Inno healtcare vol 8 web by Maritime Media

Bringing new healthcare products and interventions to life

West and South Yorkshire and Bassetlaw Commissioning Support Unit

NHS SLCSU

NHS Staffordshire and Lancashire

NHS Central Southern

NHS WSYBCSU

Salix

Patient Access

Community Health Partnerships

Ordnance Survey

Innovation in Healthcare

Innovation in healthcare

Elephant kiosks

First Databank

Good4Health

ANDROID APP ON

NHS South CSU

www.innovationinhealthcare.org Inno Healtcare Vol 8 book.indd 1

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Clinical research. What can you do? Clinical research is vital to the development and improvement of patient treatments across the NHS. So much so, that a commitment to promote, conduct and use research to improve healthcare is part of the NHS Constitution. As a Commissioner or CSU you will be aware of your statutory duty to promote and support clinical research, but perhaps you want a deeper understanding of what this means in practice? Or to explore what you can do, through your commissioning decisions, to ensure we continue to gather robust and useful evidence about â&#x20AC;&#x153;what worksâ&#x20AC;? for patients, so that future treatments are both effective and affordable. To: find out more about CCGs and clinical research, view our short online presentation at: www.bit.ly/crnbrighttalkccgs Or share your thoughts and questions with us on our new LinkedIn Forum at: www.bit.ly/ccgsandresearch

Supporting research to make patients, and the NHS, better

The NIHR Clinical Research Network t: 0113 343 2314 e: crncc.info@nihr.ac.uk w: www.crncc.nihr.ac.uk

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Innovation in Healthcare is published by:

The Central Southern difference Clinical excellence from start to finish Commissioning Communications Suite 19, this, Hurlingham If you’re reading the odds areStudios, that you spend a lot of time thinking about how to improve care for people Ranelagh Gardens, in your area, and how to get the best possible value for London SW6 3PA money for what you do for them.

W H Robinson

•

Associate Publisher •

our involvement in end-to-end commissioning, not just providing business support functions our ‘clinical edge’, senior people with clinical qualifications and expertise, which means better commissioning decisions an unrivalled level of insight into –

dedication to – the needs of JULIEN WILDMAN and our customers

In our first year of operation, we’ve learned that there are five things that customers really look to us to help them do: •

• access to some of the most innovative E: julien.wildman@mar-media.com and effective solutions and services transforming services for patients around, via our network of partners. M: +44 (0) 7801 478425

A COMMISSIONING ORGANISATION

Designer

helping them run their businesses effectively

•

improving quality for patients

•

delivering efficient services and driving out value for our customers

•

JUSTIN IVES

We believe that a CSU isn’t about delivering ‘back office services’. Our customers are able to draw on our strength and experience in endto-end commissioning. Central Southern is a commissioning organisation, not just a support service. We dont just produce reports advising organisations how to do things and then leave – we work on everything, from commissioning to delivery.

E: justindesign@live.co.uk

providing evidence based services and advice.

© Copyright Maritime Media Ltd Above all, though, we are a commissioning support unit (CSU). Limited Our core purpose CCC isisato division of make a difference for patients – we’re an We are the hidden strength in our customers’ NHS organisation, and proud of it. Maritime Media Ltd commissioning cycle.

is focused on transforming clinical outcomes and patients’ experience

•

actively engages clinicians and patients in shaping services

•

makes the best use of knowledge and data to reach evidence-based decisions

•

As well as understanding the local health system and clinical issues, we truly prize the knowledge of understanding our customers. We’re not the only CSU with account managers for our core customers, but what makes us different is that at Central Southern this is a full-time, senior role.

requires a partnership approach between service users and staff, between the NHS and local government, and between commissioners and providers

Some of our best people spend their whole working day on-site with our CCG customers, making sure that we know exactly what they want and need from us, and ensuring that all our people are delivering that to the best of their ability. Each customer also has the support of someone from our Executive Team - as their named account partner – who takes ultimate responsibility for us getting it right for the customer.

If you’re reading this, the odds are that you spend a lot of time thinking • invests taxpayers’ money in a way about how to improve care for people inmaximum your area, which delivers benefit toand how to get the patients and the public. best possible value for money for what you do for them. John Wilderspin

Dianne Conduit

Managing Director

Nursing and Quality Director

“

So of course we have to do the ‘transactions’ well – managing invoices and payments, data collection and reporting, PALS and complaints, monitoring contracted activity, and so on. But what makes even more of a difference is the ‘transformational’ – using all the information we gather to look deeper and understand the underlying reasons for issues in the healthcare system, and then developing new and better ways to make the system work for the benefit of patients.

Dianne is a registered nurse and experienced manager. She has experience from a wide range of clinical and managerial positions, including as Director of Commissioning and Professional Practice at one of the few integrated health and social care trusts.

CENTRAL SOUTHERN IS FOCUSED ON PROVIDING CONSISTENTLY HIGHQUALITY SERVICES, THAT A personal view – IMPROVE THE EXPERIENCE OF PATIENTS AND SHOW NHS South CSU. DEMONSTRABLE BENEFITS IN CLINICAL OUTCOMES.

CSUs, one year on

and the public •

•

The Central Southern difference excellence from start to finish

Mark Smith, Director of Strategic Development, And to do this well, it’s absolutely essential to have a clinical view on the issues.

