CiP 7 Flashcards
Steps of Needs Assessment
1) Identify Health priorities
2) Health priority for action
3) Plan for change
4) Review
Needs Assessment
Systematic method
reviewing health issues facing a population
-agree priorities
-resource allocation
to improve health and reduce inequalities
Health functioning
Individual/population’s experience as to whether something affects:
- social roles
-physical ability
-pain
-mental illness
-vitality/energy levels
Health triangle
identify health issues, review associations, collection/presentation of data
1) health functioning (rank 1 to 5)
2) determinant factors
3) health conditions
What is a stakeholder?
partner/sector that should be involved in decision making
Health Impact Assessment
policy/project
predict impact on population
Integrated Impact Assessment
policy/project
impact on- economic, social, environmental
Health Equity Audit
review enquiries into cause of ill health and access to service of population
Wilson and Jungner principles of screening
1) Condition is an important health problem
2) Accepted treatment
3) Diagnosis/treatment is available
4) Recognised latent/early symptomatic phase
5) Suitable test/examination
6) Natural history well understood
8) Agreed policy on whom to treat
9) Balanced cost of case finding
10) Case finding is a continuous process and not once and for all
Cervical Screening statistics
Screening prevents death
80% reduction in mortality
reduced incidence of cancer and death
reduced benefit and increased harm if over 25
reduced benefit if >65 and 2 negatives in last 10 years
> 50= 5 year interval
25-49 = 3 year
What is commissioning?
planning, purchasing and monitoring of services
-health needs assessment
-service specification
-design pathways
-contract negotiation/procurement
-continuous assessment
Health and Social Care Act 2012
1) Competition enshrined by law
2) Payment by results (tariff system)
3) Clinical Commissioning System (CCGs to commission secondary care/specialists)
Women’s Health Strategy 2022
Women spend significantly longer in ill health/disability
disparities across country
10 years:
boost outcomes for women and girls
improve how system engages/listens to
-lifecourse approach
-improve access
-improve info/education
-improve research
-listen to voices
-address disparities
-increase understanding in the workplace
Women’s health strategy aspects
Menstrual health
Gynaecology
Fertility and pregnancy
mental health
violence
menopause
cancer
ageing and long term health
-Women’s Health Ambassador
-Women’s Health Lead in NHSE
-Women’s Health Hub
-Investments in research
-pregnancy loss certificates
Hatfield Vision
Reduced reproductive health inequalities by 2030
1) Increase supply in SRH workforce
2) increase supply in primary care workforce
3) service specifications should include training requirements
4) Collaborative commissioning
5) Accountability in SRH/ICS
6) digital service platform
7) London measure of unplanned pregnancy
8) Teachers
9) improve resources
16 Goals of Hatfield Vision
reduce unplanned pregnancies to <30%
reduce disparity in unplanned pregnancies
offer full range of contraception at chosen location
patient-centre consultations
increase access to contraception/ hardly reached groups
equitable LARC access
free oral EC in all pharmacies
PNC
preconception care
menstrual health
menstrual products in schools
abortion
80% cervical screening target by 2025
menopause access
reduce disparities in black women
make information easily accessible
What is Clinical Governance
a system through which NHS organisations are accountable for:
continuously improving quality of services
safeguarding high standards of care
creating an environment in which excellence will flourish
monitoring systems and processes (patient safety/quality of care)
What is a care pathway?
process for treating patient with a specific condition/needs
based on expert opinion/evidence
-improve satisfaction
-ensure feels understood
-improve engagement
-reduce need for unplanned/unnecessary care
-encourage pt to take active role in healthcare
Patient Safety Strategy 2019
Patient safety incident response 2022
-no obligation to investigate every event
-explore themes
-how can we make it easier to do the right thing?
-include those with lived experience
What went wrong? What can we learn?
After action review
discussion with external team
Swarm huddle
immediate conversation with team
MDT/M&M
themes/systems
Pt safety incident investigation
MUST investigate
Never event
death caused by incident
maternity
suicide
Datix
Feed into national system ‘learning from patient safety events’
-72 hours to review
-30 days to close
Duty of Candour- moderate harm
If threshold of moderate harm met:
-tell patient/NoK and apologise
-agree next steps with above
-apologise in writing
-keep record/datix
Never Event
Wholly preventable due to strong systemic barriers (eg wrong IUD)
trigger patient safety incident investigation (currently out for consultation)
100-200 a year
Patient Safety Incident
Something unexpected or unintended has happened, or failed to happen
that could have or did lead to patient harm
for one or more person(s) receiving healthcare.
Low physical harm
When all of the following apply:
minimal harm occurred – only extra observation or minor treatment
did not or is unlikely to need further healthcare beyond a single GP, community healthcare professional, emergency department or clinic visit
did not or is unlikely to need further treatment beyond dressing changes or short courses of oral medication
did not or is unlikely to affect that patient’s independence
did not or is unlikely to affect the success of treatment for existing health conditions.
