Month: January 2023

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Helping a local council order equipment efficiently

Following taking over the management of the the community equipment service contract at Staffordshire County Council, staff across Staffordshire and Stoke-on-Trent are now able to order and receive equipment quickly, which supports timely hospital discharges.

Background

Following the retirement of the contract lead at Staffordshire County Council, the NHS Midlands and Lancashire CSU took over the management of the community equipment service. However, there were no governance arrangements in place, and stakeholder relationships had dried up since meetings and communications had been paused during the COVID-19 pandemic.

There were approximately 150 backlogged emails to process, and it was taking an average of 16 days to process new users.

Action

Although unfamiliar with the community equipment ordering site, we quickly got to grips with the system and cleared the backlog. The team took the opportunity to streamline administrative processes, review costs, highlight risks, and strengthen the quality assurance process.

By networking and building good working relations with stakeholders – including supplier Medequip and staff at Staffordshire and Stoke-on-Trent Integrated Care Board – the team re-established meetings and communications.

New terms of reference were agreed for joint contract quality review meetings and contract review meetings, which review complaints and feedback, discuss the impact of COVID-19 on services, and monitor key performance indicators (KPIs).

The Community Equipment Prescribers Action Group was formed to share good practice and help to resolve operational issues.

Impact

Since taking over the management of this contract, the backlog of adding users to the community equipment ordering site has been cleared. The team process an average of four new requests for users every day, and they are now processed within one working day.

Staff across Staffordshire and Stoke-on-Trent are now able to order and receive equipment quickly, which supports timely hospital discharges, which in turn has a positive impact on patients and staff.

Contract review groups all now meet monthly, and relationships between stakeholders are positive. The Action Group has taken ownership of a seven-point action plan to review processes and make recommendations for improvements.

Governance, risk and issues are now managed effectively.

Contract KPIs are being met and more are being developed. The contract itself is still awaiting novation over onto the NHS Contract.

“We value the support of CSU colleagues for their proactive organisation and administration of the recently reinstated CEPAG and CQRMs as part of the Community Medical Equipment contract. This includes the setting up of meetings, communicating with system partners, and circulating agendas and papers.

“CSU colleagues also chair the meetings which enable effective time-keeping and sharing of information, which supports discussions. CSU colleagues are always very helpful and responsive to requests, and we would like to thank them for all their hard work.”

Quality leads, Staffordshire
and Stoke-on-Trent
Integrated Care Board

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Using automation to reduce waiting lists across two ICSs

Using a combination of automated chatbot, robotic process automation and human call agents, we helped trusts within two integrated care systems (ICSs) contact over 80% of their waiting lists, with about 10% of patients coming off them.

Background

The pressure on hospital patient waiting lists created by the pandemic required new ways of assessing the validation of waiting lists. Following a pilot with Worcestershire Acute Hospital Trust in 2021, we were approached by Lancashire and South Cumbria ICS about our combination of automated calls (chatbot) and our Referral Management Centre to validate their inpatient and outpatient lists over a number of specialities. The aim was to provide a more efficient way to cleanse the waiting list and expedite work that otherwise would take considerable time and staff resource to complete.

Action

Specialists from our Digital Innovation Unit, Referral Management Centre, Cloud Development team, Information Governance and Business Intelligence teams have been working together with the ICSs and acute trusts. We have developed a robust mechanism using chatbot functionality and referral management call handling expertise to support validating an initial cohort of 21,0000 inpatient and outpatient lists from across the four trusts in Lancashire and South Cumbria.

The outline process involves:

* Setting up project management for the scheme, including the end to end process
* Putting in clinical and information governance, including patient engagement
* Agreeing scripting to be run
* Accessing and processing waiting lists via a secure SharePoint
* Providing text messaging to patients advising them that they will receive a call
* Processing the calls starting with three chatbot calls and then two Referral Management Centre (human operator) calls
* Returning results of the calls to the providers to amend their patient administration system.

