EU Models of Care

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• EU Models of Care

• EU Models of Care webinar introducing the
  Esther model from Jonkoping
• 19 October 2015

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• NHS European Office
• Who are we?
• Established 2007
• Part of the NHS Confederation
• Funded by national NHS bodies
• What do we do?
• Represent NHS organisations in EU policy-making
  and legislation
• Assist the NHS with the implementation of EU law
• Offer strategic advice on EU funding
  opportunities
• Promote partnerships between NHS organisations
  and bodies from other sectors/countries
• www.nhsconfed.org/europe

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• EU Models of Care
• Working with NHS England to support Pioneers and
  Vanguards to develop links and share learning
  with organisations at leading edge of integrated
  care in Europe
• An in-depth look at four different EU Models of
  Care throughout 2015-16
• Spain (Alzira)
• Netherlands (Buurtzorg)
• Sweden (Jonkoping)
• Germany (Gesundes Kinzigtal)
• Webinar, followed by study visit look out for
  the registration links
• EU Models of Care conference in spring 2016
• Other events and activities throughout the year

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• Integrated Care Model Pillars

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• Understanding the Esther model
• Nicoline Vackerberg, Quality manager, Esther
  Coordinator
• Anna Carlbom, Medical Officer Nurse, Esther
  Coordinator

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2014
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The Swedish Healthcare system

• All public Healthcare is subsidized.
• A patient pays a maximum of 1100 SEK (87 ) per
  year.
• The equivalent for prescription pharmaceuticals
  is 2200 SEK (175 ) per year.
• Hospital care is 100 SEK (8) per day.
• All maternal care is free of charge.
• Children have free health- and dental care until
  the age of 20.

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Municipal Healthcare

• Healthcare in residential homes have been a
  municipal responsibility since 1992
• Responsibility for Healthcare in ordinary homes
  has changed from county councils to municipality
  in the last 5 years
• Includes care up to specialist nurse level
• Doctors are still employed by the county councils
• Doctors still responsible for prescribing
  treatment, medication and so on

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Social versus Healthcare in the Municipality

• In need of social care an application has to be
  made to social workers who assess the needs
• Esther is charged a maximum fee of 1776 SEK/month
  ( 141 )
• In need of Healthcare, contact with Hospital,
  Primary- or Homecare where Doctor, Nurse and
  Patient make a care plan
• Free of charge in most municipalities

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It started with six communities/ municipalities
in Region Jönköping
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The Höglandet district

• 118 000 inhabitants
• 6 municipalities
• 1300 persons in elderly homes
• 2000 persons healthcare at home
• 8 public and 8 private primary care units
• Eksjö Hospital 263 beds
• Senior citizens organizations
• Approx. totally 7000 employees

31 public and 17 private primary care units in
the whole region
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Höglandets hospital - Average days
Days in hospital - average 2009 2010 2011 2012 2013 2014
Surgery 3,6 3,6 3,6 3,4 3,3 3,0
Gynecology 2,1 2,0 1,9 1,9 1,9 1,9
Internal medicine (3,9 4,4 period 2001 2009) 4,1 4,3 4,3 4,2 4,5 4,3
Orthopedics 4,4 4,2 4,4 4,5 4,8 4,3
Rehabilitation 19,2 19,4 17,8 12,6 9,9 9,2
Total 4,7 4,7 4,6 4,5 4,4 4,3
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The Challenge

• Person centred care
• Complexity

Delivering a service that is truly patient
centred is an enormous challenge whichcan only
be overcome by actively engaging patients as
valuable resource. GREENHALGH, T., HUMPHREY,
C. WOODARD, F. 2011. User involvement in
health care, Chichester, John Wiley Sons,
Ltd. Healthcare systems are complex, and
repairing them is complex. GLOUBERMAN, S.
ZIMMERMAN, B. 2002. Complicated and complex
systems what would successful reform of
Medicare look like? Changing Health Care in
Canada The Romanow Papers, 2, 21-53.
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The Patient Today
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Esthers journey Client integration and
co-operation - a must to built trust
Primary care
Hospital
Intensive care
Home care
Sheltered home
Medical unit
Psychiatry
Rehabilitation
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• Individual values
• What does Esther need/ want?
• What is important for Esther when she gets sick?
• Partners
• Who has to cooperate to fulfil Esthers needs?
• Changes in the environment
• Changes in the system of health care?
• New methods? New technology?
• Changes in population?

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Vision Esther
Esther will experience safety and independence
and she will live an independent life that is
supported by an energetic network.

• Esther
• Gets care in or close to her home
• Sees us as the same provider of care
• Has equal chance of receiving care over the
  whole region
• Knows where and who to turn to
• Has an individual care plan

• Höglandets care
• All personnel are concerned and committed
• Support each other in achieving the best of
  Esther
• Increase competence in the whole care chain
• Continuous improvement of quality

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The Basic idea

• What is best for Esther ?
• Esther no matter where,
• we will be there!

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Results
Type of care 2000 2014
Hospital beds 375 263
People living in Care homes 1740 1290
Amount of people getting Healthcare at home 1000 2000
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Esther start and 2014

• Waiting times for referral appointments with
  gastroenterologists fell from
• 48 days in 2000
• 14 days in 2003
• 14 days in 2014
• 80 of all patients at the internal medical
  clinic are getting an appointment within 2 months
  2014.