Most of all our size means we can ‘do things once, for all’ – whether that’s analysing the impact of new clinical guidance, reviewing contracted activity from a large acute provider, or supplying the IT infrastructure to make all our customers’ businesses work.

THE CLINICAL EDGE

“

One thing that makes Central Southern ‘not just another CSU’ is that we have a

strong – and growing – element of clinical THE SERVICES WE leadership. We are unusual in having both a PROVIDE HELP GAIN Medical Director and a Nursing and Quality AN UNDERSTANDING Director. Our senior team includes Medical, FRIENDS & FAMILY TEST // SPOTLIGHT OF WHAT PATIENTS General Nursing, Mental Health Nursing and NEED, AND HELP CREATE clinical professionals. Good other Greek philosopher, Aristotle is credited with the saying THE COMMISSIONING Jim Ward, Good4HEALTH an art wonINFRASTRUCTURE by trainingTOand habituation. We are what we www.good4health.co.uk MEET THESE is NEEDS. Excellence, then, not an act but a habit”.

We also have the capability to work with a range of other organisations – from specialist suppliers of clever, niche software tools, to big firms with established credentials in strategy and transformation.

Harnessing the habit of excellence with Aristotle

LISTENING TO THE VOICE OF THE MANY

“

Publisher

things that set us apart:

Dr Michael Dixon, Chair, NHS Alliance, Interim President, NHS Clinical Commissioners. We believe that top-class commissioning: UNDERSTANDING OUR CUSTOMERS

“

T: +44 (0) 20 7386 6100 F: +44 (0) 20 7381 We’d 8890 forgive you for thinking that all CSUs look the same. Please take another look, E: inbox@mar-media.com though, because we think there are some

We’re Central Southern, and we work for more than 60 customers who play key roles in the health and social care system, mostly around the Thames Valley, Wiltshire and Gloucestershire. Our most important job is to support 14 very ambitious clinical commissioning groups (CCGs) to do the best for the patients they serve. But we also work hard for lots of other people – NHS England and its Area Teams, local authorities, NHS trusts, third sector organisations, and even occasionally the private sector. What do they all want from a commissioning support unit?

Future of Primary Care

“Excellence is repeatedly do.

Patient experience monitoring with the Friends & Family Test Effective delivery of the Friends & Family Test presents service providers with a number of challenges. Perhaps one of the most significant yet to affect many providers, is that of processing large volumes of patient feedback comments that seek to better understand the FFT scoring and the real experiences of patients.

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.

Combined for Innovation and Benefit

Yorkshire and Humber Commissioning Support (YHCS) is a new organisation formed from a merger between North Yorkshire & Humber CSU (NYHCSU) and West and South Yorkshire & Bassetlaw CSU (WSYB CSU). Collecting feedback data in sufficient volume to meet the completion requirements, fast and efficient processing of potentially large volumes of feedback data and finally extracting enough value from the data to implement positive change so that patient experience and in turn, FFT performance improves are all key challenges to service providers.

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.

Service providers have been collecting responses to the key FFT question, to find out how likely patients are to recommend them to friends and family if they required similar care or treatment, since April 2013. Soon however the optional follow-up question that aims to divine more about the response provided and where service improvements might be made will become a compulsory element of the survey.

Working together, Good4Health, Inspiration NW and The 3rd Degree have delivered arguably the optimum service for FFT, solving the three key issues by using the best technology solution for the collection, processing and actionable insight so that providers can listen to the voice of the many.

Using the Synapta patient engagement platform, our clients are gathering their data using a ‘mobile first’ approach with access to real-time data and report generation, as well as open comment text analysis, utilising a knowledge based system for categorisation of verbatim text. Not only are our clients achieving far beyond the required targets for completion, they are also leading the field in utilising the follow up question and using automated analysis to direct focus on the key areas for improvement.

LISTENING TO THE VOICE OF THE MANY

Patient experience monitoring with the Friends & Family Test. Synapta is enabling service providers to not only capture the voice of the many but to also listen and act.

Synapta is enabling service providers to not only capture the voice of the many but to also listen and act.

Sally Burley, The 3rd Degree

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.

Access and continuity go hand in hand but 12-7? 28 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.

Cover price: £5.95 ANDROID APP ON

Mapping the way to better healthcare

For page turning technology visit: innovationinhealthcare.org Graham Hughes

Health Sector Manager Ordnance Survey

Ordnance Survey has been helping to provide valuable medical insight and intelligent location-based analysis since the days of John Snow, who famously in 1854, plotted cases of a cholera outbreak that occurred in Soho, London on a map. For the first time, he was able to identify a water pump in Broad Street as the source of the outbreak, despite the assumption that cholera was an airborne disease. Snow did not accept this 'miasma' (bad air) theory, arguing that cholera entered the body through the mouth, and used mapping to provide the evidence base behind this innovative theory.

Today, we are seeing that our data and services are more relevant than ever before and they are increasingly being used across the NHS commissioning community to help professionals rise to the challenge of eff iciently planning, securing and monitoring the commissioning of high-quality

populations, deliver targeted health campaigns and even justify investment from developers to secure capital funding for the new services.

