Month: February 2021

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Need a locum? There’s an app for that!

NHS Midlands and Lancashire Commissioning Support Unit is delighted to have won a place on NHS England and NHS Improvement’s Framework for Digital Solutions for Sessional Clinical Capacity in Primary Care. This enables us to easily offer our digital Find me a Locum solution to clinical commissioning groups (CCGs) across England and help relieve capacity pressures for practices.

Find me a Locum has been co-developed with partner GP Federations – people at the sharp end of general practice. This keeps costs low, delivering great value. Tried and tested, it is already helping practices to find locums quickly, securely and at low cost, making significant savings on agency fees.

Access to Find me a Locum is through a straightforward annual subscription per practice. It delivers a return on investment for the price of just four locum agency fees.

Find me… provides fast, efficient, high quality ‘pairing’ between practice vacancies and locums. It is accessible 24/7 by a website and easily downloadable app.

It facilitates payments by providing tools to practices and locums to manage the invoicing process, end-to-end. Practices retain full control and benefit from support of a dedicated account manager and service desk.

Other benefits for practices include:

* quick and easy digital advertising of slots to a wide audience
* assurance that locums are accredited and registered (with evidence for CQC)
* automatic validation of locums against national performers list and GMC register
* training and awareness-raising to encourage clinical and managerial uptake and ongoing use
* regular system updates and enhancements.

Staffordshire practice manager, Kirsty Moore, said: “Find me a Locum has taken the stress out of finding GP Locums. It’s made it easy to fill our locum sessions quickly, with experienced, knowledgeable, reliable clinicians. I highly recommend this fabulous resource to practices.”

Designed originally for use with GP locums, the solution can easily be expanded for other staff groups, for example nurses.

Details of the ordering process have been disseminated to CCGs by NHSE.

For more information, contact mlcsu.commercial@nhs.net or go to www.findmealocum.co.uk.

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Supporting the COVID-19 vaccine effort

As a key system partner, Midlands and Lancashire Commissioning Support Unit (MLCSU) is actively supporting the COVID-19 vaccination programme in Lancashire and South Cumbria. In partnership with system leaders, we helped to establish a network of vaccination services. We have been working closely together with colleagues from across the integrated care system (ICS), in much the same way as when we developed a tactical command room to help manage winter pressures.

Across Lancashire, the Midlands and North West, we are also supporting over 100 vaccination centres with IT and other services. Our partnership and system approach, following government direction, is enabling the most vulnerable patients to receive their vaccines quickly and safely.

Strategic Vaccinations Operations Centre

Rapidly forming vaccination centres across Lancashire and South Cumbria was no easy task. When the programme took off in November, there was a need for a control room. A Strategic Vaccinations Operations Centre (SVOC) was created at our Jubilee House site in Lancashire with the full support of ICS leads. The centre is resourced with members of MLCSU, clinical commissioning groups (CCGs), trust and wider system colleagues. Having recently built another tactical command room, also in Jubilee House, we were well positioned to support the setup of the SVOC.

Gold Command Winter Pressures Room

The earlier command room’s purpose was to support the operational activity of the Lancashire and South Cumbria NHS organisations and Out of Hospital services facing winter pressures. The Gold Command Room is a tactical support service where we monitor and analyse pressure on individual trusts and organisations – number of people in A&E, COVID-19 cases, people who cannot be admitted because they are waiting for a COVID-19 test result, and other issues such as staff sickness, lack of beds, discharge delays, ambulances queueing up, and so on. Data is looked at from a system perspective and capacity redistributed to where it is needed most. For example, pressure can be taken off one hospital or ambulances diverted to another. Business intelligence expertise is fully covered by MLCSU analysts.

System working

Work at the command room, as well as the SVOC, is ongoing seven days a week in collaboration with partners across Lancashire CCGs, all trusts, NHS England and Improvement (NHSEI) leads and ICS executives. It has made a phenomenal difference in terms of collaborative working, system thinking and helping each other for the benefit of patients.

Across Lancashire and South Cumbria, the vaccination programme is fully coordinated from the SVOC:

* We provide strategic nursing capacity, together with chief nurses from the local system, to ensure resilience through clinical governance arrangements and senior clinical oversight of vaccination delivery

* We provide strategic pharmacy capability, with the medicines lead ICS system role supported by our Medicines Management and Optimisation (MMO) Team

* We have supported the development of seven vaccinations sites in Lancashire and South Cumbria including our estate in Jubilee House and Blackburn Cathedral’s crypt

* We have supported the vaccine programme Board for Lancashire and South Cumbria with a range of other services, including managing the communications across partners to coordinate activity, programme and project management, equalities and diversity advice, IT and data advice as well as IT kit deployment.

* Vaccination programme support elsewhere in the country

In addition to the huge amount of work we do directly with the ICS in Lancashire and South Cumbria, we also help individual trusts, PCNs and NHSEI with COVID-19 vaccinations across the Midlands and North West:

* Digital enablement of more than 100 vaccination centres including training of staff on point of care delivery systems and technical support seven days a week

* Data management for University Hospitals Birmingham

* Pharmacists deployed to NHS Nightingale Hospital North West in Manchester

* Over 50 additional members of MLCSU staff recruited to carry out employment checks of vaccination centre staff

*Administration, project management, nurse training and marshals in other parts of the country.

A key part in mobilising the vaccination programme has been the outstanding work from multiple partners working collaboratively across the NHS, the Police, Fire Service, military and local authorities.

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Finance teams can make help improve care

Does your finance team struggle dealing with the very old-fashioned method of paying doctors for doing Section 12 mental health assessments? Are patients in crisis getting the best care in your area?

In this digital age, the Midlands and Lancashire Commissioning Support Unit (MLCSU) Finance team spotted an opportunity to transform this process completely. It was taking far too long to get patients seen and get pieces of paper through the system. Patients in crisis need to be seen quickly, now more than ever.

So our finance experts got together with our own Digital Innovations team to create an app to speed things up. As Find me an s12 Doctor has been developed by the NHS for the NHS, we want others to experience the same benefits. And the more people that use it, the cheaper it will be for each ICS.

It is cheap and easy to use. We just need to get various parties across an integrated care system (ICS) or sustainability and transformation partnership (STP) trained (it only takes 30 minutes), and doctors registered to use it. Then it’s simply a matter of downloading it from the app store.

I doubt any health system would think twice before implementing such a simple solution to a problem process that hasn’t changed since the 80s.

Benefits are across the whole of the ICS/STP and include:

* Improved ability to deliver 24/7 mental health care
* Reduction in time to assess patients, lowering anxiety and mitigating risk
* Significant time saving for the Approved Mental Health Professionals (AMHPs – the people that match the patient to a doctor and who usually work in a local authority or for a mental health trust)
* Assessments are significantly easier and quicker to organise
* Improved access to a wider pool of doctors
* Doctors are paid within a few days rather than months
* Doctors are only contacted when they want to be rather than taking calls at all hours, day or night
* No more manual claim forms or information governance risks
* Doctors can track the claim through Find me an s12 Doctor, so won’t need to chase for payment by phone
* Reduced likelihood of unlawful detention
* Potential for significant cost efficiencies in the employment of AMHPs
* Clinical commissioning groups and CSUs have more information available and more checks in the system
* Reduction in finance staff time dealing with high numbers of GPs chasing for payment
* For the first time, much improved qualitative and quantitative information on the service’s use and cost.

If you want to know more, please give me a call. I’m Jules Harrhy, MLCSU’s Deputy Director of Finance, and my number is 07816 071379, or just email me at Julie.harrhy@nhs.net.

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Developing management and leadership

Background

South Sefton and Southport and Formby CCGs requested MLCSU’s Organisational Development (OD) services to improve leadership and management skills within their organisations. The aim was to provide critical understanding of theory and practical application of key aspects of being a manager and a leader, focusing on compassion, staff wellbeing, motivation, achieving results and managing people remotely.

Action
We created a tailored management development programme of training, designed to support the adoption of best practices in managing and leading others. There was a great emphasis on soft skills, such as communication and empathy, which enable better teamwork and more progressive relationships with the people they manage.
The programme was delivered as a virtual package of six web-based sessions covering:

* Management and leadership – motivate and engage your staff
* Effective communication and difficult conversations
* New starters induction, staff development and coaching
* Performance management
* HR policy overview
* Resilience and wellbeing.

All training sessions were delivered jointly by OD and HR experts, to ensure balance between legal framework and soft skills, required to build strong and high-performing teams.

Impact

The management development programme received overwhelming positive feedback from participants and the CCG’s senior leadership team.

All delegates agreed that the structure, content and delivery of the programme were excellent.

The implementation of the programme and the training of all managers resulted in:

* Creating a culture of compassioned leadership, and highly-engaged and motivated staff
* An understanding of work pressures so that those can be managed effectively
* Better communication and engagement at team level
* Focus on strategic goals, objectives and benefits, ensuring they are clear and optimised
* Developing more resilient leaders capable to manage change and uncertainty
* Equipping all managers with the skills and knowledge to manage in a virtual environment.

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Improving COVID-19 supply chain resilience

The Hard to Source Items (HTSI) team sources timely and sufficient quantities of required equipment and consumables to complement conventional channels and safeguard against supply chain disruptions. COVID-19 led to a surge in demand for clinical consumables and services globally, with conventional procurement channels exhausted and struggling to meet demand. This was made worse by restrictions on border movements and local production capacity constraints such as workforce availability, raw materials and procurement mechanisms in place of usual trading conditions.

MLCSU’s Improvement Unit were rapidly deployed to support a dedicated global team put in place by the DHSC to consider alternative approaches, including sourcing items from international suppliers previously unknown to the NHS and looking at appropriate clinical alternatives.

Action

The Improvement Unit were tasked with managing the largest product category range, NIV/CPAP and HEPA/HMEF filters, which included NIV masks, filters, breathing circuits, exhalation ports and reservoir bags totalling over 3 million individual items. With stocks rapidly depleting and the winter surge looming, the team liaised with British Embassy colleagues in Beijing and managed to:

* Find suppliers
* Track delivery of products into the UK keeping the NHS Supply Chain updated
* Coordinate the validation of products through a rigorous due diligence process involving clinical scientists and gaining approval from the MHRA
* Hand products over to the supply chain for distribution to Trusts for use by the most vulnerable COVID-19 patients in the event of a winter surge.

Impact

* Sourced sufficient quantities of ICU consumables and equipment for COIVD-19 patients in preparation for the winter surge.
* Secured approval from the DHSC and Cabinet Office to source millions of individual products from global suppliers and monitored their progress through to delivery into MoD airbases and warehouses.
* Opened up new international markets and future supply chain channels previously unknown to the NHS.
* Managed the technical, clinical and regulatory due diligence validation process of first-of-type items into the UK.
* Produced documentation and communications for each product to encourage uptake of novel devices in NHS Trusts.
* Forged strong relationships and built new networks of stakeholders by working collaboratively with the DHSC, NHSSC, MoD, MHRA, FCDO, external consultants, other CSUs and * Trusts involved in the testing and adoption of the products sourced.
* Contributed to the creation of the HTSI ‘playbook’ which outlined the scope, structure and processes of the HTSI team in the event of being mobilised at pace in the future.

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Improving PPE procurement data

The COVID-19 outbreak resulted in numerous organisations being involved in the procurement and distribution of vital supplies of Personal Protective Equipment (PPE) and medical equipment across the country. This led to changes in reporting and recording of data, impacting NHS Supply Chain’s database quality. MLCSU were engaged by NHSEI to provide project management and administrative support in order to review and improve data quality for core items within the NHS Supply Chain.

Action

The project management and administrative support mobilised quickly to ensure that immediate provision, keeping in line with the short timescales and key milestones. Project documentation and governance structures were implemented efficiently using an agile approach to flex with the needs and demands of the project. We set out the key tasks and milestones, providing clear visibility of progress. We implemented a robust administrative process and ensured that key actions were captured, cascaded and achieved in a timely manner.

Impact

The support and administrative expertise provided for the project led to a successful delivery of a robust and effective database for the NHS Supply Chain. We delivered much needed support in a fast-paced environment, allowing for clear visibility of key dependencies, actions and deadlines. As a result, procurement and subject matter experts could focus solely on the key deliverables and project objectives.

Mobilising at pace and implementing effective project structures ensured the project’s objectives were met. This includes:

* Improved processes
* Standardisation and improved data quality
* Support the procurement of core items within the NHS Supply Chain PPE catalogue.

Our effective relationship skills with key stakeholders and ability to deploy quickly, motivated the project sponsor to extend our administrative support by a further two months to support and deliver the second phase of the programme.

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CCGs block book beds with ease

Two Merseyside based CCGs recently engaged with MLCSU for support in procuring a block contract for Intermediate Care Beds (ICB) split over both COVID-positive and COVID-negative cohorts. Rebecca Crawford, Care Brokerage Lead at MLCSU, worked with South Sefton and Southport and Formby CCGs to explore the procurement options available. She advised that our existing DPS solution – adam, would allow the bed-base and contract to be in place in a matter of weeks.

