HEE Quality Strategy 2016-2020
Title of driver: HEE Quality Strategy 2016-2020
Source: Health Education England (HEE)
Publication format: PDF
Date of publication:
Impact on library policy/practice:
- Work with relevant education departments to ensure that LKS is supporting the needs of all healthcare learners.
- Offer support and raise awareness of LKS to those healthcare leaners and those responsible for providing and delivering learning.
- Both of the above should lead to increased awareness in library resources and services.
- Possibility of collaborative purchasing opportunities with other LKS in order to deliver financial savings and fitting in with the theme of de-duplication and silo working.
Summary of driver:
The HEE Quality Strategy 2016-2020 together with the multi-professional HEE quality framework, set out how HEE will measure, recognise and improve quality in the education and training environment. Together, these are intended to be dynamic documents that will evolve over time to reflect transformation of the healthcare learning environment.
This strategy sets out HEE’s vision of continuously improving the learning environment whilst supporting the ambitions of the Five Year Forward View.
Key features of driver
- HEE is one organisation with local teams- this strategy attempts to pull everything together into one shared vision and remove duplication and silo working and demonstrate commitment to an education infrastructure.
- This shared vision with its standards and measures for quality and improvement in education and training will ensure a comparable view between local and national enablement.
- Improvement in the quality of training will deliver a workforce with the right skillset, values and behaviours to deliver high quality care to patients
- Ensure value for money, innovation and continuous improvement in the quality of education and training.
- Demonstration of investment supporting delivery of quality of patient care
- HEE will align educational infrastructure and leadership with educational investments with local teams offering support to Higher Education Institutions.
- Promote a culture that maximises learning opportunities across all sectors. This will ensure that all learners will have access to equitable and high quality support during learning which will prepare them for future healthcare careers.
Primary audience: All health and social care providers in England with training and educational responsibilities
Date last updated: May 2017
Due for review: May 2018
Group member responsible: LK
Hot Topics: Neighbourhood Care Teams
A Word version of this briefing aimed at health care professionals is available for LKS staff to share in their own organisations. Please feel free to reproduce it (with acknowledgement) for your own purposes.
Impact on library policy/practice:
- LKS may need to consider how to provide clinical librarian services to what in effect are ‘virtual wards’
- Integrated care teams may contain members from social care, housing, and the voluntary sector that have not traditionally been served by NHS LKS, and consideration may need to be given the potential needs of these users so we can provide as seamless a service as possible to all members of the team. At a national or regional level, it would be useful to negotiate funding for NHS LKS to provide services to these groups so that this doesn’t have to be negotiated on an individual LKS basis
- LKS may need to look at information resources to support social care staff in particular
- There could be a role for LKS in providing information to service users covered by the care team, as one of the objectives is to support them to manage their own health
- As with Accountable Care Organisations, as organisational boundaries blur, LKS may be required to adapt their service delivery models accordingly, particularly as care moves increasingly into the community
What are neighbourhood care teams?
Neighbourhood care teams are a specific example of integrated care.
These are usually local teams comprising health and social care professionals, sometimes supported by housing professionals or the voluntary sector, that work with people with long-term or multiple conditions or the frail elderly. The service user usually has access to a case worker or navigator for a single point of access, medical records are usually shared between the members of the team, and members of the team may be drawn from different organisations. Their aim is to support people to remain in their own homes and live as independently as possible, and to avoid unnecessary hospital admissions.
They may also be known as integrated local care teams, locality care teams, virtual wards, neighbourhood teams or similar. Neighbourhood care teams or similar models are a feature of many local Sustainability and Transformation Plans (STPs).
What examples are there of neighbourhood care teams in practice?
The document from NHS England on new care models (1) provides examples of a couple of schemes similar to neighbourhood care teams, namely Fylde Coast Local Health Economy and Stockport Together.