• Monitoring of services

health services. In order to ensure everybody leads longer

The ongoing efficient delivery and access to services can be

and healthier lives, our data and service can specifically help

analysed using detailed mapping to monitor gaps in service

commissioners in the:

provision and pinpoint hot spots for low uptake of services. For example, immunisation and vaccination, analysis of patterns

• Planning of services

in cause and spread of disease and use of travel time analysis

By linking NHS and demographic data to Ordnance Survey

to ensure equal access to services. Additionally, mapping may

mapping, NHS commissioners can ensure the right services

be used to plot GP referral patterns, adjust opening hours

are in the right location, providing equal access to services to meet the needs of the local population. It can also map demographic changes, define catchment areas, including

of collection centres (optimising staff resources) and share information with key stakeholders such as local authorities, public health bodies and ambulance services.

out-of-hours doctors’ areas, plan for the impact on NHS services from new developments and analyse the impacts of

Through the Public Sector Mapping Agreement (PSMA), over

moving services out of hospitals and into the community.

220 health sector organisations, including NHS England, Public

INNOVATION IN HEALTHCARE

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A risk to research?

In recent years, our ability to carry out studies such as the one just mentioned, has dramatically improved. In large partCare this Act is due As the Health and Social takes effect, Dr Jonathan Sheffield, the fact that the NIHR NHS isClinical now in Research Network, looks at the chieftoexecutive of the bettereffects shape on to conduct possible clinical clinical research and the development of new researchfor than it has ever been treatments NHS patients, and argues that CCGs could help to protect a before. Whereas, in the past, research-active A collaborative approach to Strategic culture for the future research was largely confined to Estate Planning: The Urgent Care Centre at Widnes the large teaching hospitals, now Health Care Resource Centre it is widespread with 99 per cent of NHS Trusts conducting studies. This is a huge achievement, and a new pledge to use anonymised it has come about because of the information to support clinical investment government has made research and improve care for in the infrastructure others. To reduce the pressurefor onresearch the acute sector, Clinical Commissioning in the NHS. have Through National Groups (CCGs) beenthe tasked with cutting Accident and Institute admissions for Health Research There is a very good reason why Emergency by 15 per cent over five years. Clinical Research Network, NHS clinical research should occupy To reduce the pressure on the acute sector, Clinical Commissioning Groups (CCGs) have been tasked with cutting and Emergency admissionsTrusts by 15 per centreceive over five years. The redevelopment for of the more than funding Thethis Urgent Care Centre at space in central theAccident provision Widnes HCRC Health Care Resource Centre at Widnes in Halton, which is currently in the design phase, will do just that, care and saving the health system £150,000 a year in the process. 10,000 trained research nurses of NHS care, whichimproving is –patient simply – who work on our hospital wards, that it makes a huge difference to and in our doctors’ surgeries. patient care. Take for example the These clinical professionals are case of Danielle Manley, a teenager responsible for identifying patients who was left wheelchair-bound and who may be suitable to take part in needing morphine as a result of Addressing challenges of the referrals process particularthe research studies, as well severe arthritis. Standard treatment as carrying out the clinical activities options had been exhausted, but involved in conducting the research Danielle opted to take part in a itself. clinical research study to test the use of the drug tocilizumab as a It is through the efforts of this treatment for Systemic Juvenile research workforce – and other Idiopathic Arthritis. As a result clinicians across the NHS in she has now been able to leave England – that the research picture the wheelchair behind and live Health+Care returns to Excel London on 25 - 26 June 2014, for patients has been transformed. a normal life. Other patients on withWhilst more 208,000 than 7,000 professionals gathering from all over the country patients took part the study had similarly positive to take part in the UK’s largest social and primary care conference outcomes. The research study showed that after one year of taking the new treatment, 89 per cent of patients achieved a 70 per cent improvement, making a huge difference to their lives.

As the Health and Social Care Act takes effect, Dr Jonathan Sheffield, chief executive of the NIHR Clinical Research Network, looks at the possible effects on clinical research and the development of new treatments for NHS patients, and argues that CCGs could Key players help to protect a research-active culture for the future. On 1 April this year, the NHS changed. The Health and Social Care Act, which had been the subject of much debate as it went through Parliament, came into force, and Clinical Commissioning Groups – groups of GPs responsible for commissioning acute care - took up their new responsibilities. NHS Halton CCG and Halton Borough Council

Community Health Partnerships Mike Chambers, Area Director, North West

Dave Sweeney, Director of Transformation for NHS Halton CCG and Halton Borough Council

There has been a great deal of comment about the introduction of Clinical Commissioning Groups, and many column inches devoted to the possible effects of GP commissioning on the health service as a whole. But there is one aspect of the change that has not yet hit the headlines: the effect of the changes on clinical research in the NHS, and our ability to gather the robust evidence we need on “what works”, so we can keep improving treatments and the care we give to patients. Damian Nolan, Commissioner of Urgent Care Services Dr Neil Martin, GP Principal and Clinical Lead for Urgent Care

Halton CCG is made up of representatives from each of the 17 practices across Runcorn and Widnes and is responsible for planning NHS services across the borough.

www.haltonccg.nhs.uk

Community Health Partnerships (CHP) is wholly owned by the Department of Health. CHP’s aim is to support every health and social care system to improve and integrate their services by delivering the most cost effective and best value space for patients. www.communityhealthpartnerships.co.uk

Renova Developments Ltd

LIFT Company Becky Caffrey, General Manager

Renova is an awardwinning development company that specialises in providing primary care and community facilities. www.renovadevelopments.co.uk

