Category: News and case studies

We achieved a system-wide enhancement in healthcare service delivery, decision-making efficiency, and operational effectiveness through advanced data management and performance analytics.

Background

In 2020, the Lancashire and South Cumbria (LSC) area started special health networks following a national plan. These networks, called Integrated Care System (ICS) networks, aim to make health services better by working together on big projects. This includes hiring staff, funding requests, and planning how to use resources at an ICS level. These networks bring together all major hospitals and a central team of experts in areas like change management, hiring, technology, buying, and data. In 2021, NHS Midlands and Lancashire CSU (MLCSU) was asked to help the Diagnostic Imaging Network (DIN) with tasks like gathering, analysing, and showing data.

Action

Since our appointment, our collaboration with the network’s professionals has been pivotal in spearheading and sustaining key initiatives:

– Spearheaded the formation and oversight of a data workstream

– Launched a capacity and demand model tailored for the LSC, allowing for the alignment of healthcare resources with patient needs

– Innovated a localised imaging dataset, which is a crucial repository for medical imaging data, specific to our region

– Established a performance dashboard at the ICS level, providing a comprehensive view of our operational achievements and areas for improvement.

Impact

By offering business intelligence support to the LSC Diagnostic Imaging Network (DIN), we’ve set up wide-reaching methods for system modelling, data analysis, and monitoring performance. These methods have been crucial in providing solid evidence to support the hiring of new staff, the purchasing of equipment, and planning operations.

Operating from a central hub, the MLCSU can accurately and securely process data from the four trusts, both on a national scale and at an individual level. Our essential tools and resources have been fundamental in advancing the network’s projects. The smooth flow of data, our data-sharing agreements, and tools like the Aristotle platform have significantly enhanced the success of each project we undertake.

Our pre-established connections with healthcare providers throughout the system give us a broad network that enables quick and effective data access, prompt responses to inquiries, and facilitates swift advancements within the system.

In 2023, the remarkable work of the LSC DIN was recognised by a nomination for the HSJ Awards, intended to showcase its beneficial impact beyond the Northwest region. Our neighbouring System DINs within the Northwest are already looking to adopt similar initiatives, acknowledging the positive ripple effect our efforts have had throughout the NHS.

As LSC continues to introduce more diagnostic networks, there’s a clear trend of these new networks wanting to replicate the DIN’s successful framework and projects. This movement serves as a testament to the significant and positive influence our network has established, particularly in the realm of data management, serving as a model and benchmark for others to follow.

Feedback

“Ross has been a real asset to the Diagnostic Imaging Network team. He has provided business intelligence specialist expertise as an embedded programme resource, building strong relationships to work collaboratively with key stakeholders within our acute trusts. The development of a suite of business intelligence driven ‘products’, housed within an online network dashboard which sits on the MLCSU Aristotle platform, supports accurate, consistent reporting against national targets, a focus on performance improvement, identification of mutual aid opportunities, capacity and demand modelling, and the provision of evidence to support service and business planning.”

Claire Kindness-Cartwright | Senior Programme Manager | LSC Diagnostic Imaging Network.

We are absolutely elated to announce three further nominations for NHS Midlands and Lancashire CSU (MLCSU) at the HSJ Patient Safety Awards in addition to the reducing mortality project shortlisted for HSJ Patient Safety Awards 2023.

Our Medicines Management and Optimisation team has excelled this year, being shortlisted not just for one, but for three projects in the highly esteemed HSJ Patient Safety Awards 2023! This is a testament to the focus and hard work of our staff and the effective and enjoyable joint working with stakeholders. We are passionate about patient care and safety and are pleased to be having an impact across a range of areas.

Out of an astounding 515 entries received this year, MLCSU Medicines Management and Optimisation team has joined the final shortlist of 209 exceptional organisations, projects, and individuals. The sheer volume and exceptional quality of the applications bear testimony to the remarkable commitment and passion for patient care within the UK healthcare networks.

