Innovation in Healthcare by Justin Ives

Bringing new healthcare products and interventions to life

Community Health Partnerships

Good4Health

NHS South CSU

NHS Central Southern

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Innovation in Healthcare

SERVICES TO LOCAL AUTHORITIES, AREA TEAMS AND NHS ENGLAND

SUPPORT TO 700 GP PRACTICES

Innovation TO MORE THAN 23 CCG CUSTOMERS

TO THE FIVE MILLION PEOPLE WE SERVE

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Innovation in healthcare

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Innovation in Healthcare is published by:

NHS Alliance Summit: Breaking Boundaries, Dissolving Divides: From Vision to Action

CLINICAL COMMISSIONING COMMUNICATIONS Suite 19, Hurlingham Studios, Ranelagh Gardens, London SW6 3PA T: +44 (0) 20 7386 6100 F: +44 (0) 20 7381 8890 E: inbox@mar-media.com

Taking the Forward View to a Forward Plan www.cscsu.nhs.uk

Getting the right commissioning support

Associate Publisher

JULIEN WILDMAN

Alison (left) began her NHS career as a practice/fundholding manager. Since then she’s worked with primary care clinicians during periods of change, lectured on the ‘Red Book’ primary care contract, supported the implementation of the nGMS contract nationally, managed the development of practice based commissioning at a PCT level and supported a CCG with the transition period through to authorisation.

If you’re a healthcare commissioner in England then you understand, more than anyone, the significant and enduring financial pressures facing the healthcare service. People’s need for health services continue to grow faster than funding, meaning that commissioners must ensure that patient focussed services are innovative and transformational while remaining within the financial resources available.

E: julien.wildman@mar-media.com M: +44 (0) 7801 478425 Designer

Most likely you’ll be working with a commissioning support unit to help you make the right decisions to manage and improve health care in your area. At Central Southern we’re used to working with demanding and ambitious clinical commissioning groups who – like you – need individual support, professional insight and practical clinical expertise to achieve the best outcomes and value for money for patients.

JUSTIN IVES

We’re working alongside a growing number of customers to solve their most challenging strategic problems with a successful blend of capabilities to deliver perceptive and practical solutions.

organisation, and adapt working practices to ensure they remain responsive, financially sustainable and fit for purpose in the new healthcare economy.

CCGs know that a responsive and sustainable primary care system is essential if system-wide change is to be effective. Achieving this will require significant GP involvement. This needs to happen at the same time as maintaining the fundamental principle of GP leadership and engagement in commissioning decisions. Getting the balance right is key and this is where Central Southern can help support general practices in both their provider and commissioning roles. What developments in Primary Care are getting CCGs excited? The top three I’d say are firstly the opportunities that co-commissioning presents, and we’ve begun working with CCGs already in this area. We’ve hosted evening events for CCG leaders to share their thinking and discuss concerns. We’ve helped to develop collaborative approaches to the implementation of their expression of

As the potential opportunities and challenges associated with cocommissioning are being developed, we’re working with CCGs to ensure that they are ready to take advantage of the opportunities that primary care co-commissioning presents.

Secondly Outcome Based Commissioning (OBC). We’ve been excited about the genuine change and improvements OBC can offer patients for some time. At our OBC seminar in September it was clear that CCGs are also keen to get to grips with this way of commissioning and performance managing.

Thirdly helping patients and the public to understand and be a part of local changes. Transforming community services needs patient input, ideas and feedback. Without this the health system risks missing one of the absolute cornerstones of ‘Everyone Counts’.

‘We put patients at the heart of everything we do’ – these are words often spoken by NHS organisations, but what support is available to help make them a reality?

Innovations in Healthcare_October 2014EM_v0.6_01102014.indd 2-3

01/10/2014 15:18

The Role of Engagement in Service Re-design and Transformation

Yorkshire and Humber spotlights primary care

The opinions expressed in this publication are not necessarily those of the publisher. The publisher has tried to ensure all information is accurate, but emphasises it cannot take responsibility for any mistakes or omissions. The publisher does not accept responsibility for the advertising content in this publication.

Good

HEALTH

JIM WARD Good4HEALTH

...Rather than looking for quality data collection & reporting

This publication is printed on PEFC certified paper. PEFC Council is an independent, non-profit, non-governmental organisation which promotes sustainable forest management through independent third party forest certification.

The temptation for many providers, is to simply fulfill the absolute minimum required. To pay lip-service to the requirements, since no extra money is being provided. This means they will collect minimal feedback and that could easily show a misbalance towards negativity. This minimal approach also misses the very real benefits that can come from quality feedback and analysis of the comments made by patients. Feedback individualised to a clinician, that is a goldmine for service improvement, training and accreditation.

One of the country’s largest Commissioning Support Units is putting innovation in primary care at the heart of its offering to customers.

With Primary and Community Care coming online for the Friends & Family Test, the temptation is to tick the boxes…. So, what will providers do?

Mark W Smith, Transformation Programme Director for South and West Commissioning Support Alliance talks about new opportunities for engagement.

No part of this publication may be reproduced in any form or by any means including photocopying or recording, without the permission of the publisher. Written permission must be obtained before any part of this publication is stored in a retrieval system.

Unlike previous guidance, response rates have not been specified. The emphasis is on offering every patient an opportunity to provide feedback, as well as asking enough patients to ensure a balanced view of the service. Some feedback methods are hit on the head, such as Token Systems, as being too focused on Quantitative Feedback and potentially demeaning the NHS.

interest proposals, and worked with individual CCGs on their submissions.

Patient Voice South – helping you to put patients first Are there particular issues people are coming to you with? From a practice perspective the increases in patient demand, patients’ expectations and the increasing complexity of health needs mean that customers are having to evaluate their workloads and reconsider their working practices. This is vital in meeting the increasing and changing needs of their patients. Their challenge is to understand the changing demands on primary care from the patient’s perspective. To cope with this they need to identify and agree a strategic direction as a provider

E: justindesign@live.co.uk

In July, NHS England issued new guidelines for the FFT, that impacts on existing providers, as well as new areas coming on board from December to March and beyond.

If you’re a healthcare commissioner in England then you understand, more than anyone, the significant and enduring financial pressures facing the healthcare service.

Getting the right commissioning support

W H ROBINSON

Rick Stern, Chief Executive, NHS Alliance

We are Central Southern.

Publisher

Dr Michael Dixon, Chair, NHS Alliance

systemised service focusing on SMS as a feedback methodology. This is now expanding into a 3-level provision under the banner of GEM-VOICE. This allows practices to offer an easy way to provide the FFT from a few hundred pounds... Ultimately, the FFT is about giving patients a voice. That voice will indicate potential areas of service improvement, if the provider is able to easily categorise qualitative comments into meaningful areas. Information is available in real-time on the Synapta portal, with specific Analytics, Reporting and at the Professional level, Thematic Analysis of the comments.

With Primary and Community Care coming online for the Friends & Family Test, the temptation is to tick the boxes….

...Rather than looking for quality data collection & reporting

Elephant in the room…patient engagement and the

COVER PRICE: £5.95 Friends Family Test Integration of services through&the The new guidance serves to re-emphasises some key points...

Anonymity Validation Sharing of Feedback with patients Concentration on Service Improvement Effective Feedback Filtering Results by Key Demographics Issue After or Within 48-Hours of Treatment/Discharge Suitable Language for Special Needs and Children

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What’s the better option?

In a Pathfinder project over the past 6 months across the East Midlands, in partnership with Greater East Midlands CSU (GEM-CSU), we provided a

smart use of estates “My practice has been using FFT for only a few weeks but already we are gaining a good insight into our patients views on our service. The implementation of the service has been painless with no issues so far and only positive comments from patients who now have an easy way of providing feedback.”

www.FFTHealth.com

For page turning technology visit: innovationinhealthcare.org

Integration of services through the smart use of estates

Dr Sarah Raper, Executive Director of Community Health Partnerships (CHP), explains how the organisation is working closely with local partners to further the integration agenda through the strategic use of the health estate. The NHS has witnessed the biggest reorganisation for decades and, along with other public sector organisations, health commissioners, managers and clinicians alike are facing a future of growing demands, which must be met from static or reducing budgets. Dr Raper said: “The estate or infrastructure is being increasingly viewed as a strategic commodity, which, like other technology assets and human capital, can be managed to achieve better access for patients and better efficiencies for commissioners and providers. There is also a wide recognition that there needs to be a more fundamental redesign of services and that the estate, buildings and infrastructure all play a key role in making this redesign a reality. “The purpose of CHP is to provide a high quality and valued service to commissioners and local partners across England with the aim of increasing service integration through the smart use of estates, which will ultimately drive much needed savings.”

