1. Long Term Conditions Commissioning Plans Dr Adrian Mairs LTCANI Meeting 13 th August 2012 Dr Adrian Mairs LTCANI Meeting 13 th August 2012

2. LTC Service Team Reports to Commissioning Programme Board Sponsor Joint PHA/HSCB Chair Linked groups Cardiovascular Commissioning Group & Network Stroke Strategy Implementation Group Respiratory H&W Group Neurological conditions Sub-group NIVASC

3. Remit Regional commissioning guidance – Framework for local plans Annual commissioning plan Review TDPs Clinical linkages / partnerships PPI

4. Scope Cardiovascular services / Framework Diabetes Respiratory services / Framework Neurological conditions All ages

5. Commissioning Drivers PfG TYC: integrated care, “shift left”, diagnostics McKinsey Quality 2020 Strategy NICE Service Frameworks PPI

6. Programme for Government (PfG) Enhance access to life-enhancing drugs for conditions such as rheumatoid arthritis, cancer, inflammatory bowel disease and psoriasis and increase to 10% the proportion of patients with confirmed ischaemic stroke who receive thrombolysis Identify and evaluate the current baseline of patient education and self management support programmes that are currently in place in each Trust area

7. TYC - LTC Self care & prevention – partnership working Personalised care plans - home based mx. Named contacts for patients Use of information systems to support care pathways Medicines management – community pharmacy Admissions protocol Telehealth

8. McKinsey Quality & productivity improvements Better management of LTCs Reduced LoS Enhanced /effective home & community services Shift to lower cost settings

9. NICE Technology Appraisals (TAs) For each Technology Appraisal, the HSC Board will submit a Commissioning Plan to the Department within 15 weeks TA 236 - Acute coronary syndromes: Ticagrelo TA 244 - Chronic obstructive pulmonary disease: Roflumilast TA 248 - Diabetes (type 2): Exenatide (prolonged-release)

10. NICE Clinical Guidelines For each Clinical Guideline endorsed by the Department, the HSC Board will submit a Board Response to the Department within no more than 15 weeks CG 36 - Atrial fibrillation CG 87 - Type 2 Diabetes – Newer Agents (update of CG66) CG 101 - Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update) CG 105 - The use of non-invasive ventilation in the management of motor neurone disease CG 119 - Diabetic foot problems - inpatient management CG 126 - Stable Angina CG 130 - Hyperglycaemia in acute coronary syndromes CG 134 - Anaphylaxs CG 137 - Epilepsy

11. Commissioning Context Programme for Government Commissioning Plan Direction Commissioning Plan TDPs Population Plans

12. Commissioning Plan Direction AAA Screening – June 12 Thrombolysis: increase to 10% - March 13 Telemonitoring: 400k monitored pt. days – March 13 Unplanned admissions:↓ 10% - March 13 Performance indicators

13. Unscheduled Care Specification Proactive Mx of LTCs 10% ↓ unscheduled hospital admissions ↓ LoS Local economies Practice registers / risk profiling Regular primary care review Patient education & self-management Integrated community teams Escalation procedures Medicines management Tele-monitoring

14. Commissioning Plan Specific Targets By March 2013, increase to 10% the proportion of patients with confirmed Ischaemic stroke who receive thrombolysis By March 2013, achieve 400,000 Monitored Patient Days (equivalent to approximately 2,200 patients) from the provision of remote tele- monitoring services through the Tele-monitoring NI contract.

15. Commissioning Plan - LTCs Key Deliverables Implement COPD Integrated Care Pathway Expand provision of insulin pumps to children & adults with Type 1 diabetes Identify & evaluate current baseline of patient education & self management programmes in place in each Trust area

16. Self Management / Patient Education Programmes Baseline Audit Wendy Thornton Public Health Agency Monday 13 August 2012 Wendy Thornton Public Health Agency Monday 13 August 2012

17. 1. Background Key commitment (priority 2) in PfG 2011-15 Key Commitment Milestone 2012/13 Milestone 2013/14 Milestone 2014/15 Enrol people who have a long term (chronic) condition, and who want to be enrolled, in a dedicated chronic condition management programme (DHSSPS) Identify and evaluate the current baseline of patient education and self management support programmes that are currently in place in each trust area Health & Social Care Board / Public Health Agency should work with key stakeholders to develop and secure a range of quality assured education, information and support programmes to help people manage their long term conditions effectively, alongside full application of the Remote Telemonitoring contract People with a long term condition will be offered access to appropriate education, information and support programmes relevant to their needs, including innovative application of connective health

18. 2. Key characteristics? Patient Education Programmes Self Management Programmes Support Groups KEY CHARACTERISTICS  Part of care pathway  Referral from health professional  Likely secondary care setting  Time limited  Condition specific  Clinically/health professional led  Robust QA mechanisms KEY CHARACTERISTICS  Not currently part of care pathway (but ideally should be?)  Likely self referral  Likely primary or community care setting  Time limited  Fully or partially peer led  Holistic approach  Can be either generic or condition specific  QA mechanisms less robust perhaps? KEY CHARACTERISTICS  Not part of care pathway  Likely community care setting  Ongoing – not time limited  Peer led  Unscripted & informal  Focuses on social aspect  Lack of QA mechanisms Examples include.... Cardiac & pulmonary rehab programmes Various diabetes education programmes Examples include.... CH&S – “Taking Control” programme Arthritis Care – “Challenging your Condition” Examples include.... Various respiratory support groups

19. 3. Audit scope Specific programmes only (not support groups) Programmes for patients only (not carers ) Physical AND mental health programmes LTCs – key 4 - diabetes, asthma, COPD, heart failure, plus others... Includes Condition Management Programme (CMP) – DEL/Trust partnership programme Includes Trust and I.S provided/funded programmes

20. 4. Methodology Questionnaire (in form of Excel spreadsheet) Distribute to Trusts & IS orgs during Autumn 6 weeks timeframe for completion Info collated and analysed by PHA/DHSSPS LTC Regional Implementation Steering Group