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(No Transcript)
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Your confidence in the health care system in your
county / region?
A lot
A Little
Ref. Salar. NPE 2015
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Coordinator
Contact between the General Practitioner and the
Dept. of Internal Medicine before the patient
arrives to hospital. Discussion about the
patient what is the optimum care level for the
patient
- Direct to the acute clinic? Via X-ray? -
Direct to the nursing ward? - To an office hour
visit? - Give advice? - Is it necessary to admit
the patient?
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Discharge Safety receipt
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Welcome Back Home package

• Staff from municipal social care is already there
  when Esther returns from the hospital
• Make sure that- the home is in order - Esther
  has got food and a clean bed- Esther got the
  right equipment and correct medication
• If needed, attach and test a personal alarm
  around the wrist
• Check again the care and social plan together
  with Esther, make changes when needed
• Most important! Make sure Esther feels listened
  to, safe and confident

Photo Johnny Törnkvist
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Readmissions within 30 days in Tranås
It feels satisfying, to not have to leave before
Esther says everything is fine. Staff member

• Nice to know that Mum is not coming home to an
  empty house.
• Esthers daughter

2012 17,4 2013 15,7 2014 12,1
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Esther café
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Esther coach training
To work with change/improvement
?
OR
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The use of transparant data to create overall
understanding and possibility to learn and react.

• http//plus.rjl.se/infopage.jsf?nodeId40884

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What has been helpful in creating seamless care ?
Person centredness Communicating systems Mutual
responsibility for the person Multi
professionalism Improvement together with
partners Mutual meetings and education Openness
and learning Less hierarchy Your problem is my
problem
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What could we do better ?

• Esthers Participation on all levels, all the
  time.
• Use of attractive and understandable
  measurements
• Spread of good examples
• Appreciation to partners
• See Esthers next of kin

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How are we doing?
Results on the web http//plus.rjl.se/infopage.jsf
?nodeId40884 Studies done about leading and
sustaining Esther network http//www.govint.org/go
od-practice/case-studies/the-esther-approach-to-he
althcare-in-sweden-a-business-case-for-radical-imp
rovement/ Person driven care http//plus.rjl.se/i
nfo_files/infosida31383/Wales2012.pdf National
studies Http//plus.rjl.se/infopage.jsf?nodeId358
62
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Esther Networks website http//plus.rjl.se/esther

Follow us at _at_EstherNtverk
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• Understanding the Esther model

Any questions?
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• Next Steps
• We will
• Share the recording
• Organise a study visit to Sweden on 25 27
  January 2016
• Follow up with colleagues interested in
  developing direct links with Jonkoping please
  talk to your account management team to
  incorporate into your support planning
• Share webinar evaluation survey please do
  complete!
• Next EU Models of Care examples
• Gesundes Kinzigtal webinar 26 November at 11.30
  UK time
• Register now! https//attendee.gotowebinar.com/reg
  ister/9209883596882632706
• For more information, please contact
  england.integrationpioneers_at_nhs.net or
  Michael.wood_at_nhsconfed.org

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Esther Coach Course

• Learning by doing 8 days
• Making their own personal improvement project
  (PIP)
• Making an improvement at their own working place
• Coaching skills solution focus approach
• Site visits in other organisations, in and
  outside healthcare

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Who are the Esther coaches 2015?

• 151 coaches
• Nurse assistants
• Nurses
• Social workers
• Physiotherapists
• Occupational therapists
• Administrators

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Networks that are alive contain

• Total openness (take everything people bring)
• Focus on value
• Constantly seeking and tapping energy
• Creating a shared sense of system (shared map and
  shared narrative)
• Letting go of need to control an ecosystem, not
  a hierarchy (trust)
• The group asks versus share

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Networks that are alive contain

• Crisp aims and priorities
• Celebration
• Shared optimism
• Creativity and opportunism
• Simplicity
• Profound respect for logistics ( Amateurs
  discuss strategy..)

J.McCannon R Perla 2009 Learning networks for
sustainable, large scale improvement Joint
commission on quality and patient safety
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Esther international

• David and Sarah, Sheffield, UK
• Joe, Sheffield, UK
• Esther, Calderdale, UK
• Mrs Smith, Cornwall, UK
• Dorothy, London, UK
• Doris, Leeds, UK
• Margareta, Scotland, UK
• Henriette, Scotland, UK
• Alice, San Francisco, USA
• Suzanne, Gouda, The Netherlands
• Ester, Singapore
• Probably more
• No matter where .we will be there

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Local government in Sweden has a long tradition

• The local authorities and the county
  councils/regions
• are responsible for providing a major part of all
  public services.
• have considerable degree of autonomy
• have independent powers of taxation.
• have a great deal of freedom to organize their
  activities as they see fit.
• The scope for local and regional self-government
  is also affected by decisions taken in the EU.

Independent powers of taxation

• Local authorities and county councils/regions are
  entitled to levy taxes in order to finance their
  activities.
• A percentage of the inhabitants' income.
• They decide on the tax rate themselves, the
  average, overall local tax rate is 30 - 20 to
  the local authorities- 10 to the county
  councils/regions
• Tax revenues are the largest source of income for
  the local authorities 2/3 of their total income

Fees The local authorities and county
councils/regions may charge for their services.
Cost-price principle Fees may not be higher than
the costs relating to the service concerned. If
the local authorities and county councils/regions
are obliged to provide a service, they may only
charge for the service if specifically permitted
to do so by law.