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Access and continuity go hand in hand but 12-7? 36

Integration of services through the correct use of the estate

CHP’s principal focus is to deliver on an ambitious target of generating £100m of system savings for the NHS by 2018. CHP believes that these savings are achievable through a structured and targeted programme to support the strategic planning of the estate, which will deliver:

At last primary care is getting the sort of attention from government that it has always craved.

• increased efficiencies, through the better use of high-quality primary and community care estate that is in place across England • better service integration, delivering improvements in service efficiency and better health outcomes for patients • new service models, replacing outmoded and inadequate premises, and releasing capital through a structured programme of disposals Dr Raper said: “We know that in many areas the existing community and primary healthcare estate is of variable quality and is not used as effectively or efficiently as it could or should be. In many cases, it is configured to an historic model of service delivery, not a future one.

Recent research conducted by CHP has also found that the most commonly mentioned market drivers expected to impact the direction of NHS services are: • the integration of health and social care through a range of different services • the need to drive financial efficiencies throughout the entire health economy • more aggregated primary care, including larger GP units / clusters offering ‘total health management’ at scale • a clear need for local responsibility, clarity and leadership over the effective and efficient use of the community estate

INNOVATION IN HEALTHCARE

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THINK BIG, ACT NOW:

Creating a Community of Care

NHS Alliance Summit: Breaking Boundaries, Dissolving Divides: From Vision to Action Dr Michael Dixon,, Chair, NHS Alliance

Immediate action is needed to achieve the paradigm shift in the NHS, and especially in primary care, required to support a growing and ageing population living with long-term conditions. We must start implementing solutions to the challenges, rather than continuously analysing them. Procrastination is no longer an option. GPs, practice and community nurses, practice managers, community pharmacists, and community eye and hearing specialists in England are under unprecedented pressure to care for a population imposing soaring demand1 on a health service that is financially constrained and struggling to retain a demoralised workforce. This perfect storm of pressures facing primary care makes it likely that change will come, whether or not it is wanted. We want to see change by design rather than default: change led by those working within the service who best understand the issues they, and the communities around them, face. Despite the severe strain on the system, we believe there is light ahead for the primary care sector. Our report, Think Big, Act Now, presented a new approach, what we called A Community of Care. This articulated the findings of six months of research and consultation undertaken by NHS Alliance in collaboration with its strategic and professional partners across the breadth of provision within primary care and offers a patientfocused, inclusive approach.

We believe the solution to creating a stronger, re-energised primary care workforce lies within the workforce itself and within the communities they serve; where general practice sits at the centre of a cohesive primary care team of multi- disciplinary health professionals and community leaders, and works closely with colleagues in the acute sector. We want to see an end to tribalism and the start of a true collaboration that has the potential to make an immediate difference on a system that is considered by many to be near breaking point. However, achieving this community of care will rely on a fundamental shift in thinking by all who interact with the health service, one that moves from regarding the delivery of health care as transactional and process driven to one that relies on relationships. Our vision in that paper and now at our Breaking Boundaries and Beyond Action Summit mark a defining moment for general practice and primary care, a moment where we take collective responsibility for the health and wellbeing of our NHS, whether we are policy maker, care provider or care receiver. A moment where we commit to delivering and using the service thoughtfully and respectfully. A moment where we recognise that unless we are prepared to change both our thinking and our actions, we may pay the ultimate price and lose a national health service that has provided us with free care at the point of need for more than 65 years.

INNOVATION IN HEALTHCARE

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THINK BIG, ACT NOW:

Creating a Community of Care

Taking the Forward View to a Forward Plan Rick Stern,, Chief Executive, NHS Alliance

The NHS Alliance sees a bright future for primary care, one that makes the most of the traditional values of locally-based healthcare provision. One that delivers continuity of care and builds on the assets held in the communities in which people live and work. Our Breaking Boundaries manifesto called for all of us – patients, professionals, managers and policy makers – to break the boundaries that too often disable people from caring for themselves and prevent clinicians from delivering high quality, cost effective, integrated care with a new focus on health and wellbeing and prevention. We believe that such a shift will be necessary to deliver a sustainable NHS. It is built on practical ideas and solutions from within the NHS Alliance, as well as from a wide range of partners, and aims to offer a clear, positive and compelling vision for the future – not just of primary care but the NHS as a whole. We would like every patient to have the chance to create a personal health and wellbeing plan that can be used as a gateway to wider community services – not just in health and social care but also in housing, crime

prevention, personal safety and wellbeing. This will require those working in primary care to reach out beyond the boundaries of their own front doors to create new partnerships and working relationships across their communities. We would like to see secondary care liberated from the boundaries of the hospital. We want to see the boundaries between in hours care and out-ofhours care removed to provide patients with the allimportant continuity of care they require. Doing nothing and harking back to a golden age is not an option, barriers need to be broken and the system needs to change. We do not need new structures and new barriers but new relationships. Unless we tackle these long–standing boundaries the NHS will struggle to realise the benefits of patients and their wider communities working as equal partners with primary care clinicians and hospital specialists. Our manifesto was a starting point and our Action Summit is a springboard for what we hope will be a stimulating and challenging debate and will inform our future campaigns.

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We are Central Southern.

Getting the right commissioning support If you’re a healthcare commissioner in England then you understand, more than anyone, the significant and enduring financial pressures facing the healthcare service. People’s need for health services continue to grow faster than funding, meaning that commissioners must ensure that patient focussed services are innovative and transformational while remaining within the financial resources available. Most likely you’ll be working with a commissioning support unit to help you make the right decisions to manage and improve health care in your area. At Central Southern we’re used to working with demanding and ambitious clinical commissioning groups who – like you – need individual support, professional insight and practical clinical expertise to achieve the best outcomes and value for money for patients. We’re working alongside a growing number of customers to solve their most challenging strategic problems with a successful blend of capabilities to deliver perceptive and practical solutions.

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www.cscsu.nhs.uk

Championing transformation in Primary Care Frontline general practice is under extreme pressure. It’s a frustrating paradox: growing demand for increased quality of care and patient access at the same time that GP funding as a share of NHS expenditure is falling. So what needs to happen? Alison Westmacott – Associate Director for Commissioning Support (Primary Care) – explains the approach Central Southern is taking and how we’re helping CCGs turn stresses into successes. Alison (left) began her NHS career as a practice/fundholding manager. Since then she’s worked with primary care clinicians during periods of change, lectured on the ‘Red Book’ primary care contract, supported the implementation of the nGMS contract nationally, managed the development of practice based commissioning at a PCT level and supported a CCG with the transition period through to authorisation.

What’s the most common reason CCGs are approaching you for help? Well that changes from customer to customer. Although it’s interesting that whilst the presenting symptoms might differ – from supporting the integration of health and care services, addressing quality variations, or developing new models of primary care provision – the underlying prescription is the same: Central Southern helps CCGs and practices succeed in a changing primary care environment facing financial challenges. Are there particular issues people are coming to you with? From a practice perspective the increases in patient demand, patients’ expectations and the increasing complexity of health needs mean that customers are having to evaluate their workloads and reconsider their working practices. This is vital in meeting the increasing and changing needs of their patients. Their challenge is to understand the changing demands on primary care from the patient’s perspective. To cope with this they need to identify and agree a strategic direction as a provider

Innovation 9 Book 1.indb 5

organisation, and adapt working practices to ensure they remain responsive, financially sustainable and fit for purpose in the new healthcare economy. CCGs know that a responsive and sustainable primary care system is essential if system-wide change is to be effective. Achieving this will require significant GP involvement. This needs to happen at the same time as maintaining the fundamental principle of GP leadership and engagement in commissioning decisions. Getting the balance right is key and this is where Central Southern can help support general practices in both their provider and commissioning roles. What developments in Primary Care are getting CCGs excited? The top three I’d say are firstly the opportunities that co-commissioning presents, and we’ve begun working with CCGs already in this area. We’ve hosted evening events for CCG leaders to share their thinking and discuss concerns. We’ve helped to develop collaborative approaches to the implementation of their expression of

interest proposals, and worked with individual CCGs on their submissions. As the potential opportunities and challenges associated with cocommissioning are being developed, we’re working with CCGs to ensure that they are ready to take advantage of the opportunities that primary care co-commissioning presents. Secondly Outcome Based Commissioning (OBC). We’ve been excited about the genuine change and improvements OBC can offer patients for some time. At our OBC seminar in September it was clear that CCGs are also keen to get to grips with this way of commissioning and performance managing. Thirdly helping patients and the public to understand and be a part of local changes. Transforming community services needs patient input, ideas and feedback. Without this the health system risks missing one of the absolute cornerstones of ‘Everyone Counts’.

