Registration open for NHS-R Community annual conference 

Decorative Image

We are incredibly excited to announce that ticket registration for NHS-R/NHS.pycom Open-Source Conference (RPySOC) 2024 is open!

The conference is taking place on Thursday 21 and Friday 22 November 2024 in Hall 11 of the ICC, Birmingham, with a live stream offered via Zoom. Tickets are available for in-person and virtual on both days.

The aim of the NHS-R Community is to promote the use of R programming language (and other open-source solutions) to the health and care sector.

We are currently in the process of confirming the conference schedule – watch this space for updates!

Book your ticket now on the NHS-R Community website to avoid disappointment: https://nhsrcommunity.com/events/#event_type-conferences

In-depth analysis and insight: A cancer pathway review within Staffordshire and Stoke on Trent Integrated Care Board

decorative image

As referenced in the national NHS priorities and operational planning guidance for 2023/24, the significance of early cancer diagnosis is an NHS priority. One of the biggest actions the NHS can take to improve cancer survival is to diagnose cancer earlier. Patients diagnosed early, at stages 1 and 2, have the best chance of curative treatment and long-term survival. The NHS Long Term Plan set the ambition that, by 2028, the proportion of cancers diagnosed at stages 1 and 2 will rise to three-quarters of cancer patients. Achieving this will mean that, from 2028, 55,000 more people each year will survive their cancer for at least five years after diagnosis.

NHS Midlands and Lancashire Commissioning Support Unit (MLCSU) are pleased to be supporting this ambition, working in collaboration with Staffordshire and Stoke-on-Trent Integrated Care Board (ICB) to deliver a deep dive cancer pathway analysis, funded by the West Midlands Cancer Alliance. The areas of focus of this in-depth review are late-stage cancer diagnosis and a review of primary care cancer referrals. The programme of work aims to identify and investigate variations in the cancer pathway, and the impact these have on patient outcomes.

The insight gained from understanding variation in cancer pathways, will inform recommendations to improve the patient experience by optimising referral to diagnosis timescales, and improving early diagnosis, where possible and appropriate.

The programme of work is being led by the MLCSU Business Intelligence team, in collaboration with the MLCSU Nursing and Urgent Care team, together with the involvement of relevant teams within the Digital, Data and Technology Directorate. Our joint approach is key to the delivery of the project, which encompasses a clinical audit as part of the cancer pathway analysis. The analysis and engagement to date have proved instrumental in informing discussions with the ICB and wider stakeholders, in determining which cancer sites form the focus of the clinical audits.

Working in partnership with the ICB, primary care and the cancer services teams in the designated acute hospital providers within the Staffordshire and Stoke on Trent geography, means we can incorporate a wide source of data and information, and obtain the required input from clinical specialists as part of a case study approach. This methodology enables a rich study to develop, with early findings providing the evidence needed to inform recommendations for improvement and transformation of cancer pathways across the integrated care system.

Further information

If you would like to find out more about this programme of work, and how we may potentially support your organisation in this area, please contact:

Lead Consultant Analyst Ruth Green at ruth.green24@nhs.net

Head of BI Consultancy Mark Oliver at mark.oliver1@nhs.net

Chief Analytics Officer Neil Morgan at neil.morgan1@nhs.net

Enhancing stroke risk management by developing a comprehensive reporting dashboard

decorative image

The implementation of the cardiovascular disease prevention dashboard markedly enhanced stroke prevention strategies, offering healthcare providers critical data on key risk factors and driving substantial improvements in the diagnosis and management of atrial fibrillation, hypertension, and high cholesterol.

Background
In 2019, the Lancashire and South Cumbria Integrated Care Board (ICB) embarked on a significant health initiative with the release of its five-year stroke prevention strategy. This strategy highlighted a critical need: the effective monitoring of stroke prevention efforts, particularly focusing on three key risk factors – atrial fibrillation, hypertension, and raised cholesterol.

The primary goal was to develop a tool to enable health commissioners and providers to track and manage these risk factors effectively. This initiative led to the creation of the cardiovascular disease (CVD) prevention dashboard.

Action

Our Business Intelligence team played a pivotal role in realising this vision. They developed a comprehensive, visual dashboard, hosted on Aristotle Xi, a robust platform known for its data-handling capabilities.

The dashboard offers a unique, multi-dimensional view, enabling analysis from various healthcare perspectives, including integrated care systems, integrated care boards, primary care networks, and GP practices.

Regular updates are managed and refreshed quarterly by our Business Intelligence team and the report ensures up-to-date data is always at hand.

Target-driven indicators have been developed in collaboration with our data quality teams, and the dashboard provides crucial indicators. It also sets aspirational targets, focusing on priority indicators.

Impact

The dashboard has been instrumental in providing concrete evidence linking stroke risk to the management of atrial fibrillation, high blood pressure, and high cholesterol levels. This tool empowers users to identify and address gaps in the detection and management of these risk factors.

The pandemic posed significant obstacles, notably in the routine management of hypertension. The dashboard has been pivotal in responding to these challenges, guiding practices in managing hypertension effectively and aligning with NHS England’s monitoring blood pressure at home programme.

Moreover, the dashboard aids practices in adopting proactive measures in managing patients, especially those with a cardiovascular disease risk greater than 20%. It serves as a guide in achieving the national stroke prevention targets.

Feedback

“We now have clear evidence that in addition to many lifestyle factors, risk of stroke is associated with the diagnosis and management of atrial fibrillation, uncontrolled high blood pressure and the identification and treatment of high cholesterol. This dashboard allows users to identify the size of detection and management gaps for each of these risk factors.

COVID has led to many patients not receiving their annual hypertension checks and NHSE has responded to the risk of this, increasing the incidence of heart attacks and strokes by launching their blood pressure at home programme. Practices are encouraged to use this dashboard to inform them of their position in relation to achieving the national stroke prevention targets for patients on their hypertension registers and adopt a proactive approach to their management where appropriate.

Finally, the dashboard will inform practices on their position in relation to starting prescribing for patients with a cardiovascular disease risk of greater than 20%.” Jean Hayhurst | Cardiovascular Specialist Nurse

Empowering healthcare workers in population health management

decorative image

Our Health Economics Unit (HEU), in a successful collaboration with the Midlands Decision Support Network, has marked a significant milestone with the completion of its fourth cohort of Population Health Management (PHM) training as of January. This initiative underscores a commitment to enhancing the capabilities of health and care professionals in this vital area.