Key to success has been agreeing the end to end process and script design.

Impact

Using this combination of chatbot and our Referral Management Centre, we are helping trusts to prioritise and clinically validate waiting lists efficiently. It has helped to tackle the backlog of waiting lists and reduce waiting times, while maintaining quality of care.

We have successfully completed over 20,000 patient validations since starting in late 2021.

The results across the two ICSs have been remarkably similar. The key results are:

* Over 80% of those with validated numbers have been successfully contacted
* There are about 10% of patients indicating that they wish to come off the waiting list
* Of those wanting to come off the waiting list there are about 60% that have indicated that they have had their treatment elsewhere.

This solution saves huge amounts of time and staff resource, reducing hospital costs. Using automation avoids the need for temporary admin teams to be interviewed, employed, on-boarded, trained and so on. Chatbot costs are a tiny fraction of those incurred in producing, printing and posting letters.

Key stages

Stage 1 – Data receipt from trusts – The trust upload a patient cohort list (outpatient/inpatient) to a SharePoint site set up by the Midlands and Lancashire CSU (MLCSU) to enable quality checks of the data. MLCSU then uploads the data into the auto-dialler tool.

Stage 2 – Automation and referral management support – The automated call to patients asks a series of questions to determine if the patient still requires the appointment, would prefer to be taken off the list, and if they require an appointment whether they would be happy to receive a telephone or/and video consultation.

The automated call script to patients was designed with input from senior clinicians and validated through patient forums. If patients prefer not to speak to the chatbot, they are put through to our Referral Management Centre for a human call operator.

Stage 3 – Providing data to consultants to review the outpatient/inpatient waiting lists to help prioritise patients – following the validation exercise the information collated through chatbot and Referral Management Centre manual calls is provided back to the trust to enable them to take further clinical validation and remove patients who no longer require appointments due to being seen elsewhere or having reduced symptoms.

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Blog: How to look at data

Primary Care Networks (PCNs) hold some of the richest data in health and care which can tell us a great deal about our local populations and their needs. However, faced with so much data, it can be difficult to know what to look at and what we can do with it to drive improvements in health and care of our population.

Writing for PULSE and Healthcare Leader, David Sgorbati, Chief Analyst for the Health Economics Unit, offered his insight and some examples as to how data analysis is being used to drive improvements to care up and down the country.

Originally published 31 October 2022.

Data is incredibly powerful when it comes to helping us make decisions about changes to care pathways or the allocation of resources and it really is true that PCNs hold the Crown Jewels of NHS data. As the ‘front door’ of the NHS, you have an unrivalled insight into your population, covering everything from consultation data to prescription information and a whole host of secondary care markers. What’s more, you also have a very deep and profound understanding of your community and its needs. For this reason, it’s vital that you are involved in shaping any collection and analysis of your local data.

What’s the right question?

One of the most crucial elements to get right when starting any data analysis project is choosing the right question. That might sound obvious, but it can be challenging to ensure the question we’re asking will give us the answers we are looking for. For example, we might say we want to understand how many patients are attending A&E each month. However, the answer we are looking for here might really be what proportion of patients attend A&E, or what the characteristics are of those patients who attend A&E, or even why patients are attending A&E, so we can understand if there are any trends or unexpected variations in the type of patients we find.

View the full article at https://www.pulsetoday.co.uk/pulse-pcn/how-to-look-at-data/

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Prioritising health and wellbeing to improve morale and performance

Our health and wellbeing strategy has proven to have improved the morale and performance of our staff. It was also recognised by HR Magazine with an award for Best Health and Wellbeing Strategy as part of their HR Excellence Awards.

Background

With staff feeling exhausted after the pressures of the pandemic, staff wellbeing, motivation, morale and mental health were more important than ever. At a time when the NHS is undergoing vast change, we wanted to ensure that our people were well, engaged and motivated in order to deliver high quality work which ultimately impacts on patient services.