01/10/2014 09:46 15:18 24/11/2014

We are Central Southern.

Expressing an interest in co-commissioning Providing thought leadership, working through the implications and identifying the benefits and impacts of co-commissioning was a crucial project in which Central Southern supported key CCG customers, right through to the successful production of informed expressions of interest for submission to the Area Team. “Thank you everyone for the co-commissioning support these past weeks. I think it demonstrates how we work well together – with grateful thanks for providing the central coordination and being there with the advice just when we needed it.” »

Peter Crouch, Clinical Chair at NHS Swindon CCG

Left: ‘Primary Care Strategy Development and Delivery’ diagram

At the moment we’re working with Gloucestershire CCG to pilot their brand new ‘Choice+’ urgent care scheme. Amongst other things Choice+ will deliver a new way for patients to access urgent GP services and also create longer non-urgent appointments at their surgery for patients with more complex health issues. The intention is to release an additional 30 minutes of appointment time per week per 1,000 patients (2½ hours per week for the average practice). The additional benefits anticipated are

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reduced A&E activity and a reduction in avoidable emergency admissions. We are currently putting this new way of working through its paces in a range of GP practices with the hope to extend across the whole CCG. Where do you begin helping a CCG to develop its primary care strategy? Always with the development of a vision of the ambition they have for primary care in their area. With that we can go anywhere together. We’ve got a strong team of primary care

and change management experts who work closely with our customers to develop and then implement a compelling local approach and we start by using our step-by-step strategy and development model (left) to ensure a rigorous approach. Our customers come to us to provide flexible consultancy support with an adaptable team to provide the skills, knowledge and expertise to successfully deliver the outcomes they need. What our customers like about this way of working is that they’re not ‘done unto’ and left to implement grand changes unsupported. We’re there for them to embed the change and to help them to implement it every step of the way. Want to find out more? Contact Alison to discuss how Central Southern can support your primary care transformation ambition alison.westmacott@nhs.net

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www.cscsu.nhs.uk

Making Integrated Care Records a reality So many of the problems seen in the health service are related to failures in communication, our customers have found. Information exists in hospitals and out in primary care, but there hasn’t been the ability to join it up. Health commissioners in Oxfordshire identified frustrations with the obstacles to sharing patient data across health teams in the county. Worryingly this failure not only lowers the quality and efficiency of care but can also threaten patient safety. Recognising the considerable benefits to be gained from data sharing and its ability to transform patient care and experience, Central Southern supported the development of the Oxfordshire Care Summary (OCS) to implement Integrated Care Records, data sharing and interoperability. Addressing the concerns of their clinicians, real-time data could be shared across diverse care providers, utilising the innovative technology contained within the clinical decision support tool.

So has it worked? The best way to find out is to ask those using the service. Here’s what we found:

Oxfordshire Care Summary: User evaluation survey » » »

» » »

96% of users agreed that OCS improved patient safety 94% of users agreed that it improved the quality of patient care 81% of doctors reported better clinical outcomes as a result of using OCS 50% of users reported that OCS helped prevent an adverse incident 86% of users reported improved data quality as a result of OCS 80% reduction in time spent on administrative tasks.

“The Oxfordshire Care Summary is what we’ve been wanting and asking for in all areas of clinical practice, in Oxfordshire as elsewhere. It currently allows both hospital and primary care clinicians to access a much more complete picture of their patient’s current state of health, with the patient there and consenting to have their information shared when it is needed on the front line. Patients are often surprised that it wasn’t available before, and their feedback has been overwhelmingly positive they expect us to know everything that is relevant to their care when they need us to know, and OCS is a huge step forward.” » Paul Park, Chief Clinical Information Ofﬁcer at Oxfordshire Clinical Commissioning Group

To find out how Central Southern could help you to integrate your care records, contact Andrew Fenton, Associate Director of Commissioning Support at Central Southern at andrew.fenton@nhs.net or call 07826 533111.

Why choose Central Southern? Data, insight and intelligence Clinical focus and expertise Individual account management Ability to access all aspects of a solution Flexibility of services available Strong public sector consultancy base Responsive integrated team members Efficient high quality services at a cost you can afford Continual improvement

“We were very impressed with the way Central Southern responded to our request and the speed of mobilisation in getting people on the ground to start managing the project in a very short space of time. The depth of understanding of primary care that they have shown in developing solutions with and for us has been outstanding. We were particularly impressed at how Central Southern was able to work in a matrix way to call in relevant people as they were needed to ensure the project’s timely progress.” » Andrew Hughes, Locality Implementation Manager at Gloucestershire Clinical Commissioning Group

Central Southern - Supporting your aspirations for excellence in commissioning; working with you to deliver and continuously improve your services. For more information about the support and services available from Central Southern, contact Paul Tayler, Associate Director Business Development and Marketing at cscsu.businessdevelopment@nhs.net

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01/10/2014 09:46 15:18 24/11/2014

Patient Voice South – helping you to put patients first ‘We put patients at the heart of everything we do’ – these are words often spoken by NHS organisations, but what support is available to help make them a reality?

Patient Voice South (PVS) is part of a national programme of changes putting patients at the forefront of all decisions about their care. This wider programme includes the involvement of the public, voluntary organisations and key partners such as HealthWatch in the design and implementation of local health services. Our aim at PVS is to create a support network for those who wish to improve their patient and public participation practices and go beyond good intentions to make tangible improvements to the design and delivery of healthcare. We also run Patients in Control, a programme that awards NHS funding to innovative projects that put patients at the heart of healthcare decision-making. Commissioned by NHS England and launched in April, PVS is run by a team from two commissioning support units – South West (based in Somerset) and South (based in Hampshire) which form the South and West Commissioning Support Alliance (SaWCS). Each of the selected CSUs demonstrated that they met NHS England’s stringent standards for quality. They also agreed to share the learning, approaches and tools developed through the PVS programme with the wider health community.

Nik Attryde is PVS programme director, supported by Deborah Upham, PVS strategic lead; Joy Holt, programme manager; and Jan Fletcher, programme support. The field force consists of Steve Nolan, covering the Thames Valley (via Central Southern CSU), Wessex, Surrey and Sussex and Kent (Kent via South East CSU), and Martin Howard, who covers the CCG areas of Gloucestershire, Swindon, Bath and North East Somerset, Bristol, Kernow, North, East and West Devon, Somerset, South Devon and Torbay, Wiltshire and North Somerset. Between them, they have a sizeable bank of experience that they are keen to share across the region. The PVS approach is based around three core principles, to: •

Collaborate: making links across the region

•

Communicate: sharing advice, guidance and expertise

•

Change: making a difference to patients.

The programme team is also working closely with RAISE, the South West Forum, and members for the Regional Voices Network, to deliver this work.

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What’s in it for me? The website, www.patientvoicesouth.swcsu.nhs.uk, is our ‘shop window’ and primary means of bringing engagement professionals together to share best practice and connect with others. Re-launched with enhanced features in October, it’s now a one-stop-shop for relevant, up-to-date resources on patient and public participation, and an easy way to connect with colleagues. To gain full benefit from PVS, we encourage people to join our online Patient Voice and Experience Network. It’s free and simple to register, and open to engagement leads in the NHS, voluntary organisations, health professionals, commissioners, and patient, carer and public contributors with an interest in getting the best out of their local healthcare in the south of England. As a network member, you can develop a profile, join our discussion forum and, thanks to our secure ‘Find a buddy’ system, find other network members or be found yourself. This provides another means of engaging with like-minded colleagues who are willing to share their experiences with you towards a common goal – improving patient experience. Our field force team is also available to help people make connections and access learning opportunities.

Our forum allows people to connect with one another online in a secure environment, enabling ideas and queries to be discussed. Staff have a huge wealth of knowledge about all aspects of healthcare, and the PVS network enables people to tap into this rich seam of information. Pitch in with a question related to patient and public participation and someone is sure to help you out with a response – or be that key to unlocking knowledge by using your experience to help others with their dilemmas. We have a knowledge bank open to everyone, where you can browse helpful policy and guidance, case studies and useful links, all relating to healthcare participation initiatives and approaches. Or submit your own case-study to help others. We also provide online learning opportunities to broaden your skills or share your knowledge with others. A key component are our popular webinars (web seminars), which you can take part in from anywhere there’s an internet connection. All you need to get started is a telephone, laptop or computer, so you can learn from others without the associated expense and hassle of travel. Step-by-step instructions are sent to you in plenty of time before the event.