Halton Borough Council Nicola Goodwin, Community Development Manager

Halton is the local borough council covering Runcorn and Widnes. www3.halton.gov.uk

CHP Handout.indd 1-2

Clinical research is - and always has been - part of the core business of the NHS, and this is no more than common sense. How else could we respond to innovations in the development of medicines or devices, or understand how to administer treatments to best effect? The fact that clinical research is a fundamental activity is reflected in the fact that it features in the NHS Constitution – and even more strongly in the newly-revised version that was published earlier this year. Now, not only do the principles of the NHS include a commitment to promote, conduct and use research, but there is also

Elephant in the room… patient engagement and the Friends & Family Test 37

• 4,016m2 • 180 people use the centre every day, plans will double that • £800,000 investment • £150,000 savings to the health system annually • 15% reduction in A&E attendances • 15% reduction in nonelective admissions through A&E • 35% reduction in A&E attendances over time

NHS Property Services (Merseyside) Mike Hill, Head of Technical and New Projects www.property.nhs.uk

The project is the result of carefully considered strategic estate planning and a close collaboration between Halton CCG, Halton Borough Council, Renova Developments Ltd (the LIFT Company covering St Helens, Knowsley and Warrington), Community Health Partnerships and NHS Property Services.

The local picture

Widnes Health Care Resource Centre (HCRC) had been identified by the CCG as a key site to support commissioning plans in Halton. With the closest Accident and Emergency department eight miles away and one of the lowest levels of car ownership in the country, the redevelopment of the centre to create the new Urgent Care Centre will answer the need for a real primary care-facing alternative to A&E, while also integrating services like mental health, providing wellbeing services, social activities and opportunities for evidence-based brief interventions. The centre, which has been open for about eight years on a 25-year lease, is a busy building that is popular with patients. However, the site had lots of available capacity so the CCG wanted to put more services in there, get best value and use it to its full potential.

A risk to research?

The Urgent Care Centre at Widnes Health Care Resource Centre

A clear vision

Over the last year, the CCG and Renova have worked hard to establish a collaborative approach and a strong working relationship. Together they have developed an estate plan for Halton, overlaying the NHS and Halton Borough Council plans. These also allow the CCG to meet the public drive priorities and fit with the CCG’s drive to improve health and wellbeing in the area.

Map of Medicine: standardising referral activity

Dave Sweeney, Director of Transformation at NHS Halton CCG and Halton Borough Council, is responsible for driving the project forward: “We had the opportunity to reduce unwanted NHS estate, reconfigure the remaining space and improve patient care, and that just made perfect sense to me. We came together very quickly, set our stall out and established our joint vision.” The thinking behind the development of the centre is very clear, as Damian Nolan, Commissioning Lead for Urgent Care Services at NHS Halton CCG, says:

“In order to do this we have had to work closely with a number of providers, including Warrington & Halton Hospitals NHS Foundation Trust, St Helens & Knowsley NHS Trust, Bridgewater Community Healthcare NHS Trust, Halton Borough Council and Unplanned Care 24.

“This has been a challenging but fruitful exercise so far. We have had to keep a balance between providing a good level of service in both centres, but not replicating some services that would be better provided in one Centre of Excellence.”

“The overarching desire is to provide our local population with high quality, accessible, local health and social care services that support our community to maintain and improve their health and wellbeing.”

Coming together for integration

16/05/2014 16:04

Outcomes based commissioning: the health sector’s new hope?

Dispensing Health on the High Street

The largest ever gathering of clinical commissioners is upon us

This is, of course, just one anecdote, but there are similar Outcomes based commissioning is the health sector’s new hope and stories across the whole range there’s no doubt that it’s far more likely to produce the NHS we want, of therapy areas about the ability and deserve, than we got from the old block and tariff systems of clinical research to transform treatment, and achieve real benefits for patients. No wonder then that every consumer poll that has ever been conducted on the subject shows that patients are overwhelmingly in favour of clinical research, and want the NHS to Prof Robert Darracott, Chief Executive of Pharmacy Voice keep offering opportunities to participate in high quality studies.

INNOVATION IN HEALTHCARE

Future of Primary Care Dr Michael Dixon,, Chair, NHS Alliance, Interim President, NHS Clinical Commissioners

Does Primary Care have a future? The answer has to be yes if we listen to the evidence from the World Health Organisation and others. The more that you invest in primary care the better your mortality rates, population health and cost efficiency. Yes, also, if you listen to the last Commonwealth Fund Report, which gave UK general practice and primary care the highest scores in terms of cost efficiency and the care of those with long term disease, while being among the four least expensive health systems in the western world. Given this evidence, isnâ&#x20AC;&#x2122;t it strange how we have so manifestly failed to value or invest in primary care over the past ten years? In the future, I would suggest that we must now, and with some resolve, develop general practice â&#x20AC;&#x153;at scaleâ&#x20AC;? so that GP practices and other community services can not only look after their frail elderly and those with complex disease, but also go upstream and make a real impact on self-care, personal health and the health of everyone in the local community. The registered list allows general practice, potentially, to provide a uniquely holistic approach to health and care in the community. We

now require general practice to step up to the plate, and for the rest of the health service to support it doing so and help remove all the blocks and rules that stop it from being able to achieve this. In the past, we have required innovators to develop extra services often at personal financial risk and against a prevailing wind that sought to stop them doing so. If we want a change in general practice being able to take on these new responsibilities then this will need to be a co-production of the local clinical commissioning group and its constituent member GP practices. Between them they will need to (and be allowed to) co-design better and more joined up systems for providing better local health and care. Competition law must be relaxed to enable this to happen and CCGs and GP practices, for their part, will need to minimise issues of conflict of interest. These can be answered, in part, by GPs being a minority on the CCG Board (as they are in most CCGs), NHS providers all having to run open financial accounts and especially, where GP practices are acting together at scale, if they take on a social enterprise/community interest company/co-operative type model of organisation.

