Extract, Transform, and Load (ETL) is a process in data warehousing that involves
* extracting data from outside sources,
* transforming it to fit business needs (which can include quality levels), and ultimately
* loading it into the end target, i.e. the data warehouse.
This briefing outlines what integration is, examines policies to enable it and gives examples of integration in England. It also looks at the evidence on the challenges of achieving integration and assessing the effectiveness of approaches.
Cambridgeshire and Peterborough NHS Foundation Trust and mental health charity Mind in Cambridgeshire have teamed up to offer a new safe haven for those experiencing a mental heath crisis in Peterborough.
The Sanctuary will open on Monday, 19 September to allow people to get practical and emotional support.
The move marks the start of the latest stage of the Urgent and Emergency Care Vanguard programme in Cambridgeshire and Peterborough.
NHS organisations together with local authorities, police and representatives from the third sector have combined to launch a number of projects aimed at improving the way urgent mental health care is delivered and to reduce the pressures on accident and emergency departments.
The Mental Health Five Year Forward View Dashboard, published in October 2016, is a response to the recommendation in the Five Year Forward View for Mental Health that NHS England create a tool “that will identify metrics for monitoring key performance and outcomes data and that that will allow us to hold national and local bodies to account for implementing this strategy.”
It includes a suite of metrics based on the proposals in the Implementation Plan and is structured around the core elements of the mental health programme
After in-depth and comprehensive analysis of a range of data collected over the ‘Typical Weekend’, which was a four day live observation of how services work now, the upcoming ‘One Trafford Response ’ will see staff from different agencies - including Pennine Care's community health serivces - working in a central ‘hub’ on a range of real cases, as they come in, for action and support, involving: sharing information, supporting and challenging working practices, testing co-location of services, understanding how people access services day and night, and working collaboratively to help people in crisis.
£2.1 billion has been allocated this year to a Sustainability and Transformation Fund (STF), which ministers said would enable the NHS to transform services and meet the ambitions set out in the Forward View. However, £1.8 billion of this funding is being used to reduce deficits among NHS providers, leaving just £300 million to invest in new services this year.
Bradford District Care is opening first overnight service for CYP in crisis - aim is to reduce children with mental health issues presenting at A&E and also to roll out across W Yorks STP area. Please contact the library to receive a copy of this article - http://bit.ly/1Xyazai
The Redbridge HASS has a greater focus on early intervention and prevention and delivers high quality integrated care.
It has an improved single point of access for people over the age of 18 with community health or adult social care needs and it delivers an integrated service at a local level to the following people:
• vulnerable older people;
• adults with a learning disability and/or on the autistic spectrum;
• adults with a physical and/or sensory disability;
• adults with a mental health issue. We have made it easier to access our services and reduce the number of calls and number of assessments a person has to undergo.
NHS England today (29 September) published details of two more common frameworks for local health and care systems, organisations, communities and patients, wishing to develop and implement new ways of working.
The documents are based on the learning so far from the primary and acute care system (PACS) and enhanced health in care homes vanguards – describing the key ingredients that make up both models.
They demonstrate how the new models can strengthen primary care, improve access, focus on the prevention of ill-health and control costs. They follow on from the multispecialty community provider (MCP) care model framework, which was launched in July.
We are four semi-rural practices on the western edge of the Peak District, separated by Cheshire’s rolling hills. All of us at Team BDP have similar reasons to change, and this was one of our most important steps.
Selected in December 2015, 14 rapid test sites (RTS) have been implementing this new enhanced approach to primary care across England. They are not vanguards but are part of the new care models programme and consistent with the ambitions of the Five Year Forward View.
Health care leaders across Staffordshire and Stoke-on-Trent’s clinical commissioning groups have announced the appointment of Marcus Warnes as their single joint Accountable Officer.
n our new report – Some assembly required: implementing new models of care – we set out ten lessons for local leaders seeking to systematically make changes across services in their area. These are based on first-hand accounts of clinicians and managers from NHS England’s new care models programme vanguard sites, who have developed and tested new ways of joining up health and social care services.
Ten months in, and with STPs being submitted on Friday, now is a crucial time for the system to acknowledge and address some of the potential barriers to making the STP concept a successful reality, as well as considering how local areas can be supported to move from theoretical ambitious planning to realistic delivery programmes.
Yeovil initially trialling this for its own staff but may extend to patients. Virtual GP consultations via Skype. You can request a copy of this article by replying to this email. Please be clear which article you are requesting.
The innovations selected to join the programme include:
EpSMon: an epilepsy self-management tool which enables patients to monitor their well-being and know when to seek medical support
Serenity Integrated Mentoring (SIM): A collaborative model of care that sees a specialist, trained police officer working within community mental health teams to better mentor, encourage and support some of the most challenging, complex and high risk service users.