Webinars coming up in December and January are: • 11 December – Putting children and young people at the heart of commissioning Targeted at commissioners in CCGs or local authorities, those who work in children’s services, or Healthwatch • 13 January – Developing patient participation groups – the Somerset story Targeted at Patient Participation Group members, those who work in primary care, CCG or secondary care participation and engagement leads, commissioners of adult social care • Coming soon – equality and diversity, and the link with participation in commissioning To book, just go to the Events section at www.patientvoicesouth.swcsu.nhs.uk. As you can see, PVS is a dynamic and developing programme that depends on a high level of stakeholder involvement to ensure it operates at its full potential. Join in, and enjoy the mutual benefits.

To connect with and learn from other engagement professionals across the south of England, go to www.patientvoicesouth.swcsu.nhs.uk and join our network. You can contact us via email: patientvoicesouth@swcsu.nhs.uk or follow us on Twitter: @PatientVoiceSth

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The Role of Engagement in Service Re-design and Transformation Mark W Smith, Transformation Programme Director for South and West Commissioning Support Alliance talks about new opportunities for engagement.

The government’s Mandate for NHS England requires it to ‘ensure the NHS becomes dramatically better at involving patients and their carers, and empowers them to manage and make decisions about their own care and treatment’. Since its launch there has been renewed emphasis on engagement to enable patient-centred services, which is central to SaWCS’s transformation service. Commissioners have been encouraged, through the Patient and Public Voice Commissioning Support Programme, to move toward a personal health budget and care plan by April 2015. ‘Patients in control’ was launched, including practical tools to support local communities to deliver shared decision making, personalised care planning and better self-management of their health. These are exciting times for stakeholder engagement as the policy emphasis combines with new models and approaches. We firmly believe that engagement processes have the potential to contribute beyond the traditional ‘listen, record, report’ models and can be a significant component in themselves of delivering sustainable change. We have found three models helpful in thinking about our engagement around major transformations in terms of how to engender an engagement culture, whole system approaches and the limitations of diagnostic, linear approaches to change management. The Engagement Cycle helps organisations work with patients, carers and the public to transform and improve services so that patients receive integrated services, high quality care and a better experience.

INNOVATION IN HEALTHCARE

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THE ENGAGEMENT CYCLE •

Sets out what is required when engaging patients, carers and the public at each stage of the commissioning process

•

Provides the basis for developing sustainable systems and processes in order to turn engagement into everyday practice enabling an engagement culture

•

Outlines who needs to do what at each stage of the commissioning cycle, to ensure meaningful engagement for maximum impact.

The Engagement Cycle was developed by David Gilbert of InHealth Associates. www.engagementcycle.org

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The House of Care

The Dialogic Change Model

Bushe G (2009) Dialogic OD Turning Away from Diagnosis

The House of Care model is powerful because it requires making the patient or service user perspective the organising principle of integrated care. Implementing the model requires health care professionals to abandon traditional ways of thinking and behaving, where they see themselves as the primary decision-makers, and instead shifting to a partnership model in which patients play an active part in determining their own care and support needs. The house metaphor is used to illustrate the wholesystem approach and building the house involves a wide variety of organisations, professional groups and individuals working together in a co-ordinated manner, pooling budgets, sharing data and learning how to get better at delivering holistic, co-ordinated, person-centred care. Many of the challenges faced by the NHS are transformational rather than first order change and there are schools of thought that such challenges require different or ‘breakthrough’ methodologies. First order change, when effective, helps the organisation be better at what it already is and does. Transformational change, changes the very nature of the system to be better at what it aspires to be and do.

The Dialogic Change Model has caused us to think differently about how to achieve change and conclude that for some transformation challenges the objective might not be to deliver change at all but to unlock the system’s ability to change itself putting engagement in a change leading rather than a change supporting role. Instead of (or as well as) change driven by diagnosing how to objectively realign different components of the organisation or system, the dialogic approach encourages us to consider how to induce new ways of thinking by altering the ongoing organisational conversations. It is about bringing new, different and diverse voices into the change conversation. In the context of health and care, this creates the opportunity to include patients, families and community members in ways that we often haven’t engaged them before.

“South and West Commissioning Support Alliance is a strategic partnership between South CSU and South West Commissioning Support” – www.sawcs.co.uk

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YHCS_FPAd_final.qxp_Layout 1 20/10/2014 09:50 Page 1

Yorkshire and Humber Commissioning Support

DELIVERING MORE... TO MORE THAN 23 CCG CUSTOMERS

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TO THE FIVE MILLION PEOPLE WE SERVE

Joined up solutions for joined up healthcare

Innovation 9 Book 1.indb 13

COVERING 6,000 SQUARE MILES

www.yhcs.org.uk

24/11/2014 09:47

www.yhcs.org.uk

Yorkshire and Humber spotlights primary care One of the country’s largest Commissioning Support Units is putting innovation in primary care at the heart of its offering to customers. Formed in October, Yorkshire and Humber Commissioning Support (YHCS), works with more than 23 CCGs, 700 GP practices and 80 other customers, including Local Authorities, Area Teams and NHS England, serving five million people across 6000 square miles. YHCS Managing Director Maddy Ruff is emerging as a prominent voice among CSU leaders in the future of primary care debate. A member of the expert forum advising the Prime Minister’s Challenge Fund, Maddy recently co-authored a case study, “Together as one community: integrating primary, community and social services” presented to The King’s Fund conference Realising the Potential of Primary Care. The CSU has a dedicated team of professionals experienced in primary care and is supported by a network of specialist partners in areas such as estates and pathway redesign. YHCS is committed to maximising the potential of primary care in the new landscape and is also working with thought leaders to develop innovative solutions.

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www.yhcs.org.uk

Stakeholders have recognised the CSU’s contribution to the process of constructing a vibrant future for general practice saying:

“The CSU has an expert team with a deep understanding of the issues currently impacting on general practice and primary care. They have worked successfully alongside the LMC and local CCGs to support the development of general practice and shape its future role in transforming healthcare services for the benefit of local patients. This knowledge and insight makes the CSU extremely well placed to support the development and delivery of co-commissioning across primary care.”

Dr Douglas Moederle-Lumb Chief Executive, YOR LMC Ltd. “The CSU has provided the Heartbeat Alliance with valuable support throughout our journey from a group of 22 individual GP practices to a fully established GP Alliance. This has included the facilitation of initial discussions and the development of our business plan, through to embedded support for the planning and implementation of projects to transform care for our patients through the Prime Minister’s Challenge Fund – including the delivery of 8-8 patient access across our rural geography and the development of integrated GP lead community services. They are also supporting us to access new sources of funding, and deliver a wider range of services from our practices. The CSU has an in depth understanding of the issues currently facing Primary Care, and is passionate about supporting General Practice to play an increasingly pivotal role in the future of healthcare services”

Dr Stephen Brown, Chief Executive, Heartbeat Alliance.

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1867

Joseph Lister publishes Antiseptic Principle of the Practice of Surgery, one of the most important developments in medicine. He was convinced of the need for cleanliness in the operating room, a revolutionary idea then. He develops antiseptic surgical methods, using carbolic acid to clean wounds and surgical instruments. The immediate success of his methods leads to general adoption. In one hospital that adopts his methods, deaths from infection decrease from 60% to just 4%.

1879

First vaccine for cholera

1881

First vaccine for anthrax

1882

First vaccine for rabies

1895

1849

1870s

1890

Louis Pasteur and Robert Koch establish the germ theory of disease. According to germ theory, a speciﬁc disease is caused by a speciﬁc organism. Before this discovery, most doctors believe diseases are caused by spontaneous generation. In fact, doctors would perform autopsies on people who died of infectious diseases and then care for living patients without washing their hands, not realising that they were therefore transmitting the disease.

Emil von Behring discovers antitoxins and uses them to develop tetanus and diphtheria vaccines.

German physicist Wilhelm Conrad Roentgen discovers X rays.

1896

Elizabeth Blackwell is the ﬁrst woman to receive a medical degree (from Geneva Medical College in Geneva, New York).

First vaccine for typhoid fever.

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1897

1906

Ronald Ross, a British officer in the Indian Medical Service, demonstrates that malaria parasites are transmitted via mosquitoes, although French army surgeon Charles Louis Alphonse Laveran identified parasites in the blood of a malaria patient in 1880. The treatment for malaria was identified much earlier (and is still used today). The Qinghao plant (Artemisia annua) was described in a Chinese medical treatise from the 2nd century BC; the active ingredient, known as artemisinin, was isolated by Chinese scientists in 1971 and is still used today. The more commonly known treatment, quinine, was derived from the bark of Cinchona trees and was introduced to the Spanish by indigenous people in South America during the 17th century.

