CQRS Local will reduce admin time for GPs

Calculating Quality Reporting Service (CQRS) Local is a newly launched web-based payment claim system used by commissioners, GPs and primary care providers to support the management and payment of local incentive schemes. It uses an online payment tool which leads to prompt payments for primary care organisations.

The national CQRS programme is used across the country to collect data from GP practices for a wide range of purposes, including providing GP payments. It is tried and tested system and has been successfully supporting GPs and commissioners to manage payments for several years.

CQRS Local is a one-stop solution for providers and commissioners to claim and manage locally driven schemes that reflect local priorities. The system will make payments without the need for practices to submit invoices, following the approval of a claim.

The key benefits for providers and commissioners are:

* Using CQRS Local, clinical commissioning groups spend less time developing and administering the local payment via spreadsheets, which ensures a standard and consistent approach, due to the automated process
* Through a single, more secure central point of access, commissioners will be able to: track and audit data submissions; view variations in practice/uptake across local providers to inform decision- making; have access to centralised reporting abilities; access external system support teams.

The onboarding process for commissioners, GPs and primary care providers is simple, with ongoing support and training in place for all staff and users.

What users are already saying about CQRS Local:

* It’s easy to use
* We’re not losing things in the process anymore, like we were with email
* We really like working with the CQRS Local team
* The helpdesk is always responsive if you have a question or need support
* Practices complimented how easy and smooth the process was
* CCGs state that it is easier to track and submit claims now there are no spreadsheets.

CQRS Local is led by the CSU Collaborative.

To find out more about CQRS Local, please visit the website: https://welcome.cqrs.nhs.uk/ or to request a product demo email: support@cqrs.co.uk

Assessing demand for COVID-19 LAMP testing

We helped an integrated care system to evaluate demand and capacity for COVID-19 LAMP testing to ensure labs could meet the need for routine staff testing.

Background

The COVID-19 LAMP testing programme allowed staff across the Lancashire and South Cumbria Integrated Care System (ICS) to be tested routinely. As demand increased from 1,500 to 7,000 tests per week, the Midlands and Lancashire Commissioning Support Unit stepped forward to discuss potential support with analysing data on testing needs.

Predicting future demand for tests could help the national supplier forecast the number of vials required. Lab capacity could also be influenced by a variety of factors and the ICS needed to understand how it could be expanded as demand dictated.

In addition, the ICS needed to identify individual organisations where take-up was higher to highlight which efforts to engage staff with testing were more successful. These approaches could then be transferred to other organisations where uptake was lower to try and replicate their successes.

Action

We worked together with the LAMP programme team to implement the following solutions:

Demand and capacity modelling:

* Gathered data on cohort sizes offered testing and estimates on previous testing trends
* Assessed machinery factors influencing lab capacity, liaising with lab manager
* Created a dynamic model of demand and capacity as factors changed over time.

Measuring staff engagement:

* Measured unique numbers of staff testing within given time periods, and how many were repeat testing (compliance rates)
* Demonstrated how staff engagement was increasing over time and against testing targets.

Impact

The demand and capacity modelling helped the ICS to:

* Have assurance that their lab could cope with demand even if it exceeded projections
* Quickly respond to requests for reporting from the regional team
* Visualise possible demand profiles and understand how actual demand compared to forecasts
* Demonstrate which locations had exceeded minimum regional estimates for testing
* Understand when there was likely to be excess lab capacity that the project could use to respond to emerging new demands for testing.

Reports on staff engagement enabled the project team to:

* Respond to demand from partner organisations for more detailed information on staff testing levels
* Provide information to Covid teams in partner organisations so they could report internally the success of the project and demonstrate where additional resources were needed
* Assess performance of initiatives to improve staff engagement and motivate organisations with lower testing rates to replicate the success achieved by their partners.

The Lancashire LAMP lab has been one of the most successful LAMP labs earning a strong reputation nationally.

Dr Amanda Thornton, LAMP Project Director, Healthier Lancashire & South Cumbria, said:

“Emma Davis [MLCSU Business Intelligence Lead] proved a very intelligent business resource for us – quickly responding to potential risks and challenges. 

“The Lancashire LAMP lab has been one of the most successful LAMP labs earning a strong reputation nationally. Emma’s role made the programme slicker, well-armed with data and very able to show that not only did the programme efficiently deliver to contract – but it excelled – and got the national reputation it deserved.”

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.

Leading a hospital transformation programme

We developed a strategic outline case setting out the ambitions and next steps in one of the NHS’s largest hospital transformation programmes.

Background

The Transformation Unit at Midlands and Lancashire Commissioning Support Unit (MLCSU) supported Shrewsbury and Telford Hospital NHS Trust’s New Hospital Transformation Programme over a 12-month period.

The programme required experienced leadership as well as support for the production of an outline business case.

This is one of the NHS’s largest hospital reconfiguration programmes, with a capital spend of £500 million+.

Action

An initial assessment of the programme status showed that the organisation was not yet at the stage to develop an outline business case and, in fact, required significant support to strengthen the work of the programme and re-write the strategic outline case.

Following the delivery of a readiness assessment, which provided us with an overview of the strengths and weaknesses of the programme, we devised a programme plan, engaged with stakeholders, and commenced work to support the areas requiring improvement.

We guided the client helping them understand the stages of each aspect of the project and engaged with NHSEI to formulate a plan for the strategic outline case submission.

We worked with internal clinical leads, the project team, as well as architects, to finalise a design for the new build and worked in partnership with the Programme Director to produce a robust strategic outline case.

Impact

A comprehensive completed strategic outline case was delivered within the agreed timeframe. This allowed the organisation to plan for the next stage of the programme – development of an outline business case – on a solid platform.

The strategic outline case was reviewed and scrutinised through the programme’s governance and assurance framework.

We continue to provide the trust with support to develop and submit an outline business case.

Additionally, we are supporting the client with other business cases not related to the Hospital Transformation Programme.

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.

Medication reviews offer major patient benefits

Background
The long-term prescribing of anticholinergic drugs, used to treat urinary incontinence, has been associated with an increased risk of cognitive impairment, dementia and mortality.

Clinicians have been advised to consider offering patients ‘drug holidays’ for short periods to assess whether there has been any natural remission of the condition, whether the drugs are still effective and whether there is a continued need for treatment.

Action
Working with Greater Preston and Chorley and South Ribble Clinical Commissioning Groups (CCGs), our Medicines Optimisation team (MOT) created a review tool and templates for the EMIS system to enable a safe and consistent medication review process.

The team worked collaboratively with GP practices to identify patients for whom a four-week ‘drug holiday’ was appropriate.

Patients received an initial telephone consultation offering advice and guidance, followed by a further consultation four weeks later to assess outcomes.

Impact
Across Greater Preston and Chorley and South Ribble CCGs:

* urinary incontinence medication reviews were carried out across 32 GP practices
* 238 patients were identified as being suitable and agreeable to taking a ‘drug holiday’
* after four weeks, 144 patients (61%) did not restart drug treatment and their medication was discontinued
* the total anticholinergic burden score was reduced by 432 points* across the patient cohort
* an estimated annual NHS saving of £29,451 was recorded.

*assigning an ACB score of 3 on ACB calculator for each drug stopped.

Patient feedback:

“I have been taking this drug since 1999 and now I feel much fitter without it.”

“My dry mouth, headache and acid reflux have really improved since I stopped taking the bladder drug. So much so that I threw the oxybutynin tablets on the fire last week!”

“Stopping this medication has made no difference to my urinary symptoms.”

“I have been catheterised for nearly twenty years and wondered why I had to keep on taking this drug – big improvement in my life without it.”

Improving health and wellbeing for NHS workers

We developed resources and videos and provided expert advice and evaluation to help NHS England and Improvement gather, develop and outline a wide range of wellbeing support options available to NHS employees.

Background
NHS England and Improvement (NHSEI) aims to create cultures of wellbeing across the NHS, where colleagues feel looked after and cared for.

NHSEI is committed to developing a comprehensive package of emotional, psychological and practical health and wellbeing (HWB) support for NHS staff. Following a request for NHS organisations to support and contribute to its HWB agenda, the Midlands and Lancashire Commissioning Support Unit (MLCSU) offered its services.

Action
MLCSU teams supported NHSEI with a number of different workstreams on the HWB project:

* Scoping, planning producing and editing resources for the NHS People website
* Evaluation advice and support, including producing an evaluation report
* Creation of promotional materials for wide dissemination
* Project management support.

Impact

We developed resources and videos to explain the role of the Wellbeing Guardian liaising with NHSEI leads and subject experts. Our Wellbeing Guardian videos are currently being used on the NHS People website to offer further information for anyone interested in taking up the role and support for those already in post.

We developed leadership resources around stress and burnout for the Executive Suite of the NHS People website, carrying out evidence research and liaising with NHSEI to ensure that a writing style was used which matched the rest of their website content.

We provided expert advice to help the national programme team to develop an evaluation framework for the Enhanced Occupational Health & Wellbeing programme. This included developing a logic model and theory of change with the national team and local evaluation leads. Local projects were developing their own evaluations and we provided advice to some of them to develop their plans. We also wrote an interim evaluation report for the Enhanced Occupational Health & Wellbeing programme.

We produced a comprehensive and accessible brochure outlining the wide range of wellbeing support options available to NHS employees from both inside the health service and from external sources.

Adam J Turner, Improving Health and Wellbeing Lead at NHSEI, said:

“Amazing, and thank you so much again for your support. The team have seamlessly integrated into an extension of our team, and we couldn’t have hoped for better! Thank you.”

Supporting redesign of acute services

Our Transformation Unit helped develop a new model of care for acute services at a health and social care partnership alliance.

Background
Cheshire East Partnership is an alliance of health and social care partners (two acute trusts, commissioners, community service providers, one mental health provider, local authority and primary care), that are working together to improve the health and wellbeing of the population of Cheshire East Place (approximate population of 378,000)​.

Cheshire East Place is facing a range of challenges in respect of delivering sustainable health and care services. Key issues faced by acute providers include increasing demand from an older and frailer population, falling demand for some services, financial challenges, workforce challenges and some less resilient services.

Cheshire East Place needed to develop a new model of care for acute services that was aligned with the process for development of the integrated care partnership and redesign of integrated community services.

MLCSU’s Transformation Unit was commissioned to support Cheshire East Place with the redesign of acute services across two acute trusts to meet the needs of the Cheshire East population.

Action
This programme of work was delivered under the backdrop of the COVID-19 pandemic. It required exceptional flexibility and adaptability to deliver a clinical redesign programme with limited capacity from the clinical community. Key deliverables for this programme included: ​

* Confirmation of programme scope – an alignment piece designed to reach agreement between partners about the scope and desired outcomes​
* Decision-making and governance framework to set out the process for approval​
* Data analysis on the current services and population health needs to enable articulation of the Case for Change​
* A clinically-led process of designing a new model of care for acute services ​
* Baseline activity and finance model to inform future options​
* Design of an options development approach ​
* Communications and engagement strategy and support for patient and public engagement​.

Impact

Under challenging circumstances for the clinical community we delivered a co-produced Model of Care that describes acute services within the context of an integrated care model.

Engagement and support from across acute clinical, social care, community and primary care professionals was strong with consensus reached on what future services should look like and what they should collectively strive to achieve in terms of quality, accessibility and sustainability.

Using automation to cut hospital waiting lists

Fast and efficient waiting list management has never been more important, so we’re pleased to be helping to reduce backlogs and get patients the right support.
Using a combination of automated call (chatbot), risk stratification and artificial intelligence, we help organisations prioritise and clinically validate waiting lists efficiently while maintaining quality of care. This solution saves huge amounts of time and staff resource, reducing hospital costs.
Our successful pilot project with Worcestershire Acute Hospitals NHS Trust quickly cleansed the waiting list, enabling clinicians to prioritise seeing the most in-need patients in the manner those patients preferred.
Approximately 10 per cent of patients either no longer needed to be on the waiting list or wanted to come off it and 68 per cent were happy with a telephone consultation.
We are now piloting the use of artificial intelligence to reduce the amount of clinician time needed to prioritise patients on the cleansed list.
The project is being extended to Wye Valley NHS Trust and East Lancashire Hospitals NHS Trust.
For more information please email mlcsu.partnerships@nhs.net

Strategic engagement for COVID-19 support programme

We helped deliver the strategic engagement and created opportunities for shared learning in the development of a national programme of Community Champions supporting risk groups with COVID-19.

Background
Midlands and Lancashire Commissioning Support Unit (CSU) and Arden & Gem CSU were commissioned to represent NHS England and Improvement and support the Government’s Community Champions programme.

Senior leads in the communications and engagement collaborative service for the CSUs were appointed to work alongside Public Health England (PHE) and the Ministry of Housing, Communities & Local Government to help deliver the strategic engagement and support the communications on this national programme.

It aims to support people identified to be most at risk from COVID-19 (including those from an ethnic minority background, disabled people and other risk groups) to follow safer behaviours and reduce the impact of the virus on themselves and those around them.

Action
The national programme supported local authorities with:

* activity and interventions to reduce the disproportionate impact of the virus on certain communities
* engagement strategies and outreach work in the most at-risk places, with the most at risk groups
* new and existing networks of grassroots advocates or ‘champions’ from impacted communities
* voluntary and community groups and other national or local actors who specialise in working with communities shown to be most at risk from Covid-19.

Midlands and Lancashire CSU supported the programme by:

* developing an online Future NHS collaboration platform as a resource bank and vehicle for sharing best practice, case studies and events, and to encourage conversations on the discussion forum
* leading the organisation of a programme of webinars to advance learning and share best practice.
* engaging with stakeholders across Whitehall and the NHS and voluntary sector organisations in several forums – supporting the development and promotion of the Community Champions programme
* developing of resources, case studies and cascading of information both ‘up’ and ‘down’.

Impact

The Community Champions workspace created a valuable resource that was both current and iterative, supporting over 240 stakeholders in Government departments, the NHS, PHE, local authorities and the voluntary community. Feedback showed the workspace was helpful in quickly accessing all correct and timely the information and official resources in one place, allowing users to focus on delivery. The discussion forum also provided a useful place for peer engagement and sharing of ideas.

The webinar programme was highly popular, with 99% of eligible local authorities attending a webinar. A further session open to wider stakeholders achieved full capacity. Evaluations showed the webinars were highly valued and well themed to meet participant needs. Workspace members increased by an average of 20 after each webinar, demonstrating their success encouraging people to seek further information.

The national programme is considered by the Government to be a success and is currently under review for development/expansion.

Supporting development of national digital strategies

Our Transformation Unit was commissioned by NHSX to support in the development of its national digital strategies for ambulance, community, dentistry, optometry and community pharmacy sectors.

Background

There is significant potential for digital technologies to support improvements in care across the whole of the NHS towards the delivery of 21st century world class health care for all patients. This potential could be highest in those sectors which have historically received less digital funding in recent years, namely Pharmacy, Optometry, Dentistry, Ambulance and Community (PODAC) services.

NHSX needed to develop a digital strategy for these five sectors and required an extensive programme of stakeholder engagement to achieve this.

We worked in partnership with Kaleidoscope Health & Care to deliver a full programme of stakeholder engagement across the five sectors to inform development of the NHSX Digital PODAC strategy (2021 – 2026).

Key deliverables were to:

1) develop comprehensive national digital strategies across the five PODAC sectors
2) facilitate the building of social capital between stakeholders for long-term engagement and development.

Action
Our support included:

* delivery of desk-based review of digital developments across the sectors
* wide-ranging engagement activities to seek views and input to identify key needs, priorities and recommendations. Stakeholders were drawn from NHSX, NHS Digital, NHS England and Improvement (NHSEI), staff representative bodies, sector membership organisations, individual practitioners, patients and patient representative bodies, system leads and digital champions
* focused workshops to test and challenge the recommendations and implementation plans
* authorship of the sector strategies, working collaboratively with NHSX PODAC Sector Leads
* support for stakeholder management.

We engaged with over 500 key stakeholders nationally (via one-to-ones or group meetings, bespoke workshops and online feedback) to successfully facilitate the deliverables.

Impact

Our approach ensured that the digital strategy remained closely aligned to the clinical vision for each sector and built relationships with key stakeholders so that they can continue to be involved in planning and implementing the priorities set out in the strategy.

The resulting strategy was endorsed by NHSEI clinical leadership for each sector and the strategy underpinned a case for investment for the programme.

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.”

Meeting pandemic demand for oxygen and ventilators

Staff from across the Midlands and Lancashire Commissioning Support Unit was deployed to support a national programme for oxygen, ventilation, medical devices and clinical consumables which ensured that sufficient ventilators were procured at a time of huge global demand and that all patients had access to oxygen when required.

Background
The COVID-19 pandemic led to an urgent requirement to build a national stockpile of ventilators, medical devices and clinical consumables, whilst also ensuring that the oxygen infrastructure in place had the capability and capacity to support the increased demand.

The Covid-19 Oxygen, Ventilation, Medical Devices and Clinical Consumables Programme was established to fulfil this requirement. Led by the Department of Health and Social Care (DHSC), the programme employed the knowledge and skills of staff from a wide range of clinical and non-clinical disciplines across the NHS, Ministry of Defence, Deloitte and PA Consulting. This was a UK-wide programme that worked closely with colleagues in all the Devolved Administrations and Crown Dependencies.

Action
An MLCSU associate director  with specialist procurement expertise joined the cross-government team in the role of Deputy Programme Director for the first six months. He acted as a first point of contact for workstream leads with specific support and input to programme governance, international logistics and UK storage and logistics.

Programme delivery was split into four phases. Members of MLCSU’s Improvement Unit and other teams supported with programme management expertise throughout the phases.

* Phase 1 (March-June 2020) ensured the NHS had sufficient supplies of ventilators, oxygen and consumables to meet Coronavirus demand.
* Phase 2 (June-December 2020) focused on improving the quality and availability of devices, solidifying consumables system and stockpiles, establishing a ‘new normal’, and reducing reliance on complex supply chain systems.
* Phase 3 (January-March 2021) focused on solidifying and maintaining the outcomes of Phases 1 and 2.
* Phase 4 (April-September 2021) focused on transition activities towards medium to long term operational arrangements and the programme closure and transfer into the Medical Technology Directorate of the DHSC.