It is unfortunate that due to the decision by NHS England asking all local teams not to communicate any information about their Sustainability and Transformation Plans (STP), we now see inaccurate reports in the national media.
The STPs have been discussed for several months with health, local government, regulatory bodies and the third sector. The idea has been to collaboratively prepare a credible plan for delivering better services whilst also identifying cost savings. The work around STPs involves the creation of 44 geographical “footprints” across the UK, ours being Shropshire and Telford & Wrekin.
Community pharmacists must be able to routinely prescribe medicines for people with long term conditions and refer them directly to other healthcare professionals to ease the overwhelming demand facing the NHS says the Royal Pharmaceutical Society (RPS) in a new report to be launched at the House of Commons tomorrow.
The number of admissions to hospital are rising steeply and are outstripping increases in the NHS budget, according to new analysis published today by The King’s Fund.
Now our microbiologists, who are infection specialists, visit the wards every day to see every patient who is receiving intravenous antibiotics. Where appropriate, patients are either switched to oral antibiotics and discharged, or switched to the Outpatient Parenteral Antimicrobial Therapy (OPAT) service and discharged.
The patients recruited to OPAT are provided with an information leaflet and changed to intravenous antibiotics that can be given once per day. They then come to hospital daily as outpatients and hospital transport can be arranged, if required. The OPAT Clinic is a patient-friendly area where patients can relax in comfortable chairs, whilst receiving their treatment. The microbiology team clinically lead the service, direct the antimicrobial treatment and refer to other specialists when appropriate. As the service is infection specialist-led, a wider range of infectious diseases can be accepted for treatment.
As Birmingham and Solihull join the Integrated Personal Commissioning Programme (IPC), John Short explains why he believes IPC will work well for people with enduring mental health needs, as a way to offer people the flexibility they need to find their own route to recovery.
Transforming how health and care services are delivered can be both exhilarating and fiendishly difficult. The recent publication of some sustainability and transformation plans (STPs) has now brought both these issues to the fore. The plans reveal considerable ambitions to integrate services, embrace population-based healthcare and bite the bullet on painful service reconfigurations.
Practices which offered additional appointments showed a reduction in the number of their patients attending emergency departments (also known as A&E) for minor conditions. There was no overall reduction in emergency visits. Costs were reduced for emergency departments but by less than the cost of the additional appointments. The study did not evaluate whether or not this is cost saving to the health service as a whole nor if health outcomes were improved.
IPC is about making “five key shifts” in how health and social care systems and professionals deliver care, so that in addition to personal budgets, people also have access to more peer support and local community resources, with greater connections made between statutory services and the voluntary and community sector.
In Hampshire we are working to deliver IPC, locally known as “My Life, My Way”, for disabled children and adults, as well as young people who are in transition from children to adult services. We aim to ensure that over 1,000 people locally have a personal health budget or integrated personal budget by 2018.
We want our young people who are moving on to adulthood to be able to say “Transition, what transition?” and we believe that IPC offers a clear, innovative and comprehensive framework to deliver that ambition.
Following a review, including patient and carer experiences, four objectives were formed. First, there should be a fully integrated person-centred care pathway. Second, that early diagnosis should be made by a specialist memory clinic, with a clear referral pathway and a person-centred, ‘One Stop’ approach. Third, all GPs should be made able to make a diagnosis in the moderate to later stages of the illness. Fourth, that all patients should have consistent access to evidenced-based interventions wherever they were diagnosed
The redesign process was at all times in consultation with patients and carers, GPs, the voluntary sector and with reference to best practice. Project groups of clinicians from each organisation and locality were set up to design and deliver the new integrated service which was implemented across Devon nine months later.
As part of the vanguard, we’ve been working with colleagues from Nova, a local strategic infrastructure third sector organisation, on a very exciting project. West Wakefield have funded Nova to design and test the delivery of a small grants, micro-commissioning programme.
This is for grassroot voluntary and community sector groups, to develop services that provide a non-clinical activity in direct support of GP practices and their patients.
We have today issued a special edition of our Putting Patients First Newsletter.
This edition focuses on our Sustainable Services Programme and provides a greater level of detail around the preferred option.
A ground-breaking healthcare project pioneered by The Royal Wolverhampton NHS Trust (RWT) continues to grow with another GP practice joining the pilot scheme, Vertical Integration (VI), which aims to deliver better care for patients.