1899

1901

First vaccine for plague.

Sir Frederick Gowland Hopkins suggests the existence of vitamins and concludes they are essential to health. Receives the 1929 Nobel Prize for Physiology or Medicine.

1907

Felix Hoffman develops aspirin (acetyl salicylic acid). The juice from willow tree bark had been used as early as 400 BC to relieve pain. 19th-century scientists knew that it was the salicylic acid in the willow that made it work, but it irritated the lining of the mouth and stomach. Hoffman synthesizes acetyl salicylic acid, creating the world’s most widely used medicine.

Austrian-American Karl Landsteiner describes blood compatibility and rejection (what happens when a person receives a blood transfusion from another human of either compatible or incompatible blood type), developing the ABO system of blood typing. This system classiﬁes the bloods of human beings into A, B, AB, and O groups. He receives the 1930 Nobel Prize for Physiology or Medicine for this discovery.

First successful human blood transfusion using Landsteiner’s ABO blood typing technique

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17 24/11/2014 09:47

Good

HEALTH

JIM WARD Good4HEALTH

With Primary and Community Care coming online for the Friends & Family Test, the temptation is to tick the boxes…. ...Rather than looking for quality data collection & reporting In July, NHS England issued new guidelines for the FFT, that impacts on existing providers, as well as new areas coming on board from December to March and beyond. Unlike previous guidance, response rates have not been specified. The emphasis is on offering every patient an opportunity to provide feedback, as well as asking enough patients to ensure a balanced view of the service. Some feedback methods are hit on the head, such as Token Systems, as being too focused on Quantitative Feedback and potentially demeaning the NHS. The new guidance serves to re-emphasises some key points... Anonymity Validation Sharing of Feedback with patients Concentration on Service Improvement Effective Feedback Filtering Results by Key Demographics Issue After or Within 48-Hours of Treatment/Discharge Suitable Language for Special Needs and Children

So, what will providers do? The temptation for many providers, is to simply fulfill the absolute minimum required. To pay lip-service to the requirements, since no extra money is being provided. This means they will collect minimal feedback and that could easily show a misbalance towards negativity. This minimal approach also misses the very real benefits that can come from quality feedback and analysis of the comments made by patients. Feedback individualised to a clinician, that is a goldmine for service improvement, training and accreditation. What’s the better option?

In a Pathfinder project over the past 6 months across the East Midlands, in partnership with Greater East Midlands CSU (GEM-CSU), we provided a

“My practice has been using FFT for only a few weeks but already we are gaining a good insight into our patients views on our service. The implementation of the service has been painless with no issues so far and only positive comments from patients who now have an easy way of providing feedback.”

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CUSTOMER STORY: GEM VOICE: Economies of scale and personalised solutions in general practice If everyone’s “experience matters”, just how do you capture the voice of the many? That was our challenge when we began our collaboration with Greater East Midlands (GEM) Commissioning Support Unit (CSU) to deliver the Friends and Family Test (FFT) in general practice…

General Practice already has a long history of engaging patients through Practice Patient Groups (PPGs) and local GP surveys. Offering practices an integrated solution, that builds on in-house initiatives, would therefore be important to long term sustainability. As the main simple, safe and automated FFT solution for busy general practice was paramount. Minimising any initial, additional clinical and administrative workload would help focus time and attention on important service quality improvements later. A project team was set up to oversee the management, IT, communication and governance issues. This ensured compliance with NHS guidance on FFT and NHS information standards, as well as information governance and permissions. GEM’s primary interest is in developing an innovative and comprehensive FFT offer for primary care and community care services, whilst delivering savings from economies of scale. An automated SMS solution was chosen, as more than 90% of the population have personal mobile devices and many practices were already using SMS for appointment reminders, test results and repeat prescriptions.

A data extract, with no patientpractice and transferred to GEM then automatically uploaded to an online secure portal. The portal sends the SMS survey and provides real-time reporting and analysis, as well as completing the NHSE UNIFY reports. Access to the portal is password protected, but allows practices to see feedback and take action in real time. A free text follow up question enables the practice to capture ‘the best and worst’ of a patient’s experience. This helps practices understand what really matters to their patients and families, so that service improvements are prioritised. Processing high volume returns is managed through cutting-edge technology that automatically looks at sentiments within the comments and categorises and reports trends against a research-based patient experience code frame. Currently, twenty pioneer practices and an urgent care centre are testing out the SMS solution. Practice leads were and communication packs provided to build understanding and awareness of the FFT requirements and pilot process.

Prior to the launch date, patient mobile numbers were checked and patient permission sought to use their number for the purpose of FFT feedback. The voice of general practice patients is about to be heard loud and clear through a very personal media and communication channel. Gaining new insights for improvement is the real value of the FFT and the beginning of a new relationship between practices and the people they serve. Our experience in acute and clear reasons why using personal mobiles and SMS surveys is the most appropriate method for delivering the FFT in a primary, acute and community setting… A patient-centred and validated approach Use of everyday technologies Integration with existing patient record systems On-line access for monitoring, reporting and improvement action Real-time SMS feedback to mitigate risk Flexibility to ask further questions and to close the 360 degree feedback loop informing patients…‘you said, we did’

www.FFTHealth.com Innovation 9 Book 1.indb 19

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Cloud Apps A less painful approach for a richer experience Cloud Apps are a real benefit to every part of the NHS for feedback. It allows patients to either be sent a link by email or text, or to text-In a keyword to a free-to-text number, bringing back a unique link to a smartphone browser instance that looks like an app – as in the diagrams. Using a cloud based app also means that authoring expensive iPhone or Android apps has been bypassed in a flexible system, capable of modification to suit different age levels and even special needs groups. By working with providers, information from their PAS systems can extract the demographic data, such as age, gender and ethnicity, to allow sophisticated filtering of the results, without asking users these questions. Additional questions can also be asked at no extra cost. If providers are not careful, research has shown that people who take part in a service, do value being asked their opinion. It makes them feel valued and part of a community. Otherwise, it can produce a negative effect, from the feeling that they have been left-out. Children and Special Needs Children have, up till now, been excluded from the formal FFT process. Now we need to look at the voice of children directly, as well as through family and carers. Both voices have relevance to episodes of care or treatment.

Helen Sadler from MonkeyWellbeing.com and Janette Vyse from Birmingham Children’s Hospital, along with Colette Datt at the Whittington Hospital and the UCLP group, have been involved in helping children within the NHS for many years. The MonkeyWellbeing series of books and pamphlets has now expanded into help with paper-based Monkey surveys suitable for children and the FFT. Good4HEALTH, Inspiration NW and The 3rd Degree have now worked with them to bring the “Monkey FFT” to Cloud Apps on mobile phones, tablets and Web. A single SMS to a child (with permission) or their parent, contains a simple link for them to launch a rich, graphical version of the FFT, using the Monkey methodology of monkey faces from very happy to very sad, as an easy way for children of all ages to provide feedback. They are also provided with a means to leave their own thoughts in a free-text comment box. The wording has been specifically designed for age-relevance and it is possible to have different surveys for different age groups. Similarly, cloud apps are a great way to support special needs, with a potential for patients of all ages to be able to easily

understand highly-graphical questions. Foreign language support can also be enhanced with the use of images to convey emotion. These Synapta methodologies not only provide a range of entry points for the delivery of the FFT, but also a range of ways to ask questions and gain feedback – properly opening the opportunity to listen to the voice of the patient.

