Month: August 2022

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Digital support for at-home blood pressure monitoring earns innovation award short-listing

Our work with Cheshire and Merseyside Health and Care Partnership to improve the remote management of patients with uncontrolled hypertension has been short-listed for the Innovate Awards.

NHS Confederation and the Academic Health Science Networks are running the new Innovate Awards to celebrate excellence in innovation in health and care. Our digital transformation programme enabling at-home monitoring of blood pressure to help identify, triage and treat more patients has been short-listed for the Enabling Safer Systems of Care Through Innovation award.

The Digital First Primary Care-funded ‘Hypertension Accelerator’ sites of Liverpool, Cheshire, and Wirral Places have been working collaboratively on the BP@Home approach. Without the digital enablers, patients and practices rely on paper printouts, and average readings need to be calculated manually, increasing workload and scope for error or loss of results.

The digital enablement blueprint developed is the first of its kind to improve remote management of patients in primary care settings. It is being shared via the FutureNHS platform to support roll-out of remote monitoring for high blood pressure across England – and can be replicated to support other digital programmes.

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Developing a plan for an integrated workforce

Our integrated workforce plan for Dudley’s primary care networks reflects their ethos, supports sustainability of primary care and reflects new career pathways and clinical models.

The Transformation Unit was asked to generate a comprehensive plan for maximising the roll‑out of the Additional Roles Reimbursement Scheme across the six local primary care networks in Dudley to help to meet the needs of the local population.

Our multiskilled team of workforce, engagement and analytical experts adopted a robust population and place based approach to workforce planning to ensure the clinical model had the right numbers, skills, values and behaviours to deliver high quality care closer to the Dudley population.

Through stakeholder engagement, application of intelligence regarding the networks, place, population and workforce we triangulated service, finance and workforce priorities to develop future workforce design principles which informed the development of an Integrated Workforce Plan.

The plan places a real emphasis on the need to develop new ways of working and new roles to meet the needs of the population now and in the future.

“This is an absolutely excellent piece of work”
Trust Director of Operations, Strategy & Partnerships

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Integrated Medicines Optimisation Committee

The Black Country Integrated Medicines Optimisation Committee fosters partnerships across the integrated care system to optimise use medicines and care pathways, and improve patient safety and experience.

Background

Integrated care systems (ICSs) are bringing major changes in how health and care services are planned, paid for and delivered. The Black Country ICS has been setting up an Integrated Medicines Optimisation Committee (IMOC) to foster partnerships and optimise the use of medicines across the system.

The Midlands and Lancashire Commissioning Support Unit has been supporting the establishment of the Committee and leading on aspects of its formation.

Action

We worked collaboratively with the ICS to create the foundation and governance structure of the Black Country IMOC:

  • We set up joint working groups to advise the ICS and agree the key principles underpinning the purpose and operation of the IMOC
  • In the next phase, we facilitated the production of a robust governance structure and of fundamental processes required to run the IMOC
  • Finally, we supported the IMOC with organisational sign off on the governance outputs and recruitment of suitable talent.

Impact

The IMOC will have a significant positive impact on the Black Country ICS’s capability to harmonise health partnerships and strategies and optimise system wide medicines and care pathways that will benefit patients across the system. Benefits include:

  • Establishing how the proposed new structures will work in practice, and how the partnering organisations will relate to one another
  • Finding new ways to work more closely with and alongside local communities as key partners in shaping services and improving population health and wellbeing
  • Prioritising the reduction of health inequalities
  • Developing clear lines of accountability and transparency around how and where decisions are made, while continuing to allow flexibility for locally led change
  • Continuing to align oversight and regulation more closely behind the work of systems, prioritising the cultural and behavioural changes needed to support this.

We continue to consult stakeholders in the development of the Black Country IMOC.

“The formation of the Black Country IMOC is at the peak of NHS innovation in its unprecedented stage.

“Key deliverables included engagement, making sure every voice counts and listening to concerns and questions raised.

“Partnership with the MLCSU created scale working to provide solutions, service resilience and confidence when facing the challenges through this contract. The Black Country Integrated Care System innovation and collaborative working decisions in the phased approach of IMOC were made as closely as possible to the core principles and road map of the NHS Long Term Plan.”

Hemant Patel, Black Country Integrated Care Board Lead Pharmacist

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Review supports clinical service redesign

The review of gynaecological cancer services in Cheshire and Merseyside by our Transformation Unit is being used to make improvements from the point of patient presentation in primary care through to treatment.