Action

The approach was person-centred, focusing on individual needs and preferences balanced with the needs of the team and the organisation. Wellbeing was prioritised as a major part of achieving our strategic and corporate objectives.

We teamed up employee engagement and our workforce data to identify pressing issues and shaped a comprehensive plan of wellbeing activities and interventions. They were broadly framed under physical wellbeing, mental wellbeing and financial wellbeing.

To implement these changes, we employed several enablers:

-Week-long virtual health and wellbeing festival
-Training and education campaign to help managers and employees better understand -remote working, resilience and physical fitness
-Weekly wellbeing sessions to discuss tips and resources
-A trained team of mental health first aiders
-Enlisting health and wellbeing champions to push from below and members of the board to role model and communicate healthy behaviours from above
-Embedding health and wellbeing into one-to-ones and appraisal documentation
-Blogs and intranet forums.

Impact

The effect on staff wellbeing was evident in the latest staff survey and workforce data:

-92% said that they did not feel pressured by their manager to come to work when ill
-94% said that they felt empowered to take informed decisions about their health
-number of people saying they had felt ill because of work related stress dropped
-15.5% increase in people who recognised the organisation was taking positive action on health and wellbeing
-18% drop in the number of days lost due to stress, anxiety or depression.

This clearly showed that engaging with employees and acting upon their feedback was positively received, and we were making huge gains with our people’s wellbeing offering.

The health and wellbeing festival had 759 attendees at 42 sessions over the course of the week. The average score was 4.83 out of 5 for overall experience by staff and 4.73 out of 5 for whether staff felt the session had benefited their health and wellbeing.

The network of 14 health and wellbeing champions played a key role in spreading and embedding the corporate initiatives as they connected with colleagues at a local level.

Messages from the board, both in video clips and written blogs, were also received well with people saying that they like the fact that they can relate and feel empowered to do the same.

“What is remarkable about this strategy, labelled outstanding by judges, was that it was delivered on a shoestring budget by a generalist team, driven by a passion for its people.

“Judges praised its clear focus on the business issue at hand and the engagement at every angle with its end goal of providing top-quality services to patients.”

HR Magazine

“A brilliant session and surpassed all of my expectations.”

“Fantastic session and really helped me to readjust my thoughts.”

Staff feedback on health and wellbeing festival sessions

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Ensuring data protection for lung health checks

We helped a programme targeting ex-smokers with lung health checks to complete information governance procedures and ensure personal data is protected.

Background

The Targeted Lung Health Check (TLHC) Programme team at Lancashire and South Cumbria Integrated Care System (ICS) needed help with information governance (IG). The health checks are offered to current or ex-smokers aged 55-74, aiming to diagnose and treat lung conditions, often before symptoms appear.

This was part of a national pilot study, and the entire project needed a Data Protection Impact Assessment (DPIA). The main challenges were the number of stakeholders involved and the tight timescales dictated by the national team.

Action

We helped the ICS understand why and how to complete a DPIA. Where some decisions had not yet been made (for example system suppliers and clinical providers), our expert team shared their insights and recommendations to ensure the project team could move forward quickly once decisions were made.

The multi-agency project meant that multiple DPIAs were required, but we advised that the best approach would be to map and assess the project from end to end. This gave the ICS the confidence that all data protection risks would be identified and managed, and meant that a single robust DPIA could be completed for the entire project.

Impact

Although the project was fast-paced, we kept up with the key dates and ensured sufficient risk assessments were completed at every stage.

By providing expert advice on data sharing and processing across all partner organisations, we ensured that individuals’ rights were not infringed.

It was crucial that all stakeholders were able to understand the needs of the project. Our IG team took great care in explaining the key points in simple terms. This meant the IG teams at the local NHS trusts and the ICS had the confidence and assurance to support and progress the project.