Impact

For patients

* Due to action taken early in the pandemic, sufficient ventilators were procured at a time of huge global demand, to ensure that all patients had access to one when required.
* Oxygen usage was monitored daily, allowing for interventions to take place as soon as any potential issues were encountered, meaning that all patients had access to oxygen when required.

For staff

* The programme issued detailed guidance on correct use of ventilators and oxygen management via the e-Learning for Health website.

For trusts

* There were clear processes for ordering equipment, and for urgent clinical need cases, deliveries were made within 48 hours.
* Thanks to the support of multi-disciplinary teams, trusts were supported to better manage their oxygen supplies and, where necessary, urgent works were undertaken to upgrade old pipework and install new oxygen tanks.

Robert Moorhead, Deputy Programme Director, Department for Health and Social Care, said: “Thanks to the work of the Programme, no patient in the UK went without oxygen or a ventilator who needed it.” 

In December 2021 the programme won a Civil Service Award recognising excellent collaboration across organisation boundaries. 

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.

Derbyshire commissioners choose MLCSU support

We are delighted to announce that the Midlands and Lancashire Commissioning Support Unit (MLCSU) will continue to work in partnership with Derby and Derbyshire Clinical Commissioning Group (CCG) to provide individual patient activity (IPA) and continuing healthcare (CHC) services in Derby and Derbyshire. Following a competitive tendering process MLCSU have been successful in securing the contract for a further two years from 1 April 2022 with one more optional year after that.

Dr. Sam Gower, IPA/CHC Clinical Service Director at MLCSU, said:

“We are excited to continue working with the Derbyshire health and social care system to ensure value for money and quality service for patients, carers and commissioners. This decision by the Derbyshire health system will allow us to continue improving pathways and developing the use of technology to increase accessibility and inclusion.

“We invest heavily in innovation aiming for both improved experiences for patients and their families and cost efficiency. These innovations have included working in partnership with adam HTT Ltd to develop electronic referral systems and management, an electronic case management system and a range of services supporting personal health budgets with virtual wallets and more.

“Our dedicated team in Derby and Derbyshire has been supporting IPA/CHC activity since April 2017 allowing us to develop and sustain effective relationships with health system leaders. Derby and Derbyshire CCG’s choice to continue their partnership with MLCSU is testament to our staff who approach each case with compassion and care and help individuals and families through what can be very difficult times. We look forward to continuing to find innovative ways to support the people of Derby and Derbyshire and make services as accessible and inclusive as possible.”

Improving use of medicines across Merseyside

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/.

Free access to medicines optimisation advice

Welcome to our new web product where you can access free content to help improve medicines optimisation support. Visit the new website at https://medsopt.midlandsandlancashirecsu.nhs.uk to learn about opportunities for improving your current services.

Content is regularly updated and packed full of useful resources such as case studies and reports which detail how to achieve best practice outcomes. There is a wide range of innovative projects we delivered while working with integrated care systems, primary care networks and other organisations in the healthcare, government, voluntary and private sectors.

Under our ‘Services’ and ‘Publications’ sections, you can learn more about service improvement opportunities, for example:

* Implementation of new medicines services such as electronic repeat dispensing and national Community Pharmacy Consultation Services (CPCS)
* Assurance and professional support to get the best from your primary care network’s pharmacy team
* Support for improving medicines use in care homes.

Find out about our range of support and keep up to date with our latest offering:

* Project consultancy delivered by working in collaborative partnerships
* Area Prescribing Committees
* Medicines Safety Assurance Tool (MSAT)
* Primary care rebate schemes
* Care home services including training webinars and educational programmes
* High cost drugs validation/Blueteq management
* QIPP implementation service
* Prescribing analytics at scale
* Prescribing newsletter
* And much more.

Whether you’re an existing customer or would like to learn about our full suite of services, the ‘Contact us’ page provides a convenient way to get in touch directly for more details.

Finally, if you are an NHS or private sector medicines management professional, the dedicated ‘Careers’ section will help you understand the diversity of our portfolio and why working for the Midlands and Lancashire CSU’s Medicines Management and Optimisation team will be a great next move in your career development.

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.

Blog: Better decision making

This is the first in a series of blogs on decision making by the Midlands Decision Support Network, follow the series on midlandsdecisionsupport.nhs.uk. The Network comprises a collective helping health and care system leaders to make better, evidence-informed decisions through high-quality analysis and evaluation. It is developed by Midlands and Lancashire Commissioning Support Unit’s Strategy Unit.

This is a blog by Fraser Battye, Principal Consultant at the Strategy Unit.

There are two main routes for health and care services to improve the health of the populations they serve. They can: 

* Decide what to do.  
* Do it well. 

Obviously, both are needed. But do services make the most of both routes? Or do they pursue one and neglect the other? And if they do, where is the room for improvement?  

I would say that Route 2 (improving what is done) gets a great deal of time and attention, while Route 1 (deciding what to do) is neglected. This is a tricky claim to substantiate, but a quick look provides some evidence.  

Service improvement is not a specialism of mine. Yet, even as a very distant spectator, I can cite multiple methods and approaches that services use to get better at what they do. Lean. Six Sigma. Agile. PDSA cycles. QI. LGA Toolkits and support, Design Thinking, Skills for Care Guides, NICE Guides, service improvement and redesign (QSIR) tools. Services can use tools, such as Right Care, to see where to improve, before consulting large-scale programmes, such as Getting It Right First Time (GIRFT), to get it done.  

Even this casual glance reveals a wealth of tools, techniques, organisations and programmes dedicated to helping services improve what they do.  

So what are the equivalents for deciding what to do? Where are the programmes, guides, checklists, training courses (etc) for decision making? If you wanted to improve the quality of decision making in your organisation, where would you go?  

The lack of an immediate or obvious answer suggests something. And further research turns up little. Hence my claim: we don’t invest enough time, attention and effort into deciding what to do. Decision making is undervalued **.  

So how are strategic decisions made in health and care services? And how do we assess the quality of these decisions? Would we know good quality decision making if we saw it? Is there shared understanding of this? What about individual skills and attributes: do we know what makes a good decision maker? 

These questions spurred the Strategy Unit, as part of our work to develop the Midlands Decision Support Network, to design an education and training offer focused on decision making.  

For example, our ‘Decision Quality for Leaders’ programme will shortly complete its first run. We gathered and structured the best approaches, frameworks and tools we could find, before guiding a senior group through their use. It has been well received. And we have left participants with a clear sense of what better quality decision making looks like – and how to achieve it.  

Our work on decision making will continue to develop. We are preparing the leaders programme for future cohorts; we have added decision making sessions into our ‘Leadership for Analysts’ course; and we have developed a specific training workshop on ‘Thinking Tools’. More is needed and more is planned.  

This is not in any way, or even for a minute, to say that time spent improving service delivery is time wasted. It isn’t. But it is to say that we pay strangely little attention to the practice of decision making. It determines so much, yet we focus on it so little. Our efforts are a small step towards correcting this.  

** Here it is important not to confuse a ‘how’ with a ‘who’. I don’t doubt that the question of ‘who decides’ can generally be answered. An organisation, a committee, an individual: governance arrangements are usually well-focused on this type of question. The gap I see is in the how of decision making: the disciplines and methods that these decision makers use.  

Supporting infection prevention and control safety during COVID-19

We managed a programme of implementing infection prevention and control safety principles to reduce infection rates and provide better access to services during the pandemic.

Background

During the pandemic, there was an increased national focus on the effective application of infection prevention and control (IPC) principles and practice and how this relates to patient and staff safety and outcomes.

A national IPC safety support programme was established for providers of NHS services after the increase in healthcare needs associated with COVID-19 infections.

Midlands and Lancashire Commissioning Support Unit (MLCSU) managed the programme delivery, working with key leads from NHS England and Improvement’s Nursing and Improvement Directorates and regional IPC, quality and clinical colleagues.

Action

* The programme ensured effective change management processes were in place to document changes as agreed with stakeholders.
* The infrastructure and project management tools were developed at pace.
* We tracked benefits of the programme and recorded risks and lesson learnt.
* We created and maintained financial reporting templates and output reports to capture results.
* Weekly highlight reports provided assurance to the regional team.

Impact

For patients:

* Reduced rates of COVID-19 infections and other hospital-acquired infections
* Safer access to services through the establishment of clear pathways during the pandemic
* Increased confidence for patients and staff in trusts’ ability to effectively manage infection outbreaks.

For staff:

* Improved IPC systems, management, processes and practices, minimising the spread of infection, promoting staff safety, reducing anxiety and increasing confidence
* Reduced sickness absence from hospital-acquired COVID-19 infections
* Greater awareness and understanding of evidence-based IPC practices leading to better compliance and safety.

For trusts:

* Clear oversight by trust boards of IPC issues and understanding of their impact on services and patient outcomes
* Support for safety culture and quality improvement
* Reduced infections contracted in healthcare settings. This minimised loss of bed days and service capacity.

Annemarie Vicary, Programme Director, NHS England and Improvement, said:

“[MLCSU  colleagues were] experienced, keen to learn about the subject matter and the internal workings of the organisation, and had forward thinking ideas.”

Saving time in the core invoicing process

We saved time from data processing by introducing a new tool to streamline data entry when invoicing key customers.

Background

The Midlands and Lancashire Commissioning Support Unit (MLCSU) used a manual process to monitor its main contracts with key customers. This data was sent in spreadsheet form to the Order to Cash (O2C) team to create the monthly invoices manually into the ledger. This process was extremely time consuming for the following reasons:

* There was multiple handling of the data between different functions to manipulate into different formats
* Each individual invoice had to be raised and approved separately on ledger and on average took 15 minutes per invoice
* Risk of errors was high due to multiple handling of the data.

Action

We worked with NHS England and Improvement and Shared Business Services (SBS) to develop an invoice upload template.  This allows the direct upload of multiple invoices into the ledger streamlining the data entry process on the ledger.

The O2C team and income team then worked together to understand the needs and interdependencies of the information required and remapped the data collation to avoid having to rework this multiple times.

The tool and process was initially tested, and a procedure note produced so the knowledge could be shared across the team.

Impact

This process has saved two and a half hours per month of data processing and checking time.

It has also allowed for greater efficiency leaving time to be invested adding value to other activities.

Lyn Tallentire, Deputy Finance Director, MLCSU, said:

“This review of the process allowed us to use technology available to quickly streamline and improve the process.  Driving efficiency allows us to invest time in adding value.”

Tomorrow: our system coordination function

Join us at the Patient Flow Conference tomorrow 16 November to hear about our system pressure coordination function which helped an integrated care system manage through COVID-19.

Our Director of Nursing and Urgent Care, Seamus McGirr, will be speaking at the Convenzis Patient Flow Conference 2021: Improving for the future, alongside sector-leading guest presenters from NHS trusts, think-tanks and consultancies.

Seamus will be discussing the Midlands and Lancashire Commissioning Support Unit’s approach to managing system pressure across a whole ICS by combining data, systems and expertise in a specialised coordination function. Our model helps health systems make informed tactical decisions. It provides collaboration and leadership capability to ensure that resource is distributed to where it is needed most based on evidence, insight tools and real-time analytics.

The conference provides a platform for NHS urgent care professionals and clinical specialists to meet and debate national policy and strategy changes.

Other speakers include experts from University Hospitals Sussex, Warrington and Halton Teaching Hospitals, Royal College of Emergency Medicine, NHS England and Improvement, the British Medical Journal and others. Book your place today – search Patient Flow Conference 2021!

Clinical directorate contribution recognised for Nursing Times award

Our Clinical directorate have been recognised for their hard work on the Lancashire and South Cumbria mass vaccination programme which was shortlisted for a Nursing Times Award in the Public Health Nursing category. The ceremony took place in London last month. Congratulations to all winners

For the programme in Lancashire and South Cumbria, the integrated care system rapidly set up seven mass COVID-19 vaccination centres across a wide area. The centres supplemented vaccines dispensed via primary care and community pharmacy.

A nurse-led clinical leadership model was used to deliver thousands of vaccinations. A team from the Midlands and Lancashire Commissioning Support Unit (MLCSU) Clinical directorate were deployed to provide nursing and pharmacy expertise and to support with leadership of the programme.

This is the second nomination MLCSU has directly supported this year from the Nursing Times. Our workforce project is also shortlisted for a Nursing Times Workforce Award. The ceremony is due to take place on 17 November 2021.

Workforce project shortlisted for Nursing Times award

We are extremely proud our Continuing Healthcare and Individual Patient Activity (CHC/IPA) team has been shortlisted for the Workforce Team of the Year category of the Nursing Times Workforce Awards 2021.

The awards bring together talent in workforce planning and recognise those making a difference in recruitment, staff retention, wellbeing and inclusion.

The project for which we were shortlisted, the NHS CHC Workforce Development programme, saw NHS England and Improvement and the Midlands and Lancashire Commissioning Support Unit work in partnership. We developed a virtual workforce via the Bring Back Staff returners programme. Our rapid recruitment, induction and training process brought candidates onboard in two to four weeks to begin roles with partner organisations.

Candidates were sourced from many healthcare professions and came with a wealth of valuable experience. This blueprint for CHC workforce development recruits healthcare professionals considering CHC as career option, retaining their skills and knowledge within the NHS.

The awards ceremony takes place on Wednesday 17 November 2021. Well done to our colleagues in CHC/IPA and to all other finalists on the shortlist.

Automation in finance saves hours

Our Corporate Finance team has saved up to 50 hours per month in financial reporting and invoicing after introducing robotic process automation to some transactional finance processes.

Background

At the Midlands and Lancashire Commissioning Support Unit (MLCSU), we carry out a high volume of transactional finance processes every day for clients. Following a successful proof of concept using a third party bot, we invested in RPA (Robotic Process Automation) aiming to increase productivity and efficiency.

A review of tasks revealed the priority areas where automation could add the most value. The most labour-intensive activities were accessing ISFE, running and saving reports, manipulating and emailing them out and chasing care providers for responses to emails so that payments could be made.

Action
The bot provider trained MLCSU staff in coding, who worked with our finance experts to understand what, when and how needed to be done in detail. There are three aspects to the automation of ISFE reports, from simple to more complex:

Routine running of daily, weekly and monthly reports. The bot runs and saves them overnight so they are ready to be worked on in the morning
Manipulating the reports and emailing them out to customers automatically
Automated chaser emails to providers.

Impact

Staff no longer have to spend time running standard reports which are now scheduled to run and be saved ready to use automatically.  Staff previously creating, editing and emailing reports to clients every week now focus on adding more value elsewhere in the service.

Our Corporate Finance team has saved around nine hours per month from downloading ledger reports each day as part of the month-end process. The reports are available by 8am each morning during month-end, ready for the team to use.

We have also saved around 30-40 hours per month chasing responses to emails. The bot performs this action twice before it bounces back for human intervention.

We have up-skilled our staff and learnt important lessons on coding, bot providers and requirements for automation. This enhanced knowledge is allowing us to explore even more ways to improve productivity and deliver a better value service to the NHS.

Lyn Tallentire, Deputy Finance Director, MLCSU, said:

“This review of the process allowed us to use technology available to quickly streamline and improve the process.  Driving efficiency allows us to invest time in adding value.”

Data warehouse halves financial reporting time

We reduced the time it takes to process essential financial planning templates by 50% and established a data warehouse for financial reporting.

Background

Previously, the financial planning process at Midlands and Lancashire Commissioning Support Unit (MLCSU) involved individual working files for different services. To submit the planning template to NHS England and Improvement (NHSEI), the finance team was required to collate information from 40 different places and then cut this data multiple ways to complete the template. It took two full working weeks of staff time to collate and manipulate the data.

Once the detailed plan was agreed, it had to be uploaded to the ledger for reporting for the full financial year. This required going back to the individual working files and assigning codes based on top-down assumptions. The process used to take approximately 50 hours.

Action

We produced a standard template that automated the coding and categorisation of the costs to support the completion of the NHSEI template and the internal reporting requirements.

We implemented a database and invested resource in developing the reporting. The information was uploaded into a data warehouse, and this allowed it to be easily manipulated and collated to complete NHSEI reporting on time.

As all the data was in one place, it was also easier to create the journals for uploading to the ledger.

Impact

We have streamlined the process for completing the NHSEI planning templates by 50% and invested the time saved in adding value to the data rather than data collection and collation.

The process for uploading the plan to the ledger has also seen efficiencies by reducing the time needed by 75%.  This was driven by having all the data in one place which made it easier to collate, complete the template and identify and resolve discrepancies.

An added benefit of the collated data is support for other decision making processes, which has made the finance team more responsive and allowed them to invest more time in added value activities.

Lyn Tallentire, Deputy Finance Director, MLCSU, said:

“Investing in the data warehouse and this approach has delivered benefits in the planning process itself and further benefits on how we use this data on an ongoing basis.” 

New capability with leading web publishing system

As well as producing systems such as the remote booking system UBook, the Midlands and Lancashire Commissioning Support Unit (MLCSU) Applications Development team has started to deploy the web content management system Umbraco to manage business partner websites. With its Microsoft underpinnings and state-of-the-art feature set for both developers and content editors, Umbraco has been adopted by dozens of public and private sector organisations as their web publishing platform.

The Applications Development team runs 15 Umbraco websites for clients, with orders for three new Umbraco-based sites – Black Country and West Birmingham Sustainability and Transformation Partnership, the NHS Innovation Agency and the North West Population Health Network – each going into production shortly.

Earlier this month three developers in the team, Paul Warne, Matt Darlington and Martin Parker, received Umbraco certification, making MLCSU a ‘Certified Umbraco Partner’. The team’s Business Manager, Bill Douglas, recently met with Umbraco and reported great potential in the support opportunities that our new partner status can provide.

If you would like to find out more about Umbraco, please contact Bill Douglas at bill.douglas2@nhs.net

Better efficiency in uploading the financial forecast

We halved the time it takes to load the financial forecast into the ledger and reduced the risk of errors.