The projects
Let’s delve into the details of our shortlisted projects;

The first project focuses on enhancing inhaler prescribing practice. Through a comprehensive audit of inhaler prescriptions, we discovered that ingredient duplication within the same therapeutic drug class was often overlooked as a potential interaction or cause of side effects. We identified 360 patients with inhaler ingredient duplication errors, and nearly one-third of these errors persisted even during respiratory reviews. Armed with these audit results, we engaged with individual practices and initiated a thorough review of prescribing policies. To prevent future errors, we developed an easy-to-use reference guide for inhaler prescribing and extensively educated staff in primary and secondary care as well as community pharmacy settings.

Our second shortlisted project centres on promoting the Community of Practice Learning Disability and Autism pilot, which aimed to up-skill pharmacists working in primary care networks to conduct holistic structured medication reviews for individuals with a learning disability and/or autism. By providing extensive training and support, the pilot empowered primary care network pharmacists to deliver comprehensive medication reviews that consider the unique needs of these patients. This national project, co-produced with NHS England Health Improvement Pharmacy leads and the NHS Specialist Pharmacy Service, not only identified the learning and development needs of pharmacists but also delivered a model of support and collected data to demonstrate its success. The positive feedback received from participants and users further validated the effectiveness of this model, making it an ideal candidate for wider implementation.

The project team, consisting of NHS England Health Improvement Pharmacy leads, the NHS Specialist Pharmacy Service, and the NHS Midlands & Lancashire Commissioning Support Unit, developed a model of support to up skill pharmacists to undertake structured medication reviews (SMRs) in these patients. Participant and user feedback was positive, recommendations for the wider system were made, and the model is available for wider implementation.

The third project that secured our spot on the shortlist focuses on enhancing the safety of patients prescribed clozapine, a vital medication for managing specific mental health conditions. Working collaboratively with our mental health trust, the team identified that 36% of all patients prescribed clozapine by secondary care did not have this medication documented in their patient medication record in primary care. This created considerable risk in 3 ways: missed drug interactions, missed side effects, and compromised transfer of care. The team reviewed 220 patient records and added clozapine if absent. Working alongside our information technology colleagues, the team created and added a safety protocol on the prescribing system of every local GP practice which alerted clinicians to the potentially fatal complications of clozapine treatment.

The hard work and expertise of our team have been acknowledged by the judging panel, consisting of influential and respected figures within the healthcare community. They recognised our clinical and specialist excellence, as well as our unwavering commitment to enacting organisation-wide change and driving innovation.

Being shortlisted for these prestigious awards is not only an extraordinary honour but also a testament to our relentless dedication and passion for improving patient care. We are truly humbled to have the opportunity to showcase our achievements and contribute to the advancement of patient safety on such a prominent stage.

Jonathan Horgan, Director of Pharmacy Services, said:

“We are really pleased to have been shortlisted for all three of our entries as finalists across two categories for the prestigious HSJ Patient Safety Awards 2023. This is a testament to the staff and the partnership working with wider stakeholders who were part of these entries. The team works incredibly hard and are always focused on improving patient care and safety. As an NHS support organisation which works across wider organisations and borders, we want to have the widest impact and roll out best practice as much as possible. Getting recognition through awards helps us demonstrate the value and innovation we can bring to solve local problems. We are looking forward to the awards ceremony to celebrate the collective efforts and learn about the best examples contributing to patient safety this year.”

The NHS Midlands and Lancashire CSU (MLCSU) is thrilled to share that our project to reduce mortality in people with learning disabilities and epilepsy has been shortlisted for Learning Disabilities Initiative of the Year at this year’s HSJ Patient Safety Awards. These awards recognise safety culture and positive experience in patient care, celebrating the worthy finalists on a national scale.

