Partnership meeting – 23rd May 2011

Over forty of the Thames Valley Health Innovation and Education Cluster’s (HIEC) key partners met together on May 23rd to hear what the HIEC had achieved in its first year of operations, and to receive a Progress Report and other materials that set out the achievements of the year ended 31st March 2011, and the plans for the next year.

Rather than go through all the HIEC’s activities in detail, three of the main developments were showcased by the HIEC partners who are responsible for these particular pieces of work.  Each theme offered the opportunity for all the partners present to engage with the issues raised by the presenters from the multiple perspectives of the different kinds of partner organisations represented in the room.

The Future of the regional Patient Safety Federation (PSF)                                            
  Presentation by Sarah Mussett, South Central SHA

Thames Valley HIEC will be co-hosting the Patient Safety Federation with The Royal Berkshire Hospital and Wessex HIEC .  The goal of the PSF is to improve patient safety in all healthcare organisations in the South Central area and to lead the way, nationally and internationally, in reducing harm to patients.

Each of their eight workstreams is headed by a senior member of an NHS South Central Trust and draws its membership from practitioners and academic experts across the organisations.  This leads to credible, practical solutions which benefit Trusts and their patients across the Thames Valley and beyond.

The workstreams are:

  • No needless skin breakdown
  • No needless infection
  • Reducing needless harm and death
  • No needless medication errors
  • No needless ignorance
  • No needless falls
  • No needless harm in mental health
  • No needless malnutrition

Sarah demonstrated some practical outcomes of the work to date – the “green bag” initiative that helps manage patient medication and avoids unnecessary duplication in prescribing; and the DVD “The Trouble with Handovers” which has been developed by the “No Needless Ignorance” team.  Members were delighted to pick up a copy of the DVD as they left the meeting. 

PowerPoint presentation

Shared decision-making on Healthtalkonline
Presentation by Dr Louise Locock, Health Experiences Research Group

Louise began by presenting the Healthtalkonline patient narrative web site, explaining its history and its scale, together with the amazing hit rate that the site now scores from patients, the general public and clinicians at all levels.  This resource formed a valuable source of information for the shared decision making project, when they were approached by the Thames Valley HIEC and the Department of Health, with a proposal to develop a specialist site on shared decision making, to support the policy agenda of “no decision about me, without me”.

From the literature, the following eight themes were identified as central to the subject: 

  • What is shared decision making?
  • Why do people want to be involved in SDM?
  • Why do people sometimes not want a decision to be shared?
  • Different types of patient/ doctor relationships
  • Different types of decisions, settings and participants
  • What information needs to be exchanged?
  • Decisions involving values and difficult personal choices
  • What might go wrong when decisions are not shared?

Over 1000 patient stories were examined to support these themes, derived from thirty of the sixty conditions currently on the healthtalkonline website. These conditions covered a range of kinds of decisions that need to be taken in very varied contexts:

  • Elective treatment choices (e.g. hip replacement)
  • Life threatening illness (e.g. cancer)
  • Long Term Conditions (e.g. diabetes, chronic pain)
  • Decisions for others/ involving values (e.g. termination, relative in intensive care) 

Having developed the resource, healthtalkonline and the University of Oxford Health Experiences Research Group are now working with Thames Valley HIEC to develop a plan to maximise the adoption and spread of this valuable new tool in the shared decision making tool box.

 Powerpoint presentation: SDM 2
Keeping older people out of hospital – How an innovative GP Consortium are tackling this issue
Presentation by Dr Peter Petrie and Julie Line, The Practice PLC

With The Practice plc, Thames Valley HIEC are looking at ways to improve the care of residents in private sector care homes, and to keep them out of hospital wherever possible.

The project is identifying and sharing new practice which focuses on resident satisfaction, extends their choice of options for care and enhances ‘end of life’ quality. In particular, the aims are around integrating the work of GPs, secondary care providers, care home staff and the ambulance service to meet the needs of this patient group. These ideas will help to:

  • Reduce inappropriate admissions
  • Rationalise prescription (and reduce prescribing costs)
  • Eliminate errors in medicine management
  • Introduce specialist ‘quality end of life’ training for care home staff and clinicians
  • Allow patients/residents the option of dying at home whenever appropriate
  • Reduce the cost of care for this group

In her presentation, Julie emphasised the scope of the work, which will work across ten different care homes, of very different scale, and cover over 800 patients, in the period between now and September; and which will finally cover around 1000 patients in all.

Already, valuable lessons are being learned such as the important role of practice nurses in initial assessment; the value of integrating the contribution of nutritionists and dieticians into the pathway; and the important liaison role played by PCT pharmacists. In the first month, savings of £33,253 were identified by more effective medicines management in just one care home.

PowerPoint presentation

After each of the presentations, there was the opportunity for specific questions to be raised with the individual presenters; and also for a more general discussion of the broader implications of the work.  One particularly challenging aspect to the developments being discussed is the implications of redesigning pathways of care on other parts of the overall system.  It was acknowledged that delivering the QIPP agenda, which is intending to improve patient outcomes while reducing costs, does mean that there are some losers financially.  However, raising the quality of the patient experience will in itself challenge the rest of the system both to meet the new standards set, and also to innovate in their own practices to respond to changes in the provider market.

Members left the room at the end of the afternoon, engaged in a stimulating buzz of conversation, often with colleagues with whom they have not previously worked.  It was agreed that another sharing event of this kind would be welcomed as a way of exchanging ideas at a local level to the benefit of Thames Valley patients.

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