Action

MLCSU joined a weekly project group and supported the CCGs to specify their exact requirements, using adam’s wealth of intuitive functionality:

* Creation of bespoke requests including: detailed tender instructions and contact details to guide providers, responses to 18 different key requirements, all in an easy-to-compare format
* Automatic distribution to pre-enrolled providers: automatic email system, automated system ensuring submission of fully compliant offers
* Easy offer analysis and contracts creation: automatic filtering and ranking, offer collation, automatic facilitation of service agreement and payments

The CCGs quickly requested quotes for up to 20 beds for COVID-negative cases and up to 10 for COVID-positive cases, from 76 pre-vetted care home providers (within a desired distance of the CCGs). The bespoke requests meant that providers could easily understand exactly what was asked.

Additionally, providers could ask the CCGs questions via adam’s two-way communication platform, and adam’s support team were on hand to assist providers with any queries and proactively encourage offers.

Impact

Six fully compliant offers were received within six days of the request for quote. Once the CCGs had reviewed and accepted an offer, contracts were created immediately (at a rate of £100.90 per day for care homes [lower than local market average]). From the moment the CCGs engaged with MLCSU, a decision on a provider was reached in less than a month.

With Rebecca’s help and adam’s digital CHC commissioning solution, the CCGs could specify their exact requirements, be it ensuring residents were kept in one place or appropriate disease control.

Offers collated in an a structured and easy-to-follow format enabled the project group to undertake an efficient evaluation and to select the most appropriate provider.
The automatic creation of service agreements and payments resulted in patients placed swiftly in the care homes, in line with the CCGs’ timescales and pre-agreed standards.
The CCGs were so impressed with the result, that they drafted a ‘lessons learnt’ report. MLCSU experts state that block contracts can take several months of resource-intensive procurement.

Professional support

Throughout the process, adam’s and MLCSU’s service delivery teams were on hand to guide and support the CCGs with their daily and strategic use of the system. The teams also made sure that all providers were engaged and supported in using the system.

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Implementing of a PCN DES contract

Southport & Formby Health GP Federation was commissioned to implement the services detailed in the Primary Care Network (PCN) Directed Enhanced Service (DES) Contract specification 2020/21 to the nine practices that are not part of the local PCNs. MLCSU was commissioned to establish a robust project management structure and support and mentoring to the in-house project team.​

Action

The objective of the project was to develop a structured plan that supported the implementation of the PCN DES for the identified population within Southport and Formby ensuring:​

* Risks and issues to successful implementation were identified, managed and reduced with mitigations agreed and actioned​
* A governance structure was developed to support the progress of the project and to provide appropriate assurance to the Southport & Formby Health Board of Directors and the clinical commissioning group
* A communications and engagement plan was developed to ensure effective communication with all key stakeholders​
* All planned actions and recruitment were completed and the project workstreams were fully implemented ​
* Service delivery commenced for all service lines within the expected timeframes.​

Impact

Key outcomes – The Federation successfully implemented the project and its deliverables, developing a programme of audits and reviews to capture the improvements and benefits against the baselines and in line with the specification. The project team has developed strong lines of communication and is building good relationships with key stakeholders. In addition the team has increased their knowledge and practical experience of project management.​

Improved engagement with care homes – The GP Federation team had already made a good start on the project, making strong links with key stakeholders. This level of commitment to support all stakeholders highlighted a need to find the most effective ways to communicate with the care homes, which were under extreme pressure and had low expectations of any real impact from working within the DES. The team, however, kept up the momentum of regular contact, identifying WhatsApp as a useful alternative contact method, and ensuring the care coordinators prioritised understanding of how they could best work with care homes to ensure they were an integral part of the patient planning cycle.​

Matching patient needs to additional capacity – The level of uptake of the Extended Hours was much less than anticipated, so in discussion with practices and patients they looked at other ways to utilise this capacity to meet patient needs.​

Increased use of technology – The team reviewed the level of technology in use across health and care partners in the community in order to plan the requirements for future alignment and use of single platforms or of multiple platforms with the required level of connectivity and interface.​

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Recruitment of an ICS chair

Healthier Lancashire and South Cumbria is a shared vision and five-year strategy for improving health and care services and helping the people of Lancashire and South Cumbria live longer, healthier lives. To achieve this, a key focus is on challenging how and where the services are delivered and how the partnership organises itself to achieve its aims.

The integrated care system (ICS) includes the NHS, local authority, public sector, voluntary, faith and social enterprise and academic organisations, working together to join up health and care services, listening to the priorities of the communities, local people and patients and tackling some of the biggest challenges they are facing.

To assist with the programme of work an Independent Chair was required to provide non-executive and independent leadership to the ICS.

Action

The non-standard recruitment process consisted of two partner organisations working collaboratively.

* The post holder would be engaged by the Acute Trust
* The recruitment process was led on behalf of the ICS by the MLCSU People Services Team for Lancashire & South Cumbria CCGs
* The stakeholders involved included NHS, local authority and community organisations
* Given the status of the post, and in line with regional guidance, the ICS instructed an external head hunter to assist with the candidate selection
* The recruitment process had to reflect the acute trust’s recruitment protocols and governance arrangements
* The People Services Team was the central point for coordination between stakeholders and candidates
* Communication was imperative between all stakeholders to ensure a fair and consistent recruitment process to meet the ICS requirements.

Impact

The successful appointment of an experienced individual who can lead the ICS to achieve its system-wide objectives and provide constructive challenge across the system.
The Independent Chair will ensure there is a clear plan for the implementation of the ICS strategy.

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Providing HR support for a CCG merger

Midlands & Lancashire CSU is the provider of human resources (HR) services to NHS Cheshire Clinical Commissioning Group (CCG). This organisation was established on 1 April 2020 as the result of a merger of four CCGs that had HR services provided by MLCSU.

Action

As part of the merger programme, our HR team successfully:

* ran an assessment centre for the appointment of a single Accountable Officer
* led the HR elements of appointing a single Executive Team
* led the HR elements of appointing a single Governing Body and single group of clinical leads
* provided HR advice and support in relation to restructuring, including formal consultations and handling displaced staff
* led the TUPE transfer of approximately 300 staff into the new CCG
* worked with the payroll provider to merge four Electronic Staff Record (ESR) Virtual Private Databases (VPD) into one single VPD, transferring all staff and their records whilst ensuring that they continued to be paid correctly.

Impact

NHS Cheshire CCG was successfully established on 1 April 2020, with the HR elements being led by MLCSU.

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Improving management of nursing care

Nursing care providers across Lancashire and South Cumbria needed to complete and submit a monthly questionnaire for each clinical commissioning group (CCG) that they worked with. Residential care providers in the region were not asked to do this. This agreement was labour intensive for providers and difficult for the CCGs to manage, whilst creating an inconsistency in how they managed local care operators.

The integrated care system, Healthier Lancashire and South Cumbria, wanted to improve the process.

Action

MLCSU, with technology partner, adam, implemented a supplier relationship management module for the group. This highly secure, cloud-based and fully mobile-compatible application incorporates a range of features including:

* automated collation of data from providers
* systemised data analysis and interpretation (including scoring and RAG statuses)
* easy-to-use interactive charts and dashboards
* communication tools to engage and share information back and forth with providers.

Impact

Implementation of the supplier relationship management module resulted in:

* significant time savings for customers in collecting data from local providers around the quality of care
* improved insight over quality of care to inform provider management activities and policy setting
* configuration of communication tools to improve information sharing with providers
* improved quality of care across the region as staff can spend less time gathering information, and more time focusing on areas of under performance.

Just looking at hospital admissions alone, the supplier relationship management tool has helped one CCG save 17 unscheduled hospital admissions per month, which equates to a financial saving of at least £13,000 per month (assuming a minimum 2-day stay per visit).

One CCG has reported the following performance improvements over the first 12 months:

* reduction in average number of falls monthly from 238 to 93
* reduction in providers rated Red or Amber under their quality monitoring guidelines from 12 to one
* urinary tract infections down from 54 to 16 a month
* unscheduled hospital admissions down from 49 per month to 32.

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Improved domiciliary care placements

Clinical commissioning groups in Staffordshire wanted to review and change the spot purchase approach to procuring and managing domiciliary care placements and address the lack of a contractual structure. With budgets under pressure due to increasing demand, prices of domiciliary care were also rising. The aim was to move to a robust, effective and faster process that focused on maximising a robust contractual structure with quality of care for patients and value for money for the CCGs.

MLCSU, with technology partner, adam, was already delivering a range of solutions to the CCGs, including a commissioning solution for nursing care provision and a case management system for continuing healthcare (CHC) patient records.

Action

We scoped what was required, engaging with key stakeholders and providers and worked with adam to deliver:

* new policy and process documents
* new procurement and associated provider contracts
* performance and price benchmarking
* system configuration incorporating agreed processes and policies
* electronic invoicing and payment process
* migration and loading of existing package data
* training of all system users
* management of information and reporting design and configuration.

Impact

The new process is expected to result in:

* improved management of risk and compliance
* faster placement of CHC Domiciliary Care patients
* financial savings
* improved process around provider sourcing and quality of care
* all invoices being held online and paid within 30 days without exception
* providers being fully aware of all process, policies and performance metrics as they are held online
* providers having a fair opportunity to provide services for all new cases.

With this development we have now implemented adam’s full commissioning solution in Staffordshire (our first customer to have all key aspects in one system). It includes:

* provider contracting and evaluation
* care and support planning
* e-brokerage and provider sourcing
* e-contracting and placement management
* integration with case management system and finance systems
* e-invoicing and payment process
* supplier relationship management module (starting soon, delayed by COVID-19)
* interactive and real-time reporting tools
* dedicated user support and training
* data analysis and stakeholder engagement teams.

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Our help to reduce occupied bed days

Blackpool Teaching Hospital NHS Foundation Trust commissioned Midlands and Lancashire Commissioning Support Unit to lead a two-year project (2019 – 2021) focusing on a number of work streams, with each having a defined objective towards the ‘reduction of occupied bed days’. Regular board level governance incorporated both the trust and the Fylde Coast Clinical Commissioning Groups.

Action

A comprehensive deep dive of local evidence by our analytics experts helped create a suite of quality indicators that demonstrated areas of improvement and was therefore key to the success of the overall Bed Reduction Programme. The support of 600 consultant days was agreed across a 2-year time frame, with an emphasis placed on a number of supplementary outcomes that were associated with the overall objective (see outcomes). Specific key areas of intervention and support around pathways and the full utilisation of existing resources were included in a detailed project plan which formed the basis of regular reports to gauge progress into the project board.

Each workstream was allocated a MLCSU clinical subject matter expert and a defined team structure that replicated triumvirate working from the appropriate areas of nursing and operational leadership teams from both the trust and the CCGs. Programme support, monitoring and leadership for each work stream was then led by the CSU.

Intervention and support was given both on site and remotely, with a firm emphasis placed on long term cultural change and future workforce capability within the trust to ensure strategic progress was monitored and permanent change was delivered.

Impact

Expected outcomes:

* Increase in zero-day length of stay (same day emergency care) rate from 23% to 33% (in line with the regional average)
* Increase direct admission rate from current 26.1% to 32.02% (in line with regional average)
* Targeted 15% reduction in occupied bed days* per 1000 population in 65 +age group

The outcomes to date:

* An increase in the zero-day rate to ~30% at the end of December 19
* A ‘direct admission rate’ (patients admitted via any route other than the A&E) of 33% as at November 19 and subsequently ensured direct admission rates were at 32.02% for three consecutive months
* Approximately 22 beds per day (net) have been released. The increase is largely amongst Blackpool CCG residents (Blackpool increase = 40 beds per day; Fylde and Wyre increase = 18 beds per day)

Nb: Average length of stay reductions seen for 27% of all Frailty inpatient service users (pre-Covid) and the new Frailty Assessment service was proven through a test of change phase (March 2020).

Direct admission to assessment wards, effectively by-passing A&E, allows for effective handling of patients within wards, and also generates capacity in the A&E bays.

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Improved end of life care with PHM

Willows Health is a group of seven Leicestershire practices with over 43,000 patients and is part of the Aegis Primary Care Network. The GPs’ proactive approach towards population health management (PHM) includes identifying patients potentially nearing the end of their life to ensure they are given appropriate care and support. However, they have struggled to identify this population in a comprehensive manner. An audit carried out by the team identified that half of patients who had died in the previous six months did not have a care plan.

Action

MLCSU’s population health analytics platform, Aristotle Xi, gives users rapid access to an online suite of business intelligence tools and reports to support PHM. It is being used to give the clinicians a Mortality Risk Score (MRS) – a new algorithm generated from outputs of the Johns Hopkins Adjusted Clinical Group (ACG®) System. This enabled them to identify a large number of patients who had not previously been included on the palliative care register.