Cheshire & Merseyside Cancer Alliance (CMCA) commissioned the Transformation Unit to undertake a review of gynaecological cancer services across the Alliance footprint. The purpose of the work was to support delivery of the NHS Long-Term Plan, including delivery of Rapid Diagnostic Services (now the Faster Diagnostic Framework) by 2024. The last full review of gynaecology cancer services in Cheshire and Merseyside was more than 20 years ago.

We used a mixed methods approach to review data, guidance, service configuration, workforce, current practice, and transformational opportunities for symptomatic cervical, ovarian, vulval and endometrial cancers (both suspected and diagnosed) from patient presentation in primary care through to diagnosis and First Definitive Treatment. We engaged 93 stakeholders in the review process.

We developed a proposed model of care, mission, vision and 40 recommendations to inform short, medium and long term aims of the service, to be delivered through a Gynaecology Cancer Programme by the CMCA across a range of themes.

To engage stakeholders with our conclusions and gain support for delivery, we presented the outputs of our work at a regional event with over 130 people attending.

Our work has been shared with wider stakeholders including Macmillan, Cancer Research UK and Ovarian Cancer UK.

Ovarian Cancer UK has been particularly supportive of our approach and presented on our work at their national transformation meeting.

Liz Bishop, Senior Responsible Officer, CMCA said: “This clear and comprehensive review of gynaecology cancer services is a decisive step forward in improving the lives of women across Cheshire and Merseyside from presentation in primary care through to treatment.”

Jon Hayes (Managing Director) and Dr Chris Warburton (Clinical Director) at CMCA said: “[The review] gives an honest, clear, unvarnished insight into the strengths and weaknesses in cancer care and treatment and presents achievable recommendations for service change. The review will start us on a journey to achieve these aims for our population, to eliminate variation across communities and to improve earlier diagnosis, care, and treatment outcomes – whilst also giving patients a voice in how the recommendations are implemented.”

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Improving health outcomes using our PHM tool

Our population health management (PHM) tool has helped identify people with clinical and social issues across Lancashire and South Cumbria, enabling early interventions to improve health outcomes.

The PHM Segmentation Tool was developed by our business intelligence specialists to enable a place-based approach to segmenting the population based on a number of similar health and wellbeing characteristics and needs. These include wider determinants such as ethnicity, digital exclusion, housing quality and social isolation. This means they can target interventions more effectively and focus on prevention.

The tool has been built and enhanced through partnership working with clinicians and strategic PHM leads across our client geographies, as well as drawing on multi-disciplinary expertise from across MLCSU.

We have also provided analytical expertise to support integrated care systems, place-based partnerships and primary care networks with actionable insights of their population, and share best practice and relevant interventions from across our client geographies.

To date, we have helped identify and reach approximately 5,500 people with clinical and social issues, enabling Lancashire and South Cumbria Health and Care Partnership to improve health outcomes at an early stage, avoiding patients becoming unwell, reducing hospital admissions and future healthcare costs. Our insight has helped decide where best to allocate funding to address needs and health inequalities, for example:

  • identifying the best location for a new community frailty service providing convenience to those most in need
  • reducing violence by placing additional community support at the electoral wards with highest levels of vandalism and crime
  • improving young people’s mental health by placing additional support at a list of schools with the most pupils at risk of having mental health issues
  • contacting 460 individuals with previously unknown issues to ensure they had access to the services and referrals they need given their personal and clinical circumstances
  • providing a list of patients with respiratory conditions who are likely to live in houses with a lack of adequate heating, which could exacerbate their condition.

Vicky Hepworth-Putt, Acting Consultant in Public Health, Cumbria County Council, said: “The PHM Tool enables me to identify clinical areas where the inequalities are widest across the area and also the wards that are outliers compared to their peers. This can help target interventions. This data can also be used strategically to target resources, although we are yet to test the success of that. The tool works well with the other PHM and PCN dashboards to provide a holistic picture of local health outcomes.”

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MLCSU collaboration shortlisted for HSJ award

The HSJ Awards 2022 finalists were announced today, and the NHS Midlands and Lancashire CSU’s (MLCSU’s) joint project with the Greater Manchester Integrated Care Partnership was shortlisted for Provider Collaboration of the Year. This award recognises work carried out to align priorities between organisations, which lead to greater efficiency and the development of person-centred services.