INNOVATION IN HEALTHCARE

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These new collective providers of extended services and health will need to ensure that the income of their constituent GPs and other professionals is not at risk, while be prepared to pay the leaders of these new provider organisations a pro rata rate for their role as leaders/directors and being able to offer some sort of productivity bonus incentives for all those working in the organisation, when substantial efficiency/ cost savings have been made.

“

The registered list allows general practice, potentially, to provide a uniquely holistic approach to health and care in the community

We remain at a standstill because of issues around conflict of interest, competition law and insufficient headroom and resource in general practice, talking for far too long about the need to develop ‘out of hospital’ services, but doing very little. There have been numerous documents and even a white paper on the subject over the past ten years. We need to break through the impasse and for innovative, courageous and determined commissioners, working with enthused extended GP providers to provide the answers that have been lacking so far. This can only happen, however, if CCGs and their constituent general practices are willing and able to take the initiative and if the rest of the system including NHSE and Monitor – are prepared to support them. To date, the ‘will’ has been lacking but a Government that sees extended general practice as the answer to a sustainable NHS, and a new resolve among clinical commissioners, supported by GP practices - the more ambitious for their patients, could, at last, collectively bring about the solutions that have escaped the NHS to date.

For more information, contact: E-mail: admin@nhsalliance.org Tel: 020 8675 4779 www.nhsalliance.org

INNOVATION IN HEALTHCARE Inno Healtcare Vol 8 book.indd 5

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The Central Southern difference excellence from start to finish

If you’re reading this, the odds are that you spend a lot of time thinking about how to improve care for people in your area, and how to get the best possible value for money for what you do for them.

In our first year of operation, we’ve learned that there are five things that customers really look to us to help them do: •

transforming services for patients and the public

•

helping them run their businesses effectively

•

improving quality for patients

•

delivering efficient services and driving out value for our customers

•

providing evidence based services and advice.

Above all, though, we are a commissioning support unit (CSU). Our core purpose is to make a difference for patients – we’re an NHS organisation, and proud of it.

We’d forgive you for thinking that all CSUs look the same. Please take another look, though, because we think there are some things that set us apart: •

our involvement in end-to-end commissioning, not just providing business support functions

•

our ‘clinical edge’, senior people with clinical qualifications and expertise, which means better commissioning decisions

•

an unrivalled level of insight into – and dedication to – the needs of our customers

•

access to some of the most innovative and effective solutions and services around, via our network of partners.

John Wilderspin Managing Director

“

CENTRAL SOUTHERN IS FOCUSED ON PROVIDING CONSISTENTLY HIGHQUALITY SERVICES, THAT IMPROVE THE EXPERIENCE OF PATIENTS AND SHOW DEMONSTRABLE BENEFITS IN CLINICAL OUTCOMES.

“

A COMMISSIONING ORGANISATION We believe that a CSU isn’t about delivering ‘back office services’. Our customers are able to draw on our strength and experience in endto-end commissioning. Central Southern is a commissioning organisation, not just a support service. We dont just produce reports advising organisations how to do things and then leave – we work on everything, from commissioning to delivery. We are the hidden strength in our customers’ commissioning cycle.

INNOVATION IN HEALTHCARE

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We believe that top-class commissioning:

UNDERSTANDING OUR CUSTOMERS

•

is focused on transforming clinical outcomes and patients’ experience

•

actively engages clinicians and patients in shaping services

•

makes the best use of knowledge and data to reach evidence-based decisions

•

requires a partnership approach between service users and staff, between the NHS and local government, and between commissioners and providers

•

invests taxpayers’ money in a way which delivers maximum benefit to patients and the public.

Dianne Conduit Nursing and Quality Director Dianne is a registered nurse and experienced manager. She has experience from a wide range of clinical and managerial positions, including as Director of Commissioning and Professional Practice at one of the few integrated health and social care trusts.

And to do this well, it’s absolutely essential to have a clinical view on the issues.

THE CLINICAL EDGE

“

THE SERVICES WE PROVIDE HELP GAIN AN UNDERSTANDING OF WHAT PATIENTS NEED, AND HELP CREATE THE COMMISSIONING INFRASTRUCTURE TO MEET THESE NEEDS.

One thing that makes Central Southern ‘not just another CSU’ is that we have a strong – and growing – element of clinical leadership. We are unusual in having both a Medical Director and a Nursing and Quality Director. Our senior team includes Medical, General Nursing, Mental Health Nursing and other clinical professionals.