Patients and members of the public can now apply to join Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan (STP) patient reference groups. The creation of the patient reference groups are the next stage in the STP following the series of ten "Conversation Staffordshire" and "Conversation Stoke-on-Trent" events, hosted by both local Healthwatch organisations during November and December 2016, which were attended by more than 200 people.
In the latest in a series blogs focusing on Sustainability and Transformation Plans (STPs), Ed Smith, Chair of NHS Improvement, explores some of the key questions that need be asked in order to take the right approach to planning.
New models of care, including the work of the vanguards, are key to the delivery of sustainability and transformation plans (STPs) which are being developed across the country. Transforming health and care services requires a valued and engaged workforce and in this blog, Dr Nav Chana, Clinical Adviser for Workforce Redesign – part of NHS England’s New Care Models Programme, shares five ways to approach this.
In the face of increased demand for care and constrained finances, while the Better Care Fund, the principal integration initiative, has improved joint working, it has not yet achieved its potential. The Fund has not achieved the expected value for money, in terms of savings, outcomes for patients or reduced hospital activity, from the £5.3 billion spent through the Fund in 2015-16.
This paper presents NHS bed data from across the UK in one place. The data demonstrates the increasing pressures on the system in each nation. It provides evidence of the underlying cracks within the NHS.
The STP has been updated recently to build on our earlier progress and it takes account of feedback we have received from many of our key stakeholders.
As the new care models programme begins its third year, people working across the programme, both nationally and locally have been exploring how they can ensure the success of the new care models are spread across health and care services.
Samantha Jones, director of the new care models programme recently shared her top tips for vanguards and others developing new models of care on how they might help do this.
The Primary Care Home (PCH) programme is delivering a range of benefits for patients, staff and the wider health system, according to a new report released today (Friday 31 March).
The Leeds Mental Health Flow aims to deliver radical, system-wide, sustainable change to improve quality of care for patients, improve patient experience and improve the system that supports this. We started this improvement journey in September 2016 with a four day rapid improvement event with around 40 clinicians, health workers and managers from across the Leeds health and social care system.
We heard that the UK government is seeking to improve the working systems between primary care and Accident and Emergency teams in England to help reduce pressure on services and cut waiting times for patients.
So we thought you might like to hear about our experiment that has been coproduced between patients, primary care staff, ambulance staff and emergency room (ER) staff in Jönköping County Region. Our scheme is the first of its kind in Sweden.
The care home residents in Rushcliffe receive an ‘enhanced’ care package as part of the Principia Partners in Health multispecialty community provider vanguard, which includes regular visits from a named GP and independent support from Age UK Nottingham and Nottinghamshire. Greater support for care home managers and community nurses is also provided, for example through a peer-to-peer network.
The CCG launched reviews of some of the services it commissions in February to ensure that everybody in Shropshire has access to healthcare that is safe, high-quality and affordable for the future. [Includes community services review]
As of April 1 2017, Lancashire Care will work in partnership with Blackburn with Darwen Council and other voluntary sector providers to deliver the new, fully integrated, Healthy Child Programme.
Following a competitive tendering process, the new programme will build on previous achievements in the borough by bringing together health visiting, school nursing, specialist infant feeding and other third sector services to provide a consolidated public health service for children aged 0-19 years.
Public Accounts Committee publish report on integration of health and social care
Committee describe Better Care Fund as a “ruse” and say that it has made no progress in reducing emergency admissions or delayed transfers of care
We say long term solution to social care funding must bring together NHS trusts and local authorities
This report looks at the most promising reform solutions that have been correctly identified by STPs, and also sets out the range of challenges that stand in the way of them realising their vision for improved health and efficiency.
Meet Healthwatch Harriet.
The tenacious 10-year-old has turned her sights on the NHS England new care models programme. In her new video, she meets new care models programme director Louise Watson, chair of Tower Hamlets CCG Sir Sam Everington, and Hertfordshire County Council’s director of health and community services Iain MacBeath and asks them: “What on earth is a vanguard?”
This Housing LIN Case Study no 135 discusses this ‘invest to save’ project which brings together County and District Councils and other local partners in Leicestershire to help people stay safe and keep well in their homes for as long as possible.
The diagnosis then, as now, was that our problem was not quality or efficiency but our ability to effectively meet the rising demand of a largely ageing and affluent population. Chris urged us to take action and to learn the lessons of integration from around the world, particularly the experiences in Canterbury, New Zealand.
In this welcome update, Anna Charles builds on Nick Timmins and Chris Ham’s initial review of the experiences of Canterbury and reflects on the implications for new models of care and for sustainability and transformation partnerships. It is a must read for anyone developing models of community integration.