Crafted to cater to varying levels of expertise, these bespoke training courses serve as a gateway to the fundamental principles and techniques of PHM. The courses have been meticulously designed to be inclusive and accessible, ensuring that individuals from diverse backgrounds in health and care can participate effectively.

Under the guidance of the HEU’s expert training team, the past two years have seen a remarkable turnout, with hundreds of participants engaging in both in-person and online sessions. This training series not only equips healthcare professionals with essential skills but also develop a deeper understanding of PHM’s role in improving healthcare outcomes.

For a more comprehensive insight into how the HEU is empowering health and care workers through these specialised PHM training sessions, please visit the detailed case study: https://healtheconomicsunit.nhs.uk/case_study/empowering-health-and-care-workers-to-practise-population-health-management/

NHS Midlands and Lancashire CSU celebrates triple HSJ award nominations

Decorative image

We are thrilled to share that NHS Midlands and Lancashire CSU’s Transformation Unit, has earned three esteemed nominations at the 2024 HSJ Partnership Awards. This achievement reflects a dynamic collaboration with the NHS, highlighting cutting-edge healthcare projects within the UK.

Our shortlisted projects:

Clinical and Care Professional Leadership Framework

The Lancashire and South Cumbria Integrated Care Board’s clinical and care professional leadership framework, developed in collaboration with our Transformation Unit, has been shortlisted for the Most Effective Contribution to Integrated Health and Care category at the 2024 HSJ Partnership Awards. 

This project marks a significant transition from local clinical commissioning groups to integrated care systems, emphasising a multidisciplinary approach to decision-making. The framework’s development involved system-wide workshops and a multi-professional steering group, resulting in a comprehensive leadership and development framework aligned with national guidance.

Echocardiography recovery plan

The echocardiography recovery plan, a collaboration between our Transformation Unit and the Cheshire and Merseyside Acute and Specialist Trusts Collaborative (CMAST), has been shortlisted for the Diagnostic Project of the Year at the 2024 HSJ Partnership Awards. This project, a part of the diagnostic programme, aimed to reduce waiting times for echocardiograms which are essential tests for assessing heart function. The plan focused on standardising processes, addressing patient backlogs, and reducing access disparities, achieving a record number of patients seen within six weeks post-COVID.

Active hospitals (Phase 2)

Phase 2 of the Active Hospitals project, a collaborative effort between our Transformation Unit, the Office for Health Improvement and Disparities, and Sport England, has been shortlisted for the Most Impactful Partnership in Preventative Healthcare at the 2024 HSJ Partnership Awards. This program, part of the Moving Healthcare Professionals programme, focused on embedding physical activity promotion within hospital trusts, increasing staff awareness, and fostering patient engagement in physical activity to improve health outcomes.

These recognitions from the HSJ Partnership Awards are not only a celebration of our past achievements but also an encouragement for continuous development in patient-centred and integrated healthcare solutions. These acknowledgements reinforce our dedication to healthcare innovation and collaboration.

The winners will be announced at the awards ceremony at Evolution London on March 21st, 2024. The awards’ judging panel, comprising a diverse group of highly respected figures and healthcare leaders from across the UK, reflects the comprehensive and varied perspectives within the healthcare community. For more information and a complete list of the 2024 HSJ Partnership Awards nominees, please visit the HSJ Partnership website: https://partnership.hsj.co.uk/.

Navigating Winter challenges with a proactive resilience strategy

Our strategy in navigating winter challenges enabled real-time monitoring and prompt adjustments in Urgent and Emergency Care capacity, significantly improving patient outcomes and decision-making processes in the NHS during a critical period.

Background

NHS Midlands and Lancashire CSU (MLCSU) were approached by the National Health Service England (NHSE) to build a report on six key measures which they had selected to monitor Urgent and Emergency Care (UEC) capacity and resilience ahead of an expected busy winter due to Covid and flu.

These measures entailed:

– 111 call abandonment

– Mean 999 call answering times

– Category 2 ambulance response times

– Average hours lost to ambulance handover delays per day

– Adult general and acute type 1 bed occupancy

– Percentage of beds occupied by patients who no longer meet the criteria to reside.

Action

To monitor UEC capacity and resilience using the selected six key measures, our business intelligence team collaborated with system providers and used existing data sources from daily UEC Sitrep, North West Ambulance Service (NWAS) portal, and national discharge sitrep to gather the required data. Our team also augmented the six key measures with other metrics to make them more meaningful.

Our Business Intelligence team monitored trends, cause and effect, and predicted change in the UEC services to develop comprehensive reporting that met the customer’s needs. This enabled NHSE to monitor UEC capacity and resilience in real-time, make any necessary adjustments promptly, and ensure that the UEC services were better equipped to handle the expected pressures during the busy winter season due to Covid and flu.

Impact

We established new data sources and temporary collection arrangements which enabled NHSE to monitor UEC capacity and resilience in real-time, allowing for prompt adjustments to be made to handle the expected pressures during the busy winter season due to Covid and flu. We recognised that the six key measures did not allow for triangulation or the ability to see the cause and effect of performance changes over time. To address this, we collaborated with the system via the Lancashire and South Cumbria (LSC) System Control Centre (SCC) to ensure that the six key measures were supported by data that would monitor trends, cause and effect, and predict changes.

As a result, LSC colleagues were better informed when making decisions around mutual aid, NWAS diverts, admission avoidance, re-patriating patients, Operational Pressures Escalation Levels (OPEL) capacity protocol, and pressure predictions for individual providers. The addition of extra filters allowed the data to be viewed for specific days or dates, with colour code formatting highlighting any exceptions immediately. This ensured that UEC services were better equipped to handle the expected pressures during the busy winter season, improving outcomes for patients across acute providers, mental health, social services, and the community.

Feedback

“The data and reports that were produced by the Commissioning Support Unit in a very short timescale, provided an accurate and effective visual representation of our system’s performance against key urgent and emergency care metrics last winter, as required by the nationally mandated Urgent and Emergency Care Board Assurance Framework. They were included in important Board and Executive papers to enable clear oversight of performance and progress against the assurance framework, and they were also used by the System Coordination Centre.”

Craig Frost, Associate Director of Urgent and Emergency care, Lancashire & South Cumbria ICB

Examining health inequalities for people with learning disabilities

Young woman with down syndrome play with mom

This study revealed significant health disparities among people with learning disabilities in Leicester, Leicestershire, and Rutland, prompting targeted prevention efforts, increased awareness of intersectionality, and a focus on admission avoidance for this population.