Together, our two organisations worked in collaboration on a successful pilot to transfer smoking cessation care from hospital to community pharmacy.

In Greater Manchester, more than 5,000 people die each year from smoking related illnesses. Many live with the burden of smoking related diseases. Chances of quitting double if a stop smoking medicine is prescribed by a GP, pharmacist or other health professionals.

The innovative Oldham pilot scheme bridged the gap between primary and secondary care, offering stop smoking support to patients when they are discharged from hospital. This collaborative approach supports the work of hospital staff, so patients continue their stop smoking efforts.

The pilot ran until January 2022 and since it has been rolled out in pharmacies across England.

Rob Hebdon, Senior Medicines Optimisation Lead at MLCSU, said: “The smoking cessation transfer of care pilots represent a great example of cross organisational collaborative working. The outcomes of this have largely shaped how this service is being implemented nationally. So proud to have been involved and to have made the final shortlist!”

MLCSU has also worked with our partners to support several other projects and workstreams which have been shortlisted for HSJ Awards this year, including:

  • Workforce Initiative of the Year – Lancashire and South Cumbria Integrated Care Board, LAMP Programme
  • Covid Vaccination Programme Award – Herefordshire and Worcestershire ICS, Covid Vaccination Team
  • Innovation and Improvement in Reducing Healthcare Inequalities Award – Herefordshire and Worcestershire ICS, Tackling Inequalities through Covid vaccination
  • Innovation and Improvement in Reducing Healthcare Inequalities Award – University Hospitals Coventry and Warwickshire Trust, Waiting list Access and Inequalities Tool.

Congratulations and good luck to all HSJ Awards finalists!

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Implementing financial reporting tools

Our support has resulted in a significant improvement in the quality of financial information held.

Background

The Finance Department at University Hospitals of North Midlands NHS Trust required support to implement a new accounting standard (IFRS 16 Leases), a new capital asset and lease register (Asset4000 and Lease4000) and to undertake an asset verification exercise.  The NHS Midlands and Lancashire CSU (MLCSU) was approached to lead these projects and provide technical and operational support.

Action

We reviewed the work to date and worked with the trust capital team to:

– Implement IFRS 16 Leases:

  • interpret and apply guidance from the Department of Heath and Social Care (DHSC)
  • work with the estates, IT, finance and procurement teams to identify and register leases
  • collate information to prepare and submit a return to DHSC forecasting the impact of the IFRS 16
  • provide training to finance and non-finance teams
  • populate templates for the new Lease4000 system and test
  • provide IFRS 16 information for year-end planning and for the year-end accounts.

– Implement Asset4000. We worked with the capital accountant to implement the new asset register, verifying the data to be uploaded to the system, testing and reconciling reports.

– Undertake an asset verification exercise. We analysed the asset register at 31 March to establish the scope and to determine a timeline and plan. We generated reports for budget holders, providing support and collating results to enable the capital accountant to update the asset register and process any disposals in line with trust policy. We also determined future steps to ensure asset verification is regularly undertaken in line with trust policies.

Impact

Our support enabled the trust to successfully implement the new IFRS16 lease standard in accordance with the requirements of DHSC.  The trust was able to submit the mandated returns accurately and timely for the financial year ending 31 March 2022.  The training we provided and the production of a lease register and templates helped establish processes and procedures for the new standard.

The new successfully implemented Capital Asset and Lease Register will facilitate accurate and timely reporting, at both month and year end.

The asset verification exercise has provided the Trust with further information on its assets and also assurance that the information held in the Asset Register is accurate and correctly stated.   This is an ongoing project but our support to date has resulted in a significant improvement in the quality of information held in the Asset Register which meets the requirements of external audit.

Additionally, our support was able to provide extra capacity to a small capital team which would not have had the resource to deliver the project in time for the year-end of 31 March 2022.

“MLCSU demonstrated strong leadership skills to ensure the projects were finished on time and the goals achieved. They collaborated fantastically well with finance and non-financial colleagues.

“MLCSU were able to use their technical knowledge, experience and worked hard to break the complex projects into manageable pieces, this enabled Hilary to organise, lead and support the team to deliver.

“Without their professionalism we would not have been able to deliver these projects. I can highly recommend them, I would have them back tomorrow.”

Dylan Davies, Deputy Director of Finance, University Hospitals of North Midlands NHS Trust