1. What is a Care Pathway? Ali El-Ghorr Implementation Advisor

2. Overview of presentation  Different types of care pathways  How to develop an ICP for BPD  Example mental health ICP

3. Lesbian Vampire Killers

7. Pathway Algorithm Referral Pathway Protocol Care Pathway Patient Pathway Triage Pathway Service Pathway Guideline Critical Pathway Integrated Care Pathway What’s in a name?

8. Algorithm Care Pathway Integrated Care Pathway

9. Algorithm  Decision aid  One page summary  Based on evidence  Layed out as a decision tree  Usually used by 1 professional in the care of 1 individual  Clinical judgement still important

10. Example: Alcohol Screening and Brief Interventions Algorithm

12. Care Pathway

13.  Diagrammatic representation of a journey of care  Multidisciplinary  High level map of care  Based on evidence and good practice  Includes all main referral routes & referral criteria  Describes who is responsible for what  Includes main comorbidities and complications  Applies to ~80% cases

15. What is an Integrated Care Pathway (ICP)?

16. Integrated Care Pathway A system of care that allows the comparison of planned care with care actually given

17. Integrated Care Pathways  Focus on the service user  Part of the care record  Map out the expected care (multidisciplinary/multi-agency)  Describe how care should be structured and co-ordinated  Set standards along the care journey based on the evidence & best practice  Facilitate the monitoring of these standards through VARIANCE tracking

18. Mental Health ICPs

19. Policy Context Delivering for Mental Health (Dec 2006) :  National policy to improve mental health services through development and implementation of Integrated Care Pathways

20.  Person-centred  Safe  Effective The Healthcare Quality Strategy for NHSScotland

21. QIS standards

22. ICP Standards

23. How do you develop an ICP for BPD?

24. Process Standards Stakeholder involvement Process mapping

25. Delivering together Psychologists Consultants Nurses AHPsSocial Work Improvement Support StaffService users and carers Local Teams Voluntary sector Managers GPs

26. Involving Primary Care

27. Possible incentives -ICP links to Quality Outcomes Framework: Mental health register Physical health checks Dementia review Depression screening Depression assessment using validated tool -ICPs linked to psychological therapies HEAT target

28. High level Increasing level of detail Process Mapping

30. Opportunity for Redesign

31. Content

32.  Service user at the centre of care planning  Comprehensive assessment  Risk management  A service user rated measure of needs (eg Avon)  Targeted inpatient admission  Measure outcome

33.  There is a record of medication for BPD

35. Example: NHS Tayside mental health admission and discharge ICP

36. Admission & Discharge ICP

49. Implementation

50. Local implementation  Part of local strategy  Identify local champions / leads  Embed ICP work within Care Governance  Conduct awareness raising & education  Repeat education programme  Audit, review & provide feedback

51. Support available  National ICP toolkit (www.icptoolkit.org)  Network of National ICP Co-ordinators & ICP Team  BPD Network  Co-ordinated approach (Health Directorates, NHS Education Scotland, Social Work, Care Commission and others)

52. Incentives  Quality strategy (person centred, safe, effective)  Patient safety in mental health  HEAT targets in mental health  Quality Outcomes Framework  Partnership working (Social Work & Voluntary Sector  ICP accreditation

53. Conclusions  Different types of care pathways  ICPs are a system of care  ICPs are a tool for service redesign and continuous quality improvement  Focus on service user and meeting their needs  Support and help is available

54. www.icptoolkit.org

55. SCOTTISH Personality Disorder NETWORK Welcome to the Scottish Personality Disorder Network Conference Thursday 17 th March 2011