A BIGGER, BETTER SERVICE Over 500 people are part of the Central Southern team, and with this many people we can offer our customers a range of additional skills, experience and capabilities that others can’t. We also have the strength and depth to cover when key people aren’t available. Most of all our size means we can ‘do things once, for all’ – whether that’s analysing the impact of new clinical guidance, reviewing contracted activity from a large acute provider, or supplying the IT infrastructure to make all our customers’ businesses work. We also have the capability to work with a range of other organisations – from specialist suppliers of clever, niche software tools, to big firms with established credentials in strategy and transformation.

“ INNOVATION IN HEALTHCARE

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e v i t a v Inno

“

I AM THRILLED WITH OCS – THE PROBLEM LIST ALONE HAS PROVED INVALUABLE IN HELPING US LOOK AHEAD AND ADDRESS CHALLENGES BEFORE THEY ARISE.

“

Seeking new ways to deliver better, more responsive healthcare

GP, clinical lead for OCS

THREE EXAMPLES OF THE CENTRAL SOUTHERN DIFFERENCE 1. Oxfordshire Care Summary – securely sharing patient information across the whole system

Maggie Lay Clinical Transformation Lead

“

WE WORKED REALLY CLOSELY WITH OUR CUSTOMERS ON THIS PROJECT FIRSTLY TO ENSURE THAT OCS WOULD DELIVER WHAT THEY NEEDED, AND SECONDLY THAT THEY FELT CONFIDENT USING THE SYSTEM TO GET THE INSIGHT THEY NEED FOR EFFECTIVE DECISION MAKING.

“

• •

Oxfordshire Care Summary (OCS) is a clinical decision support tool, commissioned by health and social care organisations in Oxfordshire. It provides a real-time view of information held in disparate systems about patients registered at Oxfordshire GP practices. OCS makes relevant patient information available to authorised members of the clinical and social care team. OCS has quickly become a trusted tool that clinicians really value. Driving OCS at Central Southern is Maggie Lay a clinician who leads our Clinical Transformation Team. Maggie’s team helped to implement the programme more rapidly, and at lower cost, by supporting:

information governance processes, to ensure the solution meets legal requirements and can be trusted by patients clinical governance processes, to ensure the solution is safe and trusted by health and social care professionals

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the IM&T strategy, to deliver real change in service delivery

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ensuring that the system delivers clinical benefits sooner.

2. Talking Health – getting real public and patient views on commissioning decisions When we couldn’t find a sophisticated online tool to support the rich and meaningful public and patient engagement our customers dreamt of, we knew it was time to take matters into our own hands. Working in partnership with Inovem we have rigorously developed Talking Health, a fully scalable public engagement and participation management system. Now Talking Health is helping clinical commissioning groups in Oxfordshire and Berkshire – covering a population of over 1.5 million – to have ongoing conversations with their patients, public and stakeholders. Talking Health helps our customers to have conversations with their patients, the public and a range of other organisations. It enables people to take part in online polls and discussion forums, as well as to comment on strategy documents and sign up for public events and workshops. This innovative engagement tool has a self-maintaining database to easily track participation, activity and feedback. It also allows them to send targeted information based on members’ profiles and preferences. With Talking Health you can: •

carry out in-depth analysis based on details such as age, gender and ethnicity

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create automatic links to social media

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map responses in order to gain better insight into local issues

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create instant visuals in multiple formats

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capture themed responses from surveys, workshops and other sources

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stay on track by highlighting key milestones and sharing outcomes.

Talking Health gives you the insight and evidence to evaluate the work you’re doing. Refreshingly, it can also make the engagement and consultation approach far richer and enjoyable in the process.

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NHS CENTRAL SOUTHERN COMMISSIONING SUPPORT UNIT: www.cscsu.nhs.uk | contact.cscsu@nhs.net | @cscsu #supportingexcellence

Good primary care is the foundation of a cost-effective healthcare system, but frontline general practice is under pressure; demand is increasing and income is falling – both have implications on workload and staffing levels. The planning guidance ‘Everyone Counts: planning for patients 2014/15 to 2018/19’ argues that driving up the quality of primary care services will demand the transformation of these services, requiring general practices to work at greater scale and in closer collaboration with other health and care organisations. To help meet this challenge our team of primary care and change management experts are supporting local clinicians and leaders across health and social care to help develop a compelling local strategy. Our customers can call on Central Southern’s local knowledge, data and intelligence. We help them understand the impact of key drivers including: •

population projections

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health needs

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demand on primary care

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quality and clinical variation

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secondary care demand

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A&E activity levels

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alignment with CCG commissioning strategies

Building on that understanding, we work with each customer to identify the context and reason for change, setting clear achievable goals. Explaining the benefits of change, with a clear vision of success, is vital to help people to take action, do things differently, and behave in different ways. This means defining priorities to ensure that consistently high-quality healthcare can be delivered, identifying the needs of the population and how to meet them. It also means outlining how services will be delivered, and which skills are needed for that. Finally it means developing a pragmatic plan for where services should be based and who will provide them.

All CSUs are not the same – and at Central Southern we pride ourselves on doing things differently. Our services have the scale to guarantee access to best practice, with high-quality end-to-end commissioning informed throughout by clinical expertise.

Dr David Buckle Medial Director and GP

“

IN THE CHANGING PRIMARY CARE ENVIRONMENT, PRACTICES ARE SEEKING MORE EFFICIENT WAYS OF MANAGING THEIR BUSINESSES, TO MEET PATIENT EXPECTATIONS AND USE RESOURCES EFFICIENTLY.