Cloud Apps have all the advantages of an app that is downloaded from an app store but with less of the disadvantages... No need to install an app No need to maintain apps in the store and update for smart phone operating system updates Less data cost for the patient taking part Less friction to uptake, patient can receive an SMS then use the link to access the survey straight away, plus this gives the option for a validated response from invite No out of date versions of the app out in the field

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CUSTOMER STORY:

MonkeyWellBeing.com Helen Sadler, Monkey’s Mum looks to Synapta’s Cloud Apps

Finding out what children & their families think of healthcare services is the key to providers improving and catering for this huge demographic of service users. The use of mobile phones & tablets is ever growing, even my 3 year old knows how to work mine! Engaging with children encourages them to think about their health and be more informed about decisions surrounding their care. If they are educated at an early age to be involved it will help lessen the burden on providers in the future. Apps and digital technology to gather important feedback are fantastic. Having a Monkey cloud app will just help as he is such a cheeky monkey and children seem to be drawn to his positivity and super smile Helen Sadler (Monkey’s Mum)

For More Information on delivering the Friends and Family Test through the power of mobile visit our dedicated mini site at www.FFTHealth.com or contact Jim Ward at Good4Health jim@good4health.co.uk +44 (0)1555 666344 Twitter @Good4HEALTHUK Mandy Wearne at Inspiration NW mandy@inspiraitonnw.co.uk Twitter @inspirationNW

Good

HEALTH

www.FFTHealth.com Innovation 9 Book 1.indb 21

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Elephant kiosks

There is an Elephant in the room! Only this time everyone IS talking about it The Friends and Family Test for Practices As from December 2014 all practices are now under a contractual requirement to undertake the Friends and Family Test (FFT) and report on their results. Already a requirement for all NHS Inpatient and A&E departments and Maternity services, the FFT simply asks patients ‘How likely would you be to recommend our service to friends and family if they needed similar treatment?’. Patients have to answer on a scale of extremely likely to extremely unlikely. It sounds easy enough, but with increasingly strict guidelines for inclusivity, and responses and a completion measure to be published online for the public to see, it’s a huge challenge to implement. The challenges for CCG commissioners and GP providers, both faced with engaging their patients, is how to obtain the feedback from their patients in the first place, how to interpret it easily and then act on it if they need to. The FFT is just the start. CCGs need to continuously consult with the public, while providers need to collect meaningful, detailed feedback that enables them to make genuine service improvements. With thousands of responses to collect, collate and publish every month, traditional comment cards and other paper-based methods alone are not going to cut it. The whole process must be as simple and painless as possible for everyone involved.

The Elephant Kiosk An Elephant Kiosk ensures that patient engagement doesn’t turn into a mammoth task. Our specially designed touchscreen kiosks are proven to be highly engaging and uniquely accessible. They’re particularly effective in getting hard to reach groups to engage because they’re easy to use, display clear graphics and have the option of multiple languages. The data they collect can be tailored appropriately and presented in a way to suit a practice’s needs. And, because the information you get is instant and interactive, issues that you identify can be dealt with straight away.

INNOVATION IN HEALTHCARE

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Elephant kiosks The most inclusive Friends & Family Test in the UK Even for practices with effective patient participation programmes already in place, getting patient feedback that is truly representative of the views held across different patient demographics is harder than ever. We live in a multichannel world and the way people communicate is changing every day. Yet traditional methods of customer engagement are still predominant on the front-line, at the cost of excluding many of the patients using health services. To help make the FFT more inclusive we’ve worked with customers and patients to develop a tool that’s accessible, quick and easy.

•

Multi-channel delivery

•

11 different languages in text and audio

•

British Sign Language video

•

Colour contrasts and text magnifiers

•

Easy-read version

Making the process easy It’s vital that you get a patient’s feedback in a digestible form so that you can immediately identify any issues. The Elephant data dashboard presents the information you need in a form you can analyse easily. The feedback is instant with real-time alerts and you can compile weekly, monthly or quarterly reports.

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23 24/11/2014 09:47

Elephant kiosks Patient information at the point of care The Elephant Kiosk also provides a unique opportunity to ensure patients access vital information at the right time. Whether it’s local signposting or information about care or conditions, the technology means information can be delivered at the point of service, in multiple languages, audio and video. Patients can print information or email it to a personal email address, and the kiosk can also act as a useful staff resource. For more information or a live demonstration, contact us on 01223 812737 or email us at hello@elephantkiosks.co.uk – or look us up on www.elephantkiosks.co.uk

Join the herd! A few of our current customers… NHS Durham Dales, Easington and Sedgefield CCG North Durham CCG Islington CCG Heywood, Middleton and Rochdale CCG NHS Salford CCG

INNOVATION IN HEALTHCARE

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Elephant kiosks Case study Bradford District Care Trust By Shahid Islam, Patient Experience Manager, Bradford District Care Trust In 2010 we installed touchscreen and handheld technologies across our organisation to collect feedback about specific teams and individuals, relating to performance from the service users viewpoint. Data is collected in real-time and centrally collated by Elephant Kiosks who, amongst other things, ensure the technical elements run smoothly. The anonymised data is made available to individual clinicians, teams and wards. Graphical illustrations show how service users scored a number of topics, ranging from quality of food to how well treatments were explained. Labour intensive tasks such as analysing data are automatically taken care of, saving a great deal of time and mental energy. Results show most respondents rate care in a very positive way. Where there are trends which deviate from the high standards we can investigate further through inspection, audit or evaluation exercises, or rectify the issue immediately if it’s more straightforward. For example, we noted 28% of inpatients were not provided information about the ward routine. A flyer was produced in a participatory way, with information about the ward, including meal times and activities. This is now provided to all patients on admission. There are many further examples of small changes that have had a ‘drip-drip’ effect leading to service improvements, which are not always easy to quantify. This is exemplified by one doctor who stated; “By virtue of creating a system where people can score performance, one can’t help but ensure that standards are always high”. We have found e-feedback to be a powerful tool and a useful ally in our quest to increase the amount and quality of data. In an age where a great deal of activity is turning towards technology to improve convenience and outcomes, it’s only logical for feedback to follow.

For more information, contact: Mark Worger I Business Development Manager Elephant Kiosks 22 Signet Court I Cambridge I CB5 8LA I T: 01223 812737 I E: mark@ mark@elephantkiosks.co.uk INNOVATION IN HEALTHCARE Innovation 9 Book 1.indb 25

25 24/11/2014 09:48

1913

1922 1923

Dr Paul Dudley White becomes one of America’s ﬁrst cardiologists, a doctor specialising in the heart and its functions, and a pioneer in use of the electrocardiograph, exploring its potential as a diagnostic tool.

1921

Edward Mellanby discovers vitamin D and shows that its absence causes rickets.

Insulin ﬁrst used to treat diabetes.

First vaccine for diphtheria.

1926 1927

First vaccine for pertussis (whooping cough).

First vaccine for tuberculosis. First vaccine for tetanus.

1928

Scottish bacteriologist Sir Alexander Fleming discovers penicillin. He shares the 1945 Nobel Prize for Physiology or Medicine with Ernst Chain and Sir Howard Florey.

1935

First vaccine for yellow fever. Dr John H Gibbon, Jr, successfully uses a heart-lung machine for extracorporeal circulation of a cat (i.e all the heart and lung functions are handled by the machine while surgery is performed). He uses this method successfully on a human in 1953. It is now commonly used in open heart surgery.

INNOVATION IN HEALTHCARE

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1937

First vaccine for typhus. Bernard Fantus starts the ﬁrst blood bank at Cook County Hospital in Chicago, using a 2% solution of sodium citrate to preserve the blood. Refrigerated blood lasts 10 days.

1943

1945

First vaccine for inﬂuenza.

1952 1953

Microbiologist Selman A Waksman discovers the antibiotic streptomycin, later used to treat tuberculosis and other diseases.

James Watson and Francis Crick at Cambridge University describe the structure of the DNA molecule. Maurice Wilkins and Rosalind Franklin at King’s College London are also studying DNA. (Wilkins, in fact, shares Franklin’s data with Watson and Crick without her knowledge.) Watson, Crick, and Wilkins share the Nobel Prize for Physiology or Medicine in 1962 (Franklin had died and the Nobel Prize only goes to living recipients).

1954

Paul Zoll develops the ﬁrst cardiac pacemaker to control irregular heartbeat.

Dr Joseph E. Murray performs the ﬁrst kidney transplant between identical twins.

INNOVATION IN HEALTHCARE Innovation 9 Book 1.indb 27

27 24/11/2014 09:47

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Innovation 9 Book 1.indb 28

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Integration of services through the smart use of estates

Innovation 9 Book 1.indb 29

Integration of services through the correct use of the estate CHP’s principal focus is to deliver on an ambitious target of generating £100m of system savings for the NHS by 2018. CHP believes that these savings are achievable through a structured and targeted programme to support the strategic planning of the estate, which will deliver: • increased efficiencies, through the better use of high-quality primary and community care estate that is in place across England • better service integration, delivering improvements in service efficiency and better health outcomes for patients • new service models, replacing outmoded and inadequate premises, and releasing capital through a structured programme of disposals Dr Raper said: “We know that in many areas the existing community and primary healthcare estate is of variable quality and is not used as effectively or efficiently as it could or should be. In many cases, it is configured to an historic model of service delivery, not a future one.

