Ealing Community-based Health and Care Service: Commissioning a lead provider
May 2017
NHS Ealing CCG
Context:
As part of the process of moving to a lead provider model of care for community-based services, the commissioners have drafted frameworks of shared goals that they
expect the lead provider to deliver.
Achieving these goals will make a significant contribution to achieving the population level outcomes and outputs set out in both Ealing's Health & Wellbeing Strategy
and the North West London Sustainability and Transformation Plan.
These Shared Goal frameworks should be read in conjunction with the prospectus for Ealing's Local Health & Care Service.
Outcomes may be classified as being either extrinsic or intrinsic.
Extrinsic outcomes are those measured and valued by other people as well as the individual, such as
educational attainment or good health. Intrinsic measures are those valued by and relating primarily to the individual, such as happiness or self-esteem. The differences
between the two categories are important: extrinsic outcomes may be measured through datasets and objective measures (exam results, use of healthcare, prevalence
of smoking, etc). Intrinsic outcomes are, by their nature, subjective, may fluctuate over time, and can only be measured by asking people directly. However, both types
of outcomes are equally valid and this framework aims to describe a balance of both types in a pragmatic and realistic manner that reflects the priorities expressed by
local people.
Format:
The structure of the shared goals frameworks is based on Porter's Hierarch of Outcomes (see https://www.hfma.org.uk/docs/default-source/our-networks/healthcare-
costing-for-value-institute/external-resources/measuring-health-outcomes---the-outcome-hierarchy)
Shared goals have been designed as "I" statements, based on feedback from patient and public engagement undertaken in Ealing in summer 2016 and cross-referenced
with the National Voices "I" statements from their narrative on person-centred co-ordinated care (see
http://www.nationalvoices.org.uk/sites/default/files/public/publications/narrative-for-person-centred-coordinated-care.pdf)
Each goal has a corresponding metric associated with it. Where possible, metrics have been selected from standard indicator sets such as the ICHOM Older Person's
standard set (http://www.ichom.org/medical-conditions/older-person/) or indicators in use for specialist children and young people's care (e.g. those on mental
wellbeing via the Child Outcomes Research Consortium http://www.corc.uk.net/outcome-experience-measures/)
introduction
04b
Perspective
Goals
Metrics
Nature of
metric
Data source
Frequency of
reporting
Benchmarks?
Data notes
Domain 1: health
status
achieved/retained
I want to live a life that's normal for me
Health-related quality of life (e.g. EQ5D or SF36)
Subjective GP Pt Survey
Annual
Y - peers
EQ-5D incorporated into GP patient survey.
Important clinical outcomes are improving
Priority disease areas (diabetes, respiratory disease, MSK, IAPT, frailty,
pain control, End of Life care)
Objective Various
tbd
tbd
To be informed by local clinicians and JSNA
Everyone has access to the care that helps them live
normal lives
Equity: as a proxy, select a vulnerable population, e.g. care homes, and
use specific goals (see data notes)
Informed by care home vanguards. Could include:
- decreased numbers of 111 and LAS calls from care homes
- decreased numbers of care home residents dying in hospital
I am encouraged to have access to social activities
ASCOT or UCLA 3-item scale (ICHOM OP)
Subjective Annual survey
Annual
Y - peers
Also an Ealing Health & Wellbeing Strategy outcome. National
survey administered locally by council on recipients of social care.
Domain 2: Process
of care
I need to trust the people looking after me
Professionals seemed to work together like a team / ICHOM OP
Partanddec questions
Subjective tbc
tbc
tbc
Validated question/tool available but not routinely administered.
Part of ICHOM Older People standard indicator set
I am listened to
Involved in care planning / shared decision making
Subjective tbc
tbc
tbc
Validated question/tool available but not routinely administered
As a staff member, I am supported to do a good job
Feel supported to deliver the best care they can
Subjective NHS Staff survey
Annual
Y - peers
As a staff member, I feel I can trust the other partners in
the system
Would recommend their service to friends or family
Subjective NHS Staff survey
Annual
Y - peers
Care is safe, delivered to the correct clinical standard
NHS Safety Thermometer ratings? Adverse effects of medication (ICHOM
OP)? Check with Jonathan Webster, Director of Quality.