The project

Working on behalf of NHS England Midlands, MLCSU joined forces with national experts at the University of Plymouth, Cornwall Partnership Foundation Trust, SUDEP Action, and Epilepsy Action, among others to spearhead a highly successful regional improvement programme to tackle the pressing issue of premature avoidable death amongst people with learning disabilities and autism living with epilepsy. The partnership worked closely with 11 integrated care systems across the Midlands, supporting them to mobilise partners in a whole-system approach to improvement.

The programme was inspired by the story of Clive Treacey who was an individual with a learning disability and who suffered from complex epilepsy. He spent much of his life moving between care providers and sadly died aged 47. In the resulting review, The Clive Treacey – Independent Review, a breadth of opportunities was identified for learning from Clive’s life, with over fifty recommendations for system-wide improvement at a local, regional and national level.

Through the implementation of a tailored self-assessment tool and guided by lived experience and specialist expertise, MLCSU and its partners helped systems establish a shared understanding of service delivery, workforce capacity, and capability and generated evidence-based improvement plans. The programme works to support a reduction in avoidable deaths, health inequalities, and hospital admissions, providing a framework for ongoing evaluation.

A recent webinar explored the topic further.

The awards

A record-breaking 515 entries were received for the HSJ Patient Safety Awards 2023. The judging panel was made up of a diverse range of highly influential and respected figures within the healthcare community. At this first stage of judging, the shortlist was set against three clear criteria: clinical and specialist excellence, enacting organisation-wide change and service/system innovation.

Following our shortlisting, the official awards ceremony will be held on 18 September in Manchester, as a highlight during the HSJ’s annual two-day Patient Safety Congress.

Hafsha Ali, Managing Consultant at MLCSU Digital Transformation – Transforming Care, said:

“We are hugely proud to have been shortlisted for this award and humbled at the support we have encountered for this improvement programme from all our partners and, of course, Elaine – Clive’s sister.

“The recognition of being finalists at the HSJ Patient Safety Awards 2023 is the awareness boost that this issue requires, and I am thrilled that we have been given this platform to further share our findings and encourage the implementation of more improvement programmes to reduce avoidable deaths, health inequalities, and hospital admissions, across the country.”

In response to the shortlisting Elaine Clarke, sister of Clive Treacey, said:

“We, Clive’s entire family, have the privilege of carrying his love and now a legacy he would be so proud of within our hearts forever. We will forever be grateful and proud for the continuing dedication of so many who have supported and remain committed to Clive’s Way.  We could never have never imagined that Clive would help to galvanise a movement across all health and social care settings in the Midlands and beyond to create capable communities keeping people with learning disabilities and epilepsy safe and living well”.

The full list of finalists for the 2023 HSJ Patient Safety Awards can be found at https://awards.patientsafetycongress.co.uk/shortlist-2023.

Winners will be announced during the awards ceremony at Manchester Central, on 18 September 2023.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In this blog, Peter Spilsbury, Director of the NHS Midlands and Lancashire CSU’s Strategy Unit, warns about the risks of expecting rapid change and moving from theory to practice too quickly.

A good idea can be ruined by over-selling. The NHS has a tendency to adopt ideas and then move rapidly to wanting them to become certainties.

What begins as a proposition rapidly becomes an assertion, a statement of fact, a policy, a target, a line in a mandated planning template…an obligatory mention in every sentence for the aspiring manager.

Things like ‘risk stratification’, ‘integration’ and various forms of ‘early intervention’ are obvious examples where what should have been ‘might work’ became ‘will work’ and with detrimental effect. I fear that our whole national approach to ‘big data’ and ‘tech’ and indeed to ‘integrated care systems’ could get caught in this space as well.

Learning stops as soon as something is pronounced as ‘will work’. That can be because the usual impositions that go with ‘will work‘ – such as targets and ‘development’ programmes where attendance is made compulsory -generate an environment that leads to distortion of the evidence and no incentive for honest reflection and learning.

The overriding imperative becomes to assert that it works, at least until everyone can safely shift (via the usual ‘good practice case studies’) to whatever is the next big thing.