Other examples include:
- Lincolnshire Health and Care Integrated Neighbourhood Care Teams
http://lincolnshirehealthandcare.org/en/lhac-initiatives/neighbourhood-teams/ - Leeds Community Healthcare NHS Trust Neighbourhood Care Teams
http://www.leedscommunityhealthcare.nhs.uk/our-services-a-z/neighbourhood-teams/ - South Manchester Integrated Community Care Team
http://smanchesternt.manchester.nhs.uk/
What’s the evidence for neighbourhood care teams?
A Nuffield Trust report (2) looking at different community interventions including integrated health and social care teams found no evidence of a reduction in hospital admissions, but this may be due to ‘case finding’ identifying previous unmet needs, and any reduction in admissions may only happen in the long-term.
However, there is evidence (3) that co-ordination of care through integrated teams improves patient experience and quality of life, and some evidence that chronic care management models are associated with lower costs.
Further reading
- NHS England (2016). New care models: Vanguards – developing a blueprint for the future of NHS and care services https://www.england.nhs.uk/wp-content/uploads/2015/11/new_care_models.pdf
- Nuffield Trust (2011). An evaluation of the impact of community-based interventions on hospital use https://www.nuffieldtrust.org.uk/files/2017-01/evaluation-community-based-interventions-hospital-use-report-web-final.pdf
- King’s Fund (2015). Care co-ordination through integrated health and social care teams https://www.kingsfund.org.uk/projects/gp-commissioning/ten-priorities-for-commissioners/care-coordination
Long-Term Sustainability of the NHS: Policy Briefing
A Policy Briefing aimed at health care professionals is available for LKS staff to share in their own organisations. This has been produced and shared by the JET Library, Mid Cheshire Hospitals NHS Foundation Trust. Please feel free to reproduce it (with acknowledgement to JET Library) for your own purposes.
Impact on library policy/practice:
- With a longer term strategic plan for the transformation of the NHS LKS teams may be asked to deliver evidence and knowledge to managers, commissioners and transformation teams as health care services undergo this change.
- Any longer term plans for the NHS may impact on the actual delivery of LKS regionally and nationally and therefore, LKS will need to consider whether existing models of service delivery meet the requirements of a transformed NHS.
- LKS need to consider developing a longer term strategic plan for the next 15-20 years for NHS library services which maps to the recommendations outlined in this report.
Source: House of Lords Select Committee
Publication format: Web site and pdf
Date of publication: 5th April 2017
Summary of driver: The House of Lords appointed a Select Committee on the Long-Term Sustainability of the NHS on 25 May 2016 to consider the long-term sustainability of the National Health Service. The report was published in April 2017 and found that there was no short term solution to sustainability recommending that an Office for Health and Care Sustainability should be set up to look 15-20 years ahead and focus on:
- Demographic Change
- Service Demand
- Workforce and Skill Mix
- The balance of funding between health and social care
Key features of driver:
- The fragmentation and regulatory burden that stops integration between health and social care should be tackled
- NHS England and NHS Improvement should merge and then include strong representation from local government
- The NHS should remain funded from taxation and free at the point of use and health spending beyond 2020 needs to increase in line with GDP growth
- Beyond 2020 funding for social care should reflect increased need or, at least, rise by the same amount as NHS spending
- Responsibility for the social-care budget should be transferred to the Department of Health which should be renamed the Department of Health and Care
- Those who can afford care should pay for it subject to the funding caps recommended by the Dilnot Commission
- The Government should implement new mechanisms to help people to pay for their own care – this could be an insurance-based system starting in middle age
- There is an absence of long-term skills planning
- Health Education England should be “substantially strengthened” and transformed into a new, single, integrated strategic workforce-planning body – looking 10 years ahead. Its independence should be guaranteed with a protected budget
- The Government should identify parts of the NHS which are falling behind in innovation and technology and make it clear that there will be funding and service-delivery consequences for those who “repeatedly fail to engage.”