Background

The Aristotle Xi system, utilised by the Leicester, Leicestershire and Rutland Integrated Care Board (ICB) through the NHS Midlands and Lancashire Commissioning Support Unit, offers a comprehensive, pseudonymised population-level view of health conditions, demographics, and risk factors. This system aggregates data from various healthcare sources, including GP, hospitals, and prescribing systems. A limited number of practice staff can also access patient-level data. The Public Health Team in Leicestershire County Council conducted an analysis using data from the Aristotle system to investigate the health and health inequalities among people with learning disabilities in the Leicester, Leicestershire, and Rutland (LLR) region.

The primary objectives of this study were:

– To examine the health of people with learning disabilities in LLR using data from the Aristotle system

– To identify significant differences in the health of people with learning disabilities compared to those without

– To explore any health inequalities experienced by people living in areas of high deprivation (the 20% most deprived neighbourhoods according to the Index of Multiple Deprivation).

Action

To achieve these objectives, the following steps were taken.

Identified local population of people with learning disabilities, including their size, age, and sex distribution.

Assessed the proportion of the learning disability population with long-term conditions listed in the Aristotle system, and the proportion at high risk of emergency hospital admission in the next year based on risk stratification tools used in GP practices.

Examined the proportion of the learning disability population residing in the 20% most deprived neighbourhoods and the proportion with each of the long-term conditions living in such neighbourhoods.

Compared the collected data for people with learning disabilities with data from the general population of LLR.

Statistical analysis to determine the significance of any observed differences in proportions.

Impact

The study produced the following key findings.

– The registered population of people with learning disabilities across LLR is 4,925.

– People with learning disabilities are significantly more likely to live in high-deprivation areas (20% most deprived neighbourhoods) compared to those without learning disabilities.

– The learning disability population is four times more likely to be at risk of emergency hospital admission than the general population.

– A higher percentage of people with learning disabilities and health conditions live in the 20% most deprived areas compared to those without learning disabilities but with the same health conditions.

– People with learning disabilities are more likely to have health conditions, with a fourfold increase in the likelihood of having five or more chronic conditions compared to those without learning disabilities. Common conditions include asthma, hypertension, and diabetes.

The study identified several health conditions that are significantly more prevalent among people with learning disabilities in the LLR region. The findings are being used to explore targeted prevention opportunities and promote better access and treatment pathways for these conditions among people with learning disabilities.

The higher rates of ill health among those living in the 20% most deprived areas highlight the issue of intersectionality, where individuals experience multiple factors or characteristics that increase the risk of poor health outcomes due to health inequalities. These findings are being disseminated across various forums to address health inequalities in LLR.

Furthermore, the evidence of a higher risk of emergency hospital admission for people with learning disabilities is being incorporated into workstreams focusing on admission avoidance. This suggests that the learning disability population may be a potential area for preventive strategies. This case study underscores the importance of using data-driven insights to address health disparities and improve the healthcare outcomes of vulnerable populations.

Feedback

“Aristotle has finally given us the evidence to prove what we knew anecdotally about the health inequalities faced by people with learning disabilities in our local area. We are using Aristotle to ensure we target the right help in the right place to reduce health inequalities faced by people with learning disabilities in our local area.”

Justin Hammond, Associate Director of Mental Health and Learning Disability, Leicester, Leicestershire and Rutland ICB

 

 

 

Highlights from the NHS-R/NHS.pycom Conference 2023

At this year’s NHS-R/NHS.pycom Conference 2023, the NHS-R Community and its co-community NHS.pycom put together an exciting event to foster collaboration and innovation in healthcare analytics. Revisit the event’s nine virtual workshops, two completely virtual days and two in-person days on NHS-R Community’s YouTube channel: youtube.com/c/NHSRCommunity

The event was a community effort delivered by analysts and data scientists who use the open source solutions, R, Python and others, in the NHS and beyond, supported by NHS Midlands and Lancashire’s The Strategy Unit. The flourishing community came together on 17-18 October strengthening bonds, sharing ideas and encouraging each other.

NHS-R Community was set up in 2018 to promote the use of R in the NHS and quickly went above and beyond that aspiration creating a community that is broader than the NHS and a place to experiment, test and try out new things.

The NHS-R Community Committee is open to anyone interested in helping and growing the NHS-R Community.

If you are interested in being part of the Community, data science tools like R and Python or want to know more about how The Strategy Unit supports analysis, data science and training, please get in touch with zoe.turner3@nhs.net.

Revisit Health and Care Analytics Conference 2023

Health and Care Analytics (HACA) 2023 was the first national annual conference bringing together analysts and promoting, celebrating and advancing health and care analytics across the UK public sector. Lectures and workshops from the momentous conference can be found on the HACA YouTube channel: youtube.com/@HACA_Conference/playlists

With more than 150 presenters from across health and care, in England, Scotland and Wales, the conference brought together attendees with a passion for analytics, to share their work, ideas and visions for the future.

The conference was delivered by the Strategy Unit in collaboration with the Health Economics Unit and the four NHS Commissioning Support Units, supported by the Association of professional healthcare Analysts (AphA) and the Office for Health Improvement and Disparities (OHID), offering the best of analytics, without a commercial agenda.

Improving the safety of patients prescribed clozapine

Our partnership with a local mental health trust resulted in advancements in addressing inadequate clozapine documentation, leading to improved patient safety, optimised medication processes, and quantifiable cost savings.

Background

NHS Midlands and Lancashire CSU’s Medicines Management and Optimisation Team collaborated with a local mental health trust to address the issue of inadequate documentation of clozapine, a high-risk medication, in primary care patient medication records. This posed significant risks to patient safety, including missed drug interactions, overlooked side effects, and compromised transfer of care. The team aimed to improve the quality and safety of care for patients prescribed clozapine.

Action

A comprehensive review of patient records was undertaken, and measures were implemented to address the issue. The team audited 220 patient records and added clozapine where it was absent. A safety protocol was developed and integrated into the prescribing systems of all local GP practices to alert clinicians about the potentially fatal complications of clozapine treatment.

The team collaborated closely with the mental health trust, information technology colleagues, clinical pharmacists, and prescribing system specialists to ensure accurate documentation and effective implementation of the safety protocol.

