Month: January 2022

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Improving health and wellbeing for NHS workers

We developed resources and videos and provided expert advice and evaluation to help NHS England and Improvement gather, develop and outline a wide range of wellbeing support options available to NHS employees.

Background
NHS England and Improvement (NHSEI) aims to create cultures of wellbeing across the NHS, where colleagues feel looked after and cared for.

NHSEI is committed to developing a comprehensive package of emotional, psychological and practical health and wellbeing (HWB) support for NHS staff. Following a request for NHS organisations to support and contribute to its HWB agenda, the Midlands and Lancashire Commissioning Support Unit (MLCSU) offered its services.

Action
MLCSU teams supported NHSEI with a number of different workstreams on the HWB project:

* Scoping, planning producing and editing resources for the NHS People website
* Evaluation advice and support, including producing an evaluation report
* Creation of promotional materials for wide dissemination
* Project management support.

Impact

We developed resources and videos to explain the role of the Wellbeing Guardian liaising with NHSEI leads and subject experts. Our Wellbeing Guardian videos are currently being used on the NHS People website to offer further information for anyone interested in taking up the role and support for those already in post.

We developed leadership resources around stress and burnout for the Executive Suite of the NHS People website, carrying out evidence research and liaising with NHSEI to ensure that a writing style was used which matched the rest of their website content.

We provided expert advice to help the national programme team to develop an evaluation framework for the Enhanced Occupational Health & Wellbeing programme. This included developing a logic model and theory of change with the national team and local evaluation leads. Local projects were developing their own evaluations and we provided advice to some of them to develop their plans. We also wrote an interim evaluation report for the Enhanced Occupational Health & Wellbeing programme.

We produced a comprehensive and accessible brochure outlining the wide range of wellbeing support options available to NHS employees from both inside the health service and from external sources.

Adam J Turner, Improving Health and Wellbeing Lead at NHSEI, said:

“Amazing, and thank you so much again for your support. The team have seamlessly integrated into an extension of our team, and we couldn’t have hoped for better! Thank you.”

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Supporting redesign of acute services

Our Transformation Unit helped develop a new model of care for acute services at a health and social care partnership alliance.

Background
Cheshire East Partnership is an alliance of health and social care partners (two acute trusts, commissioners, community service providers, one mental health provider, local authority and primary care), that are working together to improve the health and wellbeing of the population of Cheshire East Place (approximate population of 378,000)​.

Cheshire East Place is facing a range of challenges in respect of delivering sustainable health and care services. Key issues faced by acute providers include increasing demand from an older and frailer population, falling demand for some services, financial challenges, workforce challenges and some less resilient services.

Cheshire East Place needed to develop a new model of care for acute services that was aligned with the process for development of the integrated care partnership and redesign of integrated community services.

MLCSU’s Transformation Unit was commissioned to support Cheshire East Place with the redesign of acute services across two acute trusts to meet the needs of the Cheshire East population.

Action
This programme of work was delivered under the backdrop of the COVID-19 pandemic. It required exceptional flexibility and adaptability to deliver a clinical redesign programme with limited capacity from the clinical community. Key deliverables for this programme included: ​

* Confirmation of programme scope – an alignment piece designed to reach agreement between partners about the scope and desired outcomes​
* Decision-making and governance framework to set out the process for approval​
* Data analysis on the current services and population health needs to enable articulation of the Case for Change​
* A clinically-led process of designing a new model of care for acute services ​
* Baseline activity and finance model to inform future options​
* Design of an options development approach ​
* Communications and engagement strategy and support for patient and public engagement​.

Impact

Under challenging circumstances for the clinical community we delivered a co-produced Model of Care that describes acute services within the context of an integrated care model.

Engagement and support from across acute clinical, social care, community and primary care professionals was strong with consensus reached on what future services should look like and what they should collectively strive to achieve in terms of quality, accessibility and sustainability.