- The Government should require NHS England/NHS Improvement to achieve greater levels of consistency in efficiency and performance at a local level. Greater levels of investment and service-responsibility should be given to those who improve the most.
- The Government should restore the public-health budget and maintain a ring-fenced budget for the next 10 years. It should remind the public that access to the NHS involves rights as well as responsibilities
Primary audience: All trust staff
Date last updated: 11th May 2017
Due for review: 11th May 2019
Group member responsible: TP
Hot Topic: Social Prescribing
A Word version of this briefing aimed at health care professionals is available for LKS staff to share in their own organisations. Please feel free to reproduce it (with acknowledgement) for your own purposes.
Impact on library policy/practice:
- LKS teams may be asked to try to locate or synthsise evidence to support the commissioning of specific social prescribing initiatives
- LKS teams, in collaboration with public library services may be involved in the provision of some social prescribing initiatives (such as service-user or staff reading groups, digital literacy training, books on prescription schemes or similar – see the KfH PPI group’s Ideas Bank for more ideas) or in working with social prescribing co-ordinators to signpost to suitable opportunities (many public library services will have directories of community organisations)
- LKS could work with occupational health teams to have staff referred to particular initiatives run by the library
- Social prescribing, along with other initiatives in local STPs, may represent a shift away from secondary care and this may have implications for our user base which may become more community-based
What is social prescribing?
It is a means for GPs and other primary care professionals to refer patients to non-medical interventions that can be used to improve their physical or mental well-being. The kinds of options available for prescribing could include walking groups, knit and natter groups, cookery classes, adult learning, volunteering, and self-help reading (the Books on Prescription scheme is an example of social prescribing).
Social prescribing is mentioned in the NHS England document ‘Next Steps on the Five Year Forward View’ and in the General Practice Forward View as a means of reducing avoidable demand, with an aim to work with the voluntary sector and primary care to ‘design a common approach to self-care and social prescribing’ (1). A national clinical champion for social prescribing was appointed by NHS England in 2016.
Social prescribing is a feature of many local Sustainability and Transformation Plans (STPs).
What examples are there of social prescribing in practice?
There are plenty of examples, some of which are listed in the evaluation carried out by the University of York on pages 5-7 (2). The Commissioning Handbook for Librarians provides suggestions for searching for material about social prescribing (3) which will help identify more.
The Rotherham social prescribing service is a very large scheme, and was mentioned in the NHS Five Year Forward View as an emerging model for the future.
What’s the evidence for social prescribing?
A systematic review carried out in 2016 and published in BMJ Open (4) found that there was there was little good quality systematic evidence to inform the commissioning of social prescribing programmes, as did a previous review of 2015 published by the University of York’s Centre for Reviews and Dissemination (2).
There is some evidence that social prescribing schemes can make a difference to outcomes such as quality of life, levels of depression, and reduction in use of health services, and social prescribing schemes show high levels of satisfaction from users and health care professionals. However, much of the evidence is qualitative, is from self-reported outcomes, and is from small-scale schemes. Most studies focus on a particular intervention rather than social prescribing generally(5). Evidence on the cost-effectiveness of social prescribing is limited.
Further reading
- NHS England (2017). Next steps on the NHS Five Year Forward View. https://www.england.nhs.uk/wp-content/uploads/2017/03/NEXT-STEPS-ON-THE-NHS-FIVE-YEAR-FORWARD-VIEW.pdf
- University of York. Centre for Reviews and Dissemination (2015) Evidence to inform the commissioning of social prescribing. https://www.york.ac.uk/media/crd/Ev%20briefing_social_prescribing.pdf
- The Commissioning Handbook for Librarians (2017) Social Prescribing. http://commissioning.libraryservices.nhs.uk/hot-topics/social-prescribing
- Bickerdike L, Booth A, Wilson PM, et al. Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open 2017;7 http://bmjopen.bmj.com/content/7/4/e013384
- King’s Fund (2017) What is social prescribing? https://www.kingsfund.org.uk/topics/primary-and-community-care/social-prescribing
Primary audience: LKS staff and their wider organisations
Date last updated: May 2017
Due for review: May 2018
Group member responsible: JC
Hot topic: Accountable Care Organisations
A Word version of this briefing aimed at health care professionals is available for LKS staff to share in their own organisations. Please feel free to reproduce it (with acknowledgement) for your own purposes.