Impact

The project implementation had the following outcomes:

  • Enhanced patient safety: Initially, 36% of patients prescribed clozapine lacked proper documentation in their records. By including clozapine information for all 79 patients, the team achieved 100% visibility of clozapine prescriptions in primary care.
  • Correct medication positioning: All 220 patients had clozapine accurately positioned as a ‘hospital-only repeat’ medicine, effectively preventing unintended primary care prescribing.
  • Improved awareness and management: Integrating the clozapine safety protocol into the prescribing systems of 50 GP practices led to better awareness and management of clozapine-related side effects and drug interactions.
  • Enhanced collaboration: This implementation led to improved collaboration and communication between the team and the local mental health trust, resulting in the adoption of similar initiatives for other high-risk medications.
  • Reduced risks: The project significantly decreased risk associated with care transfer, inadvertent prescribing errors and missed side effects of clozapine treatment.
  • Quantifiable value: The team assessed the value of these safety improvements at £11,297 for the financial year, in terms of lowered risk of harm and prevention of hospital admissions.

The project was shortlisted for improving medicines safety category at the 2023 HSJ Patient Safety Awards.

Feedback

The prescribing system safety protocol is certainly noticeable and has alerted me to consider the potentially fatal side effects of clozapine treatment when I am reviewing my patients.

GP Partner

This collaborative initiative enhances the care provided to patients prescribed clozapine by upskilling primary care colleagues, bolstering key safety messages at the time of prescribing and ensuring patients in need are escalated to specialist mental health services in a timely fashion.

Associate Director of Pharmacy | Mental Health Trust

Understanding mental health attendance in Emergency Departments

Our dashboard on mental health attendance in Emergency Departments empowered commissioners and providers to identify care variations, establish baselines, evaluate initiatives, and enhance support, leading to improved planning and service delivery.

Background

Birmingham and Solihull Integrated Care System(ICS) wanted a concise dashboard to provide an overview of mental health attendance in Emergency Departments (ED), including baseline, trends, demographics, and care variations.

Action

We created an interactive dashboard that links data from urgent and emergency care and mental health services. The data is extracted and transacted using structured query language scripting.

Clinical codes were used to identify the relevant diagnosis, and the data was visualised using software called Tableau and posted on the data visualisation platform Aristotle. The dashboard reports on attendances in EDs with diagnoses related to mental health, drug and alcohol, or toxicology. The information plotted is limited to specific hospital sites and the local commissioner.

Impact

The dashboard offered information on mental health attendance in EDs throughout the ICS – why they attended and the treatment they receive.

It gave the commissioners the insight they needed to:

  • identify increases in mental health presentations and variations in care between hospitals
  • establish a baseline for reducing mental health attendance
  • assess the impact of diversion initiatives
  • examine patient demographics
  • evaluate the coverage and timeliness of Psychiatric Liaison teams supporting patients in EDs who are having a mental health crisis.

Commissioners and providers were able to quickly identify care variations and support the process of planning and delivering improvements to services.

Feedback

The report enables monitoring of attendances at ED, reasons and response times by categories of need and by hospital site, which in turn supports us in both monitoring the impact of what we are doing and identifying trends in order to support future planning. Philippa Coleman | Head of Mental Health Commissioning

Travel analysis for Manchester University NHS Foundation Trust

We provided detailed travel analysis data that was central to determining the impact on patients in a complex hospital service reconfiguration project, which was essential for commissioner assurance and assessment of the right decision for patients under the care of Manchester Foundation Trust and Northern Care Alliance.

Background

As a result of a process that began in January 2016 Manchester Foundation Trust (MFT) formally acquired the North Manchester General Hospital (NMGH) site and services through a commercial transaction on 1 April 2021. Salford Royal Foundation Trust (SRFT) acquired the remaining elements of Pennine Acute Hospital Trust through a statutory transaction on 1 October 2021 and became the Northern Care Alliance (NCA). As a result of this several complex services need to be disaggregated and provided at other sites. To do this, the trusts, working collaboratively, presented options for service change to commissioners and health scrutiny committees. The travel analysis data produced by Midlands and Lancashire CSU was central to the work undertaken to determine the impact on patients.

Action

MLCSU worked with MFT, NCA and commissioners to understand their requirements for travel analysis as well as the proposed service reconfiguration options.  Using the Ordnance Survey Highways road network, TrafficMaster Speed data and public transport data from Basemap, a matrix was developed with travel times and distances from LSOAs and wards within a defined catchment to multiple hospital provider sites for various modes of transport.  Maps showing travel times to hospitals and change in travel time for each proposed service reconfiguration were also provided.  The methodology and output was presented to the Pennine Acute Complex Disaggregation Oversight Group. By providing a data matrix of journey times, it was possible to generate additional information to estimate the cost of travel for each service configuration.

Impact

The information is used to identify the existing travel times for patients who use the service and the impact upon those journeys. At the ward level, the general impact on patients can be calculated, in terms of distance and time for car journeys and modes of transport, interchanges and time for public transport. Combining these data points with government mileage rates and bus/tram costs allows for a further breakdown of the impact on patients.

The travel analysis is used in part to define the equalities impact assessment and quality impact assessment. As part of the overall case for change, travel analysis is one of the metrics considered in the options appraisal.

Customer feedback

The team from Midlands and Lancashire CSU were always happy to take the time discussing with us the impact of our specification and how we could refine our ask to get exactly what we needed.  The timescales were tight for delivering on this activity but at no point were we concerned about the quality of the output as we were kept up to date during our regular meetings.  The information provided has been an essential part of commissioner assurance and assessment of the right decision for the patients that have traditionally been managed by Pennine Acute Hospital Trust but are now under the care of Manchester Foundation Trust and Northern Care Alliance.

Sophie Hargreaves, Director of Strategy – Manchester University NHS Foundation Trust

Transforming Healthcare: Developing Integrated Service Models for the Shrewsbury Health and Wellbeing Hub

We supported the development of a new Health and Wellbeing Hub in Shrewsbury by designing and agreeing on integrated care models based on best practices for frailty, long-term conditions, peri-operative care and discharge. We delivered new fully integrated service models for the four pathways and drafted future service profiles, informed by public and provider stakeholder engagement.

Background

NHS Shropshire, Telford and Wrekin ICB were looking to inform the future service profile of a new Health and Wellbeing Hub in Shrewsbury. Strategic planning had been stalled by the COVID pandemic, and a different approach was needed to ensure service transformation would incorporate and build on the changes made during COVID.

Action

We used a combination of data sources, including demographics, local data and national data sets to develop demand and capacity models across four pathways:

– Frailty
– Long-term conditions
– Peri-operative care
– Discharge.

We explored best practice models and discussed these with providers in a series of workshops. The ICB engaged with the public at the same time. Demographic analysis and extensive engagement with providers led to the prioritisation of the frailty pathway for transformation since Shrewsbury has one of the highest percentages and fastest-growing elderly populations in the country. Alongside frailty, we looked at long-term conditions, peri-operative care and discharge as complimentary to frailty. They all required the same integrated multi-disciplinary team approach that the engagement work aspired to.