The team clearly detailed the project needs in a single DPIA document. As later versions needed to include different data controllers and processes, we used the tools and learnings from previous risk assessments to ensure that the clinical benefit was always at the forefront of these submissions.

“By completing the DPIA for the entire project, the MLCSU IG team ensured that all data sharing and processing was mapped and all data protection risks were identified and mitigated.

“All required versions of the DPIA were completed in line with the project live dates, and we were confident that the patients’ needs were always at the forefront of the project.”

Anne Turner and Lisa Flanagan | Senior Programme Managers: Targeted Lung Health Checks

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Raising awareness of health inequalities in the Midlands

We raised awareness of health inequalities among the 11 integrated care systems in the Midlands through promoting the government’s Health Equity Assessment Tool (HEAT) – used to identify and support local action to address health inequalities.

Background
Tackling health inequalities for Black, Asian and ethnic minority communities, hard-to-reach groups and deprived areas is a key priority for NHS England.

In January 2022, our Nursing and Urgent Care (NUC) team was commissioned by NHS England and the Office for Health Improvement and Disparities (OHID), to engage with the 11 Integrated Care Systems (ICS) across the Midlands to promote the government’s Health Equity Assessment Tool (HEAT) to identify and support local action to address health inequalities.

Five training sessions were to be delivered by 31 March 2022, each with a minimum of 60 participants.

Action
Our NUC team worked closely with ICS health inequality, quality and project management leads to promote HEAT training sessions to help them embed the tool into their quality improvement and business planning processes.

The team developed and delivered two types of HEAT training: ‘train the mentor’ and more general training, using evidence-based resources and live training on the Fingertips Outcome Framework (a public health framework containing life expectancy data for different communities and backgrounds).

Working closely with NHS England, OHID and other stakeholders, we developed a bespoke audit tool to support organisations to gather information about the use of HEAT and its impact.

Impact
The NUC team was given a challenging timeframe of 14 weeks in which to complete the project, but through coordinated and efficient delivery we were able to complete it in 11 weeks.

Our senior experts and project support team successfully raised awareness of health inequalities among the 11 ICSs through HEAT training sessions, attended by 407 people across five sessions – far exceeding the original target of 300.

We provided resources to support the HEAT programme going forward, including recordings of the two training sessions uploaded to the Midlands Health Inequalities and Long Term Plan Prevention Hub on the Future NHS Platform.

The audit tool can be used at both project and programme level, making it flexible for use across different organisations including ICSs, NHS, local government, devolution deals, and the voluntary sector.

A final evaluation report produced by the team outlined learning from the project. It also made a number of recommendations to NHS England and OHID to improve the HEAT training programme and help systems take this work forward.

“Can I say what a pleasure it has been to work with the [NUC] team. The CSU worked collegiately and delivered fantastic training.”

Karen Saunders, Consultant in Health and Wellbeing | DHSC, Office for Health Improvement and Disparities

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Reuse, not replace: slashing our carbon footprint

As part of the NHS Midlands and Lancashire CSU’s Green Plan and commitment to reducing our carbon footprint, we have dedicated workstreams cutting across all aspects of how we operate.

This includes IT Procurement, which is working with suppliers and manufacturers to develop a way of assessing the carbon journey of the equipment we use – from manufacture to shipping.

As part of this, IT Procurement Manager Tracey Yates and her team have been asking suppliers for their Green Plan and requesting the Carbon Data Factsheet for each product. This information is then compared against that from alternative manufacturers and an assessment is made on the suitability of products based on their carbon output.

But it doesn’t end there. The IT Procurement team also assesses the Total Cost Ownership, which means the estimated carbon cost of using equipment. For example, the power required to run a typical staff computer and monitor for eight hours results in greenhouse gas emissions equivalent to around 70g CO2e. A standard laptop and monitor, operated over a five-year period, creates a carbon footprint of around 755Kg CO2e. It is important to bear in mind, however, that 85 per cent of this results from manufacture and shipping, while just 15 per cent is from electricity consumption.