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3. Primary care strategy – shaping future models of care

And our in-depth understanding of our customers means an unrivalled level of service every time. So find out more about how our excellence can support yours.

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CSUs, one year on A personal view – Mark Smith, Director of Strategic Development, NHS South CSU

If Commissioning Support Units (CSUs) were ships, what started as a veritable armada two years ago is now reduced to a modest flotilla; not even a convoy. The ships are a little larger, the sails are better trimmed, the sailors gaze ahead, but still no one quite knows where we’re headed. To push the analogy a little further than I should, the ships appear to be breaking up into pairs and are drifting apart a little, facing all four points of the compass. So – how does it feel, cast adrift on the somewhat choppy seas of the top down re-organised NHS? I write from the perspective of NHS South CSU, one of the smaller ships of the line, sister ship to South West Commissioning Support; so our story of the last 18 months and our hopes for the next will be unique. Hopefully it will give a sense of where we’ve come from and where we are going. CUSTOMERS We hope that, in the last 18 months, we have become much more customer focussed. For staff not used to this dramatic change of emphasis, this has been quite a journey. There has been a shaking out of those few who were ‘hiding’ in the darker reaches of the holds! This is no bad thing; indeed the staff that remain are pleased that regular customer feedback forces individuals to be held to account. We have found that it takes at least a year to build up a consistent level of trust between customer and CSU, where each recognises that they have a part to play in making everything work. Because we grew our business, signing up seven new CCGs in November 2013, we can clearly see the contrast. It didn’t help that these CCGs’ initial experiences of a CSU were of one that eventually sunk, but as with our ‘foundation’ customers we are going through a period of adjustment together.

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It isn’t only the CSU which has changed. Our customers have changed too. In the early days, some CCG staff, usually the less senior, made unreasonable demands of our teams who were now supporting multiple customers. It led to some unpleasant confrontations. We are now in a place where almost all customers recognise that complex processes, which involve staff from both organisations (and sometimes several others too), do not always go wrong as the result of the actions of only one party. DISTRACTIONS Being asked to do certain novel things, at the same time as trying to establish a new entity and satisfy customers who were also new entities, at a time of unprecedented financial pressure has been frustrating for us and frankly baffling to our customers. They are certainly not interested in us spending time and money on autonomisation and most are very doubtful of the value of the Lead Provider Framework (LPF), for the same reasons. In fact, several customers are working on the assumption that they will procure ‘off framework’. Perhaps out biggest distraction in the last year has been winning so much new work. We recently conducted a full internal review of the mobilisation effort involved in bringing seven new CCGs on board and we have acknowledged that, despite our best efforts, our foundation customers were disadvantaged in the short term. PEOPLE I am immensely proud of our staff. They have been asked to work through a period of intensive and continuing change (some repeatedly put at risk of redundancy), and to learn fundamentally different approaches to work. Most have thrived. A few have chosen to leave. It has led to us making huge efforts to help our staff through a very comprehensive organisation development programme. This includes a range of training opportunities, coaching, mentoring and structured support

processes. We have also established a very simple but highly effective ‘You’re a Star’ award. It was my pleasure recently to present several of these awards to great people, all of whom had been nominated by their customers. THE FUTURE Using a crystal ball would be just as accurate as trying to predict the future from past trends in the case of CSUs. Trends alone would suggest CSUs will wither and die out in a few years. Surrey and Sussex, Anglia, Central Eastern and North West London have been the casualties this year. Who next?

“

To minimise this risk, the smaller CSUs, including ours, are joining forces. For some, it’s a convenience to support getting on to the Lead Provider Framework. Others have formally merged. It would seem likely that those who have yet to merge might well do so in the future, especially if the LPF becomes their principle route to market. This decision is also highly likely to be influenced by the requirement for CCGs to reduce their running costs by 10 per cent. Even if CCGs only ask their CSU for a fair share of this, many may well seek to apply a bigger reduction to their CSU prices than they apply to their own direct costs. This would tend to drive CSU partnerships of convenience into much deeper alliances in which costs are removed through synergies in service delivery across large geographical areas. Many CCGs are considering ‘in-housing’ as a way to reduce costs. Indeed, it is this movement that has largely accounted for the Central Eastern and North West London circumstances. Several of our customers have bought communications, engagement and quality services in-house in the past few months. At a small scale, this may work, but at a large scale, all the costs have to go somewhere and there is a serious risk that CCGs will find themselves facing large stranded costs, related to people and to property. Someone will still be paying for all this.

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Find out what we’re doing about the future of commissioning...

Meanwhile, the inexorable process of a national procurement exercise rumbles on. My guess is that most of the remaining CSUs, many in alliance with others, will succeed in getting on to the LPF. Not bidding is simply not an option, unless you conclude you are not sustainable in the longer term. But by the time the framework goes live, we’ll only be a few short months away from an election, the outcome of which is the least certain for some time. Most CCGs will pause. In which case, this time next year, I suspect the CSU landscape will not look all that different from today. There are a couple of exceptions to this: Analytics - all CSUs are working hard to maximise the value to customers of the data they gather, clean, store and analyse. Linking this information with other sources of data from across the public and private sectors is likely to be the biggest single source of ideas for true transformation across the system. Future commissioning – despite the uncertainty, we’re thinking through what our future offer looks like and how we can support our customers in solving tomorrow’s problems: www.southcsu.nhs. uk/future And as for autonomisation, some CSUs are still very keen but many CCGs are not convinced. Our customers want local services with a deep NHS values base, “Why leave the team?” they say. We will all have to wait for the consultation which is planned for the end of the year.