The NHS says that it aspires to be a ‘learning system’. Critical to being open to learning is to be willing to acknowledge and embrace what we don’t know. So I believe that, by default, we should adopt the language of ‘might work…’

The evidence base will only ever support propositions, never certainty. And, as soon as we adopt the language of ‘might…’ then obvious and powerfully useful questions start to flow: Why do we think it might work? What is our theory of change? What mechanisms do we think are likely to be key to that? Which elements of our theory are we more, or less, confident about, and why? Can we quantify the extent of that uncertainty? Which questions contribute most to that uncertainty and what does that tell us? Do our colleagues and partners see any flaws in our theory, and do we understand why? What would we expect to see if starts to ‘work’ and how might we think to best track that (and also track the most likely types of unintended consequences?).

What factors can we see up front that might derail our theory in practice and what does that lead us to in terms of implementation strategy? (A ‘pre-mortem’ exercise can help here). How long are we willing to let this run before we decide to stop/change tack/continue, and what will be the trigger for that?

Thinking this way encourages us to think ‘experiment’ rather than ‘proof’. And, as my dear colleague Professor Mohammed Mohammed said to me recently, ‘if something doesn’t stack up in theory, it’s unlikely to do so in practice’.

‘Might…’ opens up a universe of possibilities and learning. It isn’t something that should stop progress, initiative or ambition. Quite the opposite.  It is just a different and far more effective way to proceed in making change happen. It has the golden benefit of being profoundly honest and authentic. It also reduces the gap between proclamation and reality: a gap occupied by cynicism.

Decision processes will also then embrace uncertainty and seek to understand it, bound it and address it. Planning processes will need to do the same – and we really should have no more ‘single point’ delivery plans. Rather we should have plans focussed on well understood ranges, and on how those ranges have been addressed through specific flexibilities and resilience.

The leadership we need will have the confidence and the insight to know when to say ‘might…’ rather than ‘will’. We need leadership that embraces uncertainty, rather than wishing it away. Those leaders will be trusted more and will likely achieve more as a result.

This is the one instance where ‘might is right’.

Join us at the NHS Confederation’s annual conference, taking place in Liverpool this summer. Delivered in partnership with NHS England and NHS Improvement, NHS ConfedExpo will bring together leaders from across the health and care profession for a two-day conference and exhibition.

The landmark event will explore the five key themes of People, Quality & clinical improvement, Health Inequalities, Collaboration & partnerships and Driving recovery. Book your pass and hotel accommodation online. It is set to be one of the most significant events in the health care calendar.

Be inspired by our expert speakers, choose relevant sessions that matter to you from over 140 hours of engaging content and meet experts and explore new products on the exhibition floor. 

Bookings are now open and can be secured online. 

https://www.nhsconfedexpo.org/welcome?utm_source=affiliate_exhibitor&utm_medium=organic&utm_campaign=booking_launch

2021 was, of course, another tough year for the NHS and social care. Against this challenging backdrop, the NHS Midlands and Lancashire CSU played its part in the COVID response and ongoing recovery as well as supporting establishment of integrated care systems.

Add the other innovative programmes benefiting patients that we have either led or supported and the result is a record that both surprises and pleases us to look back on. So much fitted into just 12 months!  A big ‘thank you’ goes to all our staff and partners for their hard work and immense dedication.

The Annual Review isn’t an exhaustive list – that would have been far too long – but hopefully an interesting selection of highlights and an indication of how much we can support integrated care systems.

It’s a quick read and you can find it below.

Our latest report is out on the impact of the Pan Mersey Area Prescribing Committee (APC) on the appropriate use of medicines across Merseyside. See the report in the links at the bottom of this article.

The Pan Mersey APC is a professional group consisting of GPs, pharmacists and other key healthcare professionals. It seeks to identify and champion the best use of medicines taking into account cost effectiveness, quality, equity and above all, patient safety.

The Committee is responsible for making recommendations of medicines, especially high cost medicines, across the Merseyside and Warrington footprint.

