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February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

ActionOur 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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

ActionThe 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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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.)

February 10, 2021June 9, 2021

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.

February 10, 2021June 9, 2021

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).

February 9, 2021

Test Post 13: IT

Test Post 13: IT
Test Post 13: IT
Test Post 13: IT

February 9, 2021June 24, 2021

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:

February 9, 2021July 21, 2023

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.