Over the past five years, the government and national NHS bodies have conducted a unique experiment: running health services as a planned system against the backdrop of a contradictory legislative framework, one that envisages arm’s length contracting relationships between purchasers and providers, independent provider organisations, and a significant role for competition. In doing so, they have turned their backs not just on the Health and Social Care Act 2012, but on almost three decades of reforms: separate commissioners, foundation trusts, payment for activity and patient choice among others.
The objective was to provide real, honest insight into the challenges and hurdles that had been faced when designing new services. It also gave the opportunity to showcase some of the successes achieved so far.
A recent Lancet paper gives an interesting perspective. Researchers looked at elements of dependency including continence, cognition and self-reported activities of daily living in two cohorts of people aged over 65 – one cohort recruited in 1991 and the other in 2011.
The bottom line finding from this research is that the men and women studied in 2011 were living, on average, an additional 2.4 and 3 years respectively with substantial care needs. Even with a radical shift towards healthy active ageing, it’s unlikely that a hypothetical 2031 cohort would show anything but an increase in the total number of older people living with dependency.
Housing providers are helping the NHS save money by helping people out of hospital into homes faster with the right care and support, a new National Housing Federation report has found.
With over 30% of their residents living with a disability or aged 60 or over, and given the predicted surge in this demographic, housing associations have stepped in to ensure patients are not stuck in hospital longer than necessary.
Open access. Commissioning is a term used in the English National Health Service (NHS) to refer to what most health systems call health planning or strategic purchasing. Drawing on research from a recent in-depth mixed methods study of a major integrated care initiative in North West London, we examine the role of commissioning in attempts to secure large-scale change within and between health and social care services to support the delivery of integrated care for people living with complex long-term conditions.
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We present a generalized perturbative analytical formalism for evaluation and optimization of the chromatic dispersion of complex ultrafast optical systems. Notably, we identify polynomial and recursive relations associated with the chromatic dispersion orders that are identical to the Lah and Laguerre transforms. We explicitly outline the first ten dispersion terms and dispersion slope parameters and visualize the significance of the chromatic dispersion orders for several advanced ultrafast optical and photonic systems consisting of various optical materials and nanostructures, grating and prism-pair compressors, and hollow-core photonic anti-resonant fibers. The derived simple hypergeometric transforms are applicable for evaluation of infinitely high orders for any type of frequency-dependent phase and can facilitate the optimization of complex optical systems with controlled dispersion balance at the single-cycle waveform extreme.
Mat estimateRigidTransform(const Mat& srcpt, const Mat& dstpt, bool fullAffine)¶ Computes optimal affine transformation between two 2D point sets Parameters: * srcpt – The first input 2D point set * dst – The second input 2D point set of the same size and the same type as A * fullAffine – If true, the function finds the optimal affine transformation with no any additional resrictions (i.e. there are 6 degrees of freedom); otherwise, the class of transformations to choose from is limited to combinations of translation, rotation and uniform scaling (i.e. there are 5 degrees of freedom) The function finds the optimal affine transform [A|b] (a 2 \times 3 floating-point matrix) that approximates best the transformation from \texttt{srcpt}_i to \texttt{dstpt}_i : [A^*|b^*] = arg \min _{[A|b]} \sum _i \| \texttt{dstpt} _i - A { \texttt{srcpt} _i}^T - b \| ^2 where [A|b] can be either arbitrary (when fullAffine=true ) or have form
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Developing One NHS in Dorset is one of 50 vanguards across the country which were selected to take a lead on the development of new care models which will act as blueprints for the NHS moving forward and inspiration to the rest of the health and care system.
We have established 10 workstreams looking at different patient and support services: stroke, ophthalmology, women’s health, paediatrics, cardiology, non-surgical cancer, pathology, radiology, health informatics and business support services.
This Commons Library briefing paper looks at the introduction of Accountable Care Organisations (ACOs) in the NHS in England, the development of the ACO policy, and comment on its potential impact.
NHS England’s belated decision to change the name of accountable care systems to integrated care systems has the virtue of describing more accurately the work being done in the 10 areas of England operating in this way. Despite this, there is understandable confusion in many quarters about NHS England’s plans, and uncertainty about what they mean for the NHS in the medium term.
A pioneering mental health crisis service run by Cambridgeshire and Peterborough NHS Foundation Trust has received more than 14,500 calls in its first year.
The First Response Service – which can be contacted via the NHS 111 helpline and selecting option 2 - operates 24 hours a day, seven days a week, and gives people in crisis direct access to mental health advice and help them to avoid unnecessary visits to hospital.
In the first 12 months the number of people visiting local accident and emergency departments has fallen by 21 per cent.