Impacts over the past year include, amongst others:

28 NHS organisations are APC members
A website created to offer national and regional information on COVID-specific medicines issues 
22 new medicines reviews and policy statements
1 guideline and 5 formulary updates produced by safety subgroup
11 National Institute for Health and Care Excellence (NICE) technology appraisal reviews. 

We have been working in collaboration with the APC providing medicines commissioning support.

To learn about how our Medicines Management and Optimisation team can support your APC, visit our new site at https://medsopt.midlandsandlancashirecsu.nhs.uk/.

As the NHS braces itself for a surge of patients who have been putting their health issues to one side during the COVID-19 pandemic, what can be done to target interventions to improve overall health and wellbeing and protect the precious capacity of our health system? Midlands and Lancashire Commissioning Support Unit’s Director of the Health Economics Unit Andi Orlowski recently joined a panel of experts to record five short videos on the role population health management (PHM) can play. Visit https://www.novartis.co.uk/populationhealth to watch them.

The videos were produced by pharmaceutical firm Novartis and look to explain what PHM is and how it can be used to drive collaboration and partnerships across local systems and improve outcomes for the communities they serve.

Andi was joined on the panel by:

* Bevleigh Evans: Head of population health management for NHS England and Improvement (NHSEI)
* Dr Dan Alton: GP, National PHM clinical advisor for NHSEI, and PHM clinical lead Berkshire West
* Chinmay Bhatt: Managing director for the UK, Ireland and Nordics, Novartis
What is population health management?

Whilst all are big advocates for the role of PHM in proactively improving the wellbeing of our communities, the panel each had their own take on how exactly to describe it. Dr Dan Alton neatly summed PHM up as “designing services to meet the needs of our population”. That might sound obvious, but how do we really know what the needs of our population are?

This is where we can help, with our population health analytics service. Our team of passionate analysts will work with you to identify patterns in health outcomes for different groups of the population and help you better understand the challenges and risks they face. This, in turn, supports you in making informed decisions or evidence-based proposals on the best way to target new health interventions to reach the groups where the most impact will be felt.

Partnership and collaboration are key

Astonishingly, only around 20% of a person’s health outcomes are attributable to their ability to access good quality health care. The other 80% are made up of ‘social determinants of health’. These include health related behaviours, socio-economic factors, and environmental factors, and they all play a part in the chances of someone living a long, happy and healthy life.

Using data to influence change

In the videos, the panel discusses a surprising real-life example to bring this to life – assisted bin collections, a service some local councils offer to help people take their bins out if it is difficult for them to do so. When Andi and the team started looking at this data, it became clear that these people were highly likely to have a worsening condition or social need that could be improved with the right intervention. By looking at this data alongside the other metrics available to us, we were able to identify a group of people who could be proactively supported by their local primary care network.

Going a step further, Bevleigh Evans explains how this information can be used to influence other service leaders, such as acute chief executives, who all have their own pressures and priorities. “I ask them why they need to care about Mabel who can’t get her bin out anymore. The answer is because she is their next fractured hip”, Bevleigh says. “She’s the pre-frailty group that you need to work together as a system to help.”

To find out more about our services supporting population health management, tap the System Design section and see contact details at the bottom.

Our Medicines Management and Optimisation team worked with the Black Country and West Birmingham Clinical Commissioning Group, GP practices and care homes on a successful project to increase the use of proxy ordering for medicines.

Background
A national programme to support the roll out of proxy ordering – which allows care homes to order online repeat medication on behalf of their residents – has been launched to help reduce the current high workload of primary care and care home staff.

The Black Country and West Birmingham Clinical Commissioning Group (CCG) deployed extra pharmacy staff to work with GP practices and care homes to set up a local system.

Action
Midlands and Lancashire Commissioning Support Unit (MLCSU) supported the CCG with proxy ordering for four weeks in March 2021.

The successful service was then extended until the end of June.