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Using automation to cut hospital waiting lists

Fast and efficient waiting list management has never been more important, so we’re pleased to be helping to reduce backlogs and get patients the right support.
Using a combination of automated call (chatbot), risk stratification and artificial intelligence, we help organisations prioritise and clinically validate waiting lists efficiently while maintaining quality of care. This solution saves huge amounts of time and staff resource, reducing hospital costs.
Our successful pilot project with Worcestershire Acute Hospitals NHS Trust quickly cleansed the waiting list, enabling clinicians to prioritise seeing the most in-need patients in the manner those patients preferred.
Approximately 10 per cent of patients either no longer needed to be on the waiting list or wanted to come off it and 68 per cent were happy with a telephone consultation.
We are now piloting the use of artificial intelligence to reduce the amount of clinician time needed to prioritise patients on the cleansed list.
The project is being extended to Wye Valley NHS Trust and East Lancashire Hospitals NHS Trust.
For more information please email mlcsu.partnerships@nhs.net

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Strategic engagement for COVID-19 support programme

We helped deliver the strategic engagement and created opportunities for shared learning in the development of a national programme of Community Champions supporting risk groups with COVID-19.

Background
Midlands and Lancashire Commissioning Support Unit (CSU) and Arden & Gem CSU were commissioned to represent NHS England and Improvement and support the Government’s Community Champions programme.

Senior leads in the communications and engagement collaborative service for the CSUs were appointed to work alongside Public Health England (PHE) and the Ministry of Housing, Communities & Local Government to help deliver the strategic engagement and support the communications on this national programme.

It aims to support people identified to be most at risk from COVID-19 (including those from an ethnic minority background, disabled people and other risk groups) to follow safer behaviours and reduce the impact of the virus on themselves and those around them.

Action
The national programme supported local authorities with:

* activity and interventions to reduce the disproportionate impact of the virus on certain communities
* engagement strategies and outreach work in the most at-risk places, with the most at risk groups
* new and existing networks of grassroots advocates or ‘champions’ from impacted communities
* voluntary and community groups and other national or local actors who specialise in working with communities shown to be most at risk from Covid-19.

Midlands and Lancashire CSU supported the programme by:

* developing an online Future NHS collaboration platform as a resource bank and vehicle for sharing best practice, case studies and events, and to encourage conversations on the discussion forum
* leading the organisation of a programme of webinars to advance learning and share best practice.
* engaging with stakeholders across Whitehall and the NHS and voluntary sector organisations in several forums – supporting the development and promotion of the Community Champions programme
* developing of resources, case studies and cascading of information both ‘up’ and ‘down’.

Impact

The Community Champions workspace created a valuable resource that was both current and iterative, supporting over 240 stakeholders in Government departments, the NHS, PHE, local authorities and the voluntary community. Feedback showed the workspace was helpful in quickly accessing all correct and timely the information and official resources in one place, allowing users to focus on delivery. The discussion forum also provided a useful place for peer engagement and sharing of ideas.

The webinar programme was highly popular, with 99% of eligible local authorities attending a webinar. A further session open to wider stakeholders achieved full capacity. Evaluations showed the webinars were highly valued and well themed to meet participant needs. Workspace members increased by an average of 20 after each webinar, demonstrating their success encouraging people to seek further information.

The national programme is considered by the Government to be a success and is currently under review for development/expansion.

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Supporting development of national digital strategies

Our Transformation Unit was commissioned by NHSX to support in the development of its national digital strategies for ambulance, community, dentistry, optometry and community pharmacy sectors.

Background

There is significant potential for digital technologies to support improvements in care across the whole of the NHS towards the delivery of 21st century world class health care for all patients. This potential could be highest in those sectors which have historically received less digital funding in recent years, namely Pharmacy, Optometry, Dentistry, Ambulance and Community (PODAC) services.

NHSX needed to develop a digital strategy for these five sectors and required an extensive programme of stakeholder engagement to achieve this.

We worked in partnership with Kaleidoscope Health & Care to deliver a full programme of stakeholder engagement across the five sectors to inform development of the NHSX Digital PODAC strategy (2021 – 2026).

Key deliverables were to:

1) develop comprehensive national digital strategies across the five PODAC sectors
2) facilitate the building of social capital between stakeholders for long-term engagement and development.