Tracey said: “There is a lot to think about and assess when making green decisions in IT procurement, but it is very interesting to understand the carbon cost of different types of equipment. When we consider the full lifecycle impact of providing and using IT, we need to consider both the upstream impact of supply and the downstream impact of disposal.

“For example, there is a significant difference between the carbon impact of a desktop and a laptop, mainly due to people wanting to replace the laptops more frequently. Therefore, the option to re-use/repair/upgrade should be considered wherever possible, before the decision is made to scrap, and buy new.”

Tracey’s team has also looked at using one larger screen monitor as a greener alternative to running two smaller monitors – thus reducing power usage and the need for a docking station. They have included social value and net zero questions in tenders and assess the suitability of suppliers on a wide range of environmental factors, including the use of an electric-powered fleet and non-plastic packaging. And the team has also embarked on carbon literacy training and started questioning the need to purchase equipment when an upgrade or repair is more suitable.

Tracey said: “Given that 85 per cent of carbon output is in the manufacture, if we don’t need to buy something, we shouldn’t.”

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What you need for a common electronic patient record

Through over 330 ours of focused work on engagement and gap analysis, we identified and consolidated the requirements for implementing a common Electronic Patient Record (EPR) system to enable seamless health care.

Background
Dudley Integrated Health and Care (DIHC) had already taken significant steps to integrate services, but were ambitious to push this further. An integrated Electronic Patient Record (EPR) system would be a major part of their drive towards much more seamless care for patients and efficiency for clinicians.

The Common EPR programme of work began in 2021/22 with support from the NHS Midlands and Lancashire CSU’s Digital Transformation team. The first phase to identify and define requirements has been completed, and the second phase involving the implementation is due to commence imminently.

Action

To establish DIHC’s requirements, we undertook a series of interviews and workshops with service leads, frontline clinicians, partners and other stakeholders. Building on this intelligence, we turned the identified requirements into a detailed, richer system specification.

We looked deeper by performing a gap analysis against the incumbent core clinical system supplier to establish and identify:

-how their solution could fulfil the requirements
-which requirements it could fulfil
-the implication of the gaps and the roadmap to fill these.

The team provided strategic EPR options and an executive recommendation for the project, before establishing the foundations for a Common EPR Business Case spanning primary care, mental health, children’s and adult community services.

Impact

In a truly collaborative effort, a total of 70 services and teams throughout Dudley were engaged in this project.

From October 2021 to March 2022, our Digital Transformation team spent over 330 hours of focused work on targeted service engagement, discovery workshops and interviews, documentation, follow-ups, validation and requirement consolidation and traceability activities.

The discovery process involved more than 115 NHS colleagues through more than 110 meetings, interviews and workshops. This ensured that service leads, frontline clinicians, partners and other stakeholders were at the forefront of defining what the Common EPR would look like.

We gathered 3,742 requirements through this process. These were consolidated into 843 individual EPR requirements before being categorised and prioritised.

Our iterative, analytical and fully traceable EPR Gap Analysis process involved:

-Fit and gap assessments with the incumbent system supplier
-Categorisation of requirements (e.g. Fully Met, Partially Met, Not Met) with supporting action plans
-Dashboard level analytics for communication across a wide range of stakeholder groups
-Emerging themes and barriers to progress consolidated into four strategic areas of concern for executive review and steer.

We completed a digital tools operational review for DIHC Primary Care Clinical Support Services in parallel to the Common EPR process, and established an action plan for operational system improvements.

“I was impressed with the way the team developed and implemented a programme structure which enabled a complex set of requirements to be delivered. The outcome of the EPR programme has enabled the organisation to understand the requirements of individual services, address gaps with current system suppliers and identify potential solutions for the future EPR. Thanks to everyone that has supported this project.”

Matthew Gamage, Acting Director of Finance, Dudley Integrated Health and Care