Darzi: A golden opportunity? To put ‘quality’ back on the performance agenda? To scope and then measure and monitor ‘what really matters to service users’? To make service providers accountable for the quality of provision?
.....So what does that mean? Moving away from crude process measurements: 4 hour trolley waits Length of stay Discharge rates Developing more sophisticated clinical outcome measures – identifying those that tell us what we want to know Measuring the ‘how was it for you’ factor – taking into account the service user perspective
Patient Pathway – Trajectory of Long Term Conditions Home/Community Home/Community/ Acute Care Acute/ Hospice/Home Very well Well Stable Unwell Unwell & Unstable V Unwell & Unstable Moribund Deceased Complex Case RiskAmberGreenAmberRed Level of Input (Workforce) Primary Care & Spec Diagnostics Case Management (monitor) Complex Case Mgt & Early Intervention Key Quality OutcomesKeeping Well Maintaining Independence Resolving a crisis quickly and effectively
Patient Pathway – Continued into Mid/End Stage Home/Community Home/Community/ Acute Care Acute/ Hospice/Home Very well Well Stable Unwell Unwell & Unstable V Unwell & Unstable Moribund Deceased Complex Case RiskAmberAmber (High)AcuteEnd of Life Level of Input (Workforce) Case ManagersComplex Care Case Managers Key Quality Outcomes Maintaining Independence as complexity increases Preparing for end of life (advance care planning, GSF, LCP)
Patient Pathway – Potential Expansion of Mid Stage Management Home/Community Home/Community/ Acute Care Acute/ Hospice/Home Very well Well Stable Unwell Unwell & Unstable V Unwell & Unstable Moribund Deceased Complex Case RiskAmberAmber (High)Red Level of Input (Workforce) Topic for debate Key Quality Outcomes Increased lengths of time where someone is well managed at home/in the community Quick resolution of crises Good, well planned End of Life Care
Band 1 Support Worker Basic Skills 5.9% Band 2 Support Worker NVQ Level 2 & 3 17.9% Band 3 Support Worker Apprenticeship Level 2 & 3 10.8% Band 4 Assistant Practitioner Foundation Degree 1.9% Band 5 Practitioner (Registered) Degree 31.8% Band 6 Advanced Practitioner Masters 18.8% Band 7 Specialist Practitioner Masters 10.5% Band 8 Consultant Practitioner Masters/PhD 2.5% Band 9 0% Career Pathway – Nursing & Support Workers
Questions for you Group 1 Who is currently doing what? Is this the right person/grade?
Questions for you Group 2 What should a ‘modernised/flexible’ career really look like?
Questions for you Group 3 What will the qualified/unqualified workforce balance look like?
Questions for you Group 4 How can ‘new/developing’ roles be integrated with Social Care?