Action
Our support included:

* delivery of desk-based review of digital developments across the sectors
* wide-ranging engagement activities to seek views and input to identify key needs, priorities and recommendations. Stakeholders were drawn from NHSX, NHS Digital, NHS England and Improvement (NHSEI), staff representative bodies, sector membership organisations, individual practitioners, patients and patient representative bodies, system leads and digital champions
* focused workshops to test and challenge the recommendations and implementation plans
* authorship of the sector strategies, working collaboratively with NHSX PODAC Sector Leads
* support for stakeholder management.

We engaged with over 500 key stakeholders nationally (via one-to-ones or group meetings, bespoke workshops and online feedback) to successfully facilitate the deliverables.

Impact

Our approach ensured that the digital strategy remained closely aligned to the clinical vision for each sector and built relationships with key stakeholders so that they can continue to be involved in planning and implementing the priorities set out in the strategy.

The resulting strategy was endorsed by NHSEI clinical leadership for each sector and the strategy underpinned a case for investment for the programme.

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Supporting infection prevention and control with analytics

We analysed data and provided insight which informed a national programme for improving infection prevention and control about where to focus support to reduce infection levels.

Background

Following the global pandemic of COVID-19, NHS England and Improvement (NHSEI) required analytical support for their infection prevention  and control (IPC) safety support programme. The aim was to support providers in improving infection prevention control mechanisms not just relating to COVID-19 but to include all Health Care Associated Infections (HCAIs).

Action

Support was agreed for eligible trusts struggling with high levels of HCAIs.

The Midlands and Lancashire Commissioning Support Unit provided reporting and analytical support and programme management support. Nationally published and local trust data were used to understand where there may be outliers. Analysis included assessing rates of infection, addressing unwarranted variations and ensuring effective management of local outbreaks to minimise the spread of infections.

A dashboard was created using the Power BI reporting tool to provide evidence and identify key issues and challenges using various data visualisations. Overall there was an emphasis on leadership, safety culture, clinical engagement, governance, continuous improvement and capacity and capability of the IPC team. The dashboard gave insightful information on capacity, capability and ongoing improvements in areas such as staffing levels, levels of infection rates, bed occupancy rates and mortality rates.

Impact

This innovative piece of work has informed the programme about where to focus support to reduce HCAI levels.

In some trusts, as COVID-19 levels took precedence, non-COVID HCAIs steadily rose too. Additional analysis was requested to understand rates of MRSA, MSSA, E.coli, Pseudomonas aeruginosa and Klebsiella species.

The data analysis provided via the dashboard enabled a deep dive into areas of concern. With this evidence, trusts were able to make the necessary improvements across areas such as:

* Workforce activity levels
* Provision and use of personal protective equipment
* Awareness and training in infection control procedures
* Isolation bed capacity.

The dashboard also confirmed a point at which safety support was no longer needed by trusts. This followed a period of sustained improvement rates of HCAIs and  COVID-19 infections and timely identification, management and resolution of any infection outbreaks.

Annemarie Vicary, Programme Director, NHSEI, said: “The dashboard data enabled the programme to review potential hotspots and resource availability with national concern.  

“The demand for data analysis was pressing. Dipika Patel [Senior Analyst at MLCSU] managed to navigate through new ways of working, with individuals who were new in post and a team that was initiated during and in answer to a pandemic. She not only met the brief but went way and beyond the ask. Her ability to showcase her analytical mind was wonderful and enabled a clear picture of IPC concern at organisational, regional and national level.”

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Meeting pandemic demand for oxygen and ventilators

Staff from across the Midlands and Lancashire Commissioning Support Unit was deployed to support a national programme for oxygen, ventilation, medical devices and clinical consumables which ensured that sufficient ventilators were procured at a time of huge global demand and that all patients had access to oxygen when required.

Background
The COVID-19 pandemic led to an urgent requirement to build a national stockpile of ventilators, medical devices and clinical consumables, whilst also ensuring that the oxygen infrastructure in place had the capability and capacity to support the increased demand.

