1. Integrated Care Pathways (ICPs) Ali El-Ghorr Rosie Cameron www.nhshealthquality.org

2. Overview Background What are ICPs NHS QIS Work Programme Results of scoping exercise

3. Integrated Care Pathways A way to compare planned care with care actually given

4. Kerr report (2005) “Need to improve access, quality and efficiency of NHS services” 62 days cancer target 9 weeks for diagnostics 16 week target for cardiac intervention 18 weeks whole patient journey target for cataracts 18 weeks for outpatients 18 weeks for inpatients and day cases Policy Context Delivering for Health (2005)

5. “National standards will be developed for Integrated Care Pathways (ICPs) for the main diagnoses: - schizophrenia - bi-polar disorder - dementia - depression - personality disorder by late 2007.” National Policy on ICPs Source: Delivering for Health (2005)

6. NHS Boards to develop local ICPs to meet National Standards by 2008. Implementation of the standards will be accredited by NHS Quality Improvement Scotland. National Policy on ICPs Source: Delivering for Health (2005)

7. 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

8. Key Features –Multidisciplinary / multi-agency –Part of the clinical record –Defined beginning and end –Evidence based and best practice –Service user focused –Measurable outcomes –Record and act on variation from ICP

9. How QIS ICP Project will operate

10. Subgroup 1: Develops ICP standards Subgroup 2: Develops consensus on information issues Subgroup 3: Develops evidence summary for bipolar disorder Subgroup 4: Develops evidence summary for dementia Subgroup 5: Develops evidence summary for depression Subgroup 6: Develops evidence summary for personality disorder Subgroup 7: Develops evidence summary for schizophrenia Project Steering Group QIS Team: Programme Manager National Coordinators Senior / Project Officers Admin support

11. Toolkit for ICP development Evidence Summaries ICP Standards Model for ICP Development Support & advice

12. Timeline Jan-06Ap-06Jul-06Oct-06Jan-07Ap-07Jul-07Oct-07Jan-08Ap-08Jul-08Oct-08 Project Initiation Recruit Steering Gp / Subgps Scoping exercise Generic standards for ICPs Evidence summaries Combine Local ICPs Develop accreditation tool Accreditation Communication plan

13. Implementation –Clinical Leadership –Management support –Whole system acceptance –Reduced duplication of records –Ease of use –One person responsible for each ICP –Simple variation tracking –Continued education programme

15. Local Board

16. Mental Health Integrated Care Pathways This series of Integrated Care Pathways serve as a guide to treatment and progress. Professional Judgement should always be used and will override, but any variations in care must be clearly documented. Contact person: name@nhs.net

17. List of contents Generic elements: Admission Assessment Nursing / AHP notes Medical notes Results Care Plans Condition specific elements:Bipolar disorder Dementia Depression Personality disorder Schizophrenia Generic elements: Discharge Outcome measuring tools Variance analysis

23. Depression

24. Stepped Care model

27. Variation Analysis

29. ICP Scoping Visits

30. Scoping Visits 15 visits to all NHS Board areas in April/May 06 Scoping questionnaire sent out to each board area prior to visit Visit objectives –Follow up to questionnaire –Meet key people –Discuss additional aspects of ICP development –Learn from peoples experience to date

31. Key Findings 14/15 NHS Board areas had done some work on what they perceived as ICPs 1 NHS Board area had systems and processes in place that could be easily developed into an ICP

32. What ICPs have they done? Admission/discharge-11 Perinatal-8 Schizophrenia-4 Depression-3 Rehab-2 Early Intervention-2 Forensic-3 Personality Disorder-1 Transfer-3 Detox-2 Falls management-1 ECT-1 Generic Process ICP-3 Dementia-2

33. Key Issues Variation analysis Issues re development and implementation process Key Challenges and messages given

34. Variation Analysis A variety of variance recording tools Few examples of variance information feeding service development Many had no variance analysis at all Some used access databases 1 had IT system fully operational Several had paper based forms

35. Development and Implementation issues 8/15 boards had identified ICP people Mostly it was part time or part of a wider remit Very few had an ICP strategy Lack of commitment at corporate level Resource intensive system to develop ICPs Most success was dependent on enthusiastic individuals Very little evidence of IT support or systems Development was successful but implementation and ongoing review was difficult.

36. Conclusions –ICPs a tool for continuous improvement –Ambitious programme –Short timescale –NHS Boards required to deliver ICPs –NHS QIS working in partnership with Boards