1. Integrated Care Pathways Integrated Care Pathways for Mental Health: An over view & your part in variance reporting (debate). Mark Fleming Linda McKechnie David Thomson National ICP Coordinators NHS Quality Improvement Scotland

2. Delivering for Mental Health Commitment 6 “NHS QIS will develop the standards for ICPs for schizophrenia, bipolar disorder, depression, dementia, and personality disorder by the end of 2007. NHS Board will develop and implement ICPs and these will be accredited from 2008 onwards.”

3. Definition An ICP determines locally agreed multidisciplinary practice, based on guidelines and evidence where available for a specific patient/client group. It forms all or part of the clinical record, documents the care given, and facilitates the evaluation of outcomes for continuous quality improvement. Source: National Pathways Association, 1998

4. Definition A way to compare planned care with care actually given NHS QIS 2007

5. Key Features Multidisciplinary / multi-agencyMultidisciplinary / multi-agency Part of the clinical recordPart of the clinical record Defined beginning and endDefined beginning and end Evidence based and best practiceEvidence based and best practice Patient focusedPatient focused Measurable outcomesMeasurable outcomes Variance analysisVariance analysis

6. Variances What are variances? If care is not delivered as planned the reason (variance) is completed on the ICP Compare planned care against care actually given

7. What is variance analysis? A summary of reasons when care is unable to be delivered as planned Examine trends, patterns of variance and identify if something needs to change as a result e.g training needs, provision of services, pathway changes.

8. Benefits of Variance Analysis Highlight issues which the service can resolve Help clinicians understand better why care might not have been delivered as planned Identify gaps in service provision and training needs Highlight areas where extra resources may be required Identify differing practices and reasons behind these Clinicians receive routine feedback on performance /activity and practice Identify areas of development for care pathway Provide important information for clinical governance reporting/audit/meeting standards

9. What is it really!!! Real time clinical audit within a Governance Framework??

10. Assessment Care Planning Care Delivery Social needs Recovery approach Interventions Talking therapies Admission/transfer Review & follow up information Management of variance / decision making Tier 1: patient variance leading to individual care redesign Tier 3: NHS board level leading to service redesign Tier 4: SEHD / NES / NHS QIS national redesign Performance Management Mechanism for tracking variations from plan Measurement of outcomes Values base/Evidence base/good practice Local ICP Governance Tier 2: clinical team level leading to local service improvements

11. Perceptions can differ!

12. We think things are working but is there a better way of doing it?

13. How do we gauge the experience? Let others know?

14. How can we ensure the facility and opportunity is available to collect variance in a meaningful way?

15. What measures could be put in place for BPD and what are the challenges? Consistency of care Decisions on hospital admission Crisis management Medication management of symptoms Risk assessment and management Patient involvement in care planning DISCUSS/ASK ???