During the project, the MLCSU medicines team worked with GP practices and care homes to:

* provide additional pharmacy technician staff to complete the setting up of proxy ordering with MLCSU pharmacist oversight

* develop partnership working with all stakeholders and ensure regular reporting

* use knowledge and outputs from wider MLCSU teams, avoid repetition of work and support education by developing a resource pack

* provide strategic leadership support for the additional pharmacy response across the region. This included technical and workforce planning and ensuring that processes for safe and effective implementation of proxy ordering systems were developed in both care homes and GP practices.

Impact

A resource pack was developed and distributed to CCG medicine leads at the end of March 2021.

This pack has since been shared with GP practices across the Black Country and West Birmingham to support the implementation process.

Our effort was concentrated on working with care homes to get staff trained and prepared for the system to go live, while local CCG leads worked with GP practices to finalise the set up of proxy ordering.

During the project we contacted 79 care homes at least once a week. As a result, 14% of the care homes that were contacted (11 homes) are now actively using online proxy ordering and a further 37% (29 homes) are in the process of implementing online proxy ordering. When our work ended in June 2021, we arranged a handover to the local CCG teams to help them with future implementation. We also provided a status report on the uptake of proxy ordering in all care homes across the area and shared our learnings with all partners.

Rachael Thornton, Older Persons Specialist Pharmacist – Dudley Integrated Health and Care NHS Trust, said:

“Sonia Bigra [Senior Pharmacy Technician at MLCSU] has been supporting care homes in Dudley to implement proxy ordering with some success. Although the timeline for the project was quite short, we have had a lot of interest from our care homes which we are aiming to take forward in the near future. Sonia has approached the project in a very professional way and communicated effectively with all local stakeholders.”

We created an effective programme management office (PMO) to support Shropshire CCG and Telford and Wrekin CCG during their merger in 2021.

Background

In 2020, Shropshire Clinical Commissioning Group (CCG) and Telford & Wrekin CCG sought additional support from MLCSU for a fixed period project/programme management office (PMO) function associated with the proposed merger of the two organisations to create a single clinical commissioning group.

The CCG is about to embark on a significant period of change as it begins its transformation from a ‘traditional’ clinical commissioning group to a strategic commissioner in line with the NHS Long Term Plan. This transformation will require extensive and targeted people and organisational development support to lead the design, development and implementation of the changes needed.

The initial phase of this transformational change involves the formal disestablishment of the two current organisations in order to create a new single CCG; this was proposed to have a target date of April 1, 2021 subject to a successful application, with significant activity undertaken ahead of this to ensure the current organisations were able to transition to this new arrangement successfully and safely.

Action

MLSU’s Improvement Unit provided PMO support for the merger. We focused upon providing a robust and resilient PMO function to the CCGs, to help ensure that all merger activities are coordinated and delivered in line with local delivery and implementation plans, and to support the identification of any risks and issues which might arise – with mitigation actions put in place to deal with them, where needed.

Other actions include:

* Creating a programme plan – developing a comprehensive programme plan which includes all of the detail associated with all aspects of the merger including, lead, key dates, internal reporting, etc. It is essential that the programme plan is sufficiently clear to provide assurance that all steps being undertaken are understood and are fully planned
* A risk register – developing a merger risk register to record and report any strategic and operational risks identified
* Stakeholder engagement/document submission – arranging regular meetings with all of the workstreams, including regular reports, supporting the development of submission documentation with each workstream lead and arranging for the secure storage and submission of documents to NHSEI on the agreed submission dates.
Impact

MLCSU support during the development of the programme has resulted in many benefits to the CCGs. These include the following.

The development of a clear programme structure and PMO:

* Face-to-face meetings, allowing a greater visibility and the ability to structure the programme
* The PMO are involved in the shaping of the programme and in ensuring that progress is sustained and that any risks identified are mitigated.

The development of key documentation:

* We have managed the submission of documents to NHSEI
* Joint meetings have been arranged with workstream leads to support the development of submission documents and to review the documentation against the criteria set by NHSEI throughout the transition.