In addition, high-level financial profiles were developed for the pathways based on indicative workforce modelling.

Delivery by MLCSU

• Demographic analysis indicating population trends and likely impact on health service capacity.

• Presentation of best practice evidence base for frailty, long-term conditions management and peri-operative care.

• Extensive engagement and workshops with all providers (multi-disciplinary and multi-organisational). Maintained a link with the public-facing engagement exercises being run in parallel.

• Contributed to public focus groups and developed and delivered workshops for frailty, discharge and children and young peoples services (a further area for exploration that came up through the engagement work).

• Development of demand and capacity models for frailty, long-term conditions, peri-operative care and discharge.

• Indicative workforce forecast for new models of care
Financial modelling (high-level)

• Led the multi-organisational Service Integration Group who were responsible for sign-off of pathways and business case inputs from a system service perspective.

• Drafted the ‘Future Service Profile’ section of the outline business case incorporating primary care inputs for GP practices and the primary care network alongside the proposed service transformation.

Impact

We successfully delivered a high-level future service model with pathways and demand modelling informed by public and provider stakeholder engagement. We supported the development of a new health and wellbeing hub in Shrewsbury by designing and agreeing on integrated care models based on best practices for frailty, long-term conditions, peri-operative care and discharge.

In addition, we delivered new fully integrated service models for the four pathways. Future service profiles were agreed upon and drafted for the outline business case for the Shrewsbury Health and Wellbeing Hub. Providers were successfully engaged in the design of the new models of care via interviews and workshops.

Customer Feedback

CSU colleagues successfully delivered a high-level future service model with pathways and demand modelling informed by public and provider stakeholder engagement. MLCSU were excellent to work with and very organised and structured in their approach.

Emma Pyrah | Associate Director of Primary Care, NHS Shropshire, Telford and Wrekin ICB

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/

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.”

Wellbeing conversations with health and care staff

We helped health and care leaders in the Midlands to take a transparent, collaborative approach to uncovering opportunities for improvement in staff health and wellbeing and creating an actionable plan for the whole region.

Background

The Be Well Midlands programme created an opportunity for everyone working in health and social care in the Midlands to have a conversation about wellbeing by sharing thoughts, ideas and experiences in a safe, anonymous environment. This covered 260,000 staff across 11 integrated care systems (ICSs) and 81 NHS organisations.

Action

The NHS Midlands and Lancashire CSU (MLCSU) Business Intelligence and Improvement Unit helped with collecting information on existing health and wellbeing interventions and understanding of potential barriers to access. We worked with a third sector organisation (Clever Together) to facilitate staff engagement and gather insight.

We used workforce intelligence and triangulated data with population and wider inequalities. For example, sickness absence data may suggest a higher absence for BAME staff during the last 12 months. We looked into how this correlates to the health inequalities data for specific areas. This created comprehensive profiles based on population and workforce analysis, and it provided the basis on which ICSs across the Midlands could shape and develop health and wellbeing strategies.

The overall aim was to eventually have the Be Well Midlands work on the national agenda and be held up as a gold standard service.

Impact

The aim of the programme was to create an action plan that will improve wellbeing provision for people working in health and care – so that they can continue providing exceptional care to people living in the Midlands.

It created a first-of-its-kind workforce and population profile across the 11 ICSs. Leaders will now interpret it to develop health and wellbeing strategies and ensure that health inequalities in the workforce are addressed.

“The NHS Midlands and Lancashire Commissioning Support Unit (MLCSU) were recommended by another NHS organisation and I am so pleased to have made the connection.  From the first exploratory meeting, through the contract arrangements, to the final product itself – MLCSU colleagues were professional, knowledgeable, supportive and flexible, recognising the challenges of delivering within an NHS environment in the context of COVID and vaccination as a condition of deployment. 

“Nothing was ever too much of an ask for any of the team – always there to listen, support the programme and offer assistance to ensure successful delivery. 

“I am proud to say that these colleagues formed a trusted and reliable team, providing not only important value and contribution to their own role in delivery, but significant input on other factors of the programme that were delivered by other partners. 

“The skills that the team brought to the programme were invaluable, understanding the programme outcomes and recommending how best to support delivery.  The team always made themselves available and valued their understanding of an NHS environment to ensure the final product was delivered within context.”

Vicky Self, Programme Manager, Regional (Midlands) Enhanced Health & Wellbeing Programme

MLCSU director named HSJ100 wildcard

Andi Orlowski, Director of the Health Economics Unit, part of NHS Midlands and Lancashire CSU (MLCSU), has been named as one of the 20 “wildcards” for the 2022 HSJ100.

Andi Orlowski, Director of the Health Economics Unit

The HSJ100 is a list compiled by the Health Service Journal of the 100 most influential people in health. The HSJ100 wildcards are people and organisations with no formal power over the direction of national heath policy but who have ideas that could and should influence it.

The HSJ explains: “to select the final 20, we focused in on those who were well placed to make an impact on the particular challenges of the forthcoming 12 months.”

Andi has been named on the list alongside GPs, journalists and notable staff and directors from other NHS organisations, charities and the private sector.

The HSJ continues:

“Population health management may be a buzzword but it describes an important concept. Understanding the health needs of communities will be crucial for ICSs and will help recovery by ensuring the right services are provided to meet those needs. Mr Orlowski and his team provide the expertise and analytics to make this happen. He is also a strong and informed voice on how data can identify health inequalities and how such gaps can then be addressed.”

Find out more about the Health Economics Unit at https://healtheconomicsunit.nhs.uk/

Find out more about the HSJ100 wildcards at https://www.hsj.co.uk/hsj100-the-wildcards/7032608.article

Discovering efficiencies and service improvements

We helped an NHS trust analyse and visualise data on key performance indicators with the aim of releasing efficiencies and to assess inequalities in service provision on a range of areas.

Background

Leicestershire Partnership NHS Trust (LPT) were planning to take a systematic approach to transforming their services by reviewing a basket of indicators by service line. The aim was to enable efficiencies as part of their three-year financial plan, and to assess inequalities in service provision.

Action

The Midlands and Lancashire Commissioning Support Unit created a comprehensive report for LPT at the end of the 2021/22 financial year. The report provided detailed analysis of each of the indicators in the basket by service line and made recommendations for next steps based on the findings.

Impact

We provided insight on the following indicators:

* Workforce analysis – staffing profile and spend
* Average caseloads
* Travel undertaken
* Estates use, including travel spend
* Clinical activity: commissioned volume versus actual volume by contract type
* Demographic growth (historical and forecasted).

