><li>Keep leadership up to date </li></ul><ul><li>Measure progress often </li></ul><ul><li>Share data </li></ul><ul><li>Embrace Failure </li></ul><ul><li>Never Give up </li></ul>

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“ You may never know what results come of your action, but if you do nothing there will be no result” Mahatma Gandhi