RESPIRATORY SERVICES & RESPRIATORY SERVICE FRAMEWORK Dr Muhammad Sartaj Consultant Public Health, Public Health Agency

Content Quality of Respiratory Services Role of Revised Respiratory Framework Respiratory Diseases &Examples of standards for Asthma Implementation and Way forward

Focus on Quality not Performance to identify individual failures. Systems should not rely on single sources of data but should use a range of information. Consumers should be prominently involved, and the results of assessments should be transparent and freely accessible to the public.

Bring clarity to quality Bring clarity to quality. This means being clear about what high quality care looks like …. Quality is systemic. It is not the responsibility of any one part of the system or, indeed, any one part of the HSC Commissioning. Rather, it is a collective endeavour, requiring collective effort and collaboration at every level of the system in order to safeguard patients and drive continuous quality improvement. Institute of medicine 2001 definition

PATIENT AND CLIENT FOCUS Quality of Service SAFETY EFFECTIVENESS PATIENT AND CLIENT FOCUS

Productivity and value Quality Chain Leadership Internal Quality Staff satisfaction Productivity and value Patient Satisfaction Adaptation of the service-profit chain at Sears, Harvard Business School, January-February 1998, pp83-97

Where to begin? “If I had to reduce my message for management to just few words. I would say it all to do with reducing variation” W Edward Deming.

What is a Respiratory Service Framework Framework is subject to review and refinement in the light of new evidence. ‘Respiratory service framework sets standards in relation to the prevention, diagnosis, treatment, care, rehabilitation and palliative care of individuals and communities at a greater risk of developing respiratory diseases’ DHSSPS 2014 Each standard is supported by levels of KPI to be achieved over 3 years

AIM OF THE FRAMWORK Improve health and wellbeing; Reduce inequalities in health; Promote social inclusion; Transparent standards of care, on behalf of public; Reduce variation in treatment and care; Link public health with quality and safety of care; Safeguard vulnerable individuals and groups; and, Improve partnership working with other agencies/sectors.

Key Stakeholders The public; HSC organisations and other providers; Commissioners – HSCB/PHA and LCGs; Voluntary, community and independent sector; RQIA; and, DHSSPS/Minister. Tra Travellers life expectancy is around 20% lower than the general population. Only 10% of the Traveller population are over 40 years and only 1% are aged over 65 years

Patient/client Pathway Prevention / Promotion Protection /Lifestyle Assessment & Diagnosis Treatment Ongoing Care / Chronic Disease Management End of Life Care / Palliative Care Discharge/Completion of Care

Structure of Framework Overarching Health Promotion and Patient and Public Participation standards Disease specific standards Standards relating to all conditions

Health Development Smoking Weight Physical activity Immunisation

Specific diseases COPD Asthma Community acquired pneumonia Obstructive Sleep Apnoea Long Term Ventilation Cystic Fibrosis Bronchiectasis Interstitial Lung Disease

Standards relating to a number of diseases 21-Sections 46-Standards, 168-KPI's Pulmonary rehabilitation Acute Oxygen therapy Transitional services Social and emotional support Training Medicine Management Information

2-Sections 8-Standards, 38-KPI's Standards for Asthma 2-Sections 8-Standards, 38-KPI's Cover Adult and Paeds Asthma Eight Overarching standards Diagnosis Self-management Ongoing management Management of acute sever asthma Difficult asthma

Implementation Structures Regional Respiratory Forum Patient Reference Group Project Groups 5 Trust Respiratory Forums Regional Paediatric Asthma, Allergy & Anaphylaxis Group

Next Step a phased approach to implementation. To fully implement all standards for which there is already a data source in year 1 For the remaining standards, appropriate steps to be taken to establish data sources and baselines. Performance levels for these standards are to be determined once baselines had been established.

www.asthma.org.uk

Service Frameworks Joan O’Hagan 22 April 2015

Asthma: The Problem 182,000 people in Northern Ireland have asthma 146,000 adults and 36,000 children 30 deaths adults(2012) 972 emergency hospital admissions for adults (2012/13) 680 emergency hospital admissions for children and young people (2012/13) Inconsistent care across Northern Ireland

Role of Asthma UK Northern Ireland Member of Regional Respiratory Forum and all sub-groups to influence as appropriate Commissioned by DHSS/PS to obtain user/carer views to inform development of standards for the first framework (in partnership with NICHS) Contributed to development of Easy Access version Commissioned to independently monitor certain standards in first framework Continue to seek and champion user views to identify gaps in revised framework

Future role of Asthma UK Northern Ireland More of the same Target service specifically/implementation Focus on NRAD recommendations Hopefully commissioned by PHA to independently monitor standards in the course of this revised framework

Any questions?