Impact on library policy/practice:
- LKS teams may be affected by changes to organisational structures as a result of the emergence of Integrated Care Systems, Integrated Care Partnerships and Accountable Care Organisations (ACOs).
- There may be an opportunity to deliver evidence and knowledge to managers, commissioners and transformation teams as health care services undergo this change.
- As organisational boundaries blur and take a ‘whole population’ approach, LKS may be required to adapt their service delivery models accordingly.
- If healthcare moves away from a competitive structure and towards a collaborative one, there will be many opportunities relating to knowledge management that could support the sharing and dissemination of good practice, innovation and organisational knowledge.
- LKS will have to consider how the negotiation and procurement of resources needs to adapt to reflect the changes in organisational structures.
- There is a clear role for technology in supporting the emergence of these news systems that presents an opportunity for digitally enabled LKS.
What is an Accountable Care Organisation?
An Accountable Care Organisation (ACO) or Accountable Care System (ACS) brings together a number of providers (e.g. acute hospital care, general practice, mental health, social care, ambulance services and pharmacies) to take responsibility for the cost and quality of care for a defined population within an agreed budget (1).
ACOs have been proposed as one way of overcoming fragmented responsibility for the commissioning and provision of care in the NHS. They could in principle offer an organisational structure that draws together previously siloed or competing providers into a network with a shared sense of purpose and financial interest (3).
Next Steps on the Five Year Forward View (5) describes ACOs as “an evolved version of an STP” and states that ACOs “provide joined up, better coordinated care”. It published the names of nine geographical areas that are likely to emerge as ACOs in 2017/18.
What can we learn about ACOs from elsewhere?
ACOs have evolved recently in the United States and they build on a much longer history of integrated care systems such as Kaiser Permanente and Intermountain Healthcare (1).
In the UK, three ‘Vanguard’ schemes stated their intention to explore the potential of the ACO as an organising structure in the NHS: Northumbria, Northamptonshire and Salford (3).
The first wave of Integrated Care Systems (formerly shadow Accountable Care Organisations) are currently assuming accountability for local operational and financial performance in: South Yorkshire and Bassetlaw, Frimley Health and Care, Dorset, Bedfordshire, Luton and Milton Keynes, Nottinghamshire, Blackpool and Fylde Coast,
West Berkshire, Buckinghamshire, Greater Manchester (devolution deal), Surrey Heartlands (devolution deal) (8).
What are the challenges involved?
- Relationships: Establishing strong relationships between the leaders of participating organisations and the clinicians who deliver care;
- Technology: Accelerating the implementation of electronic care records to help predict avoidable hospital admissions and to coordinate discharge planning;
- Finance: New ways of commissioning and paying for services need to be established across traditional organisational boundaries (1).
- Legal challenge: The proposed changes to regulations and consultation on the draft ACO contract have resulted in two legal challenges from 999 Call for
the NHS and JR4NHS. (7)
Further reading
- King’s Fund, 2016, Accountable Care Organisations explained
- King’s Fund, 2014, Accountable Care Organisations in the United States and England
- National Health Executive, 2016, Accountable care organisations: the future of the NHS?