Once the list was created, it was given to members of the clinical team so they could undertake a review of patients on the list to determine whether they would benefit from a palliative care plan and to determine the urgency of such a process.

Impact

This innovative work has enhanced and supported Willows Health’s care planning work with palliative care patients and enabled them to provide patient-centred reviews and end-of-life care plans for those with higher levels of risk. These have helped reduce hospital attendances and length of stays.

Aristotle Xi and the ACG System support the group’s clinical programme, enabling proactive assessments, enhancing the quality and experience of care through optimisation of long-term conditions, undertaking medication reviews, signposting to additional support systems and exploration of patients’ care preferences and best interests in this context.

Willows Health GPs are now able to offer the right support to a greater number of patients who are nearing the end of their life.

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Rapid development of COVID-19 sit-rep dashboard

Leicester, Leicestershire and Rutland health system needed visibility of COVID-19 suspected or confirmed cases, deaths, bed capacity and mortuary capacity.

Action

Our business intelligence (BI) specialists quickly developed a daily COVID-19 sit-rep dashboard covering the required system-level information as well as trends and comparisons with the national picture. The report also included workforce information from local NHS organisations and councils, as well as primary care information.
Quick modification was required to adapt to changing national reporting requirements, for example the inclusion of care home deaths.

We also developed twice-weekly system Management Information reports bringing in data and intelligence regarding the independent sector, care homes, voluntary sector, NHS 111 and shielded patient information.

Impact

The daily dashboard was delivered on time, meeting all requirements and available to all system partners. It has received excellent feedback from all system partners, including local providers’ executive boards. Local authorities have used it for modelling work.

The dashboard is supported by the twice-weekly management information reports.

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Coordinating primary care apprenticeships

The five locality training hubs making up Lancashire and South Cumbria Training Hub (L&SC TH) work together to form a multidisciplinary clinical and administrative team supporting primary care teams across the patch. They promote the positive benefits of diversifying primary care roles. MLCSU’s Improvement Unit provided project support to the apprenticeships programme by fulfilling the L&SC Apprenticeship Coordinator role.

Action We worked with the Chair of the Training Hub to roll out, facilitate and promote apprenticeships within General Practice in line with the Local Delivery Plan. Including:

* Facilitating regular intake of health care support workers (HCWs) from General Practice to the Trainee Nurse Associate Apprenticeship Programme
* Offering support, advice and guidance to practices on the nurse associate role, application and financial/levy process
* Co-developing and facilitating the first cohort for a senior HCSW apprenticeship
* Maximising apprenticeship development in General Practice by promoting apprenticeships (of all types) at events, presenting the benefits and providing information to individual practice.
* Supporting non-levy-paying practices in placing a member of support staff onto an apprenticeship by allocating Health Education England funding for priority areas.

Impact

Thirty six new or existing staff have enrolled onto apprenticeships. This is helping to:
* support succession planning
* address the skills gaps in the workforce
* aid staff retention and create continuing professional development (CPD) opportunities
* increase the number of practices accessing apprenticeships
* develop the primary care workforce
* help practices understand the benefits and utilise apprenticeships.

Fourteen HCSWs enrolled onto the Trainee Nurse Associate Apprenticeship. The nurse associate role bridges the gap between HCSW and registered nurse helping to meet changing health and care needs. Nurse associates can increase the capacity of General Practice Nursing (GPN) teams in areas such as cervical cytology and long-term health condition clinics.

Six people enrolled onto the Senior HCSW Apprenticeship for General Practice. This apprenticeship provides highly skilled employees back in practice with a recognised qualification offering progression to higher/degree apprenticeships.

Twenty seven expressions of interest were received for apprenticeship development in L&SC Primary Care.

Sixteen new or existing staff enrolled across L&SC for HCSW, administration, and management apprenticeships.

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Integrating data analytics in Dudley

Population Health Management (PHM) is an approach that uses data to identify and anticipate the needs of population groups and individuals so that services act as early as possible to keep people well and target support where it will have the greatest impact.

Our business intelligence specialists supported Dudley Clinical Commissioning Group (CCG) with PHM, using integrated data analytics to help determine how best to commission preventative and interventional care.

Action

We worked with the CCG and Public Health colleagues to produce the intelligence and insight needed for their decision-making. We analysed integrated datasets (taking primary, secondary, community and mental health care data along with population, epidemiology and prescribing data) to create a visualisation report. This segmented the blended data to group similar people together.

Using machine learning tools, we searched the blended data (for example by extracting patterns of need, demand, deterioration, complexity and expense) for opportunities to systematically optimise population level commissioning.

We held a system level workshop to analyse opportunity, assess impact and determine priorities.

Impact

Blending the CCG’s data with other sources produced a holistic picture and enabled data quality management. The insight led to better understanding of populations and unwarranted variation. This in turn meant interventions or service redesign could be targeted and tailored for maximum impact, optimising cost effective care and outcomes.
Our triangulation of data sources at population level gave the commissioners new insight, for example regarding deprived Asian men’s utilisation of planned and unplanned care, older white affluent people’s use of mental health and A&E services, and GP socioeconomic profile against their prescribing costs.

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Reducing inappropriate referrals for treatment

Clinical commissioning groups (CCGs) need to ensure that funds are spent on treatments and procedures bringing the greatest value and benefits to patients in a way which is affordable and equitable. Chorley & South Ribble CCG and Greater Preston CCG wanted to improve their funding application process. The challenge was to change behaviour, educate clinicians, improve the patient journey, reduce inappropriate referrals and ensure consistent outcomes.

Action

We trained clinicians and created a bespoke, streamlined system for submitting funding applications. Our comprehensive Individual Prior Approval Scheme involves the provider of treatment seeking funding approval from the commissioner prior to treatment. CCGs can challenge providers for activity that does not have the relevant authorisation codes generated by the scheme, ensuring only appropriate treatments are delivered.

With Chorley & South Ribble CCG and Greater Preston CCG, we developed and implemented a robust manual Individual Prior Approval Scheme for seven policies over an initial six-month period. Following a successful outcome, this was extended for a further two years to cover 15 procedures of limited clinical value and nine cosmetic procedures.
In addition to the monitoring and validation of activity data, we captured qualitative data in relation to themes and trends affecting potential future commissioning intentions. We ensured commissioners and referring clinicians understood the requirements of the scheme. Reporting mechanisms were developed and continually reviewed in line with CCG requirements.

Our ‘wrap-around’ service included finance and contracting expertise to support reconciliation process at intervention level and clinical policy development support to ensure effective application of policy criteria.

Impact

Inappropriate referrals at Chorley & South Ribble CCG and Greater Preston CCG have fallen, resulting in efficiency savings and improved patient flow, with applications receiving a decision within five working days. Health outcomes have improved by ensuring the right treatment for patients at the right time, only undergoing elective treatments and interventions where benefit outweighs the clinical risk.

More than 9,000 applications went through the process over the first two years of implementation and 13 per cent were declined.

With increased knowledge of clinical policy criteria at secondary and primary care level, clinicians are managing patient expectations more appropriately, improving patient experience and reducing misunderstandings and complaints. Working relationships are enhanced between stakeholders, with a culture of continuous improvement.

Hospital providers involved have praised the Prior Approval system, saying they would like all CCGs to commission this process so there would be a single, robust and efficient system, making processing applications simple and easy for clinicians.

The scheme has contributed to quality and improvement programmes through the reduction of activity. It has also supported other commissioning demand management schemes to support CCGs to realise further activity and cost savings.

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Rapidly rolling out video consultations during the COVID-19 pandemic

Background

The NHS Long Term Plan outlines NHS England and NHS Improvement’s commitment to transforming outpatient appointments. In April 2019, their Outpatient Transformation Team began a pilot to scale up the use of video consultations for outpatients. This work was rapidly accelerated in light of the COVID-19 outbreak to implement video consultation capability within all trusts.

Specialists from MLCSU’s Improvement Unit, who were already working for the NHSE North Elective Care team, were quickly redeployed to support the rapid roll-out across the North. They programme managed and delivered training on the Attend Anywhere online video consultation platform to all trusts across the North of England, linking with NHS Digital and NHS England programme teams.

Action

Two teams of trainers were quickly established from within the Improvement Unit. Under the guidance of the national video consultation project team they became experts in the platform so they could deliver train-the-trainer sessions and support Trusts to implement video consultations. A lead trainer was assigned to each Trust.
Working with the NHSE and NHS Digital onboarding teams, we arranged licences, carried out data protection impact assessments and checked technical requirements to ensure Trusts were able to adopt video consultations successfully.

Impact

* Within just three weeks the Improvement Unit team had delivered training on the Attend Anywhere online video consultation platform to 54 Trusts.
* Over 100 services and specialties across the north of England are now using video consultations daily to maintain appointments with patients safely.
* Our team has also given advice regarding virtual consultations to ambulance Trusts throughout England via a webinar organised by NHSE/I South West and facilitated by NHS Horizons.
* By reducing the need for physical attendance at NHS sites, video consultations are preventing the transmission of COVID-19 as well as enabling clinicians to see patients who are unable to travel. Patients can have their consultations in a place that is convenient to them.
* Video consultations are also enabling clinicians who are themselves at risk or who are self-isolating to work from home.
* Seven months after implementation, over half a million consultations have taken place using the platform, with the North West consistently one of the highest users

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Chatbots improve referral management

MLCSU’s Referral Management Centre (RMC) makes bookings when a patient is referred (usually by their GP) to see a specialist. The patient can call to make an appointment, or they may be called by the RMC. In either case the patient will be offered an appointment at a number of local hospitals.

The RMC team uses the NHS Digital e-Referrals system and the Integrated Care Gateway (ICG) referrals system developed by software developer Accenda. The 56-strong call centre team were making and receiving in the region of 1,200 – 1,800 calls per day 8am – 6pm with an average 40 seconds wait time.

In September 2019 the RMC and MLCSU’s Digital Innovation Unit reviewed this ‘calling out’ process. Approximately half of calls were unanswered meaning an ineffective use of staff time and, if unable to leave a message, no value was added to the patient or service.

Action

We introduced chatbots (developed by Arcus Global) to automate outbound calls. Patients answering the call are directed to a cxaall handler. When calls are not answered, a message is left by the bot where possible. The aim was to greatly reduce human intervention where there was currently little or no outcome to the call and also create capacity within the team to focus on delivering an excellent service to the incoming calls.

A live pilot study commenced in February 2020.

Impact

Using a mixture of SMS messages, calls and the occasional letter as a last resort, the centre has seen a 94 per cent reduction in time taken to make outbound calls and over 60 per cent of patients are reached.

The RMC is now saving around 1.3FTE staff time per day to concentrate on patient services.

Qualitative benefits are also being recognised, such as ensuring calls that are made benefit patients and the improvement in staff morale in not having to listen to voicemails or make fruitless outbound calls.

Following this success, the Digital Innovation Unit is using voice automation to improve other processes for customers as well as for the CSU.

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Supporting delivery of Staffordshire’s integrated care record programme

MLCSU has provided the programme management team for the introduction of the integrated care record (ICR) in Staffordshire and Stoke-on-Trent. Our team comprises senior information management and technology managers, project coordinators and communications and engagement specialists.

The team is responsible for day-to-day operations of the flagship One Health and Care project and reports to the ICR Project Board and the overarching Digital Programme Board representing the 16 partner organisation making up the STP.

Action

To date, work we have undertaken includes:

* Development of terms of reference
* Construction of the ICR Partnership Agreement and coordination of its sign-off
* Management of the ICR budget and the wider Digital Programme budget to ensure allocated finances allow for flexing through resource intensive stages of the project
* Production of the system specification and coordination of the procurement process including all supporting documentation
* Completion Equality Impact Assessment
* Completion of Quality Impact Assessment
* Creation of the full business case, project initiation document, project plan, and communications and engagement plan
* Administration of STP partner organisational readiness and preparatory work required for the ICR, including data scoping and specification, and system configuration, testing and training.
* Management of information governance, including and the Data Processing Agreement (DPA), Information Sharing Agreement (ISA), and Data Protection Impact Assessment (DPIA)
* Facilitation of the Fair Processing campaign for the ICR and the development and issuing of all communications and engagement material to STP stakeholders
* Planning the ICR service support model, including helpdesk and associated service level agreements.

Impact

The ICR is now being rolled out across the county. With Staffordshire placed as frontrunners regarding ICR in the region, the programme team is liaising with counterparts in Shropshire & Telford, Wolverhampton, Walsall, and Worcestershire to share experiences and lessons learnt.

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Data protection for a GP federation

North Staffordshire GP Federation is a membership organisation for all 76 GP practices serving the whole of North Staffordshire. The federation has commissioned the MLCSU Information Governance (IG) Team to provide Data Protection Officer support services.