Improved flow of information:

* We have built a good working relationship between PMO, CCGs and NHS England and Improvement (NHSEI)
* We have helped to improve understanding of the key lines of enquiry (KLOEs) and the requirements from the regulatory body. Following this, we have cascaded them to the CCG workstream leads.

Production and continued management of the programme plan:

* A detailed programme plan has been produced, which has been well received by internal and NHSEI staff, updated and distributed weekly to the Joint Exec group and referred to as a master document for the transition
* This plan includes all of the relevant workstream actions (operational and transactional) and milestones throughout the process from proposal to creation of a single CCG.

Production and continued management of the risk register:

* We have produced a comprehensive risk log which has been well received by internal and NHSEI staff and which is updated and distributed on a weekly basis to the Joint Exec group.

MLCSU’s Improvement Unit set up and managed a successful programme management office (PMO) for the National NHS Continuing Healthcare (CHC) Strategic Improvement Programme.

Background

NHS England established the national NHS CHC Strategic Improvement Programme to contribute towards the transformation and efficiency goals of the Five Year Forward View.

The programme goals were to:

* Reduce variation in patient and carer experience in quality, timeliness and speed of assessment, eligibility decisions and appeal processes

* Establish national standards of practice and outcome expectations

* Ensure the best possible package of commissioning is in place

* Achieve the spending review target of reducing growth in CHC expenditure, through standardisation and adoption of best practice

* Ensure that assessments occur at the right time and place and reduce the number of full assessments for CHC in acute settings

* Influence national policy framework and care market oversight to maximise the policy contribution

* Strengthen the alignment between NHS England work programmes which have a CHC component, such as Personalisation and Choice.

Action

The Improvement Unit established and managed the PMO for this highly complex and challenging national programme, working closely with NHS England colleagues, system leads, clinical commissioning groups (CCGs) and social care.

The programme consisted of two programme directors and five workstreams, and the Board was led by an independent chair, ensuring that all decisions received  the maximum challenge and assurance.

Responsibilities

* Programme Board establishment and management

* Overall responsibility for PMO

* Oversight of programme plan

* Oversight and review of papers produced and collated for board by PMO

* Production of additional board papers as required

* Facilitate regular update meetings with workstream leads

* Facilitate workshops/meetings involving multiple workstreams

* Responsibility for benefits realisation plan

* Creation and upkeep of programme plan

* Regular meetings with workstream leads to update plan and challenge on timelines and dependencies

* Collation of workstream highlight reports into board report

* Drafting of/input into additional board papers as required

* Set up and management of Programme Board meetings and additional delivery group meetings as required

* Give support to Programme Manager for Programme Board

* Records management for programme

* Onboarding and offboarding programme resources

* Clear terms of reference and objectives for workstreams

* Responsible for delivery of workstream objectives

* Responsibility for completing workstream highlight report

* Presentation of updates to programme board and national/system leads as required.

We produced a series of ‘Knowing Our Patch’ reports which provide a range of demographic and health inequalities data and analysis. Data covers different areas across the footprint of the Midlands and Lancashire Commissioning Support Unit (MLCSU) . The reports give a picture of groups at risk and look to address structural health inequalities which may contribute to poorer health outcomes and prevalence. Download reports below.

When considering service design or policy changes, health and care organisations are required by law to take into account the needs of protected characteristic groups. These are defined in the Equality Act (2010) and commissioners must ensure that appropriate engagement takes place.

Doing this at the beginning of projects helps to identify any potential negative impact to protected characteristic groups and demonstrate ‘due regard’ to the Public sector equality duty.

The reports provide valuable insight to support decision making processes including Equality and Health Inequalities Impact Risk Assessments. The demographic profiling of their area can also give organisations a greater understanding of the type of communities they serve, and their needs.

The reports are based on data from public sources such as Public Health England and the Office of National Statistics. This was then compiled and analysed by MLCSU’s Equality and Inclusion Project Team.