Cheshire and Wirral Partnership NHS Foundation Trust (CWP) is delighted to announce that it has been awarded the contract to provide primary care services at Willaston Surgery, from December 2017.
Willaston Surgery, a GP Practice near Neston in Cheshire, becomes the second GP practice to be managed by the Trust
We’re helping them develop the vision, confidence and skills to be equal partners in Public Health’s plans to improve the lives of local children. It’s the only way to get it right. And why are we doing this?
This briefing analyses information on the community care contracts held by 78% of clinical commissioning groups (CCGs) in England to enable better understanding of the provision of these services.
Trustworthy Collaboration, written for NHS Employers by Prof Veronica Hope-Hailey of the University of Bath, explores the challenges of building trust across health systems, in the context of the 50 vanguard sites tasked with delivering transformational change through new care models.
“In short, ‘No’, not unless they change direction”, say the authors of a new report, entitled ‘Sustainability and Transformation Plans: How serious are the proposals? A critical review’, published this week by London South Bank University (LSBU).
Thirty practices in South Cheshire and Vale Royal CCGs are using Medefer – a service that enables GPs to access online consultant advice and management plans – for patients who may otherwise be referred for outpatient care.
Since July 2016, Medefer has enabled around 150 Cheshire GPs to manage in the community 77% of patients they refer to the service – significantly reducing unnecessary hospital outpatient appointments.
A National Senior Manager for the New Care Models programme explains why her mum drives her passion for improving care.
I frequently use my mum as a frame of reference when thinking about what multispecialty community providers (MCPs) are doing to improve care and support for patients and communities.
A survey by Care & Repair England reveals that the majority of Sustainability and Transformation Plans (STPs) include very few references to older people, even though they are the majority users of the NHS, nor do they identify housing as a potential contributor to NHS transformation.
The service is for adults who live independently but who, because of suffering either a medical or social crisis or carer breakdown, are at risk of a hospital admission within the next 24 hours.
Coinciding with not just the health and wellbeing challenges of the District but the new coding curriculum requirements in primary schools, the Schools App Challenge competition was created to uniquely sit as ‘the intersection’ between health and education.
Launched by West Wakefield Health & Wellbeing back in January 2015 as part of the Prime Minister’s Challenge Fund and now in it’s third year, the competition asks children to help co-create health apps. Apps that help other youngsters their age make good physical, mental health and wellbeing choices in the future.
What originally started out with just a handful of schools within West Wakefield’s footprint, the competition has now expanded to primary schools across Wakefield thanks to funding secured from NHS England, with the ultimate intention to roll out nationally from 2017.
The Extensive Care service aims to greatly improve care for people who often need it the most by providing one comprehensive service for all of their needs in order to reduce their risk of hospitalisation.
This means all the doctors, nurses, care co-ordinators and other professionals which their needs require are in the same place, working together, to provide the necessary support to keep them well for longer and out of hospital.
The service is aimed at people aged 60 and above who have two or more long-term conditions, such as diabetes or chronic heart problems. People in this category can often find themselves seeing the doctor regularly about a number of different conditions and can feel confused, frustrated and uneasy about where to go for medical help.
The team – based centrally in one location at Leechmere, Grangetown – aims to support adults who live in Sunderland, who are registered with a Sunderland GP and need short term health and or social care support, that can help to keep them living at home, with care wrapped around them while they’re at their most vulnerable.
Support is tailored to a person’s needs and can be any combination of a short term care package, from nursing to therapy to get them back on their feet without having to be hospitalised or needing long term care. GP support is also available within the service.
Blog entry on the financial problems with the Cambridgeshire and Peterborough contract and how this is/should be avoided in future contracting processes.
The vanguards are partnerships of NHS, local government, voluntary, community and other organisations that are implementing plans to improve the healthcare people receive, prevent ill health and save funds.
Considerable progress has been made since the vanguards were launched in 2015 and there is emerging evidence that they are making significant improvements at a local level. This includes reducing pressure on busy GP and A&E services.
In addition to the funding, the vanguards will continue to receive support from NHS England and other national bodies to implement their plans, including how they harness new technology including apps and shared computer systems. They are also receiving help to develop their workforce so that it is organised around patients and their local populations.
Interaction between local healthcare organisations is becoming both more formalised and complex. Money is running low, pan-organisation planning has become mandated, and the pressure is on to transform.
This session asked leaders from across different organisation types to give their perspectives on the pitfalls and benefits of local planning, including how they get the governance right, balance the books and keep relationships positive.
The National Audit Office has found that the Department of Health and NHS England have a high-level vision for improving patient access to general practice and have increased the funding available, but are seeking to extend access despite failing to provide consistent value for money from existing services.