“We also know that the system changes have created a significant degree of uncertainty for commissioners with regards to estate and estate planning. This is backed up by independent research commissioned by CHP in spring 2014, which reported that whilst many commissioners appreciate the strategic importance of property; estate and estate issues are often not ‘front of mind’ or an area of expertise.” Recent research conducted by CHP has also found that the most commonly mentioned market drivers expected to impact the direction of NHS services are: • the integration of health and social care through a range of different services • the need to drive financial efficiencies throughout the entire health economy • more aggregated primary care, including larger GP units / clusters offering ‘total health management’ at scale • a clear need for local responsibility, clarity and leadership over the effective and efficient use of the community estate

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Helping local authorities and the health sector work together CHP has an important role in helping local authorities to work with health organisations to bring together and integrate various services, depending on the needs of the local population. Dr Raper said: “CHP is not just a property surveyor. We have recruited highly experienced and knowledgeable professionals with local government experience. “Local authorities across England have access to our services and we are happy to work with, lead and facilitate integration on behalf of local authorities.”

Bringing local partners together to assess local needs Providing an integrated service to the public requires co-operation and involvement from a range of local partners, including clinical commissioning groups, NHS trusts and local authorities. Priorities for commissioners and local partners include the integration of services and efficiency, therefore CHP’s first task is to bring together local partners so that the needs of the local population can be assessed. Then partners work together to ensure the delivery of efficient and effective services. One of the ways this is achieved is through the locally focused Strategic Partnering Boards and Strategic Estate Forums, which specifically focus on the estate and integration.

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Dr Raper said: “Bringing local partners together ensures an improved patient or customer experience, which is why the Strategic Partnering Boards will discuss what is right for the local population, whether there is a duplication of properties, or if we can use properties for dual purposes.”

The role of LIFT and PPP CHP’s role as national lead for the Local Improvement Finance Trust (LIFT) programme has given it invaluable knowledge and experience. In the past 10 years, LIFT companies, which are public private partnerships, have created more than 300 integrated health centres in England. An independent report, which examined the socio-economic impact of the LIFT programme over the past 10 years, demonstrated how the co-location of services in LIFT buildings has enabled a more united service, which in turn has facilitated improved joint working, as well as better integration of primary and secondary care and specialist services. It has also helped to reduce unnecessary hospital appointments, allowed more efficient referrals, avoided people ‘getting lost’ in the system and brought care closer to patients. GP Dr Jack Aw, from Milehouse Primary Care Centre in Staffordshire, comments: “Primary care centres will become more community focused as it makes much more sense to have everything geographically under one roof as opposed to scattered throughout the area.

“Traditional clinics in hospitals need to move closer to the local community and their patients. The hospital is too expensive a setting when the same service can be provided in places like Milehouse, where it is much more personal.” Through the co-location of previously separate bodies, LIFT has facilitated broader linkages and a more holistic approach to the delivery of health and community services. For example, the Liverpool LIFT developments, such as the Kensington Neighbourhood Health Centre, provide flexible accommodation where Citizens Advice Bureau, Sure Start projects and third sector providers in fields such as mental health, smoking cessation and counselling services, are all based together under one roof. Inter-agency co-operation has also improved through this integration of service. A good example of this can be seen at Sparkbrook Primary Care and Community Centre in Birmingham. It houses three GP practices along with a range of service providers, including health (dental, physiotherapy, district nursing), local authority (a city council customer service centre, benefits and council tax advice and information, adult education services), and third sector and private providers (legal advice service for immigration, domestic violence agency, drug and alcohol misuse charity).

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Cumbrian hospital rises from the floods

Cockermouth Community Hospital & Health Centre embodies the concept of the ‘one NHS’ and how co-locating health services has greatly improved access for the local community. In late November 2009, the rivers Derwent and Cocker burst their banks and flooded the Cumbrian town of Cockermouth, damaging homes and businesses. Following the flood, the previous local cottage hospital was relocated into temporary buildings to ensure the continuity of care within the neighbourhood. Justin Harris, Architect and Studio Director at IBI Nightingale, said: “As the extent of the damage was assessed, NHS Cumbria took the opportunity to review its health provision, deciding to create a new ‘joined-up’ service. “This strategy inspired the new building, Cockermouth Community Hospital & Health Centre, designed to provide a 21st century environment for patients, families and staff.” Designed and delivered in collaboration with eLIFT Cumbria, Cockermouth Community Hospital houses GP and dental practices, together with imaging and in-patient facilities. CHP is Head Tenant for the building.

Innovation 9 Book 1.indb 31

The layout of the new building promotes collaborative working between the different departments, through the use of flexible, multi-functional spaces, reflecting the aspiration to promote an integrated healthcare model. On the first floor there are 16 GP rooms and ten nurse suites, as well as consulting rooms for visiting consultants. The first floor also houses the pharmacy and dispensary, the physiotherapy department, a GP study room, GP administration offices and a staff room. The lower floor houses the new in-patient ward – the Isel ward. The ward has eleven individual spacious rooms for patients, all of which are en-suite. Each room is decorated in a different colour and all have a view over the garden area of the hospital grounds. Also on the lower floor is an open plan office for district nurses, children’s services, midwives and therapy services, two health education rooms, for things such as ante-natal classes, and also the dental surgery.

“

NHS Cumbria took the opportunity to review its health provision, deciding to create a new ‘joined-up’ service. This strategy inspired the new building, Cockermouth Community Hospital & Health Centre, designed to provide a 21st century environment for patients, families and staff.

”

Justin Harris, Architect and Studio Director, IBI Nightingale

Responding directly to the local architectural vernacular, the new building is accessible and therapeutic. Situated close to the town centre, users benefit from views over the beautiful Cumbrian countryside, and historic Cockermouth Castle.

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Delivering better health outcomes in Hull through service integration With East Hull’s population set to grow from 18,000 to over 21,000 in the next three years, commissioners, managers and clinicians are facing a future of growing demands with static or reducing budgets. The recent completion of the new £3.4m Morrill Street Health and Wellbeing Campus, however, is set to help meet this ever increasing demand for health services and growing patient footfall and ensure that the health budget within the region is carefully used to significantly improve patient care.

The development of the Morrill Street campus is an example of how the public sector will make the best use of existing facilities and maximise their value by reconfiguring them to suit 21st century service needs. Charles Lewis, Chair of Hull Citycare Ltd, the organisation that developed the Morrill Street campus on behalf of NHS Property Services Ltd, said: “It’s all about working together to find new and innovative ways to improve access to services, whilst getting best value for the public purse. “Albeit a complex solution to deliver, a campus with services across two facilities was the right solution for the patients and staff at Morrill Street, and that’s what it’s all about.”

With the practice population ever increasing in this East Hull area and a wider variety of health and community services now provided at Morrill Street, the existing facility was overcrowded and teams were disjointed around the building. The existing centre, which was built 30 years ago, has undergone a significant refurbishment and a new annex building, The New Green Surgery, has been built alongside. The modernised campus is now fit to house a variety of health and community services for local people and has created better working environments for staff.

Sparkbrook Primary Care Centre – local authority and primary / community care led integration of services The £12m landmark health and council building, which has a BREEAM Excellent rating, is the first of its kind in Birmingham. Its creation was the result of a collaborative vision of the NHS, Birmingham City Council, the Diocese of Birmingham and BaS LIFT, a public private joint venture company, to regenerate community facilities and services for local people.

Sparkbrook Primary Care Centre serves a highly deprived and ethnically-mixed community. The key health priorities affecting the local population include improving life expectancy, reducing premature deaths from circulatory disease and high levels of diabetes, promoting healthier lifestyles and reducing childhood obesity. A survey of service users found that 98% of them consider the centre to be ‘much better’ than previous facilities. It has also ‘greatly improved NHS service delivery efficiency’ and facilitated integrated working practices.

Occupants and services available at the centre include: • Three GP practices • Birmingham Community Healthcare Trust: - Community dental services - Physiotherapy - District Nursing Health • Third sector providers - Legal advice service (immigration) - Domestic violence agency - Kikit drugs and alcohol misuse charity - Opticians • Birmingham City Council: - Customer Services Centre - Benefits and Council Tax advice and information - Homelessness service - Housing repair reporting facilities - Adult Education Service including access to training - Neighbourhood library including free IT access • Community rooms for letting • Church • Community café

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Finchley Memorial Hospital – a 21st century facility built on an historic site of healthcare Since opening its doors almost two years ago, the purposebuilt Finchley Memorial Hospital in Barnet has provided a wide range of health services to thousands of patients. When first conceived by NHS Barnet in 2007, the new Finchley Memorial Hospital was a central part of a wider strategy, focused on the transformation of local health services to meet the future healthcare needs of the community. It provides high quality services closer to home and reduces the reliance on acute hospitals in the surrounding area. The hospital was developed and built under the LIFT programme, led by LIFT company, North London Estate Partnership, uniting public and private sector partners, including CHP, the head tenant, Galliford Try Plc, Bilfinger Berger and gbpartnerships. The partnership looked at how the development could provide the local community with the most advanced primary and community health services, housed within a modern and environmentally advanced building, located on a park-like health and fitness campus setting.