Stoke-on-Trent City Council and Stoke-on-Trent CCG have commissioned the federation to provide a health care support service to the homeless. The service will be operational from Brighter Futures in Hanley and the support workers (a nurse practitioner and a health care assistant) are employed by the federation. Health information would need to be shared with other organisations (City Council, The Police, Housing, Brighter Futures, and any third sector housing associations) along with sharing with the registered GP of the homeless person. The acute and mental health trusts would also need to be partial to the sharing of this data, particularly in cases of high-volume attenders.

Action

We provided a named Data Protection Officer (DPO) and ensured accountability and key approvals were evidenced throughout.

As information on specific cases would be shared at cross-organisation multi-disciplinary meetings recorded for accuracy, the confidentiality requirements were stipulated in the terms of reference for this group.

Success of the scheme is heavily dependent on effective data sharing mechanisms. To ensure the federation understood roles and responsibilities in relation to the data sharing requirements of the project, our DPO advised that a Data Protection Impact Assessment (DPIA) would be required to clearly identify any risks to the rights and freedoms of the individuals concerned, followed by the production of a Data Sharing Agreement to hold all organisations accountable to the highest standards of use.

Our IG Business Partner for Primary Care then met with federation representatives to discuss all aspects of the process, the mechanism for sharing the data, the legal basis and the way to evidence accountability throughout. The DPO then reviewed the DPIA in line with current legislation and approved it.

Impact

All organisations involved in the scheme signed the Data Sharing Agreement, having ensured they fully understood the requirements in relation to the sharing of special categories of personal data.

The process was handled with high levels of attention to detail, and ensured adherence to the data protection legislation at all times. The process was made so much easier with effective, clear communication from both the MLCSU IG Team and the North Staffordshire GP Federation, who throughout the process, remained committed to the requirements.

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Helping patients get the most benefit from their medicines

We worked with NHS Greater Preston and NHS Chorley and South Ribble CCGs to give patients a greater understanding of their medicines. We used resources from the Me and My Medicines campaign developed in Leeds. The campaign includes The Medicines Communication Charter and encourages patients and their carers to ask questions about their medicines to help them get the most benefit.

Action

One GP practice was selected as a pilot site for the Me and My Medicines clinics. Our practice-based medicines optimisation technicians created an EMIS web search to identify patients aged between 65-80 taking three to seven therapies.

Using the campaign resources, they conducted non-clinical medication reviews during 30-minute appointments. Each patient was encouraged to ask questions about their medicines or raise any concerns. They were asked to bring their medicines in to the appointment.

The technicians provided an overview of the clinics at a medicines coordinator GP practices training session.

After successfully running and reviewing two pilot clinics, a further nine GP practices were selected.

Impact

In the first seven months 257 patients with a wide range of comorbidities were seen in the Me and My Medicines clinics. The technicians gave inhaler counselling to 23 and realigned 52 medicine quantities.

There were four high level quality interventions (for example, stopping duplication of medication), 146 medium level (for example, correcting variation to licensed doses) and 532 low level (for example, appliance maintenance and reminder of blood pressure check).

Patient feedback during and at the end of consultations, and in follow-up conversations, was positive. Patients’ relatives and GP practice staff also gave positive feedback.

We are continuing to roll this programme out to other practices.

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Evaluating the NHSE continuing healthcare digital specification project

Continuing Healthcare (CHC) is a complex, important and high cost element of clinical commissioning groups’ responsibility for the NHS with over 159,000 individuals receiving funding during 2017/18 and a total spend of £3.1bn on standard and fast track care packages. Having identified the considerable benefits that could be achieved nationally in the widescale digitisation of CHC services, NHS England (NHSE) and NHS Improvement (NHSI) decided to evaluate the NHS Continuing Healthcare (CHC) Strategic Improvement Programme (SIP) specification for the provision of a digital CHC service. Our Digital Innovation Unit undertook the evaluation with operational input from our CHC service.

Action

Our Digital Innovation Unit led a gap analysis from a technical perspective, focusing on:

* cyber security standards
* interoperability standards and application programme interface standards.

Our CHC experts led a gap analysis from a CHC operational perspective, including a review of the specification against the current national standards.

The ability and willingness of the market to react was assessed via interviews with several solution providers who had been involved with the SIP during development of the CHC Digital Specification.

We developed a maturity matrix to assist CCGs and service delivery partners in understanding where their own CHC services aligned to an ‘end-to-end’ digital service and where there were gaps. We also produced an example CHC digital roadmap showing the steps a digitally immature CHC service would need to take.

Impact

The NHSE CHC SIP aim is ‘to provide fair access to NHS CHC in a way which ensures better outcomes, better experience and better use of resources.’ This project contributes to that aim across all the programme goals, with the CHC Digital Specification being one of the key enablers.

An early outcome of this project has been the inclusion by NHSE of the CHC Digital Commissioning Specification and CHC Digital Consultancy Services within the October 2019 Health Support Services Framework (HSSF). This is a vital enabling step supporting the move towards a digital CHC market.

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Supporting care navigation with data expertise

Care navigation uses signposting and information to help primary care patients move through the health and social care system as smoothly as possible to ensure that needs are met.

The introduction of care navigation is seen as a key action in the GP Forward View to release capacity in practices. Frontline staff can direct patients to the wider health and wellbeing team or to external services, as appropriate, at the time an appointment is requested.

Our data quality specialists working with North Staffordshire and Stoke-on-Trent Clinical Commissioning Groups have been supported by West Wakefield Health & Wellbeing (a GP federation and wave one GP Access Fund site) in developing the CCGs’ care navigation approach.

Action

Our data quality specialists were involved from the outset, advising about coding and templates so data could be provided around time saved in GP appointments.
We advised on read codes and created clinical system templates. These were tailored to individual practices to incorporate their in-house services along with Pharmacy First, walk-in centres, dentists, opticians and the Voluntary and Community Services’ VAST Hub (social prescribing). Wellbeing services have since been included in the templates.

We embedded a link to MiDOS (a local directory of services) in the templates so reception staff could access information quickly and easily. We also embedded inclusion criteria documents for each of the services.

Using a dashboard, we monitor and analyse the practices’ data to produce a monthly report for the CCGs and a quarterly one for the practices.

We installed the bespoke clinical templates onto participating practices’ clinical systems prior to go-live of the service and trained practice staff in completing them.

Impact

Care Navigation is live in 20 North Staffordshire practices and 25 Stoke practices.

* September 2017 – March 2018: 17569 signposts saving 2721 hours of GP time
* April 2018 – November 2018: 18786 signposts saving 2732 hours of GP time

The single most accepted service is to nurse practitioners. The most used external signposting is to Pharmacy First, closely followed by walk-in centres, however Pharmacy First has a higher rate of patient rejections.

Our work with West Wakefield has been used as a case study for best practice nationally, which involved filming for NHS England.

Physio First has been a pilot in three Newcastle North practices and the dashboard has been used to monitor its impact with a view to the service being commissioned more widely.

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Improving the handling of complaints

Background

Our Complaints and PALS Team has conducted a benchmarking exercise across NHS complaint handling bodies in Lancashire and South Cumbria (LSC). This followed concerns emerging about how complaints were being handled across LSC by both commissioners and providers.

Action

We created a benchmarking questionnaire that was sent via NHS England and NHS Improvement to all LSC clinical commissioning groups and NHS trusts (10 complaints handling bodies in total). Analysing their responses highlighted wide variation in performance against targets. We also found potential examples of best practice worth further investigation to identify learning that could be shared.

We drew up a list of recommendations to ensure effective use of the data gathered.

Impact

Our recommendations set out scope for further exploration where this exercise highlighted disparities or good practice.
The benchmarking returns showed commissioners how their providers handle complaints and what additional information could be gathered to drive improvement and inform future commissioning.

It also led to a discussion about options for how complaints could be handled across the emerging integrated care system and primary care networks as care pathways become better coordinated around the needs of the patient. A task and finish group of heads of complaints/patient experience was set up to make proposals for service change and improvement across the LSC Integrated Care System, reporting back to the Directors of Nursing Group in early 2020.

We plan to replicate this work in other areas.

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Successfully navigating a commissioner through a large contract dispute

Background

The Staffordshire Clinical Commissioning Groups’ East Staffordshire Division needed support in navigating through a multi-issue dispute concerning the Improving Lives contract with a supplier external to the NHS. This required extremely detailed technical understanding of the NHS Standard Contract and its interpretation.

Action

Our Improving Lives Contract Management Team worked with CCG partners in navigating through the three-year dispute, while continuing business as usual with the provider.

Impact

The successful outcome of the dispute, which was completely in the favour of the CCG, has insulated the healthcare system from approximately £35million worth of multi-faceted and challenging contract claims.

In supporting the CCG, our team led, influenced and managed the responses throughout the dispute process, ensuring that the CCG remained protected from further claims and ensuring adherence to the innovative contract that was agreed.

The Improving Lives project is an innovative contract which, although challenging, has enabled us to lead the way in advising the CCGs on the forthcoming changes to the commissioning environment as the system moves into a more integrated care model of service.

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Improving equality and diversity reporting in Leicestershire

The three Leicestershire CCGs (Leicester City CCG, East Leicestershire and Rutland CCG and West Leicestershire CCG) wanted to significantly improve the quality of equality and diversity reporting by provider organisations.

Action

Our Equality and Inclusion team held a workshop to provide contract managers from the CCGs and providers with clarification on the CCGs’ expectations of equality and diversity reporting. The 22 attendees were drawn from provider organisations, the three CCGs and the MLCSU contracts team.

Topics covered in the workshop were:

* Section 13 of the NHS Standard Contract
* Accessible information Standard
* Workforce Race Equality Standard
* Workforce Disability Equality Standard.

Impact

James Hickman, Children’s Planning and Commissioning Manager with Leicester City CCG, who requested the workshop:

“I just wanted to say thank you for the brilliant Equality Workshop you facilitated last week. Equality and Diversity has been a real sticking point in reporting across all of our contracts in the past year, with providers (and me) being unsure of what/how/why they have to monitor and report to be compliant with the NHS standard contract.

“Everyone said that they found it really useful; the content was spot on and the Dragons Den group activities helped to put it all into context. Personally, I think it’s something that could be a mandatory CCG-wide training day as it highlighted how services (and CCGs!) are going to have to change their attitude towards Equality and Diversity monitoring/reporting to keep up with new national requirements.”

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Delivering a wave of rapid improvement challenges

In response to the continued operational pressures in elective care and following the success of the national 100-day challenges, NHS England commissioned MLCSU’s Improvement Unit to deliver a wave of specialty-based rapid improvement challenges across the North Region.

Action

The Improvement Unit supported eight healthcare sites/systems to utilise the 100-Day Challenge methodology to drive rapid improvement in specific elective care specialities. We did this by:

* Providing hands-on coaching and facilitation support to each site during the development and delivery phases, bringing leaders and frontline staff together to test ideas
* Facilitating a series of local and regional collaborative events to guide sites through tools to help them identify, develop, test and monitor improvements
* Providing dedicated ongoing coaching support to local site leads to ensure the progress and success of the activities
* Supporting the development and delivery of local sustainability plans for each initiative to ensure improvements
* Programme evaluation, including training and support for the development of case studies and social media materials for local sites, impact analysis and production of a final report.

The Improvement Unit offered additional project management support, coaching and facilitation where it was required and adopted a collaborative approach to all events; using practical workshops to support localities to achieve their goals.

Impact

* One system looking at the spinal MSK pathway saw Physio First referrals increase threefold in pilot practices, leading to fewer referrals to secondary care
* Paediatric Ophthalmology Did Not Attend rates reduced by 4 per cent with follow-up DNA rate down by 9.1 per cent in one month with one pilot trust
* The same trust also successfully trialled a Virtual Glaucoma Clinic with 41 per cent of suspected glaucoma patients discharged back into the community
* A trust working on ‘cold’ site utilisation reported no patient cancellations, improved patient experience, improved referral to treatment (RTT) performance and cost avoidance of £226,800 as a result of transferring more elective care activity to the cold site
* Another trust saved 15.66 bed days in one month as a result of a successful move for urology patients undergoing trial without catheter in an outpatient setting, another 25 patients (in one week) had their pre-op via telephone on the same day as being listed for surgery, reducing gaps in theatre lists and improving patient experience.

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Helping setup cervical screening service

Primary Care Support England (PCSE) provided by Capita, supplied the administration support for the National Cervical Screening Programme on behalf of NHS England, sending invitations, reminder letters and test results to patients.

On 20 March 2019, NHS England (NHSE) Chief Executive Sir Simon Stevens advised the Public Accounts Committee into failings with adult health screening programmes, and confirmed that action was being taken to bring the service back to the NHS.

Action

The Commissioning Support Units were requested to work collaboratively to provide an overview of the service and establish a programme office to manage its transition back to the NHS by 1 August 2019.