Background

The Midlands and Lancashire Commissioning Support Unit (MLCSU) used a manual process to load the financial forecast into the ledger by changing each subjective code line by line. This process was extremely time consuming for the following reasons:

* It was necessary to run multiple reports from the ledger to extract the data to create the forecast journals
* Checks had to be made to ensure the journals had achieved the desired position and we could make corrections if necessary
* The risk of errors was high due to the reports having opposite signs to the journal entry requirements.

Action

The bulk upload template is Web Applications Desktop Integrator (Web ADI) and allows for multiple lines (or cost centres) to be amended in one go.

The Forecast Out Turn uploader tool ensures that there are no errors prior to the upload as there are control checks embedded within. The tool also populates the income the correct way so that when a report is downloaded, this is captured and mirrored in the accurate way.

The tool was initially tested, and a procedure note produced so the knowledge could be shared across the team.  Based on experience it was identified this was only effective if you were changing multiple lines (or multiple costs centres) as downloading the Web ADI can take some time.

Impact

Within the first month the tool was implemented there was a 50% efficiency achieved despite the learning curve of implementing.

This approach has also been embedded into month-end processes and is providing ongoing benefits.

“This review of the process allowed us to use technology available to quickly streamline and improve the process.  Driving efficiency allows us to invest time in adding value.”
Lyn Tallentire, Deputy Finance Director, MLCSU

GP practices sign up for our locum gap app

Staffordshire and Stoke-on-Trent Clinical Commissioning Groups have signed up to use NHS Midlands and Lancashire Commissioning Support Unit’s digital Find me a Locum solution for their GP practices.
They have commissioned it via NHS England and NHS Improvement’s Framework for Digital Solutions for Sessional Clinical Capacity in Primary Care. Being on the framework enables us to easily offer Find me a Locum to clinical commissioning groups across England and help relieve capacity pressures for practices.
We developed Find me a Locum with partner GP Federations – people at the sharp end of general practice. This keeps costs low, delivering great value. Tried and tested, it has already been helping practices to find locums quickly, securely and at low cost, making significant savings on agency fees.
Find me a Locum provides fast, efficient, high quality ‘pairing’ between practice vacancies and locums. It is accessible 24/7 by a website and easily downloadable app.
It facilitates payments by providing tools to practices and locums to manage the invoicing process, end-to-end. Practices retain full control and benefit from support of a dedicated account manager and service desk.
Other benefits for practices include:
• quick and easy digital advertising of slots to a wide audience
• assurance that locums are accredited and registered (with evidence for CQC)
• automatic validation of locums against national performers list and GMC register
• training and awareness-raising to encourage clinical and managerial uptake and ongoing use
• regular system updates and enhancements.
Deputy Director of MLCSU’s Digital Innovation Unit, Priyantha Jayawardane, said: “We are delighted that we will be able to see Find me a Locum helping to relieve capacity pressures for GP practices across Staffordshire.”
For more information, contact mlcsu.commercial@nhs.net or go to www.findmealocum.co.uk

MLCSU Finance win regional NHS award

We are extremely pleased to announce that we won the Finance Team of the Year award at yesterday’s Healthcare Financial Management Association (HFMA) West Midlands Branch Annual Conference.

This award recognises the contribution that our Finance Team has made in the last twelve months to promoting and improving teamwork, innovation, collaboration, transformation and governance in the NHS finance community.

Tony Matthews, Director of Finance and Commerce at the Midlands and Lancashire Commissioning Support Unit, said:

“I am delighted that our Finance Team has been recognised by the HFMA and to win such a prestigious award as HFMA West Midlands Finance Team of the Year.

“To have been recognised by the HFMA in the West Midlands in amongst the many other brilliant NHS finance departments and to have been singled out is fabulous and recognition of the hard work and dedication the team displays each and every day for the NHS clients we support.”

In a year with many challenges, the team kept their high spirits and committed dedication to improving their staff, processes, performance and sharing best practice with the wider NHS.

With over 200 delegates at the event, two awards were presented by the West Midlands Branch of HFMA, which promotes the highest standards and innovation in financial management and governance across the UK health economy through its local and national networks. It is a huge honour to be recognised by this award – well done to our colleagues!

Insight to action: lessons from think tanks

Join us tomorrow, 15 October for the grand finale of the Insight 2021 festival of analysis and learning.

‘Insight to action: lessons from think tanks’ brings together the leaders of the Health Foundation, The King’s Fund, Nuffield Trust and the Strategy Unit for a panel discussion on how to move insight into action for the improvement of health services.

Insight 2021 is an annual festival of free events on learning and sharing for the NHS, local government and other partners across health and care. It is hosted by the Midlands Decision Support Network, in association with the Midlands and Lancashire Commissioning Support Unit’s Strategy Unit.

The Midlands Decision Support Network exists to support health and care leaders generate insights from high quality analysis and evaluation and move these into action – better, evidence-informed strategic decisions in Integrated Care Systems.

But moving insight to action is challenging – particularly for those without a direct hand on the levers of power, such as think tanks and researchers. How do we ensure that the insights we generate get converted to meaningful change? What needs to be in place in health and care systems in terms of capacity, capability and culture? What can we learn from the experience of responding to the COVID-19 pandemic?

An expert panel of the leaders of the national analytical collaboration of think tanks, which worked to support the health and care system in the fight against COVID-19, explores these questions:

* Dr Jennifer Dixon – Chief Executive, the Health Foundation
* Richard Murray – Chief Executive, The King’s Fund
* Nigel Edwards – Chief Executive, the Nuffield Trust
* Peter Spilsbury – Director, the Strategy Unit

…alongside the Director of the newly formed IMPACT centre for implementing evidence in adult social care.

* Professor Jon Glasby – Professor of Health and Social Care, the University of Birmingham

To register for the event, please search for the Midlands Decision Support Network and scroll down to ‘Upcoming training & events’ .

This year’s festival is running from Monday 4 October until Friday 15 October, and includes a mixture of talks, workshops and panel discussions.

Recordings of all the excellent sessions already taken place, are available from the full programme of events on the Midlands Decision Support Network website.

Promoting health and wellbeing in the NHS

Following a series of successful wellbeing initiatives at the Midlands and Lancashire Commissioning Support Unit (MLCSU), our Deputy Director of Finance, Lyn Tallentire, was recently asked to speak at a one-day conference on “Workplace wellbeing in the NHS”.

As a health and wellbeing champion at MLCSU, Lyn spoke at the event organised by the Healthcare Financial Management Association (HFMA), the professional body for finance staff in healthcare, and Future Focused Finance (FFF), the national programme designed to develop, connect and support the NHS finance community.

Together with Emma Stewart, Head of Finance at MLCSU, Lyn has pioneered several initiatives across our finance team encouraging people to find the time to look after their health and wellbeing.

Both Lyn and Emma have also supported staff within the team with personal challenges including struggling with working from home, offering support to staff with Covid who lived on their own and people with wellbeing challenges. They both proactively share their knowledge and experience with the wider finance community, contributing to motivating staff across organisations to improve NHS finance.

The conference which took place on 7 October brought together leaders in workforce policy as well as a selection of NHS case studies identifying areas of good practice in areas such as health and fitness, diversity and inclusion, mindfulness and building resilience.

How PHM analytics can influence change

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.

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

Learn and share at our Insight Festival, 4-15 Oct

The Midlands Decision Support Network in association with the Midlands and Lancashire Commissioning Support Unit’s Strategy Unit are hosting INSIGHT 2021, our annual festival of learning and sharing events for the NHS, local government and other partners across health and care.

This year’s festival will run over a two-week period from Monday 4 October until Friday 15 October, and include a mixture of talks, workshops and panel discussions. The theme is Insight to action, bringing together inspirational regional and national speakers to explore how insights from high quality analysis can drive change in health and care systems.

Sessions will be delivered virtually. The festival is open to everyone working in health and care and every session is free.

Last year’s festival had over 3500 attendees and was highlighted in the International Journal of Health Governance as one of the most ‘interesting and inspirational’ virtual conferences of 2020, alongside offerings provided by the World Health Summit, the European Observatory on Health Systems and the Nordic Health Movement.

Attendees can commit as little or as much time as they’d like. Most of the sessions will be recorded so you can fit them into your schedule in a way that suits you.

Confirmed speakers include:

Nigel Edwards (Chief Executive, The Nuffield Trust)
Jennifer Dixon (Chief Executive, The Health Foundation)
Richard Murray (Chief Executive, The Kings Fund)
Andi Orlowski (Director, The Health Economics Unit)
Professor John Wright (Director, Bradford Institute for Health Research)
Dr Kathryn Mannix (Clinician and author)

…with many more expected to be added in the coming weeks.

To register your interest:

Please search the Midlands Decision Support Network and follow the instructions to book a session.

If you have any questions, please contact Rachel.Caswell@nhs.net or Gareth.Wrench@nhs.net

New signups to UBook, our room booking system

Blackburn with Darwen and East Lancashire Clinical Commissioning Groups (CCGs) have become the latest customers to sign up for our state-of-the-art room and hot desk booking system, UBook.

In Spring 2021 the CCGs’ corporate and estates leads approached the Midlands and Lancashire Commissioning Support Unit (MLCSU) as they were investigating new ways to promote agile, office-based working and realised that they needed a powerful and responsive booking system.

MLCSU’s Applications Development team is currently digitising the CCGs’ floor plans to populate the richly-featured interactive system which can be accessed from any browser, desktop, tablet or smartphone. UBook will be deployed across their sites during the summer of 2021.

Nine organisations have now subscribed to the system, which is currently processing bookings for thousands of rooms and desks. Across these clients some 10,000 members of staff are regularly using UBook to manage the booking of meeting and treatment rooms, hot desks, parking spaces, bike racks, projectors, pool vehicles and other physical resources.

The latest version of UBook, launched in 2020, was specifically designed for NHS organisations which needed efficient, easy-to-use administrative systems at a sensible cost.

The latest version of the system includes hot desk booking with social distancing and information-rich reports which can help to inform detailed estates planning. These new features have helped clients to manage the changing demands upon their resources during the COVID-19 pandemic, particularly around staff returning to work after lockdown restrictions were lifted.

Birmingham and Solihull Mental Health Foundation Trust signed up to UBook last year after deciding to introduce one simple booking system to replace several procedures across its sites. As the COVID-19 pandemic unfolded they took full advantage of the system’s flexibility, which allowed safety measures to be quickly implemented.

Their UBook pilot scheme, launched in October 2020, allowed bookable desks to be removed from the system to comply with social distancing regulations. The system’s interactive floor maps showed staff which desks were available at any given time and the system automatically locked out desks for 72 hours after each use to ensure that they were COVID-free before being used again. Other UBook clients tie this window into local cleaning rotas to ensure desks are cleaned after each use.

QR codes were also introduced at the Trust to allow staff to check in from mobile devices rather than the planned touchscreens.

Amanda Tierney, Project Manager at Birmingham and Solihull Mental Health Foundation Trust, said: “MLCSU have been exemplary in their commitment to making the system work for our needs. The admin staff find it extremely useful and very easy to use and the ward staff are all positive too.

“I’ve learned so much from working with you and I’m extremely grateful, I couldn’t recommend you highly enough. I think that UBook is phenomenal and will benefit any organisation or trust that uses it.”

MLCSU Application Development Business Manager, Bill Douglas, said: “At MLCSU we were delighted to assist the Trust in its move to a unified room and desk booking system. As ever, we captured new ideas from those who manage estates and clinical functions and built those into the latest feature set.”

Supporting proxy medicines ordering at care homes

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.”

Better engagement with public consultation

We helped Stoke-on-Trent CCG translate a complex consultation into easy to understand documents and campaign materials to achieve better engagement with the public.

Background

The North Staffordshire and Stoke-on-Trent Clinical Commissioning Groups (CCGs) needed help to summarise a complex public consultation about improving community-based services. The NHS Midlands and Lancashire Commissioning Support Unit (MLCSU) Communications and Engagement Service led on a full suite of public-facing documents and wider campaign materials to explain the proposals and encourage residents to engage with the consultation.

Action

The MLCSU Media, Editorial and Publications Team summarised several large, internal documents to produce a public consultation document that presented the information clearly, logically and in an easy-to-understand way for the general public.

We worked with our in-house Engagement, Involvement and Insight Team and our Campaigns, Creative and Digital Team to provide a seamless end-to-end service which included design, an engagement survey, copywriting, event management and printing materials.

Impact

The 52-page consultation document formed the core copy and content for a micro-website, newsletters, media releases, social media messages and presentations at events.

A designated account manager project managed from start to finish to ensure that sign off processes were adhered to, all partners kept informed and agreed deadlines were met.

The survey was a success and received 553 responses in a 14-week period, and more than 600 people attended a range of public events, focus groups and meetings about the consultation.

For further information about how we can support you please email: mediacsu@nhs.net

Quick & easy patient referrals for post-Covid illness

Our Data Quality team developed a custom data input template to streamline referrals of patient with post-Covid illness, saving time and effort for clinicians, improving access for patients and creating better reporting opportunities. 

Background
Pennine Lancashire Clinical Commissioning Group (CCG) approached our Data Quality team to help support their primary care network’s Neighbourhood Accelerator programme. This programme supports vulnerable patients experiencing ongoing symptomatic COVID-19.

As part of this work, it was decided to create a new patient referral form to be used across the Lancashire and South Cumbria integrated care system (ICS) to refer post-Covid patients to the Lancashire and South Cumbria NHS Foundation Trust. It was later agreed that the work being undertaken across Pennine Lancashire would be rolled out across the rest of the ICS footprint.

Action
The Data Quality team advised the Pennine Lancashire team on how to make the process as seamless as possible for those referring into the service.

Due to the nature of post-Covid illness, a lot of information was being asked during referrals. Reviewing the previous referral process, the team established that it  contained some coded information but also a lot of free text. This resulted in a lot of clinician typing and the potential for important information to be missed out. Also, none of the information being gathered during referral was being recorded back into the patient record as coded data.

Our Data Quality team developed a data input template to allow all of the information needed to be captured, auto populating fields with information recorded during the referral.

We carried out rigorous testing involving GP practices and the Trust. Once the system was ready to be rolled out, our team helped practices to install the package onto their clinical systems.

Impact

Since its introduction in March 2021, the system has been installed in 167 GP practices out of 178 across the ICS area.

It has given the region’s GP practices a quick and easy way to capture the data needed to refer a patient to the post-Covid service.

This comprehensive collection of data will also allow practices to provide detailed information around patients with post-Covid syndrome if it is needed by NHS England and Improvement in the future.

The project has also improved patient access to services by creating a streamlined process which reduces the number of rejected referrals as the form clearly identifies all of the information required.

Lee Hay, Programme Director – Blackburn with Darwen and East Lancashire CCGs, said:

“A huge thank you to Emma-Jane McDonald [from MLCSU]. She has been fantastic and pulled out all the stops to get this vital piece of work completed and rolled out. Thank you so much for all your amazing hard work and dedication, we are very grateful!”

Dr Quashuf Hussain, Deputy Medical Director – Pennine Lancashire, said:

“Emma-Jane, fantastic work, really appreciate your hard work on this.  It’s been a pleasure.”

Elaine Craven, Planning, Transformation & Delivery Officer – Pennine Lancashire, said:

“You are truly amazing, thank you so much for all your hard work and support. It’s been so interesting and really useful to get a glimpse of how EMIS works.”

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

Central integrated care system media office

Lancashire and South Cumbria Health and Care Partnership (HCP) is an integrated care system where there is a collaborative partnership of local authority, NHS and community organisations that join-up health and care in the area. It’s a complex partnership that needed a central media office function to coordinate a system approach.

Action

The NHS MLCSU Media, Editorial and Publication Team provide assurance that media enquiries and requests across the system are being handled in a timely and efficient manner ensuring that protocols are followed, and stakeholders and partners informed. Our full-service professional media office function includes an out-of-hours service, crisis management and media monitoring for complete resilience.

Impact

The NHS MLCSU media office serves as a front-line contact between the Lancashire and South Cumbria Health and Care Partnership and the media, with a focus on building strong relationships and providing reputational reassurance by ensuring all enquiries are managed, approved and handled centrally.

The newsroom supplies local organisations, services, and functions in the partnership footprint with a designated contact for media specialist support and strategic advice.

The extensive logging, reporting and monitoring produce an unparalleled overview of reactive and proactive media whilst the out of hours crisis management service supplies essential resilience to communication teams during evenings and weekends. In just one month during the Covid-19 pandemic, we managed 105 media enquiries and 8 proactive media releases resulting in a total PR reach of over 1 billion 397 million.

We have also been commissioned to support on shorter-term projects and campaigns more recently working with the Lancashire and South Cumbria Cancer Alliance.

Neil Greaves, Head of Communications and Engagement for Lancashire and South Cumbria Health and Care Partnership, said:

“The excellent work and invaluable support that the NHS MLCSU Media, Editorial and Publications Team have provided in Lancashire and South Cumbria over the past four years has been outstanding.

“I am safe in the knowledge that I can rely on their media specialists to work seamlessly with my team to manage media enquiries and that there is increased capacity to support when there are fluxes in requests or if there is a crisis occurs.

“It’s really reassuring to have the resilience of a full press office function but also a designated Media and Public Relations Manager lead who has extensive knowledge of the local area and our organisation. The media team excel in providing complete end-to-end media management at pace and are adept at following complex protocols across organisational boundaries when liaising with key stakeholders. Their invaluable understanding of how the NHS, integrated care systems and health and care partnerships work makes them a real asset to my team.”

For further information about how we can support you please email: mediacsu@nhs.net.

Database supports national CHC workforce recovery project

We designed a national database to record, monitor and report the onboarding, training and development of continuing healthcare (CHC) staff recruited quickly and in large numbers to clear the backlog of CHC assessments caused by the pandemic.

Background

Additional NHS Continuing Healthcare (CHC) staff had to be quickly recruited to clear a backlog of patients due to the suspension of the CHC framework during the pandemic.

NHS England and Improvement (NHSEI) commissioned the Midlands and Lancashire Commissioning Support Unit (MLCSU) to design and implement a national database designed to capture details of staff recruited or seconded, any training given and additional working hours completed.

Action

* We designed the database following consultations with NHSEI and CHC regional leads.

* Weekly progress reports and weekly update meetings through Microsoft Teams allowed us to develop a good working relationship with NHSEI, meet database requirements and respond to queries.