“

The new hospital replaced an old facility that was originally founded in 1908. In the decades that followed, the former cottage hospital was gradually expanded through a series of ad-hoc extensions, however the estate was outmoded, inadequate and wholly unsuitable for delivering 21st century healthcare. Today, the new £28m building provides a wide range of services, including: • inpatient rehabilitative care • outpatient services • blood tests

• x-ray and other diagnostics • a walk-in centre to treat minor injuries and illnesses • pharmacy • patient information library Finchley Memorial Hospital was redesigned and constructed through LIFT because the funding model has a proven track record of providing modern, integrated health services in high quality, purpose-built premises, as well as increasing access to health and social care services for people in underprivileged communities.

The purpose of CHP is to provide a high quality and valued service to commissioners and local partners across England with the aim of increasing service integration through the smart use of estates, which will ultimately drive much needed savings.

”

Dr Sarah Raper, Executive Director of Community Health Partnerships (CHP)

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1955

Jonas Salk develops the ﬁrst polio vaccination.

1957 1962

First oral polio vaccine (as an alternative to the injected vaccine).

1964 1967

Dr Willem Kolff and Dr Tetsuzo Akutzu implant the ﬁrst artiﬁcial heart in a dog. The animal survives 90 minutes.

First vaccine for measles.

First vaccine for mumps. South African heart surgeon Dr Christiaan Barnard performs the ﬁrst human heart transplant.

1970 1974

First vaccine for chicken pox.

1977 1978

First vaccine for rubella.

First vaccine for pneumonia.

World’s irst test-tube baby is born in the UK. First vaccine for meningitis.

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1980

World Health Organization announces smallpox is eradicated.

1981

1982

1983

First vaccine for hepatitis A.

Dolly the sheep becomes the ﬁrst mammal cloned from an adult cell (dies in 2003).

1998

2007

Dr William DeVries implants the Jarvik-7 artiﬁcial heart into patient Barney Clark. Clark lives 112 days.

HIV, the virus that causes AIDS, is identiﬁed.

1992 1996

First vaccine for hepatitis B.

Scientists discover how to use human skin cells to create embryonic stem cells.

First vaccine for lyme disease.

Advances in Innovation in Healthcare. The future is in development

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35 24/11/2014 09:47

Access and continuity go hand in hand

but 12-7? At last primary care is getting the sort of attention from government that it has always craved. The PM Challenge Fund has put up £50m so that at least for one year, and at least for the 12% of the population covered by the lucky winners, there will be better access to your GP. It’s supposed to be 8am to 8pm, seven days a week although some of the larger scale schemes can’t promise this. Your doctor, any time you want? So the government recognizes that it’s hard for many to see their GP soon and at a convenient time, and something must be done (especially in an election year). That’s politics and we might as well make the best of it. At the very same time the GP-patient relationship is centre stage of the 2014 GP contract, with a new requirement for a named clinician to be responsible for the care of everyone over 75. It’s a shame that doesn’t cover everyone, and a shame that the specifics are untested but here’s a good thing: it recognizes that there’s value in the relationship. This is different from the purely transactional view from successive governments since targets were the wonder drug from the late nineties. No, the old view hasn’t been abandoned (phoned 111 lately?) but cracks are appearing.

Put the two things together and let’s see what happens. We want better access, for more hours. 12 hours a day, 7 days a week is 84 hours. And we want to see the doctor of choice, for continuity. By the way, relationship continuity rings all the bells on outcomes such as patient satisfaction, GP satisfaction, lower use of emergency and elective secondary care. It is a good thing. Do you think you can see your doctor of choice for 84 hours a week? Do you want your doctor on duty that many hours? Don’t worry, they won’t be. No one in their right mind would accept that kind of job. So a contradiction appears at the heart of the two pronged strategy. If you want access and continuity at the same time it can’t work.

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“

Continuity can only work with good access in core hours

The Doomsday scenario The number of GPs isn’t going to change, at least in the short term (the RCGP claims we need 10,000 more, a number I don’t think the taxpayer will stomach). That means the same workforce will be spread over more hours to achieve 12-7 access. Keeping the average working hours constant means fewer GPs during core hours. Yet it’s difficult to get a GP appointment in core hours – now it becomes even more difficult. Your chosen GP is working fewer core hours so has less chance to see you, and out of hours will be dealing with urgent demand only so no chance to pre-book. You will wait longer, and often decide not to wait several weeks so accept an appointment with another doctor. All very well and the other doctor is nice but not your doctor – so you book ahead as well and accept the wait. However this means you have taken two slots instead of one, rework which has reduced the available access to your GPs for others. This means that more patients are turned away during core hours, so they are more likely to go to A&E or wait until the out of hours service starts, maybe the new one provided by GPs opening 8-8 and weekends. Trouble is, with overtime rates that is more expensive to deliver and means a longer journey for the patient to a bigger centre and unknown GPs. Oh dear. Demand is up and continuity down, exactly what we didn’t want. Not the first time in history that well intentioned policy has unintended consequences.

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Is there a way out? The secret is understanding demand, designing the system to meet all objectives at the same time, and experimenting to find out what works. Here’s some data on demand: about half of patients express a preference for a specific doctor. Yes, it is very important to offer a choice for them, and will save time too. But happily it doesn’t matter for everyone, so we can build some flexibility into the system.

30%

are long term conditions

10%

60% acute

acute exacerbations

More data on demand for GPs: about 60% of patient presentations are acute, another 10% are acute exacerbations and only 30% are long term conditions. So it does make good sense to deal with the vast majority of patients on the day, the sooner the better. Doesn’t mean they are clinically “urgent” though – this is only 20-25% of cases, and only 1 in 200 is “emergency”. What this means is that to provide an appropriate and safe service in primary care, we don’t need the same GP coverage 7 days a week. At most it would be a quarter of the level at the weekend as core hours. Our data shows that when access is good, by late afternoon demand tapers to a very low level. Opening until 8pm will mean little extra traffic. Data on weekends is lacking, but experience from OOH suggests a much lower level than in core hours. A solution emerges: provide good rapid access at all times, but offer a choice of doctor for continuity only in core hours. Out of hours offer expert GP help, but no choice. That way, people who want a choice are channeled into core hours, yet for urgent needs a GP is there to help.

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1 in 4 presentations to a GP is urgent (same day) but only 1 in 200 is emergency

typical median response 30 minutes

Service innovation needed Whichever you cut the cake, capacity in primary care in many parts of the UK and in many local practices is at the limit. Throwing money at it won’t help. We need innovation to make it more efficient and generate capacity. For three years we’ve been helping practices do just that, with a model based on a GP innovation where, within a whole system, the GP responds to each patient demand with a phone call. It’s fast (typical median response 30 minutes) and gives patients a choice of doctor, most of the time. GPs get control of their day, deciding who they need to see. Consistently GPs are around 20% more productive as the system beds in. The extra capacity can be income protection, or larger lists, or simply dealing with more of the demand which was previously unmet. It’s simple in concept, sophisticated in execution and gives you all the management information to know how well you are doing. Is it the last word in GP performance? No, of course not. New and better things need to happen. But for the moment, it’s the best that we can find and it requires no new technology, either for the GP or the patient.

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39 24/11/2014 09:48

not important important but not achieved

By age group, is continuity important?

important and achieved

100% 90% 80%

Proportion

70%

“Continuity is important in this consultation” rises from 20% for children

60% 50%

To 60% for elderly

40% 30% 20% 10% 0%

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-80

85+

Age Band

Squaring the circle Three principles which just might work: 1.

Provide excellent core hours access – fast, and with continuity Most patients want this, and if the answer is always “yes” they will stick to their local surgery and choice of GP.

Out of hours, rapid response but with no choice of doctor

This should be the second choice for patients, only for urgent and emergency demand 3.

Make it a GP led service, and with full electronic record support. They know their stuff, and any attempt to downgrade the response ends up costing more. Patients will just get shunted around.

Will providers and commissioners have the sense to see this? Let’s hope so for all our sakes.

See how patient dynamics drives demand on our video blog at:

gpaccess.uk/pmcf .uk/pmcf

Harry Longman

INNOVATION IN HEALTHCARE

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