Objective tbc
tbc
tbc
My care was timely
NHS Constitution waiting times
Objective NHS performance
monitoring
Monthly
Y - peers
Domain 3:
Sustainability of
health
I feel I'm in control
ASCOT (ICHOM OP): How much control you have over your daily life? (By
‘control over daily life’ we mean having the choice to do things or have
things done for you as you like and when you want)
Subjective Annual survey
Annual
Y - peers
National survey administered locally by council on recipients of
social care. Could be expanded/extended using same
questionnaire to wider sample of people
I am able to live at home
Total length of stay in hospital over last 12 months (ICHOM OP)/ DTOCs
Objective NHS SUS data
Rolling monthly
tbc
Combines data for all admissions and will incorporate DTOCs,
readmissions, emergency admissions etc. as well as routine.
As a carer, I feel involved, supported and have time for
myself
Zarit Burden 4 questions
Subjective Local
tbc
tbc
Validated question/tool available but not routinely administered.
Part of ICHOM Older People standard indicator set
The resources available are used in the most effective
way to provide 24/7 care
Unplanned / emergency admissions to hospital for ACS conditions /
conditions that could have been managed in primary care
Objective NHS SUS data
Monthly
Y - peers
More focused/specific subset of data from 'Time in hospital'
indicator
Different organisations work well together. As a member
of an organisation, I feel supported by the Community
Health Provider(s)
Handoffs work/MDTs work/co-ordinated care/organisational 360 degree
review
Objective tbc
tbc
tbc
Drivers
Technology is used to innovate and support
To be confirmed.
Proportion of people who have access to their own records? Systm One
(interoperability line in urgent care business case)? Automation,
algorithms, manage demand in a different way? Digital logistics to
manage and co-ordinate the system?
Objective tbc
tbc
tbc
Staff have the right skills for working together
To be confirmed.
Proportion of staff who are trained in health coaching? Retain, skill up,
create new opportunities and types of roles and skills?
Objective tbc
tbc
tbc
There is investment in building community resilience
To be confirmed.
Involvement of community-based third sector groups in support and care.
Ringfenced minimum spend (£1.8m) - show the return on investment
expected from this?
Objective tbc
tbc
tbc
Shared goals adults
Perspective
Goals
Metrics
Nature of metric
Data source
Frequency of
reporting
Benchmarks?
Data notes
Tier 1: health status
achieved/retained
I feel healthy
Subjective
Important clinical outcomes are
improving
Priority disease areas
Objective
I am achieving
Time off school because of medical issues
Or, something relating to quality and use of Education
Health & Care Plans
Objective
I feel good about myself
Something on children's mental health and emotional
wellbeing?
I can build and enjoy positive
relationships
Subjective
Tier 2: Process of
recovery
Care is provided in an environment and
with equipment appropriate to my age
and needs
Adherence to 'You're Welcome' standards
Or, something about wheelchair services meeting
users' needs
Objective
I am listened to and involved in making
decisions about my care
Subjective
As a staff member, I am supported to do
a good job
Feel supported to deliver the best care they can
Subjective
NHS Staff survey Annual
Y - peers
As a staff member, I feel I can trust the
other partners in the system
Would recommend their service to friends or family
Subjective
NHS Staff survey Annual
Y - peers
I feel safe
Subjective
My care was timely
Objective
Tier 3: Sustainability
of health
I am growing towards independence and
adulthood
Subjective
My transition from young person to
adult does not affect the quality of my
care
Objective
As a parent/carer, I am involved as much
as is appropriate in my child's care plans
Subjective
The resources available are used in the
most effective way to provide 24/7 care
Objective
Different organisations work well
together
Objective
Enablers
Technology is used to innovate and
support
Objective
tbc
tbc
tbc
Staff have the right skills for working
together
Objective
tbc
tbc
tbc
There is investment in building
community resilience
Objective
tbc
tbc
tbc
Shared goals CYP
Health & Wellbeing Strategy outcomes
STP delivery areas
https://www.healthiernorthwestlondon.nhs.uk/sites/nhsnwlond
on/files/documents/nwl_stp_october_submission_v01pub.pdf
https://www.ealing.gov.uk/downloads/download/3755/health_and_wellbeing_strategy
Appendix Ealing Population Outcomes
Perspective Outcomes
Example metrics
Nature of metric Data source
Frequency of reporting
Benchmarks?