* Supporting materials including videos were designed showing how to use the database, with training sessions for staff inputting the data.

* A central CHC training inbox was created to deal with employer and employee queries regarding staff registrations and employees booking onto CHC workshops.

* We facilitated the online booking system for the workshop sessions.

* Anonymised data reports were provided to NHSEI on a monthly basis throughout the project.

Impact

The success of the project was the result of highly-effective collaborative working with NHSEI and Health Education England, with all organisations working as one team to deliver the project at pace.

The database enabled a swift registration process to be set up, providing access to comprehensive workforce development information. We were able to regularly report the workforce numbers being registered to NHSEI.

It also allowed us to break data down into workforce training numbers by organisation and training accessed by type (national/ local), along with anonymous feedback on the process – including experience of working in NHS CHC – to inform improvements and evaluation of the training. The database for employer registrations was closed on 31 March 2021, with a total of 745 registrations made on the system.

Ten CHC workshop sessions, offering a total of 1,500 places, were supported by the booking system, directing CHC employees and employers to the National NHS CHC training programme, newly developed by Health Education England on the e-Learning for Healthcare platform.

Andrea Westlake, Assistant Director of Nursing and Quality at NHS England and Improvement – Midlands, said:

“The involvement of MLCSU has been highly valued in helping deliver the workforce recovery project during the pandemic.

“The CSU is able to deliver at pace, responding to our needs in a highly professional, creative and efficient manner.

“The team were always professional, courteous and supportive; going the extra mile when we needed assistance. A highly recommended team.”

UBook transforms room booking at NHS trust

We created a single online system which allows staff at Birmingham and Solihull Mental Health Foundation Trust to book desks, meeting rooms and clinic rooms. UBook really came into its own during the COVID-19 pandemic as it was quickly modified to enable social distancing and other infection control measures.

Background

Before signing up to use UBook, Birmingham and Solihull Mental Health Foundation Trust identified their room booking system as creating major time management issues.

Operating across several sites, the Trust had used several different methods of allocating desks and meeting rooms, including Outlook calendars, Excel spreadsheets and paper diaries. Staff often had to ring around several sites to find the size of meeting room they needed, and there was no audit trail so if bookings were unexpectedly changed or rooms were double booked there was no way to trace the source of the problem.

Action

Since piloting UBook in October 2020, the Trust now enjoys a centralised system which every member of staff across the Trust can access to determine the availability of all sizes of rooms across all sites to book the one closest to their needs. As well as meeting rooms, the Trust is using UBook for clinic room bookings, desk bookings and arranging meetings with approved visitors.

MLCSU has worked closely with the Trust’s Programme Management Office (PMO) to adapt the system to local needs, and attends regular meetings to map out future enhancements, provide updates and seek feedback on changes made. These changes have included the swift introduction of new features to help the Trust coordinate onsite working during the COVID-19 pandemic.

Impact

UBook has had a major impact on improving the efficiency of Trust systems. Teams sometimes book larger (or smaller) meeting or clinic rooms than they need, but UBook allows managers to review bookings and change bookings to ensure the most efficient use of available meeting room space is made. Ubook can also prompt a user that a better-sized room is available before they commit to a booking.

Initially, a desk booking system was introduced at the Trust HQ to support hot desking and reduce the need to provide allocated desks. This was quickly adapted during the COVID-19 pandemic to ensure that desks could be removed to comply with social distancing regulations.

UBook’s new interactive floor map showed staff which desks could be booked at any given time and the system locked out desks for 72 hours after each use to ensure that they were COVID-free before being used again. Before the pandemic, the trust intended to install touch self-check screens, but infection control measures made this inadvisable, so MLCSU quickly created a QR code ‘check-in’ capturing when staff arrived.

The Trust operates three secure forensic units and all patient visitors have to be approved by the clinical team before they visit using a cumbersome paper system. To resolve this, MLCSU worked with the Trust’s electronic patient record (EPR) team to integrate UBook with the Rio EPR, so that details of approved visitors are automatically imported into UBook.

Amanda Tierney, Project Manager, Birmingham and Solihull Mental Health Foundation Trust, said:

“MLCSU have been exemplary in their commitment to making the system work for our needs. Their response time to queries is excellent and at no point have I had to chase any updates/actions.

“Hand on heart, I’ve not had any negative feedback about UBook. The admin staff find it extremely useful and easy to use and the ward staff are all positive too. I’ve learned so much from working with CSU and I’m extremely grateful, I couldn’t recommend them highly enough. I think that UBook is phenomenal and will benefit any organisation that uses it.”

Managing PMO for Shropshire CCGs merger

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.

Digital app streamlines care payments

The objective of the project was to streamline payments for joint-funded packages between MLCSU and Staffordshire County Council (the LA) by moving to a monthly electronic process. We previously used a paper-based process which in some cases could take over six months to reconcile due to disputes. As a result, the full payment would be withheld until there was an agreement on the full payment list, a process which was very resource-intensive.

How we helped

MLCSU currently uses adam for their commissioning and case management systems, so using the same system for this project was a good fit.

Project governance included weekly meetings between adam, MLCSU and Staffordshire project stakeholders. In these meetings the completion of project milestones was tracked and potential risks were raised. The category went live on time and the first payment was made within the agreed timeline.

This new category has been set up as a collaboration between MLCSU and Staffordshire County Council, where MLCSU use the new category to manage the reimbursement of the local authority for the payment of joint-funded packages of care.

Staffordshire council has a provider (read-only) view of their joint funded packages of care, but is able to track changes to any particular package, such as a rate change, throughout the process.

Impact

The new process has resulted in:

* Quicker payments and improved cashflow
* Centralised online storage, records cannot be lost or damaged
* The system configuration has been set up and is ready to go
* Automatic Service Receipt (invoice) generation within the system
* The LA will benefit from transparency and visibility of packages of care
* The LA will view the same package details as MLCSU
* Full audit trail available, including an audit of any changes
* Improved reporting functionality available to the LA and MLCSU
* Payments can be made on a regular basis (monthly)
* LA and MLCSU can review the invoice files generated by the system before payment is finalised
* Any disputes can be removed from the invoice file and investigated separately
* Only disputed invoices will be withheld from payment

Before the project, the average time to pay invoices for the 2019/20 financial year was 376.6 days – the average payment time is now 30 days as standard. At the end of 2020/21 financial year there were no outstanding debts owed to the council for this cohort of packages – for 2019/20 there was a debt owed of £9.2million at the finance year end. The improvement in terms of cashflow and the time taken to resolve the level of queries and reconciliations has been significant.

Karen Webb, Joint Funding Lead at Staffordshire County Council, said:

“Cashflow has been significantly improved. Originally it could take up to 6 months to reconcile and agree any disputes before any payments were made to Staffordshire council. We now get paid monthly and any disputes do not stop payments from being processed.

“The implementation of this solution means there is full transparency over the data which means when the invoice files are shared, there is a significantly less amount of time we are spending reconciling invoices.”

Rapid recruitment to tackle CHC backlog

The enormous pressures placed on CCGs to recover from the backlog in CHC assessments following the suspension of the CHC Framework for six months during the COVID-19 pandemic required a rapid, flexible and targeted recruitment and training process not delivered before.

We worked in partnership with NHS England/Improvement (NHSEI) to develop a virtual talent workforce pool via the Bring Back Staff (BBS) returners programme.

We sourced staff from many healthcare professions who came to the project with a wealth of valuable experience to share, and we saved CHC employers at least 260 hours of recruitment, administration and onboarding time.

How we helped

We set up a rapid recruitment process and provided people with equipment by courier, allowing us to function even at the height of the national lockdowns. Our candidates received a bespoke training package, and were trained, supported, mentored and given clinical supervision by experienced CHC professionals via interactive webinars and training videos that we developed in-house.

A number of bespoke, tailored packages of support were developed to encourage returning staff to join the initiative and an offer has been developed with a view to ensuring the future sustainability of the project.

Candidates were able to be brought onboard in between two-to-four weeks, which meant that members of this workforce were then ready to begin their roles with partner organisations already trained and ready for local induction to commence. The programme attracted people who wanted to work flexibly in the NHS and retained their commitment, expertise and experience, offering the best use of resources and public investment.

The impact of our work

Being able to train our BBS returners at pace and then mobilise this agile workforce illustrated just how adaptable and transferable their skills and previous experience were and how useful their expertise was to NHS CHC. The project offered CCGs and providers access to an NHS CHC workforce that is trained to national standards and offered the opportunity to offer virtual assessments so that the workforce could work flexibly nationwide, where needed. This virtual workforce model proposes a blueprint for future workforce solutions across the NHS, not just for NHS CHC and will help to reduce the costs associated with delivering and coordinating a solely face-to-face CHC assessment service.

On the recruitment programme, one applicant remarked:

“I was contacted immediately and the process of recruitment began, swiftly and seamlessly. Once contracted to work for the team I received the equipment required for the role – laptop and phone plus a very comprehensive set of instructions for the necessary IT, contacts, team leaders etc, team meetings etc.

“I feel supported in all aspects. The training is thorough and clear, I have a workbook to progress through, I am currently awaiting shifts whereby I will shadow experienced Nurse Assessors, I have practice care plans to follow.

“As I say, I can compare with recent experience plus 44 years as a skilled Registered Nurse and I am enjoying my experience with MLCSU CHC and only wish I had started sooner.”

Centralising media management in an ICS

Lancashire and South Cumbria Health and Care Partnership (HCP) is an integrated care system where there is a collaborative partnership of local authority, NHS and community organisations that join-up health and care in the area. It’s a complex partnership that needed a central media office function to coordinate a system approach.

How we helped

The NHS MLCSU Media, Editorial and Publication Team provide assurance that media enquiries and requests across the system are being handled in a timely and efficient manner while ensuring that the correct protocols are followed, and stakeholders and partners informed.

Our full-service professional media office function includes an out-of-hours service, crisis management and media monitoring for complete resilience.

What we helped achieve

The NHS MLCSU media office serves as a front-line contact between the Lancashire and South Cumbria Health and Care Partnership and the media, with a focus on building strong relationships and providing reputational reassurance by ensuring all enquiries are managed, approved and handled centrally.

The newsroom supplies local organisations, services, and functions in the partnership footprint with a designated contact for media specialist support and strategic advice.

The extensive logging, reporting and monitoring produce an unparalleled overview of reactive and proactive media whilst the out of hours crisis management service supplies essential resilience to communication teams during evenings and weekends.

In just one month during the Covid-19 pandemic, we managed 105 media enquiries and 8 proactive media releases resulting in a total PR reach of over 1 billion 397 million.

We have also been commissioned to support on shorter-term projects and campaigns more recently working with the Lancashire and South Cumbria Cancer Alliance.

Of the work, Neil Greaves – Head of Communications and Engagement for Lancashire and South Cumbria Health and Care Partnership, said:

“The excellent work and invaluable support that the NHS MLCSU Media, Editorial and Publications Team have provided in Lancashire and South Cumbria over the past four years has been outstanding.

“I am safe in the knowledge that I can rely on their media specialists to work seamlessly with my team to manage media enquiries and that there is increased capacity to support when there are fluxes in requests or if a crisis occurs.

“It’s really reassuring to have the resilience of a full press office function but also a designated Media and Public Relations Manager lead who has extensive knowledge of the local area and our organisation. The media team excel in providing complete end-to-end media management at pace and are adept at following complex protocols across organisational boundaries when liaising with key stakeholders. Their invaluable understanding of how the NHS, integrated care systems and health and care partnerships work makes them a real asset to my team.”

Medicines management support to Sue Ryder

The Sue Ryder charitable organisation has a portfolio of 10 services, one hub site and central support delivering palliative and neurological care services across the UK. In early 2020, the organisation’s clinical governance group approached MLCSU to scope out what support and advice we could offer in terms of medicines management and medicines governance across the organisation.

How we helped

Two site visits and face-to-face interviews were conducted and the medicines management systems were audited.

From this information, two anonymised questionnaires were developed, one for Heads of Service and clinical directors via Microsoft (MS) Teams and the other was a medicines governance review designed for a wider audience. 53 responses were received.

Additional stakeholders including pharmacists and business intelligence specialists were interviewed by telephone to discuss the support provided to the services, and the use and application of the Datix database.

Weekly meetings via MS Teams and the production of an interim report ensured the board were kept well informed of progress. A full report that included recommendations for next steps for the organisation was presented at the Healthcare Governance meeting.

Impact

MLCSU and Sue Ryder developed an excellent working relationship and both the interim report and full report were well received.

Recommendations included:

* Increase the number of medicines management audits in the services
* Each service to develop its own medicines policy
* Evaluation of the service level agreements with the community pharmacies that provide support to the services
* A scoping exercise to consider senior pharmacist support for the organisation both at central level and within the services
* Develop a governance framework for non medical prescribers (NMP) with audits of prescribing patterns
* Further develop the use of Datix with individual benchmarking for both neurological and palliative services.

Sue Ryder has approached MLCSU to discuss the provision of pharmacist support to assist with progressing the recommendations in the report.

Of our support to the charity, Dr Paul Perkins, Sue Ryder Chief Medical Director, said:

“Sue Ryder commissioned the Midlands and Lancashire Commissioning Support Unit to perform an assessment of governance in relation to medicines across our charity. 

“It was great to work with people with such knowledge and expertise. 

“The work was conducted efficiently and feedback from staff at our hospices and neurological care centres was positive with regards to interactions with the team. 

“We were provided with a final report which outlined the good things, but also where we could improve. 

“Helen and Rob were a pleasure to work with.”

Discharging patients during COVID-19

In March 2020 the Government published its COVID-19 Hospital Discharge Service Requirements, placing an immediate requirement on clinical commissioning groups (CCGs) to arrange the transfer of patients from hospital as soon as it was clinically safe to do so. It was anticipated this would take no more than three hours, following discharge from the ward. At the time of the COVID-19 outbreak, MLCSU delivered a full tech-enabled CHC service to eight customer CCGs across the Staffordshire and Merseyside regions, via adam HTT – a managed digital platform. The solutions in place covered a population of 11.6 million, with thousands of active patients under management, and approximately 700 referrals and 360 new placements per month.

How we helped

MLCSU liaised with local bodies across the care sector to share important information with their providers. The team at adam took the lead in distributing communications, establishing which would be relevant to specific providers within the region. Subsequent to this, distribution of communications could be automated, improving staff productivity. After the initial phase was over, MLCSU and adam used their Provider Management Tool to help collect data from providers. A survey was sent out via the tool which allowed immediate distribution and management of queries and responses. The responses allowed MLCSU to create a daily dashboard to show where the virus was in the community, and thus where it was safest to move patients to.

Time to place was a key priority. Whilst the solutions MLCSU and adam deliver to CCGs accelerate the placement process, additional efforts were undertaken to improve placement speed. Whereas typically around 50% of CHC placements are coming from hospital, approximately 75-85% of all referrals during March and April were for patients in an Acute setting.

All patients had to be easily identified as COVID-19 patients, so the adam team amended the system within two hours to establish a new DOH stage. This allowed easier management for MLCSU and easier reclamation of funds later if appropriate.

MLCSU was able to further reduce time to place despite the case load more than doubling. With a robust and technology-enabled process, the team in place could take on the additional workload without a long lead time or extensive training.

During March and April MLCSU used the adam commissioning solution to source 1721 placements which represented a 108% increase on normal levels. A new process was established whereby the technology was used to source open care home beds for patients, with calls starting after 60 minutes to supplement the options sourced. Using data held around capacity and availability of local beds, calls were able to be focused on providers most likely able to take new patients.

Impact

With the fast response of MLCSU and adam, time to place for patients needing care homes beds decreased to a customer-wide average of three days.

With the teams working flat-out to engage local providers and ensure that patients were being kept away from local breakouts, they were still able to source two different options per patient on average. Despite caseloads more than doubling during March and April, the time to place patients during this period was halved.

As a result, providers have been able to demonstrate both compliance and the ability to meet the patients’ assessed needs.

Working at scale and underpinning process with technology has allowed CCGs to benefit from a robust and scalable service offering, able to withstand the most serious of events.

Contact our leads to learn more about how our digital platform can help you.

Cost savings and better care in Staffordshire

We worked with commissioners, providers and other stakeholders across Stoke-on-Trent and Staffordshire to improve the quality of service for patients and cut costs across planned care.

Background​

Planned care is a top priority for Staffordshire and Stoke-on-Trent Sustainability and Transformation Partnership (STP). The current acute cost is £348million and has been growing by 14 per cent over the last four years, well above the rate of population increase.

National standards are not being met and backlogs are increasing. The target is to improve quality and patient experience in addition to delivering savings of £14million by 2020/21.

Action​

* A planned care workstream was set up with clinical and management representatives from commissioner and provider organisations, and other major players​
* National and local data was analysed and ophthalmology and musculoskeletal (MSK) conditions were prioritised as the two highest-spend areas where changes could most easily be made​
* Engagement events were held with a wide range of stakeholders, and guest speakers from NHS England universities and other trusts​ were brought in
* Seven task-and-finish groups were created, focusing on specific ophthalmology and MSK conditions​
* Site visits by the groups were arranged to map current processes and then use improvement techniques – such as the five whys – to determine why activities were not adding value. Action plans were then established.

Impact

* The programme is predicted to save between £1.9m and £4.4m per annum across seven pathways
* Data sharing at a system level has led to a greater understanding of the way planned care has been provided and has led to changes in practice
* Standard service specifications have been introduced
* The referrals process has been improved and the number of referrals has been reduced
* We have noted improved theatre productivity
* Unnecessary scanning and injections have been eliminated
* Commissioning around pain management has been improved
* Follow-ups are now being carried out in the community, closer to patients’ homes.

Mark Seaton, Staffordshire and Stoke-on-Trent STP Planned Care Workstream Programme Lead, said:

“During our planned care project in Staffordshire, it was clear we needed to forge much stronger relationships across a number of organisational boundaries and change cultural thinking.

“The CSU has been instrumental in helping us put clinical engagement at the centre of our work. Organising, facilitating and designing workshops to gain insight and involvement; the CSU also invited guest clinicians to share learning.

“This was not an easy process but together we worked hard to share expertise and design pathways to bring real benefits to patients.”

