Warrington Clinical Commissioning Group ‘
2. What we want to achieve 2.1 Core mission and values Our core purpose is to turn £250 million of resources into the best possible health outcomes for the people of Warrington . Our Strategic Objectives This core mission is underpinned by our core values: These values drive our strategic objectives: Improve healthy life expectancy for all Our Core Values Reduce inequalities Excellence All Commissioned Services support delivery of the NHS Constitution for our population Valuing patients and partners Continually improve quality of commissioned services Accountability Achieve sustained financial balance Partnerships in everything Maintain a highly effective and motivated workforce Honest and Integrity Open and transparent Ensure sound governance arrangements are in place To support this we will: Courage • Promote appropriate integration of commissioned services narrow the gap in health needs between the wards of the town. • be driven by a desire to continually improve service quality and outcomes • Patients, service users, carers and their families will see: use evidence based practice to effect whole system change • • a difference in service provision with holistic management of care; use sustained patient and public engagement and involvement in review, • models of care based on service user led pathways with no organisational development and implementation of pathway and service redesign. • boundaries and systems that work; use sustained clinical and provider engagement and collaboration to • more care delivered closer to home; redesign and implement pathway and service redesign. • • individuals supported to better manage their own conditions; deliver a whole system information strategy will ensure a single care • an increased use of technology; patient care record with patient access to their information • • more appropriate signposting to services, particularly in moments of crisis; Improve availability of information to support informed choices • • increased use of education by all agencies to help people; and reflect service changes in quality contracts • • more use of existing support networks such as the family. improve information to target services more effectively
Our Whole System Vision Self-sufficient communities enjoying improved health and wellbeing and better life experiences, who and when they need them have access to high quality and efficient services.
Transforming Services Primary Care Urgent Care End of Life Long Term Frail Older Conditions people Preventing Children Premature Death Medicines Planned Care Management Mental health
Reframing our Vision Event - 2013 The graphic represents the whole system event we hosted in June 2013. All partners explored the model of support required into 2014 and beyond to reflect the profile of our population. People considered the whole system transformational programmes of work to ensure they are developing appropriately to provide the right models of support for our population as they age, requiring effective inter-professional care co-ordination and navigation through complex health & social care systems
Transformation Programme In 2014/15 incorporates previous work programmes for Long Term Conditions, Older People and End of Life Care. How will we do it? What do we want to achieve? • By working with partner organisations to develop integrated, co-ordinated, inter- • People living as long and as well as disciplinary services across health, social possible in their own environment and care and the voluntary sector using communities (NOF 13/14 2.1)( ASCOF 1A) contract levers and service specifications • Integrated, co-ordinated services which • By clustering inter-disciplinary services around the ‘primary care home’ model support people to maintain health and independence in their place of • By increasing awareness around the needs residence (NOF 13/14 -2.1, 2.3a, 3.6) (PHOF 4.11) of people with dementia. A Dementia Action Alliance will be established. • Care which is proactively planned and • By reducing unscheduled admissions in managed and has moved away from a areas which we believe should be markers reactive model of care of strong community management such as • Recognising where complexity exists UTIs, pneumonia, cancer and for people on and co-ordinating multi- agency care End of Life care pathways where required • By embedding comprehensive, standardised assessment and care planning processes
Transformation Programme Continued: • By working with all of our provider organisations to reshape commissioned service provision to provide inter-disciplinary, systematic access to case management and care co-ordination, using service redesign models, service specifications and contracts to facilitate change • By establishing strong quality markers for care home health provision and by providing a supportive system to manage those with complex needs in a safe way • By ensuring that the flow of care from secondary providers into community and primary care management is timely and seamless • By ensuring that people have the understanding and knowledge to become equal partners in their care management • By recognising the impact of lifestyle choices, social well-being and environment on health outcomes through collaboration with Public Health, NHS England and Public Health England colleagues
End of Life Care How did we say we would do it? What did we want to achieve? • Commission services that deliver integrated approaches to providing care at the end of • Improve the experience of care for people life at the end of their lives (NOF 13/14 - 4.6) • Develop services to ensure clinicians have • Increase the number of people achieving 24/7 access to specialist palliative care their preferred place to die. advice, • Reduce the number of people dying in •Implement ‘whole system’ use of hospital Community Care Plan (CCP) to incorporate • Improve quality of service offered (NOF 13/14- • Targeted Care Home support 4b) • Work with partners to enhance peoples • Improve reported patient experience understanding of issues related to death and (NOF13/14 -4b) • Enhance the quality of life for carers (ASCOF dying using ‘Dying Matters’ philosophy 1D) • Top 10 quality markers from the End of Life Care Strategy 2009 in all provider contracts (quality markers for each sector as appropriate from the strategy)
End of Life Care How we know we are succeeding: • Significant improvement in the number of people having care plans, particularly in the nursing and residential home environment and community. • Care of the Dying Pathway (also called LCP) is still used and continues to give patients and their families comfort in the dying phase. All patients and their families/carers receive information and able to discuss their wishes. National guidance is awaited and we will implement the system that replaces the Liverpool Care Pathway • The number of people dying in their preferred place of choice across all settings continues to increase • The end of life work across all settings has helped contribute to the number of unplanned admissions in conjunction with all other programmes. • Successful introduction of a community-wide Do Not Attempt Resuscitation (DNACPR) policy that will help families/clinicians/professionals and patients to stay in their preferred place of care at the end of life. • Anticipatory prescribing for people at the end of life will be launched across Warrington in March 2014
End of Life Care What we also want to achieve in 2014/15: • Audit the number of hospital admissions of 8 days or more which end in death with the aim of reducing this further, developed through links with the ‘Primary Care Home Model’ • Continue to work towards developing 24/7 specialist palliative care advice for health professionals • Work with McMillan and St Rocco’s Hospice to develop a local information service to support cancer / end of life patients and their carers
Preventing Premature Death • • What did we want to achieve? How did we say we would do it? (Public Health lead) • • Local Enhanced Service for ‘Health In accordance with domain 1 of the Checks’ to identify and manage risk National Outcome Framework prevent people from dying prematurely and factors increase life expectancy at 75 (NOF 13/14 – • Promote participation in cultural and 1b, 1.1, 1.2, 1.3, 1.4,) (POF 4.4, 4.5, 4.6, 4.7) sporting activities as a means of • Earlier detection of cancer (NOF 13/14 1.4 (i) promoting health and wellbeing (ii) )(POF 4.5) • Improve uptake of screening • Consistent reporting of cancer staging programmes for early intervention and data better outcomes • Decrease in mortality from cancer (NOF • Tackling health inequalities / targeting 13/14 1.4 (i) (ii) )(POF 4.5) • areas of greatest need Closing of inequalities gap • Commissioning ‘Lifestyle’ programmes • Decrease in alcohol related morbidity to promote positive life choice that impact on health
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