The expertise of MLCSU’s Improvement Unit was requested for the immediate mobilisation and transition of the service, along with providing operational oversight, leadership, management and improvement support.

Impact

* Cervical Screening Service “in-housed” within timescales from Capita to NHS England on 1 August 2019
* Exemplar of collaborative working with experienced, skilled and dedicated expertise, resulting in a successful transfer and continuity of service delivery
* Consistent leadership and operational management support in the absence of a head of service, providing stability and consistency
* Creation and implementation of a streamlined case management system, including dashboard reporting functionality to support operational management
* Support in the redesign and implementation of a complaints service
* Creation and implementation of a dedicated call handling service, improving customer experience and improved processing of operational queries and enquiries
* Identification of areas for improvement, prioritisation and development to enhance service delivery
* Responsive and inclusive communication and engagement, resulting in improved staff morale, staff and customer satisfaction.

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Helping practices find and recruit locums

North Staffordshire GP Federation asked us to help solve the problem of locum sessions not being filled (with clinics being cancelled as a result), and high agency fees.

Action

Our Digital Innovations Unit worked with the federation, Howbeck Healthcare Ltd and the South Cheshire and Vale Royal GP Alliance to create an app, ‘FindMeALocum’. Frontline general practice staff and locums were involved in its design and development.

Impact

FindMeALocum is helping practice managers in the area wanting to find high quality locums quickly, and also helping GPs wanting to work more flexibly. Practices have used the project to:

* retain clinicians on flexible terms
* help sustain primary care
* increase the medical workforce numbers in primary care
* attract new workforce to the area
* add skill mix, with standardised minimum expertise, within primary care.

Within the first eight months almost 100 GPs registered with the app, and approximately 1,400 vacancies were filled.

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Enabling block booking of discharge-to-assess beds

NHS Vale Royal Clinical Commissioning Group (VRCCG) required support to block book eight discharge-to-assess beds (four for the elderly mentally infirm (EMI) and four general nursing).

Action

Two requirements were published (one for each block of four beds).

MLCSU drafted a communication to providers for approval by VRCCG.

adam set up new service categories for discharge-to-assess within the system.

VRCCG held a provider event involving MLCSU and adam. This included a short presentation and a question and answer session.

Impact

The exercise was agreed as a success by all parties, especially when considering the quick turn-around of the required actions (within 17 working days of initial conference call between VRCCG, MLCSU and Adam).

The general nursing beds received eight offers and the EMI beds three. The EMI results, however, were more expensive than expected, so this requirement was rolled back out to the market for a further week to allow for more offers. This produced a new offer at a lower cost than expected from a provider just one mile from Leighton Hospital and this was subsequently selected.

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Setting up a primary care network

Following successful application for funding through the primary care network (PCN) development fund in 2018, Chester East PCN was formed, covering a network population of 37,020 patients. The network engaged the services of The Improvement Unit in November 2018 to provide project management support to deliver their shared vision: “Working together to deliver high quality, innovative and sustainable healthcare for our community with commitment, compassion and integrity”.

Action

Taking an agile approach, we aligned workstreams and provided a clear programme structure by developing an overarching project specification, detailed plan, risk register, mitigation strategies and communication plan. We did this alongside providing support and expertise for development of the operational board structure, Memorandum of Understanding and governance arrangements.

Impact

* The Chester East PCN project was identified by an independent audit on behalf of NHS England as an exemplar of best practice
* Using an 0365 platform to share project information and documentation has provided visibility of project progress and supported collaborative and agile working in the absence of shared file arrangements
* Dedicated programme support has enabled the work to move at pace, providing a structure for everyone to feed into and embrace
* CSU expertise within the programme management provided valuable support in sharing best practice across the network, using case studies to support current and future opportunities in collaborative working
* The programme has provided an opportunity to standardise the approach to future projects on a “do it once” basis, providing a rich library of accessible templates
* Creating a robust governance structure has enhanced working relationships and provided visibility and clarity on roles and responsibilities across the network
* An “out of box”  approach has stimulated creative thinking in the design of a collaborative Dressings and Visiting service, focusing on a phased approach embracing LEAN practices and principles.

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Using our dynamic purchasing system to help a family in difficulty – and achieve best value

A patient in Staffordshire required a continuing healthcare (CHC) placement in a care home. Her daughter was undergoing chemotherapy and needed her mother to be somewhere easily accessible by public transport so that she could visit her.

Action

We used our dynamic purchasing system, ‘adam’, to source a care home placement. The best value provider it came up with was difficult to get to using public transport. Our CHC placement team were able to use this to negotiate with the family’s preferred care home to get an offer that matched the best value one.

Impact

The best outcome was achieved, both for the family and for Stoke-on-Trent Clinical Commissioning Group. The cost was negotiated down by £105 a week.

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Predictive analytics to prevent hospitalisation from A&E

In our role partnering sustainability and transformation partnerships and emerging integrated care systems, we are always looking for digital solutions to challenges involved in improving health and integrating care. Staging an innovation conference in 2018, we announced our partnership with artificial intelligence (AI) and predictive analytics experts PredictX aimed at using AI to answer challenges in care and health.

A good example of a real-world health and care challenge lies in Wolverhampton in the West Midlands. With a population of 262,500, Wolverhampton’s age distribution is similar to the rest of England but the healthy life expectancy (i.e. how long can expect to live unhampered by illness or injury) for males at birth is 58.2 years in comparison to 63.4 years in the rest of England. Similarly, the female healthy life expectancy is 58.7 years (England average 63.8 years).

With support of NHS Digital Demonstrator funding, City of Wolverhampton Council partnered with us to develop predictive analytics models to understand the care pathway of patients and whether they are accessing the right care package at the right time. It was hoped this would assist in targeting interventions to help people remain independent, in their own homes, for longer.

Action

Using health and social care data, PredictX and MLCSU created a model predicting hospital admissions from A&E. The data used included:

* Patient demographics
* Hospital data – including hospital location, department, arrival time and arrival mode
* Details regarding current social care packages
* Care pathways – including previous touchpoints
* Deprivation data.

After the data was explored and key features identified, machine learning models were trained to predict how many patients would be admitted.

What we found

Of the sample of 66,321 observed patients entering A&E, 3,615 of them were admitted. Our model accurately predicted 81% of these 3,615 patients would be admitted.
Overall, the hour of arrival and the length of time between arrival and departure most impacted on whether a patient would be hospitalised. Patients who arrived later and stayed at the A&E longer were more frequently admitted.

Long-term conditions also had a strong influence, particularly conditions like cancer and coronary heart disease (67.2% of all admitted patients (94.2% of those aged 65 and over) had at least one long-term condition).

Impact

Correctly predicting these factors gave us a basis for understanding the driving factors behind hospital admission. This provided the Wolverhampton team with a solid evidence base from which to effectively plan programmes and interventions which could reduce hospital admissions and the cost of care packages, while helping people remain independent for longer.

This can potentially lead to an opportunity for patients to receive the best care at the right moment – improving life expectancy in the borough as a whole.

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Supporting financial reporting and control for a rapidly expanded GP federation

North Staffordshire GP Federation (the Federation) is a membership organisation to all 76 GP practices currently serving the whole of North Staffordshire. Rapid expansion meant the Federation required support enhancing its financial reporting, financial procedures, and financial governance to meet its new requirements. MLCSU was approached to undertake a review, produce an issues log and recommendations and commence routine financial reporting.

Action Our support acted at an operational level to address shortcomings in the recording of financial transactions and providing the Federation with a first year to date and forecast outturn focused board report. It included:

* Review and recoding of financial transactions to correctly reflect the Income and Expenditure category and apportion to the various Federation projects and workforce schemes. There was particular focus on the expenditure classified as consultancy to determine the correct classification for each transaction

* Introducing accruals basis reporting by identifying monthly processes resulting in transactions not being recorded to the reporting period they related to and introducing an accruals process to rectify this

* Analysing pay costs to split code salary costs and HMRC pay-overs across the relevant Federation projects and workforce schemes

The in year and forecast outturn reporting by providing the Federation’s Board with its first Finance Report identifying and analysing year to date positions for:

* Income
* Pay costs
* Non-pay costs
* Overheads
* Surplus / deficit per project and workforce scheme.

Impact

Our financial deep dive enabled the Federation to have a timely and accurate understanding of the latest Income and Expenditure position for each of its 15 projects and 20+ workforce schemes. This has been enhanced with a monthly reporting process.

The CSU has been able to produce a Year End Forecast Outturn for each of these and an overall Federation position, enhanced with a monthly running cost for each scheme and associated surplus / deficit.

Based on this information the Federation Board has been able to make informed investment decisions for the remainder of their current financial year and budget setting for 2019/20.

The Board Report has also provided the Federation with a list of issues / risks regarding financial procedures, scheme of delegation, separation of duties and associated recommendations for its consideration.

The CSU has automated some of the Federation’s processes to make them more efficient and remove the opportunity for human error.

Additionally, we are able to provide a layer of resilience to the Federation, which as a relatively small organisation does not have the staffing levels to provide cross cover for business-critical areas such as payment of the monthly payroll, authorisation of payment runs and so on.

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Ensuring safe use of data for population health

Healthier Lancashire and South Cumbria ICS is participating in a national Population Health Management (PHM) Development Programme. A key element of the programme involves performing analytics on patient-level-linked datasets to draw insight. There was a need to ensure from the outset that information governance (IG) topics would be addressed appropriately for this type of exercise.

One PHM Data Access Request application form and Independent Group Advising on the Release of Data (IGARD) approval was required for each of the eight CCGs, naming the CCG as the data controller and MLCSU and Optum as data processors.

Action

Our head of IG:

* worked with the programme from the outset to ensure all critical foundations were in place so that IG could be an enabler rather than being seen as a barrier in any way
* worked with the Data Services for Commissioners Regional Offices (DSCRO), business intelligence leads and Optum to finalise the Data Access Requests
* captured the required information within the Data Protection Impact Assessment necessary before data can be used in a new way or shared differently.

Impact

Our Head of IG ensured all SIROs and Caldicott Guardians were kept up to date during the fast-paced work programme and had the required assurances before they were asked to start signing applications.
 
The IG solution for this programme is expected to influence and shape those used by many others across ICS footprints.

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Effectively dealing with a cyber security incident – WannaCry

In May 2017 our IT team received alerts from our software of an irregularity within some of the managed networks: 300 machines in two CCGs in Lancashire and Cheshire were subject to a WannaCry attack.

Action

We immediately activated our Business Continuity Plan and rapid response procedures, prompting the quick collection of intelligence and establishment of an emergency task force. Managers of the acute trust were contacted, and, with their agreement, isolated from the wider network to contain the damage. Whilst some deep processes were affected, the hospital continued to operate, isolated from further risk, and patient care continued using an interim (paper-based) system.

We opened emergency internal communication channels over the weekend and the team worked around the clock, developing an action list of software to replace and systems to fix. We used our solid supplier relationships to rapidly source the equipment and skills needed.

To minimise the impact on primary care, a community team was set up to repair and replace systems. Our response was rapid, intense, robust and continually reviewed as the situation evolved.

Impact

Our good work ensured that no surgery was affected by closure or disruption to work. We linked to NHS England Gold Command and collaborated with other affected organisations. Knowledge, best practice and solutions were shared – a critical success factor. Our exemplary response earned us a seat on the National Cyber Security Group, regarded as the voice of expertise for managing scalable cyber security incidents.

During the WannaCry cyber attack, the MLCSU experienced a range of impacts. Using a root cause analysis approach to examine a wealth of information in our service desk knowledge base tool, we examined variations and identified two key areas for learning and investment.

Firstly, we have invested in enhanced software resilience to achieve a more robust infrastructural barrier to future cyber attacks. Secondly, we are tackling the risk of human behaviours. In January 2018, we became the first NHS organisation to secure GCHQ accreditation for our bespoke end-user cyber security awareness course, CyberStrong, which now forms part of our organisation’s mandatory training programme.

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Shaping ideas for primary care

The Strategy Unit developed EPIC in response to national challenges facing primary care, informed by the GP Forward View and the ‘Ten high impact actions’. EPIC is an evidence-based and experience-informed local primary care development programme.

The aim was to enhance the capacity and capability of general practice staff to develop and implement innovative ideas and to transform service delivery: focusing on quality and efficiency of care; patient experience and collaborative working.

Action

EPIC had three workstreams:

* 1. ‘Business management’, providing core business skills to every practice in Dudley, to improve productivity, workflows, data management and reporting
* 2. ‘Performing as a team’, supporting practices to improve what they do through ideas generated in joint learning sets, with bespoke support within individual practice settings
* 3. ‘Transforming’, facilitating practices working in partnership with external organisations to design and deliver ambitious new pathways, through a supported programme of action learning.