Transforming NHS CHC across England

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.

Enabling NHS Digital weight management services

The NHS Digital Weight Management Programme (DWMP) launched this week will help thousands of adults achieve a healthy weight and improve their wellbeing. Patients will access ‘tier two’ digital weight management services via the DWMP Referral Hub designed and produced by Midlands and Lancashire Commissioning Support Unit (MLCSU). This is a tool that allows people to choose the weight management provider which they feel they can connect with most successfully, and which then provides a flexible and tailored service to match their individual needs.

Part of the government’s obesity strategy, the Department of Health and Social Care announced that new services will be offered across England including online tools and funding for face-to-face consultations. The NHS DWMP will offer free online support for adults living with obesity, who also have diabetes, high blood pressure or both, to help manage their weight and improve their health.

Following an e-referral, MLCSU’s Referral Hub uses a triage algorithm process to identify the appropriate level of intervention based on the patient’s likelihood of completing the programme. The Hub then offers patients a choice of weight management service providers. They can select a provider they choose, and the system links them through and passes across key information to enable the patient to register and get started.

Easily accessing the Hub via smartphone or computer means more people are likely to complete the DWMP and improve their health. By cutting back on applications paperwork and making referrals through the Hub, primary care has seen a potential for major efficiency gains in saved time and resources.

Eligible NHS staff have also been offered free access to the Hub via self-referral.

New flexible resourcing service: TalentOne

The Midlands and Lancashire Commissioning Support Unit is launching today a new flexible resourcing service: TalentOneTM, to help you find high-quality resource and staff your projects in as little as half a day!

As the NHS is working vigorously to continue establishing truly integrated care throughout the health and social care system, we are seeing an ever-increasing need to find resources quickly for a wide range of short- and longer-term projects.

The new service benefits from the extensive experience of our HR and recruitment experts in working with NHS talent. As an NHS organisation ourselves, we are ideally placed to have direct access to candidates with the specialist skills you need.

What’s more, TalentOneTM dedicates effort and capability to provide you with swift and efficient access to additional resource, supporting your workforce resilience at short notice. We are aiming to provide options of talented people within half a day of receiving your request.

A new electronic system is in place that will help us match opportunities to people, internally and externally, quickly and efficiently, and provide much needed support where additional flexible resource is required.

TalentOneTM also gives our own people exciting industry leading opportunities for development – supporting and advancing our approach to talent management and staff learning.

Accessibility innovation: Digital easy-read surveys

By producing easy-read versions of our questionnaires we can improve participation in our engagement and consultation exercises with people who would otherwise be put off by longer, more complicated forms.

Background

Easy-read is a method of presenting written information to make it easier to understand for people with difficulty reading. Easy-read advocates sentences of no more than ten to fifteen words, with each sentence having just one idea and one verb. Active sentences are used instead of passive sentences. Any difficult word or idea is explained in a separate sentence. An easy read document is usually presented in at least 14-point text and includes carefully selected images to help people understand.

Action

This year we developed easy-read versions of the questionnaires and combined them with our online survey tool for even greater accessibility. The survey tool is used to host all of our surveys, but it had not been used to host easy-read versions of the questionnaires before now. We are not aware of anyone doing this before.

As a result, these questionnaires are now accessible online and can be quickly and widely spread to interested individuals and groups via email and social media.

The project was launched six months ago and, so far, we have produced two online easy-read surveys, which are currently live and part of ongoing engagement exercises.

Impact

Hosting the surveys which are prepared in the specialist easy-read format on our online survey tool has increased responses more than 18-fold and provided several other benefits for our clients and their stakeholders. By using the online tool, respondents do not need to send a request for a paper version or download the PDF version to print, complete and post back. The survey is fully accessible online via a click of a button, making it much easier to access and participate in.

The link to the survey can be shared much more easily and this has been particularly useful when working with specific groups or individuals who may or do require the easy-read version, such as people with a learning disability, whose first language isn’t English or who have a lower reading age.

Our easy-read versions have always been visually more engaging for participants, using such tools as photographs and graphics to make them more attractive and understandable. We can now enhance the specialist format further on our online version, using designs and iconography for rating scales (such as smiley faces) to make them more visually appealing and interesting. They also come across as less formal and intimidating to people who might be put off from responding to more official-looking questionnaires which use more complex language.

Sue Venables, Head of Communications and Insight, LLR CCGs, said:

“We commissioned MLCSU to help design our Mental Health consultation survey. During the planning stage they suggested that we may like them to both design and host on their in-house survey tool an easy-read version of the mental health consultation questionnaire. I was immediately interested but requested an example to review first.

“I was delighted! I could immediately see the potential benefits of the easy-read version. We have placed the links side by side on our consultation website.

“The easy read version of the consultation survey has proven far more popular than we initially envisaged. Whilst it still has simplified language and engaging imagery and pictures this has now been extended to a more interactive and impactful approach as things like ratings buttons now have smiley/sad faces.

“I’m really pleased and definitely feel it is assisting us to engage more effectively with our patients and public.”

Digital referrals help hard-to-reach patients

We strongly believe that improving patient experience is at the heart of all that we do. In creating the Weight Management Referral Hub, we have embraced a person-centred approach and designed a tool that allows patients to choose the weight management product which they feel they can connect with most successfully, and which then provides a flexible and tailored service to match their individual needs.

Background

Managing weight and reducing obesity have become major health issues in recent years and the realisation that a patient’s weight can have a major impact upon their experience of – and recovery from – COVID-19 has only made the issue more pressing over the last year.

This web-based Referral Hub has been developed to give eligible patients access to tier 2 weight management services delivered digitally as part of the NHS Digital Weight Management Programme, following automated e-referral from general practice.

Action

A triage algorithm process identifies the appropriate level of intervention the patient will need based on their likelihood of completing the programme and offers a choice of WMS providers to deliver the service. The patient selects the provider of choice and the system links to the chosen WMS and passes across key information to enable the patient to register and get started.

The NHS Digital Weight Management Programme (DWMP) is targeted towards people with a diagnosis of diabetes or hypertension who are living with obesity (BMI 30+ adjusted appropriately for ethnicity), where we know we can have a significant impact on improving their health, reducing health inequalities and costs.

It is also designed to offer effective weight management services to people with obesity and co-morbidities (diabetes and/or hypertension).

The programme features interventions of varying intensities, delivered by commercial providers, offering tailored approaches which target people from Black, Asian and minority ethnic groups, men, younger people, and those from deprived communities – and make a real difference to their health and wellbeing.

The Hub provides a single point of access for health professionals to manage patient referrals and allocate patients to appropriate DWMP providers and acts as a single point of contact for all potential patients, offering them a choice of provider appropriate to their level of intervention, and sending the chosen provider details of the person’s eligibility assessment.

Impact

Following extensive testing of the Hub, we have signed up 218 practices to take part. Staff have reported saving significant amounts of time in processing referrals as the Hub makes the relevant templates electronically available to all GP practices.

Referrals are then automatically generated into the Hub via an application programming interface which then leads to swift contact with patients. Each user can then access the Hub via their smartphone or computer, and by following a series of simple steps they can select their chosen provider and begin their programme.

The savings produced in terms of time and resources and the improved completions of the programme by patients using the Hub have demonstrated the value of this approach and the potential for major efficiency gains, as well as a large reduction in the amount of money spent on treatment for patients with weight management issues.

By cutting back on applications paperwork and making referrals through the Hub, and by making the transfer of patient details automatic, the Hub leaves NHS staff free to concentrate on other tasks.

Feedback from early testers:

“Very simplistic process and easy to follow. From what I remember it was only about 6/7 steps so very user friendly.”

“It was simple to use and and quick to use. Very easy to understand.”

“It looks great on the phone and really easy to use !!”

“All went smoothly. Received a text message, clicked the link, answered all questions through to choosing the provider, shut it down and clicked back on the link in the message. Previous answers were pre-filled, chose the provider and it said everything completed. No issues.”

Rapid recruitment for COVID-19 vaccine drive

Our work supported the recruitment of the bank and volunteer staff working at vaccination centres, at a time of high pressure in the NHS when work volumes were already extremely high, capacity was already strained, and staff were having to navigate difficult home lives because of COVID.

Background

Between January and June 2021, our project provided large-scale recruitment services to five NHS organisations which were supporting ICS/PCNs with the mass vaccination roll out. We supported the completion of around 2,500 pre-employment checks for volunteers and bank workers.

Action

We quickly recruited and trained 40+ recruiters to support an original small team of seven; we set up IT systems, provided a corporate induction, took project scope calls with area leads to determine support requirements and put in place processes that met data sharing regulations so that we could quickly source staff for vaccination centres.

We collated volunteer forms and converted them into applications and conducted remote ID verification calls and pre-employment checks, and processed checks for the Bring Back Staff Scheme. The team organised an alternative occupational health provider to support with fit-to-work and immunisation checks to relieve pressures on the existing occupational health team. We also pre-arranged immunisation sessions at a local GP practice for applicants.

The team supported Cheshire CCG while Mid Cheshire Hospitals NHS Foundation Trust hosted the bank, using volunteers and bank staff deployed to Cheshire PCNs and to the Cheshire Racecourse and Alder Hey vaccination centres.

MLCSU also supported with the recruitment drive for the Shropshire, Telford and Wrekin region. We quickly established a process to use the existing systems at St Helens and Knowsley Teaching Hospitals NHS Trust, East Lancashire Hospitals NHS Trust and Midlands Partnership NHS Foundation Trust to process applications on their behalf.

Impact

Over the last two years, MLCSU have built the capability to flex staffing requirements to meet NHS demands by developing a temporary staffing team who specialise in generating flexible workforce solutions such as bank and associate pools. This innovative private sector/agency-type model was a massive advantage when it came to deploying 40+ bank staff to work on this project at short notice.

Its streamlined processes and integrated systems allowed the team to provide services with little front-end set up, and by drawing on skill sets from the wider people services department, the model produced effective training and onboarding solutions for new staff.

Due to their speed and efficiency, the team have supported with the overall success of the vaccination rollout locally and nationally, processing approximately 2,500 applicants.

Phil Meakin, Programme Lead for COVID-19, Cheshire CCG, said:

“This has been an amazing system effort from the people of Cheshire, Trust staff, ICPs, CCG, Liaison Workforce, and MLCSU.

“The team from MLCSU provided us with daily updates of applicants’ process status and held weekly meetings to make sure our processes were working effectively. This helped us to understand the timings of when we would have enough resource to support Vaccination Centres.

“We are very grateful for their accurate and effective work of MLCSU in supporting people through a challenging process. Without all partners working together, it would have taken far longer to vaccinate the people of Cheshire.”

Blog: My time helping vaccination centres

In this blog, we hear how Kelly Bishop, a senior nurse within the Midlands and Lancashire Commissioning Support Unit’s Urgent Care Team, has been supporting Lancashire and South Cumbria in delivering their COVID-19 mass vaccination programme.

Since December 2020, I have been supporting the Healthier Lancashire and South Cumbria (HLSC) integrated care system, as one of three clinical leads over their seven mass vaccination sites. Carrying the title ‘Senior Nurse, Mass Vaccination Programme’ has been the most privileged yet responsible time of my career and one I will look back on with great pride.

Finding the right space and people

So, what does providing MLCSU’s vaccination support services mean for a nurse in the Urgent Care Team?

The initial task was to assess potential sites and floor plans for clinical suitability, alongside estate management colleagues from HLSC. We looked at empty shops, sport centres, town halls and cathedrals across the region, eventually deciding on seven sites. An amazing team of joiners, electricians and plumbers got to work.

Duties of a senior nurse

As the work on the sites progressed, my focus moved to training and onboarding over 500 new members of staff made up of the most amazing and diverse people. The programme has seen the coming together of existing NHS staff, retired nurses returning to practice, new recruits offering to be vaccinators, the fire service and armed forces, alongside our own army of volunteer marshals. Inductions and training commenced, uniforms were issued, and finally rosters formed.

Other days were spent: writing the clinical protocols and policies within which the sites would operate; unpacking and checking all the equipment onto the sites; building relationships with provider trusts as Care Quality Commission registration was confirmed. Ensuring no detail was missed, such as installing plug sockets in squash courts in time for the vaccine fridges, pulled in the full use of my clinical and programme management skillset!

Opening day and beyond

Finally, the opening of the seven sites in quick successions within seven days came! I can only describe opening a mass vaccination site like trying to roll a large boulder downhill, it takes every bit of your being, energy, and strength to get it moving; but once it goes, it goes.

Now the vaccination programme is well on its way, my daily life involves the operational running of the sites and ensuring high clinical standards are maintained, assurance is given to HLSC and lead provider trusts and, most importantly, that our population receive a timely vaccination and a good experience.

I am only one of many in MLCSU that have supported the mass vaccination programme, and we should be proud. Thank you to the Urgent Care Team for affording me this great opportunity.

5000+ delayed CHC assessments cleared

The NHS Continuing Healthcare Framework was suspended from March to August 2020 due to COVID-19. All care that facilitated hospital discharge or prevented admission to hospital during that period was automatically paid for directly by the NHS without assessment. Once the framework was reinstated, there were over 5,000 patients due a ‘deferred assessment’ which needed completing as soon as possible. Clinical commissioning groups (CCGs) would receive funding in November 2020 to support individuals eligible for NHS CHC funding.​

To establish an efficient process, health and social care systems employed a ‘Trusted Assessor’ model, designed to reduce delays when people are ready for discharge. It is based on providers adopting assessments carried out by suitably qualified ‘Trusted Assessors’ working under a formal, written agreement.​

Action

The Midlands and Lancashire Commissioning Support Unit (MLCSU) set up projects supporting the CHC activity based on the Trusted Assessment model in five integrated care systems (ICSs). Together with CHC expertise, we also employed clinical and business resource to address the issue.​

Working in collaboration with CCGs, NHS trusts, local authorities, community providers and others was key to completing the retrospective assessments This was achieved through excellent partnerships, the development of key systems and exceptional working practices to ensure deadlines were met.​

Impact

All care packages across the five ICSs, which were funded automatically by the NHS during the first phase of the pandemic, have now been assessed against the core NHS CHC Framework. This ensures that the packages:​

* Provide the most appropriate care according to individuals’ needs​
* Are realigned to the correct funding stream
* Eligible patients are now funded by core CCG CHC budgets. For remaining patients, the payment of their care costs has transferred from the COVID-19 budget to local authority responsibility, which has determined a variety of different pathways to support their care costs

The successful completion of assessments also earned the team a nomination for ‘Best working across CCGs and local authorities’ at a national awards ceremony by the CHC Strategic Improvement Programme (SIP) Collaborative.

Finance team celebrate leadership accreditation

We are delighted to announce that following a recommendation by the Future-Focused Finance (FFF) assessors, the Midlands and Lancashire Commissioning Support Unit’s Finance team have been awarded Level 3 Towards Excellence Accreditation.

The Future-Focused Finance Towards Excellence Accreditation, awarded by the NHS Finance Leadership Council, recognises organisations with excellent finance skills development culture and practices in place. There are three levels, each designed to reflect the continuous development of the finance function and recognising the highest standards of financial competence and commitment to skills development.

For our clients, the accreditation provides further assurance that our staff working on their behalf have the very best finance skills and are benefitting from the highest levels of investment in their development.  This is reflected in the quality of our services for which we regularly receive very positive comments, including this recent feedback: “A professional, proactive, efficient, friendly and knowledgeable financial services team!”

Tony Matthews, Director of Finance and Commerce at MLCSU, said: “This is fantastic news. This level of accreditation is very significant as it shows that we have achieved the highest level of finance skills, development culture and practices. I would like to thank all our staff for their efforts and contribution in arriving at this fabulous outcome.”

National award nomination for CHC

The Staffordshire and Stoke-on-Trent Continuing Healthcare team has been recognised at a national award ceremony for their work to complete all deferred patient assessments following the COVID-19 suspension of the NHS national framework for continuing healthcare funding. 

NHS continuing healthcare (CHC) supports adults with long-term complex health needs with free social care arranged and funded solely by the NHS. Following a patient assessment, the care can be provided in a variety of settings outside hospital, such as in a person’s own home or in a care home. The NHS CHC framework setting out the assessment process was temporarily suspended between March and August 2020 to protect the NHS when the COVID-19 pandemic hit. All care that facilitated hospital discharge or prevented admission to hospital during that period would be automatically paid for by the NHS, leaving a large gap in patient assessments.

The Midlands and Lancashire Commissioning Support Unit provides CHC services across the Midlands, Staffordshire, Derbyshire, Leicestershire, Lancashire and Cheshire and Merseyside. The Staffordshire team worked in partnership with Stoke-on-Trent City Council to successfully complete retrospective assessments of individuals supported via COVID-19 funding arrangements during the suspension of the framework. This was achieved through excellent partnerships, the development of key systems and exceptional working practices to ensure deadlines were met.

The team was nominated in the ‘Best working across CCGs and LAs (local authorities)’ category by a senior social care worker from Stoke-on-Trent City Council.

Receiving recognition in this category is particularly meaningful given that better collaboration between health and social care is one of the most significant areas of development for the NHS currently. Being nominated by the local authority highlights the effectiveness of employing a multi-agency partnership approach and is a testament to the relationships we have created for the benefit of improving patient and family experience.

The awards were organised by NHS England and Improvement to reflect and celebrate the success of the CHC Strategic Improvement Programme (SIP) Collaborative, which supports local healthcare leaders and CHC experts to work together to help improve services for the population. SIP was key in encouraging multi-agency participation in improving outcomes for individuals in need of care.

Our year – through COVID and beyond

The past year year has been a challenging and turbulent one. In our annual report 2020/21, we focus on what being a responsive system partner supporting the NHS through COVID has truly meant. We also summarise how we’re helping systems in delivering the goals of the Long Term Plan, and we highlight key areas where we made a difference across all our services.

In the past year, we, along with colleagues from across the NHS and wider health and care sector, have adapted to shifting priorities and made many changes to our way of working. Our vision has remained to be pivotal in fully supporting the delivery of major improvements in health and wellbeing. Our philosophy is to face every new challenge and opportunity together with systems as partners.