Data notes
Person
Quality of life
Health-related quality of life (e.g. EQ5D or SF12)
Subjective
GP Pt Survey
Annual
Y - peers
Goal Attainment Score
Subjective
None - tool available
tbd
tbd
Experience of care
Treated with dignity and respect
Subjective
Pt Surveys
Annual
Y - peers
Involved in care planning / shared decision making
Subjective
None - tool available
tbd
Y - best practice
Professionals seemed to work together like a team
Subjective
None - tool available
tbd
Y - best practice
Ability to self-care
Patient Activation Measure; empowerment
Subjective
None - tool available
tbd
Y - best practice
Practitioner Important clinical outcomes
Priority disease areas (e.g. early cancer diagnosis, proportion of
people receiving recommended care - diabetes, COPD)
Objective
Audits, NHS Digital
Annual
Y - peers
Workforce environment
Feel supported to deliver the best care they can
Subjective
Staff survey
Annual
Y - peers
Would recommend their service to friends or family
Subjective
Staff survey
Annual
Y - peers
Population Life expectancy
Life expectancy at 65 (for older people)
Objective
ONS
Annual - Rolling 3 years
Y - peers
18-24 months time lag
Healthy life expectancy
Proportion of life spent in good health
Objective
ONS
Annual - Rolling 3 years
Y - peers
18-24 months time lag.
Can't compare
overlapping time
periods
Inequalities in health outcomes
Health equity audit plan agreed and audits undertaken and acted
upon each year
Objective
Local data
Annual
Y - best practice
System
Financial balance between providers System financial balance
Objective
Local data
tbd
Y - best practice/peers
Effective resource allocation
NHS Constitution waiting times
Objective
NHS Digital
Quarterly
Y - targets
Unplanned / emergency admissions to hospital for ACS
conditions / conditions that could have been managed in primary
care
Objective
NHS Digital
Quarterly
Y - peers
Maintain safe care
NHS Safety Thermometer ratings
Objective
Local data
Quarterly
Y - best practice
Enablers
Digital transformation
Proportion of people who have access to their own records
Objective
To be developed
tbd
tbd
Workforce upskilling
Proportion of staff who are trained in health coaching
Objective
To be developed
tbd
tbd
Community development
Involvement of community-based third sector groups in support
and care
Objective
To be developed
tbd
tbd
Appendix Framework Template
Porter outcomes hierarchy
ICHOM Older Persons' Standard Indicator Set
National Voices narrative on person-centred co-ordinated care
Dept of Health. Children and Young People's Health Outcomes Strategy. Report of the Children & Young People's Health Outcomes Forum. London, May 2013
Six aspects of healthcare that children and young people say are important to them:
- Care to be delivered by competent professionals
who communicate well with them
- to be involved in decisions about their health and
care and make informed choices
- to be treated with dignity and respect
- Care to be in environments which are appropriate
to their age and needs
- An appropriate and efficient system for the transfer
from child to adult services
- Access to timely and effective care
Scottish Government: Getting it right for every child. http://www.scotland.gov.uk/Topics/People/Young---People/gettingitright/well---being
Eight indicators of wellbeing. If services are being provided well, then children and young people should be able to say:
- I feel safe
- I am healthy
- I am achieving
- I feel nurtured
- I am active
- I feel respected
- I am responsible
- I feel included
Young Foundation: A framework of outcomes for young people (July 2012)
Five key themes in the aspirations of young people:
- Achieving in education
- Career succcess
- Being healthy
- Having a positive relationship
- Involvement in meaningful, enjoyable activities
References
Dept of Health. Children and Young People's Health Outcomes Strategy. Report of the Children & Young People's Health Outcomes Forum. London, May 2013
Six aspects of healthcare that children and young people say are important to them:
- Care to be delivered by competent professionals
who communicate well with them
- to be involved in decisions about their health and
care and make informed choices
- to be treated with dignity and respect
- Care to be in environments which are appropriate
to their age and needs
- An appropriate and efficient system for the transfer
from child to adult services
- Access to timely and effective care
Scottish Government: Getting it right for every child. http://www.scotland.gov.uk/Topics/People/Young---People/gettingitright/well---being
Eight indicators of wellbeing. If services are being provided well, then children and young people should be able to say:
- I feel safe
- I am healthy
- I am achieving
- I feel nurtured
- I am active
- I feel respected
- I am responsible
- I feel included
Young Foundation: A framework of outcomes for young people (July 2012)
Five key themes in the aspirations of young people:
- Achieving in education
- Career succcess
- Being healthy
- Having a positive relationship
- Involvement in meaningful, enjoyable activities
References
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