Impact

EPIC evaluated well. It received very positive feedback from practices. It showed improved skills and knowledge within the practice teams, hence empowering staff, as well as improving relationships with local partners.

Cost savings were demonstrated, arising from reduced repeat prescription processing, as well as reduced paper flow and document transfer – saving time. There were also reductions in GP appoint-ments for pill reviews and a reduction in avoidable appointments, saving GP time.

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Developing an innovative procurement process to support transformation of a discharge pathway

Leicester, Leicestershire and Rutland (LLR) Sustainability and Transformation Partnership (STP) wanted to improve reablement services so that patients could safely return to their usual residence with as much independence as possible. Previous procurements had failed due to a lack of interest from the residential and care home market.

Action

Successful procurement for this project required an innovative, flexible approach. On behalf of LLR STP, we developed a procurement process to support transformation of the whole pathway.

We designed a procurement process to:

* ensure a joined-up approach between STP partners (by creating a steering group with representation from each partner)
* engage the provider market
* involve local providers in development of the service model and specification.

We reviewed the financial package and developed a more attractive pricing structure to stimulate interest from a wider sector of care homes. We proposed two different offerings: a single provider to deliver a 14-bed unit and a multi-provider local framework to deliver beds for more complex patients. These different elements of the pathway were tendered for separately and independently. In addition, there was a separate open procurement for the therapy unit to support the other two services. This approach gave providers flexibility and meant there could be some provision even if there were no bids for other elements.

We held a separate market engagement event for each element to ensure that local providers were fully engaged in a two-way dialogue with commissioners. This helped with effectively shaping a service model and specification that supported higher interest in the procurement.

In addition, health commissioners worked closely with local authority partners to ensure there was a joined-up approach to engaging with the care home market.

Impact

Contracts were awarded following a competitive process with an engaged market and the new services for all three elements of the pathway commenced on 1 April 2018. The procurement process has resulted in a sustainable ‘Home First’ model for providing reablement and assessment, including ‘discharge to assess’ options in a bed-based facility.

Performance of the pathway has improved by:

* delivering a shortened length of stay (LOS) – prior to the procurement the average LOS on the pathway was about 40 days. As of December 2018, the average LOS on the framework discharge to assess is 33 days and in the reablement beds is 25 days
* reducing the number of long stay patients in the acute trust – University Hospitals of Leicester has significantly fewer long stay patients with 161 in December 2018 (201 in 2017/18).

Within the first nine months almost £800,000 had been saved – the target saving for the whole financial year.

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Procuring a cutting-edge communications system for Worcestershire GPs

When GP surgeries across Worcestershire came together with a need to transfer their communication systems, they called on us to deliver a robust and tailored solution.
We aimed to source a Voice over Internet Protocol (VoIP) solution to help manage calls, patients, and staff through their own configuration consoles, along with tools to support a flexible, mobile workforce and deliver business continuity in the event of damage to a building or circuit. The project’s high-level aspirations included:

* VoIP based solution with resilient cloud-based or centrally hosted solution with high service availability
* Improved functionality to enable customised interactive voice response, messages and recordings, call recording and monitoring, call forwarding, ‘follow me’ functionality, teleconference facilities and enhanced reporting functionality
* Integration with existing EMIS software applications
* Reduction in hardware requirements, including introduction of soft phones where appropriate
* Allocation of equipment to the CCGs, with invoicing by the end of the financial year.

Action

We held soft market testing events to gain intelligence on the viability of the outcomes required by the GP surgeries and to enthuse the potential marketplace.
We used the Crown Commercial Services RM1045 framework, which gave us a swift effective route to conduct a mini competition with specialist, motivated suppliers. The specification and tailored question bank we created gave suppliers clear understanding of our requirements and flexibility to create a solution to meet the GP surgeries’ needs.

Impact

The result was strong interest from the marketplace and one solution from Maintel Europe achieved an exceptionally high evaluation score. As well as proposing an excellent technical solution and enhanced warranty, Maintel Europe partnered with X-on, who integrated their ‘Surgery Connect’ into the offering.

The commercial solution achieved the project’s aspirations and came in significantly below project budget, offering excellent value for money.

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Supporting a hospital trust to transition systems in record time

North Staffordshire Combined Healthcare NHS Trust (NSCHT) needed to transition systems. The upgrade was essential for the client’s financial reporting but it needed to be implemented within three months. Most organisations take 12 months to successfully implement an upgrade of this nature.

Action

Our Digital Innovation Unit provided technical consultancy and development support to this project, enhancing and adapting existing finance tools to ensure the client experienced a smooth transition during the upgrade. The unit also assisted in the development of the new reporting structure following the recent restructuring.
Our Finance Team worked long hours to ensure the system went live on time, as planned.

Impact

Our specialists ensured a smooth transition to an upgraded system for North Staffordshire Healthcare NHS Trust within the tight timeframe.

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Innovative procurement of pain management services

West Lancashire had no specialist community-based chronic pain service; patients were being managed between GPs and hospitals. An attempt to procure a service using a traditional OJEU (Official Journal of the European Union) approach and fixed specification had failed even though the marketplace showed interest.

West Lancashire Clinical Commissioning Group (WLCCG) worked with our Procurement Team to procure a service that would:

* meet patients’ holistic needs through a personalised care plan, using new technology to enable self-management and non-medical interventions
* end unnecessary referrals to secondary care
* reduce prescription of pain medication.

Action

We worked with WLCCG to develop an OJEU Innovation Partnership procurement under the Light Touch Regime. We defined the problem and gave bidders freedom to create a solution. They were able to collaborate with commissioners throughout the process so they could fully understand patient needs and produce a tailored solution.
Our approach included:

Soft market testing event:
* Stimulated interest
* Enabled potential bidders to meet Voluntary, Community, Faith and Social Enterprise (VCF&SE) organisations who could help them design their solution

Workshop sessions:
* Bidders and VCF&SE organisations contributed to the vision of iHELP and helped shape the procurement process

Design phase:
* Bidders had access to the project team, CCG specialists, local GPs, patient engagement groups and third sector providers to help shape their solution

Two-year pilot phase tender:
* Included focus on increasing social value

Negotiation workshops:
* Helped shape a solution that was affordable, able to deliver savings in line with the WLCCG’s aims, and able to furnish the provider with adequate return.

Impact

The Innovation Partnership was such a strong enabler for WLCCG to be bold in seeking creative solutions that it has begun another procurement using it (the first NHS commissioner to attempt a second).

iHELP (Integrated, Holistic, Empowering, Learning Programme), the new service resulting from the procurement process, offers specialist care with a holistic approach to meet patients’ pain management needs. The innovative solution:

* facilitates safe and speedy access to relevant information
* improves care, outcomes and experience
* streamlines the use of resources
* realises cost savings.

The successful provider, Inhealth Pain Management Solutions, exceeded expectations with their solution. The pilot contract commenced 1 April 2019 for two years, with provision for a further five years following review.

RightCare indicators suggest WLCCG could save on chronic pain spend whilst also improving care and the health of current and future patients. Around £600,000 of net savings are predicted for a full year.

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Delivering personal health budgets for children and young people with complex health needs in Leicestershire

Clinical commissioning groups (CCGs) in Leicester, Leicestershire and Rutland (LLR) wanted to improve the wellbeing of children with continuing care needs (complex health) by making personal health budgets (PHBs) the default offer for all those eligible children and young people (CYP) who require home care packages.

PHBs enable people with long-term conditions and disabilities (and their carers) to have greater choice, flexibility and control over the healthcare and support they receive. A Department of Health pilot found PHBs had a positive impact on care-related quality of life and wellbeing, and were cost-effective.

In April 2016 there was one PHB for children and young people in LLR. MLCSU’s LLR Children’s Continuing Care Team then began work to achieve the goal of moving all CYP historical and new cases eligible for homecare packages over to a PHB, through development of local processes and policy.

Action

Firstly, the team reviewed the process for obtaining funding for a complex care package. Barriers to introducing PHBs as a default offer were overcome with support from the CCGs to devise a new policy, in-depth discussions with the local authorities regarding updating their practices, and good working relationships with providers aided by regular update meetings.

A key step was taking the resource allocation system (RAS) tool from paper-based to online and combining it with the decision support tool (DST). The team used a live system called FACE (Functional Analysis of Care Environments) to determine the PHB.

Impact

PHBs are now the default offer for all eligible children in LLR who have home care packages. The biggest value lies in making PHBs more easily available to eligible children so they and their families have greater choice, flexibility and control over their care; which follows through during the transition period into adulthood.

The in-patient hospital experience is enhanced because locally it is agreed that the care package follows the child into the hospital setting. Accessibility to a PHB could assist in reducing admissions, by altering the provision at home to meet the needs of the child during times of illness.

As a result of being the first children’s CC team to have 100 per cent of eligible cases on a PHB (for those who have a home care package), NHSE asked them to share knowledge and best practice to other teams across the country. So far, they have provided training at an NHSE study day and on a webinar. They have also directly helped teams in other CCG areas, receiving great feedback.

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Creating a cutting-edge website for an innovative primary care organisation

The nation’s first GP super-partnership, The Modality Partnership is a single GP practice that operates nationally. It had an established web presence, but due to rapid expansion across myriad GP practices and a wide area (including Birmingham, Sandwell, Walsall, Hull, Airedale, Wharfedale, Craven and East Surrey) the website had become unfit for purpose.

The Partnership required a scalable, intelligent website it could amend, enhance and develop as it recruited further GP practices, incorporating their websites. The website also had to be easily navigable for users from around the country looking for information regarding their locality specifically.

Action

We created a scalable, modular website that used geolocation technology to provide an intuitive, aesthetic experience for all users. We developed an automated user journey for staff, patients and prospective patients, but also provided the option for easy manual navigation.

The bespoke content management system we built provided GP practices with their own templated area of the wider Modality website. Our modular solution gave practices all the facets of a basic, standalone website. With a short training session, a new GP practice could develop their area. This CMS linked through to the geolocation technology, and the interactive map of the country we built for people interested in areas outside of their current location, to ensure that the information on each GP practice sat within the correct portion of the website.

Outcome

Our solution delivered a cutting-edge, innovative website https://modalitypartnership.nhs.uk/ that acted as an enabler for The Modality Partnership as it continued to deliver innovation in healthcare by expanding its nationwide operation.

We created a bespoke digital tool that works with the current Modality operating model and can expand and flex to meet the requirements of an organisation at the forefront of NHS innovation.

The website works across multiple devices with an ‘app’-like aesthetic.

Recognising the user’s location, the website automatically directs them to information regarding their nearest GP practices. From here, they can navigate to their own GP practice page – if they are already a member of a Modality GP practice – or they can investigate their local practices and request to join. This approach helped Modality mobilise within new areas with ease, making them accessible to established patients as well as making it easy for new patients to enquire or join.

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Ensuring safety of residents during a nursing home crisis

A nursing home in Southport was closing down following a high profile criminal investigation. Conviction of the owner left the residents in a very vulnerable position; for many it had been their home for a long time. They all had to leave as a matter of urgency. Most of the home’s registered general nurses (RGNs) had left at this stage and several residents were still there awaiting new placements. There was a period when no nursing home RGNs were available for duty.

Action

Our Merseyside CHC team worked with Southport and Formby CCG’s chief nurse in supporting residents of the nursing home and their families during this difficult time. While suitable nursing home placements were found, our nursing staff went in to the home to perform and oversee nursing duties in order to keep all of the remaining vulnerable residents safe, as agreed with the CCG. Our staff ensured the remaining patients had their dressings applied and ensured medication was given out. They often willingly stayed beyond their normal work hours to maintain residents’ safety and to ensure continuity until their placement was sourced. They assisted in the transfer to other nursing homes to reduce the trauma and impact on the residents.

Impact

Our team ensured the residents’ care was not compromised and helped all to find alternative suitable accommodation.

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Profiling populations and integrating data to improve care in Leicester, Leicestershire and Rutland

Background

MLCSU’s Business Intelligence (BI) Team is involved in several exciting developments across the Leicester, Leicestershire and Rutland (LLR) STP area, known locally as ‘Better Care Together’.

LLR is one of the first areas in the country to have received approval from the Independent Group Advising on the Release of Data (IGARD) to link key datasets across the health and care system, including Secondary Uses Service (SUS), adult social care, emergency services and community health services.

We are driving forward work on population profiling and risk stratification. Alongside this, we are warehousing data as part of LLR’s data integration project.

Action

Using the Johns Hopkins ACG Risk Stratification tool, we are identifying cohorts of people for targeted intervention. We have produced analysis which demonstrates how service use and cost is driven by a small proportion of the population, reveals the prevalence of multi-morbidity across different areas and demonstrates how multi-morbidity, rather than ageing, drives costs.

We are carrying out data warehousing, working in close partnership with Leicestershire County Council to develop appropriate analytic products for all partner organisations. A phased approach will see SUS data linked to adult social care data initially using an open pseudonymiser to test feasibility and scoping for the rest of the project.