Midlands and Lancashire Commissioning Support Unit team members have been and continue to be deployed in the national Supply Cell, working on procuring ventilators and hard-to-source items, and have provided reporting and programme support to NHS England and Improvement’s national effort. We have reallocated a range of service teams and funding to response, recovery and restoration programmes. As a system-wide service, we provided advice and support to our partners, including the sharing of intelligence, best practice and volunteers to support COVID-19 operations and Winter Rooms.

Beyond COVID, we’ve developed an unparalleled experience across a wide range of areas. In addition to our established transactional support services, we continue to contribute with significant strategic  and programme management expertise, providing tailored transformational support to 10 health systems. Examples, among many others include advancing the application of machine learning and AI in addressing population health management challenges; driving forward work on population profiling and risk stratification; using automation and chatbot technology to facilitate more efficient care delivery; reducing waiting times and hospital length of stay rates; solving flexible capacity issues for GP practices, saving them time and money.

We bring added value and we work with customers as partners, whatever the need. In the future, we know commissioning will become far more about the strategic management of the health of the population. We have the dedication of our expert staff and the flexibility in our delivery models to collaborate with you, developing and delivering services within a single system plan.

PrimaryPoint: a digital portal for primary care

PrimaryPoint is a website, designed to provide primary care organisations with fast and easy 24/7 access to the latest policies, procedures, toolkits, and other services. Developed exclusively for primary care, the online portal helps our customers be compliant with current legislation and best practice. The site has templates, ready to be personalised with the customer’s information and logo, helping to cut down on day-to-day administration. Currently, services accessed through the site include information governance (IG), human resources (HR) and finance.

A bit of history…

Our very successful IG portal was already serving more than 600 GPs, providing them with essential documents and guidance. This made us think whether other services across the CSU could be provided in a similar way.

Our in-house app development team, the Digital Improvement Unit (DIU), was drafted in to build a site that would extend the IG service and offer other services to primary care. There is a useful homepage which explains what the portal is and shows all the services MLCSU offers to primary care. The IG portal was migrated across to PrimaryPoint, and our HR and finance departments got to work producing a library of policies, procedures, and standard letters.

In October 2020, we successfully launched PrimaryPoint. Since then, the IG service has gone from strength to strength, with now more than 900 GPs accessing the portal. The IG service on PrimaryPoint is comprehensive, covering contracts and agreements, IG policies and processes, DSP Toolkit guidance and help (for the annual return GPs must send to NHSE), as well as policies and templates and a monthly newsletter. In addition to the online service, our IG experts can also train GP staff and answer any questions primary care organisations have in relation to IG.

Our services

HR is well suited to an online service too, offering tailored policies, procedures and standard letters. Based on best practice, the HR section of Primary Point provides support with absence management, annual leave, flexible working, disciplinary procedures, grievances and performance management, among others. The online service can be used independently, or it can be supported with additional HR advice, guidance, and training.

Our finance service on PrimaryPoint is at its best when used together with additional finance expertise supporting GPs and PCNs to manage their accounts. The online service includes help with financial governance documents, an accountable officer template, a standard finance report template, as well as a guide to coding transactions. There is also a comprehensive guide to the Xero accounting package (which MLCSU uses with its primary care customers), although other systems can be used.

Later in 2021, we will be adding business continuity services to PrimaryPoint, with more areas to follow later this year, such as procurement, communications, and medicines optimisation.

What our customers say

“I have found the resources available from MLCSU most useful in completing the IG annual return.  It was useful to have documents populated with our information which we have been able download and save for staff to access.  Once set up, the portal easy to use and self-explanatory with correlating GDPR reference numbers.”

Katrina Dipple, Business Manager at Darwin Medical Practice

“I have accessed the IG section of the portal frequently since its launch in January 2020. The quality and detail of the policies available appear to be of a high standard and where possible we are using these to replace our current policies/processes. We are also grateful to MLCSU for taking requests for policies that we feel would be a useful addition to the portal, such as a National Data Opt Out Policy.”

Stephen Fitchett, Practice Manager (IM&T), Leicester

Shropshire vaccine recruitment success

A huge recruitment drive in Shropshire, Telford and Wrekin has seen nearly 1,000 new staff added to the roster at vaccination centres. Most of the staff mobilised to work on the vaccination programme so far have been redeployed from their jobs elsewhere in the NHS. Having new dedicated recruits will bring stability and improve staff turnover at vaccination sites, while other health and care services can continue to be restored now that personnel can return.

The campaign began at Christmas with the slogan ‘Be A Part of History’ and has been lead by The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (RJAH) supported by the Midlands and Lancashire Commissioning Support Unit (MLCSU) and other partners. People have stepped up to work as vaccinators, healthcare assistants, administrators and car park marshalls. More than 1,700 applications were received across the Shropshire and Telford system.

Sarah Sheppard, Director of People for both RJAH and MLCSU, said:

“It has been a phenomenal team effort to recruit so many people in such a short space of time.

“I’m so grateful to all colleagues across the system who have come together to make this happen. Recruiting so many people, so quickly, really is a stunning achievement.”

Why vaccine uptake varies in communities

Data from the first wave of the pandemic showed that people from certain backgrounds and communities are at higher risk to virus prevalence and mortality, which may contribute to poorer health outcomes. When planning the rollout of the vaccination programme, it’s important to consider equality early on. We have been working as a collective with experts from across the Integrated Care System (ICS) in Lancashire and South Cumbria to assess how the COVID-19 vaccination programme could impact different population groups, and to ensure good uptake.

Vaccination programme across Lancashire and South Cumbria

For the vaccination programme across Lancashire and South Cumbria, an Equality and Health Inequalities Impact Risk Assessment (EHIIRA) was undertaken. It looked at potential impact for each of the nine protected characteristics under the Equality Act (2010) – age, race, religion, disability, sex, marriage and civil partnership, maternity, gender reassignment and sexual orientation.

We developed the EHIIRA, which is under constant review, using regional assessment work by the regional team at Public Health England.  The purpose is to highlight how the way vaccinations are delivered might impact the uptake from groups at risk, and to point out what needs to be considered.

Risk of impact

The assessment highlights considerations and equality risks for different groups. One example is black, Asian and minority ethnic communities, where we might need to think about language needs and how to establish a dialogue early on to encourage high take up.

Once the risk was raised, colleagues from the ICS set out to gain insight directly from the communities. They reached out to influential religious leaders of the Muslim community in Blackburn and Darwen, asking what we needed to think about and what we could do to get a good level of acceptance.

The result was “a significant uptake in vaccinations from eligible members of the community”, as picked up by Amanda Pritchard, NHS England and Improvement’s Chief Operating Officer, and NHS Improvement’s Chief Executive, in a bulletin to healthcare leaders on 5 February.

Potential impacts were also raised about vaccinations during the month of Ramadan, a religious festival which is celebrated by Muslims. Work is under way both locally and nationally to provide clear information about the vaccine and that the vaccine can be received during Ramadan.

Equality audits

We also developed an audit for considering equality related matters at individual vaccination sites. It examines issues of disability access, location and travel, signage and communication and religion and belief – especially relevant where religious sites were considered.

Equality assessment in Cheshire

Our equality and inclusion experts are also supporting Cheshire CCG with an ongoing assessment of how factors specific to different communities could impact vaccine uptake. For example, early on in the vaccination programme, we identified an impact for housebound patients. The only approved vaccine at the time had to be kept at very low temperatures meaning it could not be transported to their homes. To receive the jab, these patients needed to be helped into the vaccination centres, which posed further risks.

While the approval of other vaccines resolved this issue, other community characteristics continue to create impacts which could lead to low levels of vaccinations. As a result of highlighting the risk, the CCGs in Cheshire have brought in a specialist consultant to further investigate why there may be hesitancy.

The assessment in Cheshire identified potential barriers to accessing the proposed mass vaccination sites and highlighted factors such as signage, parking and welfare facilities. Local communities, such as the farming and boating communities, as well as groups with protected characteristics, were carefully considered as part of the plan for ‘hard to reach’ groups. Our advice and guidance will continue throughout the vaccination programme, supporting both mass sites and hospital hubs, GPs and pharmacies.

Equality assessment elsewhere in England

We believe the findings from the assessment in Lancashire and South Cumbria may have similarities with risks associated with equality impacts in other regions and nationally. This is why we shared the assessment template with CCGs in Leicestershire, Hertfordshire, Worcestershire, Cheshire, Wirral, Trafford, Staffordshire and the North West Regional Delivery Team.

Free demographic & inequalities analysis

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.

Free model to ease COVID-19 vaccine queues

Our colleagues at the Strategy Unit have developed a capacity model to help people planning and running COVID-19 vaccine clinics to ease the flow of patients, reduce queueing and make the best use of facilities and staff for maximum effect.

Using modelling is a fast and cheap option for spotting problems and allows you to prevent them and plan ahead. The model is free for use by anyone and can help the design and operation of clinics.

This work stemmed from the Strategy Unit’s collaboration with the Wolverhampton Prevention and Population Health Unit team to aid in their advice on planning vaccine centres in Wolverhampton.

See model and instructions for use on the Strategy Unit’s website at www.stratgyunitwm.co.uk.

Introduction: Workforce

Through a combination of centralised and embedded teams, we support organisations and staff through change. We help you understand your culture and create positive shifts in attitudes and behaviours, developing an effective, supported and flexible workforce. We use a population and place-based workforce planning approach to enhance recruitment and resourcing, increasing your resilience.

Find out more about how we can help:

Introduction: Patient Flow

Tackling the backlog of clinical care, managing system pressures and waiting lists and assessing funding and referrals consistently will be a key focus of system leaders in the years to come.

We understand your challenges and contribute by combining data, systems and expertise in clinical pathways to enhance your strategic and tactical decisions. We provide consultancy services, working with you to utilise real-time analytics, insight tools, evidence, research and project management capability.

Find out more about how we can help:

Need a locum? There’s an app for that!

NHS Midlands and Lancashire Commissioning Support Unit is delighted to have won a place on NHS England and NHS Improvement’s Framework for Digital Solutions for Sessional Clinical Capacity in Primary Care. This enables us to easily offer our digital Find me a Locum solution to clinical commissioning groups (CCGs) across England and help relieve capacity pressures for practices.

Find me a Locum has been co-developed with partner GP Federations – people at the sharp end of general practice. This keeps costs low, delivering great value. Tried and tested, it is already helping practices to find locums quickly, securely and at low cost, making significant savings on agency fees.

Access to Find me a Locum is through a straightforward annual subscription per practice. It delivers a return on investment for the price of just four locum agency fees.

Find me… provides fast, efficient, high quality ‘pairing’ between practice vacancies and locums. It is accessible 24/7 by a website and easily downloadable app.

It facilitates payments by providing tools to practices and locums to manage the invoicing process, end-to-end. Practices retain full control and benefit from support of a dedicated account manager and service desk.

Other benefits for practices include:

* quick and easy digital advertising of slots to a wide audience
* assurance that locums are accredited and registered (with evidence for CQC)
* automatic validation of locums against national performers list and GMC register
* training and awareness-raising to encourage clinical and managerial uptake and ongoing use
* regular system updates and enhancements.

Staffordshire practice manager, Kirsty Moore, said: “Find me a Locum has taken the stress out of finding GP Locums. It’s made it easy to fill our locum sessions quickly, with experienced, knowledgeable, reliable clinicians. I highly recommend this fabulous resource to practices.”

Designed originally for use with GP locums, the solution can easily be expanded for other staff groups, for example nurses.

Details of the ordering process have been disseminated to CCGs by NHSE.

For more information, contact mlcsu.commercial@nhs.net or go to www.findmealocum.co.uk.

Supporting the COVID-19 vaccine effort

As a key system partner, Midlands and Lancashire Commissioning Support Unit (MLCSU) is actively supporting the COVID-19 vaccination programme in Lancashire and South Cumbria. In partnership with system leaders, we helped to establish a network of vaccination services. We have been working closely together with colleagues from across the integrated care system (ICS), in much the same way as when we developed a tactical command room to help manage winter pressures.

Across Lancashire, the Midlands and North West, we are also supporting over 100 vaccination centres with IT and other services. Our partnership and system approach, following government direction, is enabling the most vulnerable patients to receive their vaccines quickly and safely.

Strategic Vaccinations Operations Centre

Rapidly forming vaccination centres across Lancashire and South Cumbria was no easy task. When the programme took off in November, there was a need for a control room. A Strategic Vaccinations Operations Centre (SVOC) was created at our Jubilee House site in Lancashire with the full support of ICS leads. The centre is resourced with members of MLCSU, clinical commissioning groups (CCGs), trust and wider system colleagues. Having recently built another tactical command room, also in Jubilee House, we were well positioned to support the setup of the SVOC.

Gold Command Winter Pressures Room

The earlier command room’s purpose was to support the operational activity of the Lancashire and South Cumbria NHS organisations and Out of Hospital services facing winter pressures. The Gold Command Room is a tactical support service where we monitor and analyse pressure on individual trusts and organisations – number of people in A&E, COVID-19 cases, people who cannot be admitted because they are waiting for a COVID-19 test result, and other issues such as staff sickness, lack of beds, discharge delays, ambulances queueing up, and so on. Data is looked at from a system perspective and capacity redistributed to where it is needed most. For example, pressure can be taken off one hospital or ambulances diverted to another. Business intelligence expertise is fully covered by MLCSU analysts.

System working

Work at the command room, as well as the SVOC, is ongoing seven days a week in collaboration with partners across Lancashire CCGs, all trusts, NHS England and Improvement (NHSEI) leads and ICS executives. It has made a phenomenal difference in terms of collaborative working, system thinking and helping each other for the benefit of patients.

Across Lancashire and South Cumbria, the vaccination programme is fully coordinated from the SVOC:

* We provide strategic nursing capacity, together with chief nurses from the local system, to ensure resilience through clinical governance arrangements and senior clinical oversight of vaccination delivery

* We provide strategic pharmacy capability, with the medicines lead ICS system role supported by our Medicines Management and Optimisation (MMO) Team

* We have supported the development of seven vaccinations sites in Lancashire and South Cumbria including our estate in Jubilee House and Blackburn Cathedral’s crypt

* We have supported the vaccine programme Board for Lancashire and South Cumbria with a range of other services, including managing the communications across partners to coordinate activity, programme and project management, equalities and diversity advice, IT and data advice as well as IT kit deployment.

* Vaccination programme support elsewhere in the country

In addition to the huge amount of work we do directly with the ICS in Lancashire and South Cumbria, we also help individual trusts, PCNs and NHSEI with COVID-19 vaccinations across the Midlands and North West:

* Digital enablement of more than 100 vaccination centres including training of staff on point of care delivery systems and technical support seven days a week

* Data management for University Hospitals Birmingham

* Pharmacists deployed to NHS Nightingale Hospital North West in Manchester

* Over 50 additional members of MLCSU staff recruited to carry out employment checks of vaccination centre staff

*Administration, project management, nurse training and marshals in other parts of the country.

A key part in mobilising the vaccination programme has been the outstanding work from multiple partners working collaboratively across the NHS, the Police, Fire Service, military and local authorities.

Finance teams can make help improve care

Does your finance team struggle dealing with the very old-fashioned method of paying doctors for doing Section 12 mental health assessments? Are patients in crisis getting the best care in your area?

In this digital age, the Midlands and Lancashire Commissioning Support Unit (MLCSU) Finance team spotted an opportunity to transform this process completely. It was taking far too long to get patients seen and get pieces of paper through the system. Patients in crisis need to be seen quickly, now more than ever.

So our finance experts got together with our own Digital Innovations team to create an app to speed things up. As Find me an s12 Doctor has been developed by the NHS for the NHS, we want others to experience the same benefits. And the more people that use it, the cheaper it will be for each ICS.

It is cheap and easy to use. We just need to get various parties across an integrated care system (ICS) or sustainability and transformation partnership (STP) trained (it only takes 30 minutes), and doctors registered to use it. Then it’s simply a matter of downloading it from the app store.

I doubt any health system would think twice before implementing such a simple solution to a problem process that hasn’t changed since the 80s.

Benefits are across the whole of the ICS/STP and include:

* Improved ability to deliver 24/7 mental health care
* Reduction in time to assess patients, lowering anxiety and mitigating risk
* Significant time saving for the Approved Mental Health Professionals (AMHPs – the people that match the patient to a doctor and who usually work in a local authority or for a mental health trust)
* Assessments are significantly easier and quicker to organise
* Improved access to a wider pool of doctors
* Doctors are paid within a few days rather than months
* Doctors are only contacted when they want to be rather than taking calls at all hours, day or night
* No more manual claim forms or information governance risks
* Doctors can track the claim through Find me an s12 Doctor, so won’t need to chase for payment by phone
* Reduced likelihood of unlawful detention
* Potential for significant cost efficiencies in the employment of AMHPs
* Clinical commissioning groups and CSUs have more information available and more checks in the system
* Reduction in finance staff time dealing with high numbers of GPs chasing for payment
* For the first time, much improved qualitative and quantitative information on the service’s use and cost.

If you want to know more, please give me a call. I’m Jules Harrhy, MLCSU’s Deputy Director of Finance, and my number is 07816 071379, or just email me at Julie.harrhy@nhs.net.

Developing management and leadership

Background

South Sefton and Southport and Formby CCGs requested MLCSU’s Organisational Development (OD) services to improve leadership and management skills within their organisations. The aim was to provide critical understanding of theory and practical application of key aspects of being a manager and a leader, focusing on compassion, staff wellbeing, motivation, achieving results and managing people remotely.

Action
We created a tailored management development programme of training, designed to support the adoption of best practices in managing and leading others. There was a great emphasis on soft skills, such as communication and empathy, which enable better teamwork and more progressive relationships with the people they manage.
The programme was delivered as a virtual package of six web-based sessions covering:

* Management and leadership – motivate and engage your staff
* Effective communication and difficult conversations
* New starters induction, staff development and coaching
* Performance management
* HR policy overview
* Resilience and wellbeing.

All training sessions were delivered jointly by OD and HR experts, to ensure balance between legal framework and soft skills, required to build strong and high-performing teams.

Impact

The management development programme received overwhelming positive feedback from participants and the CCG’s senior leadership team.