The trust had not analysed data in this way previously, and directors said that the visual representation (by service) is likely to support business cases to move forward much more quickly than previously.

The trust has since implemented new projects to address issues uncovered by the report such as recruitment gaps and reducing reliance on agency spend.

Claire Lacey, Programme Manager, Leicestershire Partnership NHS Trust, said: “The report was very well received by the Transformation Committee who have reviewed the initial findings and recommendations provided by MLCSU.

“The maps and visual representation of our patient journey through Covid, is showing really positive outcomes already, with the speedy implementation of new projects to address areas we uncovered – specifically recruitment gaps and reducing reliance on agency spend.”

BI supports efficient and equitable vax service

Our business intelligence experts helped the Lancashire and South Cumbria COVID-19 Vaccination Programme to provide an efficient and equitable service.
We used local GP systems and national sources of data to fashion datasets providing maximum analytical value; constructed detailed planning tools to permit complex scenario modelling with clear and actionable outputs; produced operational and performance reports relating to various aspects of the programme; provided swift and effective responses to queries at a local, regional and national level, as well as sharing best practice in business intelligence.
This helped stakeholders make data-driven decisions in key areas of operational delivery throughout the rollout. Access to detailed and highly adaptive insight contributed to achieving many of the vaccination programme’s core objectives.
In particular, the daily Situation Report provided unparalleled access to information on site activity and population uptake across the health system. It enabled leaders to closely monitor programme delivery and the impact of their decisions, and to respond proactively to operational challenges as and when they arose.
Similarly, we used data on GP systems and existing data on our established business intelligence platform to produce reports which were invaluable tools in facilitating ad hoc deep-dive analyses of vaccination uptake across a diverse geography. They also supported wider system work around population health management and the reduction of health inequalities.

Informing COVID-19 vaccination centre planning

Our dynamic heat maps showed where vaccine uptake was lower, where there was a higher concentration of social care providers and other population analyses by different criteria to inform the planning and placement of COVID-19 vaccination centres.

Background

The Birmingham and Solihull Integrated Care System (ICS) and University Hospitals Birmingham NHS Trust required support with the planning and rollout of COVID-19 vaccinations across their geography. There was a need to know where to place vaccination sites and direct resources, where the past, current and planned future vaccination sites were, and to evaluate the rollout.

Action

We provided a series of ‘heat maps’ showing areas with the highest proportion of patients at a greater risk of COVID-19 to support the placement of vaccination sites and the direction of resources.

The maps showed analysis of the population by small areas (about 1,500 residents) for the following criteria:

* Deprivation
* Population density
* Proportion of BAME residents
* Proportion of housebound residents
* Proportion of obese residents
* Location of residential and care homes.

Regular updates were provided to the maps to include COVID-19 vaccine uptake and current and proposed vaccination centres across the geography.

Using the ‘R’ data science tool, we pioneered a new way of sharing the maps which allowed quick and easy access. Interactivity enabled the vaccination team to zoom in or out and filter information.

Impact

In January 2021, we mapped vaccination centres alongside the 1,253 health and social providers across Birmingham and Solihull. At a crucial point of the vaccine rollout, this enabled the vaccination team to quickly advise providers where their nearest vaccination site was located.

In April 2021, we mapped the residency of patients vaccinated at mass vaccination sites. This enabled the team to see where patients were travelling from to be vaccinated and evaluate whether patient travel distance could be reduced.

In August 2021, we mapped uptake of the COVID-19 vaccine, split by ethnicity and gender, which supported the planning of targeted vaccination vans and sites in areas of lower uptake and with greater health inequalities.

By December 21, the regular map of current and proposed vaccination sites included 66 permanent vaccination sites and 86 sites which mobile vaccination vans had visited.

Combined intelligence for population health action

We helped key stakeholders in the Cheshire and Merseyside health system see combined intelligence reports on capacity and demand for health services, allowing them to respond to COVID-19 quickly.

Background

The CIPHA (Combined Intelligence for Population Health Action) platform was developed to bring together health and social care datasets within the Cheshire and Merseyside health system. The aim was to help inform key decisions when responding to COVID-19. Since October 2020, the Midlands and Lancashire Commissioning Support Unit have been supporting the CIPHA programme with business intelligence (BI).

Action

The Cheshire and Merseyside BI team have been providing daily reports to CIPHA. These reports cover COVID-19 testing, cases, deaths,  outbreak identification, hospital admissions, capacity and demand, discharge reporting, vaccination reporting and much more.

The team continue to provide a full end to end service in the tracking of capacity and demand for out of hospital (OOH) services. Support includes data processing, data quality validations and reporting, and also helping with any changes to the reports within the CIPHA platform.

Impact

We have facilitated a process to ensure that key stakeholders within the health system see CIPHA reports in a timely manner. This has informed clinical commissioning groups leads, provider trusts leads and others to make key decisions when responding to COVID-19.

The support provided in tracking capacity and demand for OOH services has helped the system leaders to understand current demand for OOH services including activity, case loads, bed occupancy and waits as related to intermediate care, community care, mental health services and social care. This has then enabled provider trusts to understand and utilise capacity in the community when discharging patients.

Helen Duckworth, Associate Director of Business Intelligence, Cheshire & Merseyside ICS, said: “It is a real pleasure working with you. Thank you to the BI team for your unparalleled professionalism and knowledge, and for investing your time and effort in doing an excellent job with a fantastically experienced hand. Nothing is too much to ask, and all our needs  are met with a smile. Having your support for the Demand and Capacity OOH Tracker meant we could rely on seeing up to date and easy to understand data, which helped system stakeholders make quick and informed decisions. ”

Helen Duckworth| Associate Director of Business Intelligence, Cheshire & Merseyside ICS

Equity and equality in maternity and neonatal care

We combined national metrics and local NHS, council and third sector data to help health systems understand where there are inequalities within local services.

Background

There was a national requirement from NHS England and NHS Improvement (NHSEI) for all local maternity systems to develop a maternity equity and equality audit by the end of November 2021. The aim was to understand where there are inequalities within the maternity services locally. This will be used to inform guidance to improve maternal health outcomes.

This case study looks at the Leicester, Leicestershire & Rutland (LLR) version of the maternity audit however the Midlands and Lancashire Commissioning Support Unit carried out this audit across our whole customer base.

Action

We analysed a large number of metrics:

* National metrics relating to maternity, neonatal and perinatal mental health
* Local provider data from organisations such as University Hospitals of Leicester Trust, Leicestershire Partnership NHS Trust, Leicestershire County Council and others.
* Voluntary sector data from, for example, the National Maternity Voices Partnership and others.

