1. Integrated Care Pathways in Mental Health Sean Doherty NHS Quality Improvement Scotland

2. What is an ICP Integrated care pathway
A system of continuous quality improvement
Focuses on recording, analysing and acting on variances
Put simply - a tool to compare planned care with care actually given

3. The policy context Commitment 6 - Delivering for Mental Health (2006)
‘NHS QIS will develop the standards for ICPs for schizophrenia, bipolar disorder, depression, dementia and personality disorder by the end of 2007.
NHS board areas will develop and implement ICPs and these will be accredited from 2008 onwards.’

4. Links to performance management
HEAT targets
Benchmarking
Single Outcome Agreements

5. Standards for integrated care pathways for mental health
Developed collaboratively
Consulted on widely
Evidence based
Published December 2007

6. Process Care – generic Care – specific Service improvement
the essential foundations for development of ICPs
Care – generic
the framework for all mental health care
Care – specific
five mental health conditions
Service improvement
Ensuring that ICPs are making a positive impact on care

7. Condition specific care
Bipolar disorder
Borderline personality disorder
Dementia
Schizophrenia
Depression

8. What now? - baseline scoping
All NHS boards visited during April – June 2008
Local factual reports – NHS QIS
Degree of development and implementation of ICPs – variable across NHS board areas
Local action plans – NHS boards

9. What now? - ICP toolkit ICP resources – available online now
Focus group sessions – what do you want from the ICP toolkit?
All NHS boards invited to participate
External web design company to be commissioned
Piloting and launch

10. Crerar Review
Looked at audit inspection and regulation of public services
42 recommendations to improve the role of scrutiny within the public sector

11. What now? - accreditation
Complex
System under development - but - this is NOT a barrier to ongoing local ICP development and implementation
Facility for ongoing data collection
Supportive and developmental
The products of a functioning ICP will provide the evidence for accreditation

12. Our approach All NHS boards developing and implementing
Continued support from NHS QIS
ICP national co-ordinators
Measuring and acting on variance

13. Mental Health Collaborative
A brief overview

14. Collaborative Approach
Providing the capacity (time) and capability (skills) to learn to see our systems afresh:
Experiential – understanding how it feels to those on the receiving end of services
Factual - using data to focus our attention
Informed - using the evidence base and learning from experience

15. Systems Approach 95% variance is caused by the system
We need to give front line staff the skills to understand why the system is failing and how to fix it
Instead we have become self-taught experts in working around broken systems

16. Mental Health Collaborative 3 Workstreams & 4 HEAT Targets
Better treatment for depression
Improved inpatient processes and community mental health services
Timely diagnosis of Dementia and appropriate follow-up support
Each underpinned by:
Improvements in the quality of the experience

17. Mental Health Collaborative
We don’t have all the answers in advance
We do have tools and techniques to help us find the answers together

18. Results delivered by…
Developing links across other national programmes and organisations
Allocating funding to NHS Boards for Improvement Infrastructures
Providing training on improvement tools and techniques
Generic Core Skills Training
Customised to Mental Health and Local Needs

19. Results delivered by…. Providing toolkits for local use
Generic Improvement Toolkits
Customised to Mental Health (Simulation process improvement game and Demand & Capacity Model)
Identifying High Impact Changes and Measures for Improvement
Reference Group

20. Results delivered by….
Developing mechanisms for sharing learning and knowledge
Web based resources
Newsletters
Networking events

21. “To change an organisation, the more people you can involve, and the faster you can help them understand how the system works and how to take responsibility for making it work better, the faster will be the change.”
Marvin Weisbord,Training and Development Journal

23. Why do we need measurement in mental health?
Information about delivery and outcomes of clinical and social care can make a vital contribution to facilitating the safety, efficiency and effectiveness of health care.

24. Who is the information for?
Three Ps (in America 6 Ps)
Patients
Providers
Policy makers

25. What do we need to measure?
Our challenge is to select measures that matter in terms of
Clinical outcomes
Strategy
Legislation

26. What are the key aspects of performance?

27. Key Aspects of Performance
QUALITY – patient experience and health outcomes
EFFICIENCY – How resources are managed and used
SUSTAINABILITY – Whether the functions provided by services are sufficiently sized and appropriately positioned to meet needs of local communities
COST – resources are limited so best value must be achieved from current investment

28. What are appropriate performance tools to measure the data?
Benchmarking/Balanced score cards (indicators/definitions)
HEAT (targets)
ISD
LDPs
Review visits (templates)
Joint Futures Outcomes (indicators)
DoH – compendium of clinical outcomes

29. What do these tools measure?
Benchmarking measures - Responsibility
Benchmarking template reports annually try to achieve consistent definitions across the system
Costing project – relates costs to definitions
Balanced scorecard

30. What do these tools measure?
Balanced Scorecards
National
Local
Subspecialities

31. What do these tools measure
HEAT – measures Accountability

32. What do these tools measure?
ISD mental health information programme
Inpatient returns SMR4, SMR1 (SPARRA)
Outpatients returns SMR00
Prescribing information (monthly)
Practice team information (GP plus nurse individual contacts)
QOF

33. Performance tools not used
MMI (monthly management Information)
18 week wait

34. Asprational PerformanceTools
Data system (eHealth) – data sets
IPACC versus PMS versus others
eHealth supporting ICP data set
IPACC core data set operating in some areas

35. What are the challenges?
Robust, meaningful data sets and collection (definitions, IT, software, core data)
Using the data appropriately

36. How it all fits together

37. Mental Health Collaborative Programme NES Psychological Therapies
DRAFT – V3
NQIS ICP
Programme
Mental Health Collaborative
Programme
NES Psychological Therapies
Programme
Mental Health Benchmarking Programme
Are we doing
the right things
Setting National Standards for ICP Development
Identifying High Impact Changes – that if implemented will make a significant difference to outcomes
What therapies should we be delivering to which diagnostic groups?
Provide benchmarking comparisons to help to identify which services/functions may be less effective than others
Supporting systems to process redesign to ensure evidence based care is being delivered
in the most
efficient way
Providing evidence for most efficient pathway of care
Competency Framework
Agree model - stepped or matched care
Review cost-effectiveness of therapies
Provide benchmarking comparisons to help to identify where there may be inefficiencies
Supporting systems to process redesign to ensure reduction of duplication and waste, removal of bottlenecks and efficient flow of work through system
Modelling the demand for psychological therapies and capacity needed to respond
Reviewing no of staff at different levels needed to meet demand
with
appropriately
skilled staff
Developing knowledge and skills of staff to develop and implement ICPs
Funding Improvement Infrastructures in NHS Boards
Developing knowledge and skills of frontline staff in improvement methodologies
Supporting staff to put these into practice
Developing a competency framework
Providing training on psychological therapies and training for supervisors
Funding NHS Boards to put in place governance arrangements
Advice to boards on commissioning local training
Provide benchmarking comparisons to help to identify where there may be skill mix issues
and using
information
to review
Reporting on variance analysis and using this to inform further service development
Setting standard definitions to enable comparison
Providing reports which show how health boards compare
Accreditation of ICPs
Developing the ability to collect and
analyse information to inform
service improvement
Using variance analysis, outcome and impact assessment data to inform commissioning of psychological therapies training programme