All delegates agreed that the structure, content and delivery of the programme were excellent.

The implementation of the programme and the training of all managers resulted in:

* Creating a culture of compassioned leadership, and highly-engaged and motivated staff
* An understanding of work pressures so that those can be managed effectively
* Better communication and engagement at team level
* Focus on strategic goals, objectives and benefits, ensuring they are clear and optimised
* Developing more resilient leaders capable to manage change and uncertainty
* Equipping all managers with the skills and knowledge to manage in a virtual environment.

Improving COVID-19 supply chain resilience

The Hard to Source Items (HTSI) team sources timely and sufficient quantities of required equipment and consumables to complement conventional channels and safeguard against supply chain disruptions. COVID-19 led to a surge in demand for clinical consumables and services globally, with conventional procurement channels exhausted and struggling to meet demand. This was made worse by restrictions on border movements and local production capacity constraints such as workforce availability, raw materials and procurement mechanisms in place of usual trading conditions.

MLCSU’s Improvement Unit were rapidly deployed to support a dedicated global team put in place by the DHSC to consider alternative approaches, including sourcing items from international suppliers previously unknown to the NHS and looking at appropriate clinical alternatives.

Action

The Improvement Unit were tasked with managing the largest product category range, NIV/CPAP and HEPA/HMEF filters, which included NIV masks, filters, breathing circuits, exhalation ports and reservoir bags totalling over 3 million individual items. With stocks rapidly depleting and the winter surge looming, the team liaised with British Embassy colleagues in Beijing and managed to:

* Find suppliers
* Track delivery of products into the UK keeping the NHS Supply Chain updated
* Coordinate the validation of products through a rigorous due diligence process involving clinical scientists and gaining approval from the MHRA
* Hand products over to the supply chain for distribution to Trusts for use by the most vulnerable COVID-19 patients in the event of a winter surge.

Impact

* Sourced sufficient quantities of ICU consumables and equipment for COIVD-19 patients in preparation for the winter surge.
* Secured approval from the DHSC and Cabinet Office to source millions of individual products from global suppliers and monitored their progress through to delivery into MoD airbases and warehouses.
* Opened up new international markets and future supply chain channels previously unknown to the NHS.
* Managed the technical, clinical and regulatory due diligence validation process of first-of-type items into the UK.
* Produced documentation and communications for each product to encourage uptake of novel devices in NHS Trusts.
* Forged strong relationships and built new networks of stakeholders by working collaboratively with the DHSC, NHSSC, MoD, MHRA, FCDO, external consultants, other CSUs and * Trusts involved in the testing and adoption of the products sourced.
* Contributed to the creation of the HTSI ‘playbook’ which outlined the scope, structure and processes of the HTSI team in the event of being mobilised at pace in the future.

Improving PPE procurement data

The COVID-19 outbreak resulted in numerous organisations being involved in the procurement and distribution of vital supplies of Personal Protective Equipment (PPE) and medical equipment across the country. This led to changes in reporting and recording of data, impacting NHS Supply Chain’s database quality. MLCSU were engaged by NHSEI to provide project management and administrative support in order to review and improve data quality for core items within the NHS Supply Chain.

Action

The project management and administrative support mobilised quickly to ensure that immediate provision, keeping in line with the short timescales and key milestones. Project documentation and governance structures were implemented efficiently using an agile approach to flex with the needs and demands of the project. We set out the key tasks and milestones, providing clear visibility of progress. We implemented a robust administrative process and ensured that key actions were captured, cascaded and achieved in a timely manner.

Impact

The support and administrative expertise provided for the project led to a successful delivery of a robust and effective database for the NHS Supply Chain. We delivered much needed support in a fast-paced environment, allowing for clear visibility of key dependencies, actions and deadlines. As a result, procurement and subject matter experts could focus solely on the key deliverables and project objectives.

Mobilising at pace and implementing effective project structures ensured the project’s objectives were met. This includes:

* Improved processes
* Standardisation and improved data quality
* Support the procurement of core items within the NHS Supply Chain PPE catalogue.

Our effective relationship skills with key stakeholders and ability to deploy quickly, motivated the project sponsor to extend our administrative support by a further two months to support and deliver the second phase of the programme.

CCGs block book beds with ease

Two Merseyside based CCGs recently engaged with MLCSU for support in procuring a block contract for Intermediate Care Beds (ICB) split over both COVID-positive and COVID-negative cohorts. Rebecca Crawford, Care Brokerage Lead at MLCSU, worked with South Sefton and Southport and Formby CCGs to explore the procurement options available. She advised that our existing DPS solution – adam, would allow the bed-base and contract to be in place in a matter of weeks.

Action

MLCSU joined a weekly project group and supported the CCGs to specify their exact requirements, using adam’s wealth of intuitive functionality:

* Creation of bespoke requests including: detailed tender instructions and contact details to guide providers, responses to 18 different key requirements, all in an easy-to-compare format
* Automatic distribution to pre-enrolled providers: automatic email system, automated system ensuring submission of fully compliant offers
* Easy offer analysis and contracts creation: automatic filtering and ranking, offer collation, automatic facilitation of service agreement and payments

The CCGs quickly requested quotes for up to 20 beds for COVID-negative cases and up to 10 for COVID-positive cases, from 76 pre-vetted care home providers (within a desired distance of the CCGs). The bespoke requests meant that providers could easily understand exactly what was asked.

Additionally, providers could ask the CCGs questions via adam’s two-way communication platform, and adam’s support team were on hand to assist providers with any queries and proactively encourage offers.

Impact

Six fully compliant offers were received within six days of the request for quote. Once the CCGs had reviewed and accepted an offer, contracts were created immediately (at a rate of £100.90 per day for care homes [lower than local market average]). From the moment the CCGs engaged with MLCSU, a decision on a provider was reached in less than a month.

With Rebecca’s help and adam’s digital CHC commissioning solution, the CCGs could specify their exact requirements, be it ensuring residents were kept in one place or appropriate disease control.

Offers collated in an a structured and easy-to-follow format enabled the project group to undertake an efficient evaluation and to select the most appropriate provider.
The automatic creation of service agreements and payments resulted in patients placed swiftly in the care homes, in line with the CCGs’ timescales and pre-agreed standards.
The CCGs were so impressed with the result, that they drafted a ‘lessons learnt’ report. MLCSU experts state that block contracts can take several months of resource-intensive procurement.

Professional support

Throughout the process, adam’s and MLCSU’s service delivery teams were on hand to guide and support the CCGs with their daily and strategic use of the system. The teams also made sure that all providers were engaged and supported in using the system.

Implementing of a PCN DES contract

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.​

Recruitment of an ICS chair

Healthier Lancashire and South Cumbria is a shared vision and five-year strategy for improving health and care services and helping the people of Lancashire and South Cumbria live longer, healthier lives. To achieve this, a key focus is on challenging how and where the services are delivered and how the partnership organises itself to achieve its aims.

The integrated care system (ICS) includes the NHS, local authority, public sector, voluntary, faith and social enterprise and academic organisations, working together to join up health and care services, listening to the priorities of the communities, local people and patients and tackling some of the biggest challenges they are facing.

To assist with the programme of work an Independent Chair was required to provide non-executive and independent leadership to the ICS.

Action

The non-standard recruitment process consisted of two partner organisations working collaboratively.

* The post holder would be engaged by the Acute Trust
* The recruitment process was led on behalf of the ICS by the MLCSU People Services Team for Lancashire & South Cumbria CCGs
* The stakeholders involved included NHS, local authority and community organisations
* Given the status of the post, and in line with regional guidance, the ICS instructed an external head hunter to assist with the candidate selection
* The recruitment process had to reflect the acute trust’s recruitment protocols and governance arrangements
* The People Services Team was the central point for coordination between stakeholders and candidates
* Communication was imperative between all stakeholders to ensure a fair and consistent recruitment process to meet the ICS requirements.

Impact

The successful appointment of an experienced individual who can lead the ICS to achieve its system-wide objectives and provide constructive challenge across the system.
The Independent Chair will ensure there is a clear plan for the implementation of the ICS strategy.

Providing HR support for a CCG merger

Midlands & Lancashire CSU is the provider of human resources (HR) services to NHS Cheshire Clinical Commissioning Group (CCG). This organisation was established on 1 April 2020 as the result of a merger of four CCGs that had HR services provided by MLCSU.

Action

As part of the merger programme, our HR team successfully:

* ran an assessment centre for the appointment of a single Accountable Officer
* led the HR elements of appointing a single Executive Team
* led the HR elements of appointing a single Governing Body and single group of clinical leads
* provided HR advice and support in relation to restructuring, including formal consultations and handling displaced staff
* led the TUPE transfer of approximately 300 staff into the new CCG
* worked with the payroll provider to merge four Electronic Staff Record (ESR) Virtual Private Databases (VPD) into one single VPD, transferring all staff and their records whilst ensuring that they continued to be paid correctly.

Impact

NHS Cheshire CCG was successfully established on 1 April 2020, with the HR elements being led by MLCSU.

Improving management of nursing care

Nursing care providers across Lancashire and South Cumbria needed to complete and submit a monthly questionnaire for each clinical commissioning group (CCG) that they worked with. Residential care providers in the region were not asked to do this. This agreement was labour intensive for providers and difficult for the CCGs to manage, whilst creating an inconsistency in how they managed local care operators.

The integrated care system, Healthier Lancashire and South Cumbria, wanted to improve the process.

Action

MLCSU, with technology partner, adam, implemented a supplier relationship management module for the group. This highly secure, cloud-based and fully mobile-compatible application incorporates a range of features including:

* automated collation of data from providers
* systemised data analysis and interpretation (including scoring and RAG statuses)
* easy-to-use interactive charts and dashboards
* communication tools to engage and share information back and forth with providers.

Impact

Implementation of the supplier relationship management module resulted in:

* significant time savings for customers in collecting data from local providers around the quality of care
* improved insight over quality of care to inform provider management activities and policy setting
* configuration of communication tools to improve information sharing with providers
* improved quality of care across the region as staff can spend less time gathering information, and more time focusing on areas of under performance.

Just looking at hospital admissions alone, the supplier relationship management tool has helped one CCG save 17 unscheduled hospital admissions per month, which equates to a financial saving of at least £13,000 per month (assuming a minimum 2-day stay per visit).

One CCG has reported the following performance improvements over the first 12 months:

* reduction in average number of falls monthly from 238 to 93
* reduction in providers rated Red or Amber under their quality monitoring guidelines from 12 to one
* urinary tract infections down from 54 to 16 a month
* unscheduled hospital admissions down from 49 per month to 32.

Improved domiciliary care placements

Clinical commissioning groups in Staffordshire wanted to review and change the spot purchase approach to procuring and managing domiciliary care placements and address the lack of a contractual structure. With budgets under pressure due to increasing demand, prices of domiciliary care were also rising. The aim was to move to a robust, effective and faster process that focused on maximising a robust contractual structure with quality of care for patients and value for money for the CCGs.

MLCSU, with technology partner, adam, was already delivering a range of solutions to the CCGs, including a commissioning solution for nursing care provision and a case management system for continuing healthcare (CHC) patient records.

Action

We scoped what was required, engaging with key stakeholders and providers and worked with adam to deliver:

* new policy and process documents
* new procurement and associated provider contracts
* performance and price benchmarking
* system configuration incorporating agreed processes and policies
* electronic invoicing and payment process
* migration and loading of existing package data
* training of all system users
* management of information and reporting design and configuration.

Impact

The new process is expected to result in:

* improved management of risk and compliance
* faster placement of CHC Domiciliary Care patients
* financial savings
* improved process around provider sourcing and quality of care
* all invoices being held online and paid within 30 days without exception
* providers being fully aware of all process, policies and performance metrics as they are held online
* providers having a fair opportunity to provide services for all new cases.

With this development we have now implemented adam’s full commissioning solution in Staffordshire (our first customer to have all key aspects in one system). It includes:

* provider contracting and evaluation
* care and support planning
* e-brokerage and provider sourcing
* e-contracting and placement management
* integration with case management system and finance systems
* e-invoicing and payment process
* supplier relationship management module (starting soon, delayed by COVID-19)
* interactive and real-time reporting tools
* dedicated user support and training
* data analysis and stakeholder engagement teams.

Our help to reduce occupied bed days

Blackpool Teaching Hospital NHS Foundation Trust commissioned Midlands and Lancashire Commissioning Support Unit to lead a two-year project (2019 – 2021) focusing on a number of work streams, with each having a defined objective towards the ‘reduction of occupied bed days’. Regular board level governance incorporated both the trust and the Fylde Coast Clinical Commissioning Groups.

Action

A comprehensive deep dive of local evidence by our analytics experts helped create a suite of quality indicators that demonstrated areas of improvement and was therefore key to the success of the overall Bed Reduction Programme. The support of 600 consultant days was agreed across a 2-year time frame, with an emphasis placed on a number of supplementary outcomes that were associated with the overall objective (see outcomes). Specific key areas of intervention and support around pathways and the full utilisation of existing resources were included in a detailed project plan which formed the basis of regular reports to gauge progress into the project board.

Each workstream was allocated a MLCSU clinical subject matter expert and a defined team structure that replicated triumvirate working from the appropriate areas of nursing and operational leadership teams from both the trust and the CCGs. Programme support, monitoring and leadership for each work stream was then led by the CSU.

Intervention and support was given both on site and remotely, with a firm emphasis placed on long term cultural change and future workforce capability within the trust to ensure strategic progress was monitored and permanent change was delivered.

Impact

Expected outcomes:

* Increase in zero-day length of stay (same day emergency care) rate from 23% to 33% (in line with the regional average)
* Increase direct admission rate from current 26.1% to 32.02% (in line with regional average)
* Targeted 15% reduction in occupied bed days* per 1000 population in 65 +age group

The outcomes to date:

* An increase in the zero-day rate to ~30% at the end of December 19
* A ‘direct admission rate’ (patients admitted via any route other than the A&E) of 33% as at November 19 and subsequently ensured direct admission rates were at 32.02% for three consecutive months
* Approximately 22 beds per day (net) have been released. The increase is largely amongst Blackpool CCG residents (Blackpool increase = 40 beds per day; Fylde and Wyre increase = 18 beds per day)

Nb: Average length of stay reductions seen for 27% of all Frailty inpatient service users (pre-Covid) and the new Frailty Assessment service was proven through a test of change phase (March 2020).

Direct admission to assessment wards, effectively by-passing A&E, allows for effective handling of patients within wards, and also generates capacity in the A&E bays.

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.

Coordinating primary care apprenticeships

The five locality training hubs making up Lancashire and South Cumbria Training Hub (L&SC TH) work together to form a multidisciplinary clinical and administrative team supporting primary care teams across the patch. They promote the positive benefits of diversifying primary care roles. MLCSU’s Improvement Unit provided project support to the apprenticeships programme by fulfilling the L&SC Apprenticeship Coordinator role.

Action We worked with the Chair of the Training Hub to roll out, facilitate and promote apprenticeships within General Practice in line with the Local Delivery Plan. Including:

* Facilitating regular intake of health care support workers (HCWs) from General Practice to the Trainee Nurse Associate Apprenticeship Programme
* Offering support, advice and guidance to practices on the nurse associate role, application and financial/levy process
* Co-developing and facilitating the first cohort for a senior HCSW apprenticeship
* Maximising apprenticeship development in General Practice by promoting apprenticeships (of all types) at events, presenting the benefits and providing information to individual practice.
* Supporting non-levy-paying practices in placing a member of support staff onto an apprenticeship by allocating Health Education England funding for priority areas.

Impact

Thirty six new or existing staff have enrolled onto apprenticeships. This is helping to:
* support succession planning
* address the skills gaps in the workforce
* aid staff retention and create continuing professional development (CPD) opportunities
* increase the number of practices accessing apprenticeships
* develop the primary care workforce
* help practices understand the benefits and utilise apprenticeships.

Fourteen HCSWs enrolled onto the Trainee Nurse Associate Apprenticeship. The nurse associate role bridges the gap between HCSW and registered nurse helping to meet changing health and care needs. Nurse associates can increase the capacity of General Practice Nursing (GPN) teams in areas such as cervical cytology and long-term health condition clinics.

Six people enrolled onto the Senior HCSW Apprenticeship for General Practice. This apprenticeship provides highly skilled employees back in practice with a recognised qualification offering progression to higher/degree apprenticeships.

Twenty seven expressions of interest were received for apprenticeship development in L&SC Primary Care.

Sixteen new or existing staff enrolled across L&SC for HCSW, administration, and management apprenticeships.

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.

Reducing inappropriate referrals for treatment

Clinical commissioning groups (CCGs) need to ensure that funds are spent on treatments and procedures bringing the greatest value and benefits to patients in a way which is affordable and equitable. Chorley & South Ribble CCG and Greater Preston CCG wanted to improve their funding application process. The challenge was to change behaviour, educate clinicians, improve the patient journey, reduce inappropriate referrals and ensure consistent outcomes.

Action

We trained clinicians and created a bespoke, streamlined system for submitting funding applications. Our comprehensive Individual Prior Approval Scheme involves the provider of treatment seeking funding approval from the commissioner prior to treatment. CCGs can challenge providers for activity that does not have the relevant authorisation codes generated by the scheme, ensuring only appropriate treatments are delivered.

With Chorley & South Ribble CCG and Greater Preston CCG, we developed and implemented a robust manual Individual Prior Approval Scheme for seven policies over an initial six-month period. Following a successful outcome, this was extended for a further two years to cover 15 procedures of limited clinical value and nine cosmetic procedures.
In addition to the monitoring and validation of activity data, we captured qualitative data in relation to themes and trends affecting potential future commissioning intentions. We ensured commissioners and referring clinicians understood the requirements of the scheme. Reporting mechanisms were developed and continually reviewed in line with CCG requirements.

Our ‘wrap-around’ service included finance and contracting expertise to support reconciliation process at intervention level and clinical policy development support to ensure effective application of policy criteria.

Impact

Inappropriate referrals at Chorley & South Ribble CCG and Greater Preston CCG have fallen, resulting in efficiency savings and improved patient flow, with applications receiving a decision within five working days. Health outcomes have improved by ensuring the right treatment for patients at the right time, only undergoing elective treatments and interventions where benefit outweighs the clinical risk.