The audit was submitted to NHSEI as part of Stage 1 of the national requirement in November 2021.

Impact

The audit highlighted gaps in maternity services and suggested where further work was required, for example:

* Ethnic coding in the neonatal data set
* Data quality and data consistency
* Data provided to support anecdotal evidence.

Following the submission of the ‘Equity Plan’ to NHSEI, Stage 2 will be an action plan drawn up based on the analysis to improve maternal health outcomes, and will be locally focussed. The local maternity system will work with partners to develop those plans.

What the NHS is doing and how

The NHS is working to improve equity for mothers and babies and equality in experience for staff. The NHS has set out why this work is needed, the aims of this work and how the NHS will achieve its aims in two documents:

* ‘Equity and Equality: Guidance for Local Maternity Systems’: Based on the five health inequalities priorities in the 2021/22 Planning Guidance​, this will help local maternity systems align their plans with integrated care systems health inequalities work​.
* ‘NHS pledges to improve equity for mothers and babies and race equality for staff’: The four pledges help create a shared understanding of why work on equity and equality is needed, and the aims and outcomes of this work.

Scope

The guidance seeks to respond to the findings of the MBRRACE-UK reports about maternal and perinatal mortality, which show worse outcomes for those from Black, Asian and Mixed ethnic groups and those living in the most deprived areas. In doing so, consideration was given to the strong evidence highlighted in the NHS People Plan that “…where an NHS workforce is representative of the community that it serves, patient care and…patient experience is more personalised and improves”.  Therefore, the strategy recognises that improving equity for mothers and babies also requires a focus on race equality for staff.

Decision makers can make better use of analysis

Peter Spilsbury, Director of the Strategy Unit at Midlands and Lancashire Commissioning Support Unit, writes about the very essence of the Unit’s mission and how they are defending analysts’ corner in the NHS:

Part of the Strategy Unit mission is to improve the use of analysis in decision making. Current use is, to employ a euphemism, variable.

Our mission takes multiple forms:

* We try to exemplify the behaviour we want to see. We work closely with decision makers; we share models and code alongside results.  
* Though the Midlands Decision Support Network, we run training programmes for Midlands analysts, recognising that certain skills (around leadership for example) are needed.
* And, increasingly, we work with leaders and decision makers to help them understand the value that good analysis can add.

We also advocate. We make the case for analysts in different forums – and we’ve even gone so far as to incite insurrection…

This is why I appeared in the HSJ to argue that the NHS is squandering its analytical talents. The article rehearsed a set of arguments that will be familiar to many: that the NHS has around 10,000 analysts; that they are typically skilled, but not well used; and that the decision maker – analyst relationship is vital and needs attention of the kind it does not currently get.

I also made the case for the Midlands Decision Support Network as a model.

The value of this Network is becoming clearer by the day. Whether through networking analysts, evaluators and evidence reviewers; through providing technical training and development; through working with leaders to improve their decision making; or through helping systems create local Decision Support Units.

It provides a model that addresses the requirements for Integrated Care Systems to be intelligence-driven, capable of experimenting and learning. This is a model that other regions are now interested in replicating. I encourage everyone to visit the website – https://www.midlandsdecisionsupport.nhs.uk/ – to find out more and see why.

The Strategy Unit mission will never be complete. Continuing advances in data science mean that analysts will always be capable of adding more value. But the current gap between what can be done and what is done is vast.

This is a gap we are determined to help close.

PCNs critical in population health management

Andi Orlowski, director of the Health Economic Unit at Midlands and Lancashire Commissioning Support Unit and senior adviser to NHS England on population health management, casts light on the critical role of primary care networks in population health management.

Selected questions from interview published in Pulse PCN, 1 February 2022.

What’s the current status of population health management (PHM) in England?

The challenge for PHM is using data to identify which interventions are most likely to succeed for an individual based on their wider circumstances and how interventions can be delivered in a way that is most likely to achieve a positive outcome. PCNs and organisations that really understand their populations are best placed to help tailor care to the best effect.

Who is responsible for PHM?

The responsibility lies with all of us. PCNs are critical, not only in the delivery of care but also in providing a deep understanding of local populations. PCNs can shape the care provided by local authorities, NHS providers, public health and beyond. If we are to address ‘health’ and not just healthcare, a wider understanding of what the population needs can only come from a local level. My advice for PCNs is not to wait for the ICS to come knocking but to actively engage with them now. This is the time to act and represent your population.

What is expected of PCNs in terms of PHM?

PCNs should be helping to direct care and support, ensuring the correct interventions are used and addressing unwarranted or harmful variation. PCNs are the engine room of PHM. Their insight and focus on populations will make all the difference.

Are PCNs important for PHM and do you think that is recognised at a system level?

PCNs are critical to successful PHM. Any ICS that does not engage with its PCNs will struggle to have a real understanding of its populations and will miss the key element of tailoring care – after all, how can anyone really understand all the differences in a population of 2-3 million patients? This is not a time to be passive. PCNs must make sure they are heard. If you are in a PCN, do you know who at the ICS you should be contacting? If not, find out.

Supporting infection prevention and control with analytics

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

Background

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

Action

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

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

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

Impact

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

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

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

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

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

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

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

Pandemic effect on a socially deprived UK town

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

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

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

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

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

Primary care networks – the PHM X factor

How primary care networks are critical to the success of population health management: Andi Orlowski, director of the Health Economics Unit at Midlands and Lancashire Commissioning Support Unit and senior adviser to NHS England on population health management, shares his insights in Pulse PCN magazine.

The winter issue of the magazine for primary care network (PCN) clinical directors includes an interview with Andi about the benefits of a population health management approach and how PCNs are critical for successful deployment.

PHM ensures the right care is given at the right time by the right person and allows primary care a greater opportunity to partner with other organisations to help address the health of the population.

You can read the full article in the latest issue of Pulse PCN, available on the PULSE website: www.pulsetoday.co.uk

If you’d like to find out more about how the Health Economics Unit could help you with PHM then please do get in touch.

Blog: How to make sure good analysts save lives

Andi Orlowski, Director of the Midlands and Lancashire Commissioning Support Unit’s Health Economics Unit, writes about the profession of being an analyst in the NHS and their essential role in improving decision making across healthcare.

“A good analyst can save more lives than a good anaesthetist” – new NHS England CEO Amanda Pritchard.

This is a brilliant recognition of analysts and their strategic impact on the delivery of healthcare. However, while a soundbite from the top is one thing, we need to ensure the NHS has a well-resourced and fully embedded analytical workforce to truly make this happen.