- Nuffield Trust, 2016, Accountable Care Organisations: The winners and losers
- NHS England, 2017, Next Steps On The NHS Five Year Forward View
- House of Commons (2018) Accountable Care Organisations
- Kings Fund (2018) Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England
- NHS England (2018) Integrated care systems (ICSs)
Primary audience: LKS staff and their wider organisations
Date last updated: February 2018
Due for review: May 2018
Group member responsible: VT
Making IT work
Title of driver: Making IT work: harnessing the power of health information technology to improve care in England (Wachter review)
Impact on library policy/practice:
Whilst the report focuses on electronic health records (EHRs), there are still areas that may impact on library services.
One of these may be in integration between point-of-care systems such as UpToDate, DynaMed, ClinicalKey or CEBIS, and the electronic patient record, so clinicians have easier access to healthcare library and knowledge resources. It may be necessary to share knowledge about what point-of-care systems work with which EHRs, and how to make it work successfully. Library staff may need to work with the proposed Chief Clinical Information Officers in their Trusts to push for embedding or visibility of library services in the EHR. As well as integration with commercial point-of-care systems, library and knowledge services may want to try to make their literature search or clinical question answering service or similar, easily accessible through the EHR.
Another area may in supporting the digital literacy education of students or staff, something that HEE have been asked to look at developing. Depending on what the plan developed by HEE entails, there might be areas that library and knowledge services can get involved, but this may require library staff to have the necessary training and support themselves.
Source: National Advisory Group on Health Information Technology in England, chaired by clinician and digital expert Professor Robert Wachter
Link to main document
Link to summary version
Publication format: PDF (HTML version also available)
Date of publication: September 2016
Summary of driver:
Making IT Work is concerned with the digitisation of secondary care in England (focusing on the electronic health record). The report lists 10 principles of how to do this effectively, and makes 10 recommendations on how to achieve successful digitisation, along with timescales.
In late 2015, the Secretary of State for Health and the leadership of NHS England asked for the creation of a broadly representative external body: The National Advisory Group on Health Information Technology in England, to advise the Department of Health and the NHS on its efforts to digitise the secondary care system.
In 2016, £4.2 billion was allocated to support the work of digitisation.
A specific action for Health Education England, in collaboration with the Royal Colleges and other relevant bodies, is to develop and begin to implement a plan to raise the level of digital education in all health professional educational settings, including medical, nursing and pharmacy schools, and in continuing education settings for practicing healthcare professionals.
Key features of driver:
There is a useful history of the NPfIT programme, and some history of the US experience in digitising its healthcare system.
The 10 overall finding and principles are:
- Digitise for the correct reasons
- It is better to get digitisation right than to do it quickly
- ‘Return on investment’ from digitisation is not just financial
- When it comes to centralisation, the NHS should learn, but not over-learn, the lessons of NPfIT
- Interoperability should be built in from the start
- While privacy is very important, so too is data sharing
- Health IT Systems must embrace user-centered design
- Going live with a health IT system is the beginning, not the end
- A successful digital strategy must be multifaceted, and requires workforce development
- Health IT entails both technical and adaptive change
The 10 recommendations made are:
- Carry out a thoughtful long-term national engagement strategy
- Appoint and give appropriate authority to a national chief clinical information officer
- Develop a workforce of trained clinician-informaticists at the trusts, and give them appropriate resources and authority
- Strengthen and grow the CCIO field, others trained in clinical care and informatics, and health IT professionals more generally
- Allocate the new national funding to help trusts go digital and achieve maximum benefit from digitisation
- While some trusts may need time to prepare to go digital, all trusts should be largely digitised by 2023
- Link national funding to a viable local implementation/improvement plan
- Organise local/regional learning networks to support implementation and improvement
- Ensure interoperability as a core characteristic of the NHS digital ecosystem – to promote clinical care, innovation, and research
- A robust independent evaluation of the programme should be supported and acted upon
Primary audience: NHS England, NHS Digital, Care Quality Commission, Senior management of NHS Trusts, senior IT staff.