More than 9,000 applications went through the process over the first two years of implementation and 13 per cent were declined.

With increased knowledge of clinical policy criteria at secondary and primary care level, clinicians are managing patient expectations more appropriately, improving patient experience and reducing misunderstandings and complaints. Working relationships are enhanced between stakeholders, with a culture of continuous improvement.

Hospital providers involved have praised the Prior Approval system, saying they would like all CCGs to commission this process so there would be a single, robust and efficient system, making processing applications simple and easy for clinicians.

The scheme has contributed to quality and improvement programmes through the reduction of activity. It has also supported other commissioning demand management schemes to support CCGs to realise further activity and cost savings.

Rapidly rolling out video consultations during the COVID-19 pandemic

Background

The NHS Long Term Plan outlines NHS England and NHS Improvement’s commitment to transforming outpatient appointments. In April 2019, their Outpatient Transformation Team began a pilot to scale up the use of video consultations for outpatients. This work was rapidly accelerated in light of the COVID-19 outbreak to implement video consultation capability within all trusts.

Specialists from MLCSU’s Improvement Unit, who were already working for the NHSE North Elective Care team, were quickly redeployed to support the rapid roll-out across the North. They programme managed and delivered training on the Attend Anywhere online video consultation platform to all trusts across the North of England, linking with NHS Digital and NHS England programme teams.

Action

Two teams of trainers were quickly established from within the Improvement Unit. Under the guidance of the national video consultation project team they became experts in the platform so they could deliver train-the-trainer sessions and support Trusts to implement video consultations. A lead trainer was assigned to each Trust.
Working with the NHSE and NHS Digital onboarding teams, we arranged licences, carried out data protection impact assessments and checked technical requirements to ensure Trusts were able to adopt video consultations successfully.

Impact

* Within just three weeks the Improvement Unit team had delivered training on the Attend Anywhere online video consultation platform to 54 Trusts.
* Over 100 services and specialties across the north of England are now using video consultations daily to maintain appointments with patients safely.
* Our team has also given advice regarding virtual consultations to ambulance Trusts throughout England via a webinar organised by NHSE/I South West and facilitated by NHS Horizons.
* By reducing the need for physical attendance at NHS sites, video consultations are preventing the transmission of COVID-19 as well as enabling clinicians to see patients who are unable to travel. Patients can have their consultations in a place that is convenient to them.
* Video consultations are also enabling clinicians who are themselves at risk or who are self-isolating to work from home.
* Seven months after implementation, over half a million consultations have taken place using the platform, with the North West consistently one of the highest users

Chatbots improve referral management

MLCSU’s Referral Management Centre (RMC) makes bookings when a patient is referred (usually by their GP) to see a specialist. The patient can call to make an appointment, or they may be called by the RMC. In either case the patient will be offered an appointment at a number of local hospitals.

The RMC team uses the NHS Digital e-Referrals system and the Integrated Care Gateway (ICG) referrals system developed by software developer Accenda. The 56-strong call centre team were making and receiving in the region of 1,200 – 1,800 calls per day 8am – 6pm with an average 40 seconds wait time.

In September 2019 the RMC and MLCSU’s Digital Innovation Unit reviewed this ‘calling out’ process. Approximately half of calls were unanswered meaning an ineffective use of staff time and, if unable to leave a message, no value was added to the patient or service.

Action

We introduced chatbots (developed by Arcus Global) to automate outbound calls. Patients answering the call are directed to a cxaall handler. When calls are not answered, a message is left by the bot where possible. The aim was to greatly reduce human intervention where there was currently little or no outcome to the call and also create capacity within the team to focus on delivering an excellent service to the incoming calls.

A live pilot study commenced in February 2020.

Impact

Using a mixture of SMS messages, calls and the occasional letter as a last resort, the centre has seen a 94 per cent reduction in time taken to make outbound calls and over 60 per cent of patients are reached.

The RMC is now saving around 1.3FTE staff time per day to concentrate on patient services.

Qualitative benefits are also being recognised, such as ensuring calls that are made benefit patients and the improvement in staff morale in not having to listen to voicemails or make fruitless outbound calls.

Following this success, the Digital Innovation Unit is using voice automation to improve other processes for customers as well as for the CSU.

Supporting delivery of Staffordshire’s integrated care record programme

MLCSU has provided the programme management team for the introduction of the integrated care record (ICR) in Staffordshire and Stoke-on-Trent. Our team comprises senior information management and technology managers, project coordinators and communications and engagement specialists.

The team is responsible for day-to-day operations of the flagship One Health and Care project and reports to the ICR Project Board and the overarching Digital Programme Board representing the 16 partner organisation making up the STP.

Action

To date, work we have undertaken includes:

* Development of terms of reference
* Construction of the ICR Partnership Agreement and coordination of its sign-off
* Management of the ICR budget and the wider Digital Programme budget to ensure allocated finances allow for flexing through resource intensive stages of the project
* Production of the system specification and coordination of the procurement process including all supporting documentation
* Completion Equality Impact Assessment
* Completion of Quality Impact Assessment
* Creation of the full business case, project initiation document, project plan, and communications and engagement plan
* Administration of STP partner organisational readiness and preparatory work required for the ICR, including data scoping and specification, and system configuration, testing and training.
* Management of information governance, including and the Data Processing Agreement (DPA), Information Sharing Agreement (ISA), and Data Protection Impact Assessment (DPIA)
* Facilitation of the Fair Processing campaign for the ICR and the development and issuing of all communications and engagement material to STP stakeholders
* Planning the ICR service support model, including helpdesk and associated service level agreements.

Impact

The ICR is now being rolled out across the county. With Staffordshire placed as frontrunners regarding ICR in the region, the programme team is liaising with counterparts in Shropshire & Telford, Wolverhampton, Walsall, and Worcestershire to share experiences and lessons learnt.

Data protection for a GP federation

North Staffordshire GP Federation is a membership organisation for all 76 GP practices serving the whole of North Staffordshire. The federation has commissioned the MLCSU Information Governance (IG) Team to provide Data Protection Officer support services.

Stoke-on-Trent City Council and Stoke-on-Trent CCG have commissioned the federation to provide a health care support service to the homeless. The service will be operational from Brighter Futures in Hanley and the support workers (a nurse practitioner and a health care assistant) are employed by the federation. Health information would need to be shared with other organisations (City Council, The Police, Housing, Brighter Futures, and any third sector housing associations) along with sharing with the registered GP of the homeless person. The acute and mental health trusts would also need to be partial to the sharing of this data, particularly in cases of high-volume attenders.

Action

We provided a named Data Protection Officer (DPO) and ensured accountability and key approvals were evidenced throughout.

As information on specific cases would be shared at cross-organisation multi-disciplinary meetings recorded for accuracy, the confidentiality requirements were stipulated in the terms of reference for this group.

Success of the scheme is heavily dependent on effective data sharing mechanisms. To ensure the federation understood roles and responsibilities in relation to the data sharing requirements of the project, our DPO advised that a Data Protection Impact Assessment (DPIA) would be required to clearly identify any risks to the rights and freedoms of the individuals concerned, followed by the production of a Data Sharing Agreement to hold all organisations accountable to the highest standards of use.

Our IG Business Partner for Primary Care then met with federation representatives to discuss all aspects of the process, the mechanism for sharing the data, the legal basis and the way to evidence accountability throughout. The DPO then reviewed the DPIA in line with current legislation and approved it.

Impact

All organisations involved in the scheme signed the Data Sharing Agreement, having ensured they fully understood the requirements in relation to the sharing of special categories of personal data.

The process was handled with high levels of attention to detail, and ensured adherence to the data protection legislation at all times. The process was made so much easier with effective, clear communication from both the MLCSU IG Team and the North Staffordshire GP Federation, who throughout the process, remained committed to the requirements.

Helping patients get the most benefit from their medicines

We worked with NHS Greater Preston and NHS Chorley and South Ribble CCGs to give patients a greater understanding of their medicines. We used resources from the Me and My Medicines campaign developed in Leeds. The campaign includes The Medicines Communication Charter and encourages patients and their carers to ask questions about their medicines to help them get the most benefit.

Action

One GP practice was selected as a pilot site for the Me and My Medicines clinics. Our practice-based medicines optimisation technicians created an EMIS web search to identify patients aged between 65-80 taking three to seven therapies.

Using the campaign resources, they conducted non-clinical medication reviews during 30-minute appointments. Each patient was encouraged to ask questions about their medicines or raise any concerns. They were asked to bring their medicines in to the appointment.

The technicians provided an overview of the clinics at a medicines coordinator GP practices training session.

After successfully running and reviewing two pilot clinics, a further nine GP practices were selected.

Impact

In the first seven months 257 patients with a wide range of comorbidities were seen in the Me and My Medicines clinics. The technicians gave inhaler counselling to 23 and realigned 52 medicine quantities.

There were four high level quality interventions (for example, stopping duplication of medication), 146 medium level (for example, correcting variation to licensed doses) and 532 low level (for example, appliance maintenance and reminder of blood pressure check).

Patient feedback during and at the end of consultations, and in follow-up conversations, was positive. Patients’ relatives and GP practice staff also gave positive feedback.

We are continuing to roll this programme out to other practices.

Evaluating the NHSE continuing healthcare digital specification project

Continuing Healthcare (CHC) is a complex, important and high cost element of clinical commissioning groups’ responsibility for the NHS with over 159,000 individuals receiving funding during 2017/18 and a total spend of £3.1bn on standard and fast track care packages. Having identified the considerable benefits that could be achieved nationally in the widescale digitisation of CHC services, NHS England (NHSE) and NHS Improvement (NHSI) decided to evaluate the NHS Continuing Healthcare (CHC) Strategic Improvement Programme (SIP) specification for the provision of a digital CHC service. Our Digital Innovation Unit undertook the evaluation with operational input from our CHC service.

Action

Our Digital Innovation Unit led a gap analysis from a technical perspective, focusing on:

* cyber security standards
* interoperability standards and application programme interface standards.

Our CHC experts led a gap analysis from a CHC operational perspective, including a review of the specification against the current national standards.

The ability and willingness of the market to react was assessed via interviews with several solution providers who had been involved with the SIP during development of the CHC Digital Specification.

We developed a maturity matrix to assist CCGs and service delivery partners in understanding where their own CHC services aligned to an ‘end-to-end’ digital service and where there were gaps. We also produced an example CHC digital roadmap showing the steps a digitally immature CHC service would need to take.

Impact

The NHSE CHC SIP aim is ‘to provide fair access to NHS CHC in a way which ensures better outcomes, better experience and better use of resources.’ This project contributes to that aim across all the programme goals, with the CHC Digital Specification being one of the key enablers.

An early outcome of this project has been the inclusion by NHSE of the CHC Digital Commissioning Specification and CHC Digital Consultancy Services within the October 2019 Health Support Services Framework (HSSF). This is a vital enabling step supporting the move towards a digital CHC market.

Supporting care navigation with data expertise

Care navigation uses signposting and information to help primary care patients move through the health and social care system as smoothly as possible to ensure that needs are met.

The introduction of care navigation is seen as a key action in the GP Forward View to release capacity in practices. Frontline staff can direct patients to the wider health and wellbeing team or to external services, as appropriate, at the time an appointment is requested.

Our data quality specialists working with North Staffordshire and Stoke-on-Trent Clinical Commissioning Groups have been supported by West Wakefield Health & Wellbeing (a GP federation and wave one GP Access Fund site) in developing the CCGs’ care navigation approach.

Action

Our data quality specialists were involved from the outset, advising about coding and templates so data could be provided around time saved in GP appointments.
We advised on read codes and created clinical system templates. These were tailored to individual practices to incorporate their in-house services along with Pharmacy First, walk-in centres, dentists, opticians and the Voluntary and Community Services’ VAST Hub (social prescribing). Wellbeing services have since been included in the templates.

We embedded a link to MiDOS (a local directory of services) in the templates so reception staff could access information quickly and easily. We also embedded inclusion criteria documents for each of the services.

Using a dashboard, we monitor and analyse the practices’ data to produce a monthly report for the CCGs and a quarterly one for the practices.

We installed the bespoke clinical templates onto participating practices’ clinical systems prior to go-live of the service and trained practice staff in completing them.

Impact

Care Navigation is live in 20 North Staffordshire practices and 25 Stoke practices.

* September 2017 – March 2018: 17569 signposts saving 2721 hours of GP time
* April 2018 – November 2018: 18786 signposts saving 2732 hours of GP time

The single most accepted service is to nurse practitioners. The most used external signposting is to Pharmacy First, closely followed by walk-in centres, however Pharmacy First has a higher rate of patient rejections.

Our work with West Wakefield has been used as a case study for best practice nationally, which involved filming for NHS England.

Physio First has been a pilot in three Newcastle North practices and the dashboard has been used to monitor its impact with a view to the service being commissioned more widely.

Improving the handling of complaints

Background

Our Complaints and PALS Team has conducted a benchmarking exercise across NHS complaint handling bodies in Lancashire and South Cumbria (LSC). This followed concerns emerging about how complaints were being handled across LSC by both commissioners and providers.

Action

We created a benchmarking questionnaire that was sent via NHS England and NHS Improvement to all LSC clinical commissioning groups and NHS trusts (10 complaints handling bodies in total). Analysing their responses highlighted wide variation in performance against targets. We also found potential examples of best practice worth further investigation to identify learning that could be shared.

We drew up a list of recommendations to ensure effective use of the data gathered.

Impact

Our recommendations set out scope for further exploration where this exercise highlighted disparities or good practice.
The benchmarking returns showed commissioners how their providers handle complaints and what additional information could be gathered to drive improvement and inform future commissioning.

It also led to a discussion about options for how complaints could be handled across the emerging integrated care system and primary care networks as care pathways become better coordinated around the needs of the patient. A task and finish group of heads of complaints/patient experience was set up to make proposals for service change and improvement across the LSC Integrated Care System, reporting back to the Directors of Nursing Group in early 2020.

We plan to replicate this work in other areas.

Successfully navigating a commissioner through a large contract dispute

Background

The Staffordshire Clinical Commissioning Groups’ East Staffordshire Division needed support in navigating through a multi-issue dispute concerning the Improving Lives contract with a supplier external to the NHS. This required extremely detailed technical understanding of the NHS Standard Contract and its interpretation.

Action

Our Improving Lives Contract Management Team worked with CCG partners in navigating through the three-year dispute, while continuing business as usual with the provider.

Impact

The successful outcome of the dispute, which was completely in the favour of the CCG, has insulated the healthcare system from approximately £35million worth of multi-faceted and challenging contract claims.

In supporting the CCG, our team led, influenced and managed the responses throughout the dispute process, ensuring that the CCG remained protected from further claims and ensuring adherence to the innovative contract that was agreed.

The Improving Lives project is an innovative contract which, although challenging, has enabled us to lead the way in advising the CCGs on the forthcoming changes to the commissioning environment as the system moves into a more integrated care model of service.

Improving equality and diversity reporting in Leicestershire

The three Leicestershire CCGs (Leicester City CCG, East Leicestershire and Rutland CCG and West Leicestershire CCG) wanted to significantly improve the quality of equality and diversity reporting by provider organisations.

Action

Our Equality and Inclusion team held a workshop to provide contract managers from the CCGs and providers with clarification on the CCGs’ expectations of equality and diversity reporting. The 22 attendees were drawn from provider organisations, the three CCGs and the MLCSU contracts team.

Topics covered in the workshop were:

* Section 13 of the NHS Standard Contract
* Accessible information Standard
* Workforce Race Equality Standard
* Workforce Disability Equality Standard.

Impact

James Hickman, Children’s Planning and Commissioning Manager with Leicester City CCG, who requested the workshop:

“I just wanted to say thank you for the brilliant Equality Workshop you facilitated last week. Equality and Diversity has been a real sticking point in reporting across all of our contracts in the past year, with providers (and me) being unsure of what/how/why they have to monitor and report to be compliant with the NHS standard contract.

“Everyone said that they found it really useful; the content was spot on and the Dragons Den group activities helped to put it all into context. Personally, I think it’s something that could be a mandatory CCG-wide training day as it highlighted how services (and CCGs!) are going to have to change their attitude towards Equality and Diversity monitoring/reporting to keep up with new national requirements.”

Delivering a wave of rapid improvement challenges

In response to the continued operational pressures in elective care and following the success of the national 100-day challenges, NHS England commissioned MLCSU’s Improvement Unit to deliver a wave of specialty-based rapid improvement challenges across the North Region.

Action

The Improvement Unit supported eight healthcare sites/systems to utilise the 100-Day Challenge methodology to drive rapid improvement in specific elective care specialities. We did this by:

* Providing hands-on coaching and facilitation support to each site during the development and delivery phases, bringing leaders and frontline staff together to test ideas
* Facilitating a series of local and regional collaborative events to guide sites through tools to help them identify, develop, test and monitor improvements
* Providing dedicated ongoing coaching support to local site leads to ensure the progress and success of the activities
* Supporting the development and delivery of local sustainability plans for each initiative to ensure improvements
* Programme evaluation, including training and support for the development of case studies and social media materials for local sites, impact analysis and production of a final report.

The Improvement Unit offered additional project management support, coaching and facilitation where it was required and adopted a collaborative approach to all events; using practical workshops to support localities to achieve their goals.

Impact

* One system looking at the spinal MSK pathway saw Physio First referrals increase threefold in pilot practices, leading to fewer referrals to secondary care
* Paediatric Ophthalmology Did Not Attend rates reduced by 4 per cent with follow-up DNA rate down by 9.1 per cent in one month with one pilot trust
* The same trust also successfully trialled a Virtual Glaucoma Clinic with 41 per cent of suspected glaucoma patients discharged back into the community
* A trust working on ‘cold’ site utilisation reported no patient cancellations, improved patient experience, improved referral to treatment (RTT) performance and cost avoidance of £226,800 as a result of transferring more elective care activity to the cold site
* Another trust saved 15.66 bed days in one month as a result of a successful move for urology patients undergoing trial without catheter in an outpatient setting, another 25 patients (in one week) had their pre-op via telephone on the same day as being listed for surgery, reducing gaps in theatre lists and improving patient experience.