Along with others, I have long championed the work of the NHS’ brilliant and dedicated analysts, health economists and data scientists, and the need to increase the service’s analytics capability and capacity.

I was delighted to hear Amanda Pritchard’s support for our profession. After all, we analysts are in the NHS to make a difference, not to make up the numbers! But what does it mean to be a good analyst? When I think of “good analysts” I picture someone striving to “improve decision quality” for system leaders. Such good analysts really can save lives. It’s that simple.

Creating opportunities and building the profession

Goldacre et al. set the ambition of professionalising analytics in 2020: “To capitalise on opportunities to improve health and care, we need the data and outstanding data analysis”. This means creating a professional analytical workforce that reliably produces expert and thoughtful insight to improve decision making.

We need to give the right people the right opportunities to become good analysts; however, very few analysts joining the NHS can see a clear career pathway. If the NHS analyst workforce were supported by “career trajectories and effective development and training opportunities”, as Goldacre recommends, it could be possible to build the modern, open and inclusive culture of improvement we need.

For example, a key issue raised in the paper is that many NHS data analysts are classified as “admin/clerical” rather than “scientific/clinical”. Yet much of their work is clinical in nature and analysts play a huge role in how care is delivered. So why don’t we recognise that fact and give clinical NHS colleagues a better understanding of the work we do?

Analysts can’t work in a vacuum

NHS analysts should be fully embedded within teams that include clinicians, managers, researchers, software engineers and outstanding communicators. And – to follow Amanda Pritchard’s point – anaesthetists!

This would allow analysts to build a greater understanding of the data and enable their colleagues to “ask better questions”, together making a real difference for services on the ground. With a greater parity of understanding around the benefits and limitations of data and its analysis, commissioners, managers and clinicians will better maximise the opportunities it offers.

This greater understanding among clinical team members requires an increase in data literacy and dedicated training.

Sharing knowledge is key

Analysts should be proud to share our work, code and approaches across the NHS. Let’s build a public resource library – a creative commons – that organisations and clinicians across the country can call on, sharing learning and increasing the value of the work carried out by individual data analysts.

Organisations including AphA and the NHS-R Community continue to do excellent work in promoting the conversation and collaboration around shared resources by bringing the analyst community together. We need to now bring in more clinical colleagues and system leaders, exposing them to the work of analysts so they can see how awesome they are!

There is advice from the Strategy Unit, based in Midlands and Lancashire Commissioning Support Unit, on how to develop a high functioning strategic analytics team.

Collaboration across the NHS community

Let’s inspire analysts across the NHS, value their input, ask them what questions we should be asking and seek their thoughts on how we can maximise the benefit of their work. By harnessing their skills, supporting their development and sharing best practice across the country, and by making sure we’re not duplicating efforts but learning from each other, we can support a real transformation in the NHS.

As the increasing skills of NHS analysts and the possibilities offered by the growing source data available lend credence to more and more research projects that will make a real difference to services on the ground, good analysts can work together with good clinicians to save even more lives.

I would welcome clinicians and analysts to make contact with the team at AphA for advice on work they’d like to complete and, thanks to our national networks, we will help you make connections with people looking into similar areas and support the potential for joint projects, sharing knowledge and experience.

Inclusive decision making across Leicestershire

The Midlands and Lancashire Commissioning Support Unit’s Equality and Inclusion team are supporting a showcase event highlighting the LLR Academy’s ongoing work embedding inclusive decision making across Leicester, Leicestershire and Rutland (LLR). The event takes place virtually on Thursday 30 September, 10.30am-12.30pm, and is aimed at all NHS staff who work across equality agendas.

This is part of the Inclusive Decision Making Framework (IDMF), an LLR system-wide innovative approach to help embed equality considerations (including health inequalities) within decision making.

The framework is based on six steps to consider equality when making decision. The IDMF will help to:

* Foster a culture of Inclusive Decision Making across the LLR system
* Provide a shared Equality, Diversity, and Inclusion (EDI) resource across different system partners
* Provide practical steps to ensure that the needs of different communities and staff are considered in decision making and plans
* Meet the challenges of delivering the NHS Long Term Plan across LLR to meet legal duties – in terms of equality, reducing health inequalities, and human rights.

The showcase event celebrates the progress made in implementing the IMDF across three priority areas: the LLR Reconfiguration Programme (Building Better Hospitals), the approach to reducing health inequalities and the clinical design group work.

We are joined by Dr Bola Owolabi (Director for Health Inequalities, NHS England and Improvement) who is our keynote speaker. We are also showcasing three case studies which demonstrate excellence in inclusive decision making practices across the LLR system.

For further information  and to book a place, please email llracademy@uhl-tr.nhs.uk

Data-driven approach to PHM

What is population health management (PHM)? How can the Midlands and Lancashire Commissioning Support Unit support your health system with data-driven PHM to design interventions and tackle inequalities?

PHM aims to deliver the NHS Long Term Plan’s goal to move from delivering care that mainly responds when someone becomes unwell to a system of targeted early intervention and prevention. That way, the focus moves from treating illness to having a system-wide response to prevent and reduce the impact of illness. The result? A better quality of life, health outcomes and experience for local people.

Our business intelligence team helps health systems with data and intelligence which underpin PHM. We can bring together all of your health system’s data from a variety of sources, including primary care and COVID-19 records, to create bespoke actionable intelligence. This helps you, as system leaders, identify and meet the needs of unique population groups and individuals.

Our in-house risk segmentation tool provides information on health inequalities in specific areas, allowing you to make targeted interventions. It uses a variety of different data sources such as risk stratification, geosegmentation, COVID risk, psycho-social factors, deprivation and geographical location, offering unique intelligence about population health, all the way down to the neighbourhood level.

To find out more about our business intelligence services, see our PHM videos and PHM and risk segmentation tool pages from the links below, or contact the Business Intelligence team at mlcsu.bi-productdelivery@nhs.net

Improved end of life care with PHM

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

Action

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

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

Impact

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

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

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

Rapid development of COVID-19 sit-rep dashboard

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

Action

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

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

Impact

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

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

Integrating data analytics in Dudley

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

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

Action

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

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

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

Impact

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

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.

Supporting financial reporting and control for a rapidly expanded GP federation

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

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

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

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

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

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

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

Impact

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

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

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

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

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

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

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.

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.

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.

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.

Supporting QIPP delivery in North Cumbria

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

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

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

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

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

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

Impact

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

The outputs from the project supported:

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

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.