The Covid-19 Oxygen, Ventilation, Medical Devices and Clinical Consumables Programme was established to fulfil this requirement. Led by the Department of Health and Social Care (DHSC), the programme employed the knowledge and skills of staff from a wide range of clinical and non-clinical disciplines across the NHS, Ministry of Defence, Deloitte and PA Consulting. This was a UK-wide programme that worked closely with colleagues in all the Devolved Administrations and Crown Dependencies.

Action
An MLCSU associate director  with specialist procurement expertise joined the cross-government team in the role of Deputy Programme Director for the first six months. He acted as a first point of contact for workstream leads with specific support and input to programme governance, international logistics and UK storage and logistics.

Programme delivery was split into four phases. Members of MLCSU’s Improvement Unit and other teams supported with programme management expertise throughout the phases.

* Phase 1 (March-June 2020) ensured the NHS had sufficient supplies of ventilators, oxygen and consumables to meet Coronavirus demand.
* Phase 2 (June-December 2020) focused on improving the quality and availability of devices, solidifying consumables system and stockpiles, establishing a ‘new normal’, and reducing reliance on complex supply chain systems.
* Phase 3 (January-March 2021) focused on solidifying and maintaining the outcomes of Phases 1 and 2.
* Phase 4 (April-September 2021) focused on transition activities towards medium to long term operational arrangements and the programme closure and transfer into the Medical Technology Directorate of the DHSC.

Impact

For patients

* Due to action taken early in the pandemic, sufficient ventilators were procured at a time of huge global demand, to ensure that all patients had access to one when required.
* Oxygen usage was monitored daily, allowing for interventions to take place as soon as any potential issues were encountered, meaning that all patients had access to oxygen when required.

For staff

* The programme issued detailed guidance on correct use of ventilators and oxygen management via the e-Learning for Health website.

For trusts

* There were clear processes for ordering equipment, and for urgent clinical need cases, deliveries were made within 48 hours.
* Thanks to the support of multi-disciplinary teams, trusts were supported to better manage their oxygen supplies and, where necessary, urgent works were undertaken to upgrade old pipework and install new oxygen tanks.

Robert Moorhead, Deputy Programme Director, Department for Health and Social Care, said: “Thanks to the work of the Programme, no patient in the UK went without oxygen or a ventilator who needed it.” 

In December 2021 the programme won a Civil Service Award recognising excellent collaboration across organisation boundaries. 

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Pandemic effect on a socially deprived UK town

The COVID-19 pandemic has had a direct impact on health and mortality rates, but there is evidence that there are further wide-ranging impacts, both of the pandemic and the measures taken to deal with it, on population health and wellbeing. Understanding this effect is essential in decision making for COVID-19 recovery efforts. A recent paper by the University of Lancaster undertakes a review of the impact of COVID-19 on a specific demographic using health and socioeconomic data.

Data between 2016 and 2021 in the deprived UK coastal town of Fleetwood was analysed looking at pre- and post-COVID-19 patterns in health and social outcomes. Some of the data was originally collected as part of routine clinical care. Primary care data and information about diagnosis and hospital admissions was provided by the Midlands and Lancashire Commissioning Support Unit. We are proud of Alicia Elliott and Margaret Orwin from our Data Quality team and Ross Hughes and Collette Taylor from our Business Intelligence team who worked together with the University of Lancaster and were named as co-authors of the paper.

On the Fylde Coast where Fleetwood is located, our Data Quality team and the Business Intelligence team embedded in Fylde Coast Clinical Commissioning Groups – Blackpool and Fylde & Wyre often work closely together. They have worked on a number of projects that have extended across the integrated care system (ICS). This provides opportunities for collaboration and allows for papers such as this to extract additional insight from existing datasets.

The paper’s results found that: “Initial falls in hospital admissions and diagnoses of conditions in primary care in March 2020 were followed by sustained changes to health service activity for specific diagnostic and demographic groups. Increases in the number of people receiving Universal Credit and children eligible for free school meals appear to be greater for those in the least deprived areas of the town.”

See the full text of the paper “Understanding the impact of the COVID-19 pandemic on a socially deprived UK coastal town: a preliminary exploratory analysis of health and socioeconomic data” for more information and discussion of the results: https://medrxiv.org/cgi/content/short/2021.12.22.21268232v1