Moderate harm
at least one of the following apply:
has needed or is likely to need healthcare beyond a single GP, community healthcare professional, emergency department or clinic visit, and beyond dressing changes or short courses of medication, but less than 2 weeks additional inpatient care and/or less than 6 months of further treatment, and did not need immediate life-saving intervention
has limited or is likely to limit the patient’s independence, but for less than 6 months
has affected or is likely to affect the success of treatment, but without meeting the criteria for reduced life expectancy or accelerated disability described under severe harm.
Serious harm
at least one of the following apply:
permanent harm/permanent alteration of the physiology
needed immediate life-saving clinical intervention
is likely to have reduced the patient’s life expectancy
needed or is likely to need additional inpatient care of more than 2 weeks and/or more than 6 months of further treatment
has, or is likely to have, exacerbated or hastened permanent or long term (greater than 6 months) disability, of their existing health conditions
has limited or is likely to limit the patient’s independence for 6 months or more
Business case
proposal requesting a resource
1) Case for change
2) Priorities and funding
3) Demonstrate financial impact (cost/effectiveness/saving)
4) Impact on workforce/patients
5) Understand governance/decision making process
CEU Guidelines development
1) Identify guidelines (correspondence, surveys, evidence requests-annual review)
2)submit to CEC
3) approval by CEC= development
Updated 5 yearly, start looking 12/12 before
or if significant new evidence
Guideline development process
1) Set up- GDG, PPI, timescale/proposal, at least 2 laypeople
2) Scope drafts/consultations with stakeholders
3) Guideline drafts and consultations with a) GDG b) external review c) public consultation
4) Sign off by CEU/CEC leads
5) Publish and disseminate
Guideline components
auditable outcomes
case based digest
10 SBAs
80% consensus by GDG
Severe Harm in SRH
Life threatening sepsis post IUD fit
Hysterectomy (unforeseen) post IUD fit
Never event in SRH
wrong IUD
retained object post procedure (ie swab after coil fit)
Moderate harm in SRH
perforation with IUD in pelvic cavity
late perforations diagnosed at service
ectopic with IUD
PID>sepsis>hospitalisation
vasovagal at time of fit with admission >24hrs
DoC response- low harm (UHB policy)
Apologise
hold discussion with patient/NoK by medical/nursing/ops lead
document in records and ensure reported (Radar)
DoC response- Moderate or worse (UHB policy)
1) Report
2) Identify DoC lead. Hold discussion between DoC lead, patient/NoK within 10 working days
3) Appendix C proforma in records, provide copy to clinical governance team and upload to Radar
4) Clinical Governance and Safety review stage 1- ensure DoC filled
-Never events:
Notification of investigation letter
maintain contact
-Other investigations:
maintain contact of case by case basis
Duty of Candour- GMC
something goes wrong or potential of harm/dustress
-tell the person (must record if does not want to know, must explain consequences)
-apologise
-offer a remedy or support
-explain short and long term effects of what has happened
3 components of an apology
What happened
what we can do to deal with harm
what will be done to prevent others from being harmed
does not mean admitting liability
may evidence insight in a fitness to practise panel
Do I need to tell patients about a near miss?
adverse incident with potential for harm but nil harm
use professional judgement about whether to tell patient
Guideline
suggested course of action that provides advice as to when and how activity should be performed
Policy
way of ensuring goals of service and applied uniformly
rules/framework within which everyone should work
Procedure
established local sequence/uniform method for performing activity- specific information for that activity
Marmot Review
highlights discrepancies in life expectancy between individuals and communities
ICS
local partnerships (42)
bring health and care organisations together to develop shared plans and joined-up services
NHS organisations and upper-tier local councils, as well as:
voluntary sector
social care
others
Established July 2022
ICP
integrated care partnership ran by ICS
Broad alliance of partners who all have a role in improving local health, care and wellbeing
Plan/strategise
ICB
NHS organisations responsible for planning health services for their local population
One in each ICS area
Make a five year plan to achieve ICS strategy
Commission/allocate budget
What does Local Authority Commission for SRH?
Contraception/unplanned pregnancy in SRH
LARCs in primary care
STI testing and treatment
HIV testing
Specialist SRH
teenage parents
chlamydia screening
psychosexual services
What do ICPs commission for SRH?
Abortion
Contraception for gynae reasons
sterilisation
Non-sexual health psychosex
HIV testing in non SRH setting
What does NHSE commission for SRH?
Contraception at GP
Smears
Fetal Med
HIV treatment
STI testing/treatment by GP
HPV vaccination
SARC
SRH for detained
Infectious diseases in preg screening
Wales SRH
7 local health board commission
3 year plans
Scotland SRH
14 Health Boards
31 Health and social care partnerships
NI
5 boards, aiming for a CCG like structure
GU clinic at each trust with some abortion services, limited