Date last updated: May 2017
Due for review: May 2018
Group member responsible: JC
State of Care Report 2015/16
Title of driver: The state of health and adult social care in England 2015/16
Impact on library policy/practice:
Libraries are a knowledge hub providing services such as evidence summaries, literature searching and current awareness which can be linked to challenges faced by the specific organisation (CQC inspection reports for individual organisations can be searched for on the CQC website and can be a good way to identify local priority areas).
We can ensure that the best clinical and management knowledge is available to decision-makers in the organisation, in order to tackle the challenges identified in this report. Libraries are ideally placed to identify and disseminate best practice to assist health care organisations in providing quality care with limited resources.
Collaboration across organisational boundaries is identified as a means to improve services, and this may have implications for libraries as users move between organisations or work jointly between organisations that may have different resources or library access arrangements.
Source: Care Quality Commission (CQC)
Link to main page
Link to 2015/2016 State of Care Report
Publication format: PDF (149 pages)
Date of publication: October 2016
Summary of driver:
Many health and care services were providing good quality care, despite a challenging environment,
but there was substantial variation remaining. Some health and care services were improving, but some were also failing to improve or deteriorating in quality.
People’s views of services broadly remain positive, but this masked significant variation in experiences of care
There were indications that the sustainability of adult social care was approaching a tipping point, and hospitals are under increasing pressure. The CQC was concerned about the sustainability of quality
Key features of driver:
- 71% of the adult social care services inspected, 83% of GP practices, and 51% of core services provided by hospitals were rated good
- By the end of 2015/16, NHS providers had overspent their budgets by £2.45 billion. Local authorities were reported to have spent £168 million more than they budgeted for
- More than eight out of 10 NHS acute trusts were in financial deficit at the end of 2015/16
- Strong, visible leadership continues to be a major factor in delivering and sustaining high quality services, and in making improvements
- The difficulties in adult social care were already affecting hospitals. Bed occupancy rates exceeded 91% in January to March 2016, the highest quarterly rate for at least six years. And in 2015/16, there was an increase in the number of people having to wait to be discharged from hospital, in part due to a lack of suitable care options
- All parts of local health and care systems – commissioners, providers, regulators and local people – need to work together to help transform local areas.
The document looks at the state of care in the period 2015-16, as well as looking at the future resilience of health and social care services in the context of an ageing population.
Throughout the document, there are examples from services rated as outstanding as to how these ratings were achieved.
After the initial review, the report gives more details for each of sectors it regulates.
A summary and infographic of the report findings are also available.
Primary audience: All health and social care providers in England, members of the public and other stakeholders.
Date last updated: May 2017
Due for review: May 2018
Group member responsible: JC
What do STPs mean for NHS/health libraries?
At the NW Library Manager’s meeting on 14th March Tracy Bullock, Chief Executive, Mid Cheshire Hospitals NHS FT delivered a talk about the Sustainability Transformation Plan for Cheshire and Merseyside. As my service delivered a number of evidence summaries for our local STP I have spent a lot of time thinking about how we can support our STP team to deliver their plans; also a key message at the HLG Conference in September 2016.
Talking with library colleagues about STPs at the meeting made me start to think about what the plans might mean for library services. At the heart of most STPs is the transformation of health services to deliver the 5 year forward view, so big change within a short timescale. There are lots of drivers out there such as the Carter Review and Knowledge for Healthcare which are looking at economies of scale and how services can be more efficient.
If you wanted to transform library services for your region or STP area, what would you need to consider? Here are some questions to get you started:
- If you were to start from scratch, what kind of library service would you design?
- What would library services look like in your region or STP area?
- Are there any functions which could be shared or centralised?
- What are the key services which need to be delivered locally?
With all of this in mind, we have decided to add some new pages to the MAP toolkit to pull together some useful resources around some of the key themes that seem to be coming out of the plans, so watch this space!
- Accountable Care Organisations
- Transformation
- Cross system working/Integrated care
- Reducing emergency admissions
Please let us know if you have anything to add to this list.