The reports were shared with all existing customers in the related areas last year and are now free to download and use by anyone interested in health inequalities data and vulnerability factors in these regions.

COVID-19 vulnerabilities report

The series includes a COVID-19 report which highlights that people from certain backgrounds and communities are at higher risk in relation to the virus prevalence and mortality. Findings are based on data from the first wave of the pandemic.

In exploring the issue and supporting decision making during and post COVID-19 recovery, the information can be used by decision makers to inform commissioning and commissioning intentions.

Southport & Formby Health GP Federation was commissioned to implement the services detailed in the Primary Care Network (PCN) Directed Enhanced Service (DES) Contract specification 2020/21 to the nine practices that are not part of the local PCNs. MLCSU was commissioned to establish a robust project management structure and support and mentoring to the in-house project team.​

Action

The objective of the project was to develop a structured plan that supported the implementation of the PCN DES for the identified population within Southport and Formby ensuring:​

* Risks and issues to successful implementation were identified, managed and reduced with mitigations agreed and actioned​
* A governance structure was developed to support the progress of the project and to provide appropriate assurance to the Southport & Formby Health Board of Directors and the clinical commissioning group
* A communications and engagement plan was developed to ensure effective communication with all key stakeholders​
* All planned actions and recruitment were completed and the project workstreams were fully implemented ​
* Service delivery commenced for all service lines within the expected timeframes.​

Impact

Key outcomes – The Federation successfully implemented the project and its deliverables, developing a programme of audits and reviews to capture the improvements and benefits against the baselines and in line with the specification. The project team has developed strong lines of communication and is building good relationships with key stakeholders. In addition the team has increased their knowledge and practical experience of project management.​

Improved engagement with care homes – The GP Federation team had already made a good start on the project, making strong links with key stakeholders. This level of commitment to support all stakeholders highlighted a need to find the most effective ways to communicate with the care homes, which were under extreme pressure and had low expectations of any real impact from working within the DES. The team, however, kept up the momentum of regular contact, identifying WhatsApp as a useful alternative contact method, and ensuring the care coordinators prioritised understanding of how they could best work with care homes to ensure they were an integral part of the patient planning cycle.​

Matching patient needs to additional capacity – The level of uptake of the Extended Hours was much less than anticipated, so in discussion with practices and patients they looked at other ways to utilise this capacity to meet patient needs.​

Increased use of technology – The team reviewed the level of technology in use across health and care partners in the community in order to plan the requirements for future alignment and use of single platforms or of multiple platforms with the required level of connectivity and interface.​

Following successful application for funding through the primary care network (PCN) development fund in 2018, Chester East PCN was formed, covering a network population of 37,020 patients. The network engaged the services of The Improvement Unit in November 2018 to provide project management support to deliver their shared vision: “Working together to deliver high quality, innovative and sustainable healthcare for our community with commitment, compassion and integrity”.

Action

Taking an agile approach, we aligned workstreams and provided a clear programme structure by developing an overarching project specification, detailed plan, risk register, mitigation strategies and communication plan. We did this alongside providing support and expertise for development of the operational board structure, Memorandum of Understanding and governance arrangements.

Impact

* The Chester East PCN project was identified by an independent audit on behalf of NHS England as an exemplar of best practice
* Using an 0365 platform to share project information and documentation has provided visibility of project progress and supported collaborative and agile working in the absence of shared file arrangements
* Dedicated programme support has enabled the work to move at pace, providing a structure for everyone to feed into and embrace
* CSU expertise within the programme management provided valuable support in sharing best practice across the network, using case studies to support current and future opportunities in collaborative working
* The programme has provided an opportunity to standardise the approach to future projects on a “do it once” basis, providing a rich library of accessible templates
* Creating a robust governance structure has enhanced working relationships and provided visibility and clarity on roles and responsibilities across the network
* An “out of box”  approach has stimulated creative thinking in the design of a collaborative Dressings and Visiting service, focusing on a phased approach embracing LEAN practices and principles.