Using data and intelligence to change ways of working Juliet Ashton Sapphire Nurse Consultant – Epilepsy Commissioning

My first year as Sapphire Nurse Consultant – Epilepsy Commissioning Key role in the improvement and development of quality services for people with epilepsy Identify needs of people living with epilepsy, audits of service commissioning and provision Lead the establishment of evidence based patient pathways, in collaboration with Clinical Commissioning Groups Support and consultancy provided to local commissioners

Service offeringActivityUnplanned admissions and readmissions within 30 days saved NICE Quality StandardNHS Outcome Framework 1 WTE band 7 ESN per CCG £62,080 Saving £102,720 Total saving against cost £40,640 Personal and emergency care plan Nurse led clinic primary and secondary care settings Nurse prescribing Home visits Telephone clinic Emergency clinic/telephone Educating Ambulance service Educating A&E with a presence Educating residential care advice to GPs, practice nurses and pharmacists Carer support Joint working with social services and mental health Liaison with LD teams Domain 1: Preventing people from dying prematurely Domain 2: Enhancing the quality of life for people with a Long Term Condition Domain 3: Helping people recover from episodes of ill health or following injury Domain 4: Ensure people have a positive experience of care Extra neurologist time saved by having ESN Saving on misdiagnosis £14,680 Tertiary care referral New patients seen within two weeks Referral for investigations Meet with cardiology Transition clinics with ESN Accessibility for GPs Mortality rates Meet 18 week wait 50% misdiagnosis avoidance 7 people QS 7 QS 1 QS 2 and 3 QS 9 Domain 1: Preventing people from dying prematurely Domain 3: Helping people recover from episodes of ill health or following injury GP, Practice nurse Referral Support Service per CCG Time resource to set up with ESN Saving £12,840 Income from QOF Single point of access for information on epilepsy and referral procedures Preconception counselling Register of all people with epilepsy on AEDs 10 QOF indicator EP001 QS 8Domain 5: Treating and caring for people in a safe environment and protection from harm Self management programme Cost £400 per patient Saving £1,404 Saving against cost for 15 patients £15,060 Empowering people with epilepsy Lifestyle issues Employment/benefits £1004 per patient X 15Domain 2: Enhancing the quality of life for people with a Long Term Condition 80 (Average admissions across 5 CCGs 2011/12 = 485) QS 4 QS 5 QS 6 QS 8

Patient Self management Symptom control Empowerment Living well with condition Primary Care Joint care coordination Supported patient care Supported referral Patient registers Annual reviews (by criteria) Neurology Service Model Social Care/Voluntary Post diagnosis support On-going support Carer support Education/Lifestyle Acute Care Setting Non-Acute Care Setting Referral / Discharge Complex Care Diagnosis Referral to tertiary care Annual reviews (by criteria) Inpatient specialist care Referral Support Service Management plans Clinical investigations Specialist Care Support Joint care coordination Supporting patient care Supporting referral/discharge Goal setting Annual reviews (by criteria) Patient/professional education Advice, Guidance & Support Self-management support Psychological support Neurology Service Spec Property of Vale of York CCG

Improving care and reducing costs in epilepsy and neurology: Task-finish group

Service offeringPotential impactNICE Quality StandardNHS Outcome Framework Access to an ESN for adult, learning Disability and paediatric patients. Working across settings from secondary to primary care. Demonstrated by: Multiple sites. ESNs impact tool Reduction in neurologist follow up appointments GP appointments Reduction in non elective admissions Increased self management Quality Statement 4. Children, young people and adults living with epilepsy have an agreed and comprehensive written epilepsy care plan. Quality Statement 5. Children, young people and adults living with epilepsy are seen by an epilepsy specialist nurse who they can contact between scheduled reviews. Quality Statement 6. Children, young people and adults with a history of prolonged or repeated seizures have an agreed written emergency care plan Quality Statement 9. Young people with epilepsy have an agreed transition period during which their continuing epilepsy care is reviewed jointly by paediatric and adult services Domain 1: Preventing people from dying prematurely Overarching indicator Potential years of life lost from causes considered amenable to healthcare: adults, and children Domain 2: Enhancing the quality of life for pw a LTC Overarching indicator Health-related quality of life for pw LTC Improvement areas Ensuring people feel supported to manage their condition Reducing time spent in hospital Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) Unplanned hospitalisation epilepsy in < 19s Enhancing quality of life for carers Domain 4: Ensure people have a positive experience of care Overarching indicator Patient experience of primary and hospital care GP OOH, hospital care Friends & family test for acute IP care & A&E Improvement areas Improving experience of outpatient care Improving people’s experience of A&E services Improving women and their families’ experience of maternity services

Main sources of data and intelligence

What do commissioners want? VOYCCG 18+ PopulationPrevalence Number of patients Newly diagnosed in 12 months 267, % Epilepsy 18+ populationSeizure Free 1,79052%93171 Treatment Gap 18%32225 Refractory 30%53741 Develop a checklist to support commissioners Compendium and the Neurology Intelligence Network are linked Coding of OP activity by diagnosis Evidence is vital to drive commissioning The data needs to tell a story CHIMAT is a good example of a data repository

Driving improvements in local commissioning understand the outcomes that matter most to people commissioners using outcomes set out in NHS Outcomes Framework – 5 year strategic plans to improve ‘health outcomes’ not clear on what the most appropriate approaches are need to share understanding of what approaches may be effective, in what situations and the potential pitfalls

Patient Self management Symptom control Empowerment Living well with condition Primary Care Joint care coordination Supported patient care Supported referral Patient registers Annual reviews (by criteria) Neurology Service Model Social Care/Voluntary Post diagnosis support On-going support Carer support Education/Lifestyle Acute Care Setting Non-Acute Care Setting Referral / Discharge Complex Care Diagnosis Referral to tertiary care Annual reviews (by criteria) Inpatient specialist care Referral Support Service Management plans Clinical investigations Specialist Care Support Joint care coordination Supporting patient care Supporting referral/discharge Goal setting Annual reviews (by criteria) Patient/professional education Advice, Guidance & Support Self-management support Psychological support Neurology Service Spec Property of Vale of York CCG

Outcomes:(reflect population) 1.Optimum clinical support for primary care to enable joint coordination of care for the specified neurology population 2. Access to the appropriate professional in the appropriate setting at the right time 3. People are supported to manage their condition to maximise their quality of life, at every age and every stage 4. Reduce the rate of preventable admissions 5. Reducing time spent in hospital 6. Maximise integration opportunities with social care and the third/voluntary sector

What additional data would help to drive further service improvement? Unbundling contracts Hard to challenge existing ways of providing care, or break with existing provider relationships Commissioners don’t have clearly defined and agreed metrics (across providers) to measure success in terms of outcomes Issues on both the robustness of the data and timeliness

Key issues for further consideration and support development How the wider neurological community can support progress towards these goals

Developing commissioning guidance NICE requirements fully met? NHS Outcomes Framework CCG OIS Use Public Health England cancer format? Build on ABN work? Build on SCN work on epilepsy pathways Use NHS commissioning assembly commissioning for outcomes guidance?