Impact

The population profiling and risk stratification work is being used to inform a range of activity across the STP, from public health planning, to identification of cohorts for integrated locality teams.

The data integration project will enable partners to track individual activity through the health and social care system and robustly evaluate different approaches to providing personalised care effectively and efficiently.

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System-wide bariatrics commissioning – North Region

The Tier 4 collaboratively commissioned Bariatric Service contract for the North Region was due to cease in March 2019. MLCSU services developed a paper proposing a way to secure a long-term provider of services for the Lancashire, South Cumbria, North Cumbria and Cheshire and Merseyside areas. During the engagement process with commissioners the incumbent Tier 4 Bariatric Service provider escalated a crisis point whereby a service notice of suspension was served on all referrals from these areas. 

Action

We provided support services across the North Region:

* High quality programme management and commissioning expertise and leadership to ‘caretake’ the collaborative commissioning situation
* Specialist expertise in programme management, contract management, procurement and business intelligence, supporting NHSE/commissioner assurance on patient RTT pathway and 52-week breach positions
* A robust patient transfer solution from incumbent provider to interim utilising a high quality referral management centre (RMC)
* Identification, engagement, due diligence activities and negotiation with potential interim providers in both the public and private sector
* Preparation of activities to run a robust procurement for Tier 4 and explore an innovative procurement process for interfacing Tier 3 provision.

Impact

The impact of the MLCSU team in the commissioning of collaborative Tier 4 Bariatric services was:

* The establishment of interim providers in response to a crisis situation with a commissioned incumbent provider, meaning that patients could continue their pathway and mitigating the impact of long patient waits (200+ patients received their surgery)
* The commissioning of a range of high quality, best value interim providers to manage referrals from the North Region (LSC/C&M)- delivering services closer to home for our population
* System pathway mapping and provider market engagement delivering enhanced commissioner understanding of currently commissioned weight management pathways and services
* Effective provider management of 52 week wait to ensure patient pathway progression and provide regulatory assurance and commissioner assurance on delivery
* Demonstration of the capability of MLCSU to act in the role of strategic partner within the Lancashire and South Cumbria Integrated Care System.

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Integrating data analytics to build a profile of over 65s in Walsall leads to improved patient care and significant savings

The number of people with more than one long-term condition (LTC) is rising as the population ages. This presents a challenge for healthcare providers and commissioners. Currently, LTCs and their comorbidities are not routinely analysed together to understand the full patient, cohort or pathway picture. This means patients with disease complexity are not analysed holistically in their comorbid chronic disease cohorts. Additionally, metrics used by commissioner clinical and financial leads are not always mutually understandable.

Walsall Clinical Commissioning Group (CCG) wanted to build a profile of their older person population to inform planning discussions and commissioning actions.

Action

Our Business Intelligence (BI) Team worked with the CCG using DOC, our disease origins and comorbidity tool for triangulating population health analytics. Accredited by NHS RightCare, DOC enables mutual understanding by analysing ‘whole patients’ with all their diseases, socioeconomic status, and demographics (health status influencers), as opposed to just costs and performance currencies which ‘fragment’ the person and their co- and multi-morbid LTCs.

Using DOC, evidence analysis, and input from MLCSU’s Medicines Management and Optimisation (MMO) Team, we combined RightCare, Fusion48, population and contract data to create a CCG-wide picture of older people’s health status, costs and outcomes.

We held two workshops in Walsall. Medical and nursing staff from primary, acute and community care, and leads from public health, commissioning and finance participated. Feedback regarding BI Team input was all positive.

Impact

Our work to build a profile of the older person population in Walsall CCG was the first time such an integrated analysis had been used to inform planning discussions and commissioning actions. This clinical analysis highlighted issues that financial analysis had failed to reveal. It led to reconfiguration of the acute setting’s clinical workforce and bed base, resulting in expected savings in excess of £1million over one financial year, fewer admissions and sustainable reduction in length of stay.

From the strategic perspective to the local picture, the CCG and their partners could see the specific challenges facing their older populations. They gained:

* insight into older people’s use of acute, mental health and community care services at a ‘whole person’ level
* MMO additions to the SPACE care home quality programme
* wider understanding of the evidenced effects of the innovative admission avoidance pathway
* better understanding of the multiple falls services and activity within the CCG area, revealing the acute unit had two frailty pathways and settings, creating confusion * regarding patient care, payments and access.

With new insight into activity patterns, costs, healthcare status and experience of their frail cohorts, the CCG worked with partners to:

* further investigate the dual frailty acute pathways (that created two costs for each patient during an admission), activity, costs and outcomes
* embed the START / STOPP medicine reviews’ toolkit in primary and care home settings.

Our input also informed the CCG’s analysis of RightCare opportunities, RightCare delivery plan logic model and plans for 2019-20, and input into the Black Country Sustainability and Transformation Partnership Frailty Group as a key part of its reporting support.

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Efficiency review of the Revalidation Service

NHS England (NHSE) wanted to find opportunities to provide more effective and efficient ways of delivering the Revalidation Service – Payment of Appraiser process. MLCSU, NEL, AGEM and NECS CSUs worked collaboratively with NHSE on an options appraisal and implementation plan.

Action

The CSUs worked collaboratively with NHSE to find opportunities to provide more effective and efficient ways of delivering the service. The review highlighted:

* substantial variation in the process between all of the local and regional offices
* two teams outsource to HEE, 13 use PO, four use non-PO, five use NHAIS, five use the RMS template, 11 send invoices sent direct to SBS, six submit direct to the team
* invoicing frequency varies
* trade shift usage varies
* substantial workload pressures
* every query about payment from an appraiser requires input from the local office
* use of a variable number of FTE, dependent on the structure chosen in local office
* average invoice is between £700-800, £23million per annum, 46,000 doctors, 3,000 appraisers.

Following an options appraisal, NECS CSU delivered a three-day workshop with NHSE colleagues to process map and understand the current and future state of the service.

Impact

The revised and automated process is enabling NHSE to free up resource in the move to STPs and support administration work required for the substantial uplift in revalidation recommendations commencing from March 2018.

The review led to creation of a process which will result in:

* one consistent process for the payment of appraisal work undertaken by GP appraisers
* no POs – no invoices – no receipting, saving substantial time and effort in the local offices managing and reconciling invoicing
* removal of variation between the local offices, reducing confusion for appraisers
* speeding up of the production of reports to understand payment and pension position for local offices
* reduced accrual amounts for local offices because payment does not need to wait for an invoice
* reliable indication to appraisers of payments paid and outstanding, removing queries that had to be handled by the local office

RMS developments included:

* revised email templates
* holding supplier information (not bank details), holding and processing pension information
* holding history about payments made by the team
* reporting on payments
* consultancy agreements moving online – one click acceptance by the appraiser.

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Improving patient safety with face-to-face medication reviews at a Cheshire GP practice

Western Avenue Medical Centre in Chester, with a patient population of just under 4,000, was keen to increase patient safety by conducting face-to-face medication reviews with patients.

Action

Our Medicines Management and Optimisation (MMO) Team deployed a clinical pharmacist (non-prescribing as requested) to work for a total of 25 four-hour sessions. The pharmacist conducted 30-minute face-to-face medication reviews targeting patients with 10 or more medications on their record who had not attended for an annual review within the last six months. Patients were asked to bring along all their medications to the review appointment.

The review process involved:

* educating patients about what each medication was for
* assessing current compliance and concordance with dosage instructions
* aligning medication
* reviewing necessary monitoring requirements
* assessing other medication purchased over-the-counter (OTC)
* counselling patients about possible medication changes (for example dose reductions)
* referring patients to other services (for example counsellors or smoking cessation).

The pharmacist worked closely with the GPs, offering prescribing advice to ensure patients’ medication was optimised. Trends observed were discussed with the practice as areas for further audit to either implement procedures or raise awareness with all clinicians.

Impact

The medication reviews carried out by our pharmacist enabled the practice to make optimum use of clinician time, improved patient experience of healthcare and improved the quality and safety of prescribing.
 
From 80 face-to-face reviews there were a total of 241 separate quality interventions and an additional 33 cost-saving interventions saving £802.45.
 
Several practice medication audits were developed as a result of the pharmacist interventions, including:

* review of rheumatoid arthritis patients and QRISK
* eGFR<30ml/min and dose of simvastatin * denosumab monitoring requirements for prescribing * clopidogrel and aspirin co-prescribing * consideration about how best to inform patients prescribed DAMN drugs (diuretics/ACEI/ARBSs/Metformin/NSAIDs) about sick day rules and risks of acute kidney injury * targeting and assessing all patients for a QRISK2 assessment following updated NICE guidance for lipid modification.   The individual patient reviews raised awareness amongst the GPs of the need to consider dose reduction of long term PPIs and also opiates when patients present for an appointment, and to consider drug monitoring if OTC medication, for example NSAIDs and U&Es, is taken regularly.   Clinically significant individual interventions included: * a breast feeding mother prescribed fluoxetine * mirabegron in an undiagnosed hypertensive patient * follow-up blood tests for a bariatric surgery patient who hadn’t had one * nicorandil in a patient with several severe mouth ulcers * dose of citalopram/escitalopram in the elderly * metoclopramide restrictions for the number of days of treatment.

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Reviewing continuing healthcare cases for QIPP delivery in Morecambe Bay

Morecambe Bay Clinical Commissioning Group (CCG) wanted to review continuing healthcare (CHC) cases to help meet its QIPP target of £1m for 2018/19. With demand on CHC services growing and the priority being patient safety and packages of care for supporting timely discharge from acute trusts, little time was left for step-down reviews.
The CCG required a trained nurse to review high priority CHC cases to ensure:

* quality of care
* safe placement of vulnerable patients
* care packages meet patient needs
* appropriate spending of public funds, in line with National Framework.

Action

* Focus on area of greatest saving opportunity: overdue three-month reviews of patients discharged from hospital with CHC funding in place
* Two experienced CHC nurses recruited from local agencies, employed by MLCSU and integrated with the CHC team
* One nurse covered Lancashire North, the other South Lakes, for six weeks
* Data extracted from the two case management systems to identify patients for review
* Nurses scheduled reviews and tracked patients through the process, with multidisciplinary team (MDT) meetings and decision-making panels as required
* Monitoring arrangements developed for tracking numbers and outcomes i.e. package costs before and after review, along with other benefits for patients and the CCG.

Impact

* Total savings of £425,888 demonstrated a near 12:1 return on the investment of £36,000
* All newly eligible CHC patients recently discharged from hospital were reviewed, ensuring packages of care remained appropriate and necessary
* 24 (45 per cent) of the 53 reviews undertaken resulted in patients stepping off CHC funding or stepping down to funded nursing care (FNC)  
* The additional resource provided welcome support to the CHC teams in the two CCG localities
* Findings confirmed that the correct cohort was selected for review to maximise benefits for both patients and the CCG. Patients recently discharged from hospital with CHC funding in place, often do settle or improve and nursing care needs reduce.

Funding enabled targeted resource only for six weeks – additional resource could enable these priority reviews to be delivered on time on an ongoing basis, potentially realising greater savings.

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Supporting QIPP delivery in North Cumbria

As part of the Phase 4 National QIPP Support Programme, Midlands and Lancashire Commissioning Support Unit (CSU) and North of England CSU were commissioned by NHS England (NHSE) to provide QIPP support to North Cumbria Clinical Commissioning Group (CCG).

The CSUs worked collaboratively to develop a system-wide QIPP implementation plan and to consider, scope and recommend opportunities to stretch existing schemes or identify new opportunities to optimise in-year delivery.

Action The CSUs started by reviewing the CCG’s Efficiency and QIPP Plan and associated documentation to establish a working knowledge of the specific plans and schemes and to highlight any issues, gaps or concerns to the CCG.

The review highlighted gaps in the governance process and the level of alignment of the system-wide PMO with the QIPP PMO, raising the level of risk against delivery and potentially increasing the existing financial gap of circa £940k to meet the £14m QIPP target.

Through a joint approach, the CSUs and the CCG agreed these areas of focus:

* all plans and business cases to be completed and taken through a single gateway process for scrutiny and formal sign-off
* all scheme implementation and delivery plans to be completed with clear measures and a phasing across the financial year
* a consistent set of RAG rating principles and risk adjustment percentages to be developed and agreed with a single reporting tool that captures the entire plan and delivery
* a ‘pipeline’ of scheme ideas to be developed as a rolling programme and a range of solutions to be provided to support in-year mitigation against identified slippage.

Impact

Through joint working the two teams from the CSUs were able to undertake an efficient review utilising skills and knowledge aligned to different elements of the project, to build rapport with the CCG’s senior management team providing confidence in the recommendations. These were supported by evidence and practical solutions that the CCG was able to adopt and implement in a timely manner to gain optimum benefit in-year.

The outputs from the project supported:

* improvements in project management and organisational governance
* robust reporting
* the system integration programme
* development of a wider programme of referral management and triage that supports the system-wide outpatient reduction model
* management of demand
* primary care development of best practice in demand management, peer support and clinical variation reduction
* progress in delivery of the CCG control total and mitigation to meet the identified gap of £940k.

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Analysing data to improve services in North Staffordshire and Stoke-on-Trent

We reviewed and interpreted the RightCare data for Stoke-on-Trent and North Staffordshire Clinical Commissioning Groups (CCGs) to identify opportunities for service improvements and savings.

Action
Our Business Intelligence experts carried out:

* Deep dives into admissions of children and over 75s indicated in Commissioning for Value (CfV) packs
* Analysis of Secondary Uses Service (SUS) data at Spell Programme Budget level to show proportion of activity commissioned by the CCGs and by specialised services
* Assessment of impact of incorrect provider submission of SUS data locally on the national RightCare data (showing the opportunity presented was overstated)
* Development of summaries by Spell programme budget for elective and non-elective activity to show breakdowns by key SUS fields to enable commissioners to identify and focus on problem areas
* Development of a RightCare Tool to allow the CCGs to compare cost and activity against other CCGs supported by MLCSU and see trends over time.

We put the CCGs in touch with other CCGs across our patch to find out how they commissioned services in cases where our benchmarking indicated they were performing better.

Impact

The deep dives revealed that the CCGs were outliers against peers for almost all under 5s indicators. Our work indicated that pathways were different from those in other areas and that children attending the paediatric A&E department tended to be classed as emergency admissions whilst A&E rates for children were low.

This led to discussions with the provider and ultimately commissioning of a new pathway for children’s urgent care services. Since the service went live in December 2016 there has been a 25 per cent reduction in paediatric admissions and savings of £1.3m per annum.

All our findings fed into the RightCare Working Group and helped identify priority areas for pathway redesign and improvement to services in key areas.
The CCGs have run a Falls Redesign event attended by commissioners, providers, ambulance services, and Business Intelligence, Respiratory and Diabetes workshops, all of which utilised the analysis we provided.

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MLCSU People Services are celebrating a great Trac record

MLCSU’s recruitment process was clunky and we felt we could be giving a better first impression of our organisation to potential new recruits. We decided to replace the manual system with a computerised one.

Action

We introduced a new computerised recruitment system, TRAC. Its features include a centralised system for communicating with candidates, automated chaser emails, one-click posting to NHS Jobs, centralised tracking of vacancy progress and automatic document creation.

Trac supports hiring managers to use the key elements of the person specification when shortlisting to match the right person with the right job skills, experience and knowledge.

We provided our 35 CCG customers with initial training and support, and supplement this as required. Our Learning and Development Team worked closely with our People Team to update and create new e-learning courses for recruitment and selection. A separate module was devised to cover identity checking following a need for training in this being identified by the NHS Counter Fraud Agency.

Impact

The system is now used for MLCSU’s own recruitment needs and also by 35 CCG customers. In the first five months following its launch, Trac processed 5,706 applications across 543 vacancies, with 179 offers made and 128 candidates starting in post.

Within three months of using the new system, our ‘time to hire’ (from vacancy authorisation to start date) target of 57 days (excluding notice period) had already been surpassed with an average of 44.3 days (excluding notice period). We did not have access to such rich data before Trac, but an estimated average time to hire was 75.4 days for MLCSU and 83.7 days for our CCG customers.

The recruitment team is also meeting or exceeding targets for the time taken by other aspects of the process, most notably from conditional offer to unconditional offer (15.3 days ahead of target 27.0 days).

The new system enables comprehensive reporting on equal opportunities and analysis of drop-out rates and the source of applications to inform any bespoke marketing campaigns. It gives candidates a good first impression of the recruiting organisation.

Vacancies are live-tracked and recruiting managers can easily view progress. Communications are clear throughout the process, with template messages and automated reminders making it less intensive. Recruitment team members now have more time to use their expertise to deliver training and other more proactive services.

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Managing change in planned care across Staffordshire

Planned care is a top priority for Staffordshire and Stoke-on-Trent Sustainability and Transformation Partnership (STP). The current acute cost is £348million and has been growing by 14 per cent over the last four years, well above the rate of population increase. National standards are not being met and backlogs are increasing. The target is to improve quality and patient experience in addition to delivering savings of £14million by 2020/21.

Action

* Planned care workstream set up with clinical and management representatives from commissioner and provider organisations, and other major players
* National and local data analysed and ophthalmology and musculoskeletal (MSK) conditions prioritised as the two highest spend areas where changes could most easily be made
* Engagement events held with wide range of stakeholders, and guest speakers from NHS England universities and other trusts
* Seven task and finish groups created, focusing on specific ophthalmology and MSK conditions
* Site visits by the groups to map current process and then use improvement techniques, such as the 5 whys, to determine why activities were not adding value and create action plans.

Impact

* Predicted to save between £1.9million and £4.4million per annum across seven pathways*
* Data sharing at a system level led to greater understanding and changes in practice
* Standard service specifications introduced
* Referrals process improved and numbers reduced
* Theatre productivity improved
* Unnecessary scanning and injections eliminated
* Commissioning around pain management improved
* Follow-ups now being carried out in the community, closer to patients’ homes.

(*the lower figure of £1.9m will be saved if NHS volumes remain constant following implementation of the new pathways. The higher figure of £4.4m illustrates the savings available if the created capacity is used to repatriate the volumes going to the private sector.)

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Supporting NHS England’s consultation on prescribing of low value medicines

NHS England (NHSE) wanted public and patient views and opinions on proposals to limit the prescribing of 18 products considered relatively ineffective, unnecessary, inappropriate or unsafe for routine prescription in NHS primary care.

Action

MLCSU’s communications and engagement team and medicines management and optimisation (MMO) team worked together to conduct NHSE’s low value medicines consultation in autumn 2017 and lead the analysis and reporting of consultation findings.

NHSE received 5544 responses through the online consultation survey, and a further 195 written submissions by post or email. In addition, we held eight webinars for stakeholders, two face-to-face public and patient stakeholder events in London and Leeds, and three individual meetings with key stakeholder groups including industry, pain management and mental health.

We handled all the responses, via the different channels. All open responses were read and coded against themes. Answers to closed questions were plotted in graphs and charts. Specialist letters were summarised. We compiled a comprehensive consultation report.

Impact

The responses to the consultation were presented to the NHS England board in a paper by Sir Bruce Keogh. As a result, the prescribing of some inappropriate or ineffective treatments was stopped, benefitting patients and reducing costs. The responses led to NHS England altering some of their proposals. For example, for Liothyronine the joint clinical working group recommended its prescribing for any new patient should be initiated by a consultant endocrinologist in the NHS, and that de-prescribing in ‘all’ patients would not be appropriate, as there were recognised exceptions. The recommendation was, therefore, changed to advise prescribers to de-prescribe in all appropriate patients.

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Dynamic purchasing of continuing healthcare in Staffordshire

Continuing Healthcare (CHC) is a growth area in the NHS. In Staffordshire it increased by 13 per cent from 2013-16. Procurement of CHC has historically been made by spot purchasing with little contractual management, limited qualitative measurement and no control over price.

Action

We worked with all six CCGs in Staffordshire to introduce the adam electronic dynamic purchasing system (DPS) to replace spot purchasing of care home placements. The system went live in February 2016 and was the first DPS to be implemented in the field of CHC. It is based on an open framework/fair market approach. Only suppliers that have passed both qualitative and financial criteria are able to bid for new placements. 
The system includes:

* tools for contract management
* automated service agreements and billing
* one weekly consolidated invoice per CCG, as opposed to one invoice per patient.

Impact

By streamlining the process, adam has given clinicians more time to spend with patients. The system provides more assurance regarding quality, and patients and their families benefit from the process being quicker. For commissioners, there is improved market management and development, while providers benefit from fair market opportunity, clarity of requirements, transparency and automated payments.

By January 2018:

* more than 1900 patients had been placed via the system
* time taken to procure a CHC bed had halved
* 208 providers were enrolled on the system – delivering a more sustainable and robust marketplace
* on a like-for-like basis prices were reduced by seven per cent year on year
* quality rating of placements was 90 per cent (deficiencies in quality reduce the likelihood of that provider winning business)
* contracts were in place for every enrolled provider
* significant efficiency savings had been made, for example streamlined invoicing meant two fewer full-time finance posts were required.

Following the success of adam in Staffordshire, we have worked with CCGs to introduce it in Merseyside (May 2017) and Cheshire (August 2017). 

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Introduction: Business support

You may need expert, experienced and scalable support to deliver common business processes needed by large and complex organisations: recruitment, communications, invoice payments, estates, equality and inclusion and others.

We deliver a wide range of support that enables you to plan, decide and monitor better healthcare. We provide at-scale, resilient, locally responsive and locally accountable solutions for the entire system. We can manage the day-to-day decisions that your organisations need, blending a mix of centralised and place-based support.

Read more about our scalable and innovative business support:

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Introduction: Funded care

As the largest provider of funded care services in the UK, we offer tailored solutions matched to relevant frameworks and legislation. Completing over 8,000 CHC assessments a year, we use dynamic web-based tools to ensure compliant, efficient and high-quality assessment and procurement. Our experience and systems enable us to deliver better quality of care for patients.

Find out more about how we can help:

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Introduction: Consultancy

Integrating organisations, changing accountabilities and transforming health and social care requires experienced NHS business improvement and transformational expertise ready to help.

Our expert consultants and broader supply chain partners support improvement and transformation programmes across analysis, review, evaluation, improvement, clinical redesign, business case development, economics, research and data disciplines. We work with you to research and diagnose the challenges, then develop priorities to tackle them.

Find out more about how we can help:

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Introduction: Efficiency

Health systems need to deliver cost savings by centralising back-office functions and sharing transactional approaches across the system.

We understand the challenges of centralising back-office functions and the need to bring down system costs. We work with you to redesign processes and realise efficiency savings. As a partner that’s an independent part of the system, we are unbiased, and we have a proven record in providing economies of scale in continuing healthcare and medicines optimisation.

Find out more about how we can help:

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Introduction: Digital Transformation

You may need cutting edge digital infrastructure and strategies to deliver care remotely and to blend ICS data to create actionable intelligence on citizens’ health.

We develop strategies for digital enablement deriving new benefits from modern technologies. We identify digital tools which allow you to unlock optimal value ensuring that your investment delivers real benefit and the required transformation. We support you across the whole lifecycle of technology change providing a range of tailored services.

Find out more about how we can help:

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Introduction: Planning & Modelling

Integrated care systems will need to apply intelligence-led understanding of the health of their population to redesign care and improve patient and financial outcomes.

We provide expert analytical advice and support, underpinned by optimal data management, fit for purpose and strategically-placed insight tools, and population health management (PHM) capability. We assess and model evidence-based options and ensure that implementation is well designed and well supported.

Find out more about how we can help:

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Introduction: System Design

Successful system integration needs staff and leaders to build new relationships and working processes to deliver and sustain integrated care across the system.

We provide organisational development support to build collaborative ways of working and address the challenges of becoming an integrated system. We work with you to design strategies for change and establish developing ICSs’ governance, operating models and system-wide clinical strategies. Our experience working at scale serves as a model for building a resilient and flexible system.

Find out more about how we can help:

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Developing management and leadership skills with a focus on compassion

Background

South Sefton and Southport and Formby CCGs requested MLCSU’s Organisational Development (OD) services to improve leadership and management skills within their organisations. The aim was to provide critical understanding of theory and practical application of key aspects of being a manager and a leader, focusing on compassion, staff wellbeing, motivation, achieving results and managing people remotely.

Action

We created a tailored management development programme of training, designed to support the adoption of best practices in managing and leading others. There was a great emphasis on soft skills, such as communication and empathy, which enable better teamwork and more progressive relationships with the people they manage.
The programme was delivered as a virtual package of six web-based sessions covering:

* Management and leadership – motivate and engage your staff
* Effective communication and difficult conversations
* New starters induction, staff development and coaching
* Performance management
* HR policy overview
* Resilience and wellbeing.

All training sessions were delivered jointly by OD and HR experts, to ensure balance between legal framework and soft skills, required to build strong and high-performing teams.

Impact

The management development programme received overwhelming positive feedback from participants and the CCG’s senior leadership team.

All delegates agreed that the structure, content and delivery of the programme were excellent. The implementation of the programme and the training of all managers resulted in:

* Creating a culture of compassioned leadership, and highly-engaged and motivated staff
* An understanding of work pressures so that those can be managed effectively
* Better communication and engagement at team level
* Focus on strategic goals, objectives and benefits, ensuring they are clear and optimised
* Developing more resilient leaders capable to manage change and uncertainty
* Equipping all managers with the skills and knowledge to manage in a virtual environment.