www.southcsu.nhs.uk/futu 12

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FACT FILE

What are the alternative healthcare purchasing models for CCGs? Paul Oâ&#x20AC;&#x2122;Toole, Deputy Head of Contracting for NHS South Commissioning Support Unit (CSU), outlines CCGsâ&#x20AC;&#x2122; alternative healthcare purchasing options and explains why it is so important that CSUs understand the benefits and risks. The annual NHS provider-centric business cycle for contracting revolves around the NHS Standard Contract and the National Tariff System. Commissioners have criticised this system because of the perverse financial incentives introduced through its use. Providers are discouraged from streamlining pathways by a National Tariff system where payments are made for each clinical contact, regardless of the benefit to the patient. The contracts are rolled over from year to year and amended to comply with a centrally performance-managed system focused on financial performance.

There are benefits, such as consistency of charging and that the system has been designed with plurality of provider in mind. Despite these benefits, commissioners are increasingly seeking alternative models. The most common are as follows: Prime contractor / lead provider model In this model, the contract is awarded to one lead, or prime, contractor. The prime contractor sub-contracts specific roles and responsibilities to other providers but remains responsible to the commissioners for the delivery of the entire service. NHS colleagues in acute trusts may be very familiar with this model as it has been used in the temporary staffing sector for many years and nurse bank contracts have often been awarded on this basis. Integrated pathway hub (IPH) Here, separate contracts are awarded to a number of providers. One Integrated pathway hub provider is appointed and they coordinate and manage the hub for a fee. No one provider is responsible for the delivery of the entire integrated pathway.

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Alliance contracting In this model, there are multiple parallel contracts with aligned objectives and incentives amongst providers, including sharing of incentives and risks. COBIC (Capitated Outcome Based Incentivised Contracting) COBIC refers to a systematic, copyrighted process for system redesign from COBIC Limited. It concentrates on outcomes, reflects public and user values and engages clinicians in service redesign. A budget is set based on healthcare needs and providers receive incentive payments for achieving specified outcomes, while also generating efficiency savings to stay within budget. While these models are seen by commissioners as alternatives to the usual approach to contracting, some may be used in conjunction with the NHS Standard Contract. By using this approach, integrating a different reward mechanism within the framework of the NHS Standard contract, many of the benefits of the contract, in terms of consistency of approach, can be achieved. This can mitigate the significant risk of spiralling legal fees for providers and commissioners, which occurs with any deviation from the standard NHS terms and conditions as parties seek to minimise their risks. When considering which model to choose, compatibility with the NHS Standard Contract is therefore important. The Prime and Integrated pathway hub models can be designed to be entirely consistent with the NHS Standard Contract. The provisions in the Contract around sub-contracting for 2014/15 have been specifically amended so that they better support these models. Alliance contracting models are more nebulous and may be consistent, but Contract professionals need to design the systems of risk and reward to be used with such compliance in mind. The COBIC model, on the other hand, is only compatible after significant changes to the NHS Standard Contract have been made. These approaches can offer real alternatives to the traditional approaches to purchasing healthcare and increasingly Commissioning Support Units will need to gain an understanding of these approaches if they are to offer a comprehensive contracting service to their CCG colleagues. They need to be able to describe these options in terms of risks and benefits to the CCG and be sufficiently knowledgeable to be able to explain the model to prospective suppliers.

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www.staffordshirelancashirecsu.nhs.uk

Harnessing the habit of excellence with Aristotle

Greek philosopher, Aristotle is credited with the saying “Excellence is an art won by training and habituation. We are what we repeatedly do. Excellence, then, is not an act but a habit”. Jump over two thousand years in time to 21st Century Britain, and you will find that Aristotle is alive and well – and helping clinical commissioners and practicing GPs to hone the habit of excellence in business intelligence. Aristotle is a business intelligence application available to commissioners and clinicians. Developed by the Business Intelligence team at NHS Staffordshire and Lancashire CSU, Aristotle has been designed to allow users rapid access to an online suite of business intelligence tools and reports. It supports and evidences commissioner decision making through its interactive tools which deliver reports, dashboards and scorecards to monitor and analyse business performance.

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“Our vision for clinicians and commissioners was to bring real time, actionable intelligence to the end user so that they can have a deeper understanding of service use and demand, to support the transformation of health services. As such, Aristotle was developed to utilise extensive “sort and select” functionality, allowing intuitive access to key information quickly and easily. The advanced portal design permits users to manoeuvre quickly between the various intelligence resources to meet the requirements of both commissioners and business intelligence specialists” “Aristotle has been developed to offer a much richer reporting experience, with the user given self-serve access to slice and dice, drill down and pivot information. Sophisticated visualisation of the data through a variety of presentation options really does bring the information to life. Aristotle provides users with the ability to view, query, print and export information from an online portal to enrich strategic, tactical and operational business intelligence. Users are granted the ability to develop bespoke reports using information accessed through the portal”. Through its security controlled role based access, users are able to log into a wide range of intelligence from sources including but not limited to Secondary Uses Service, SLA Monitoring, ePACT, Primary Care and Unify. Furthermore, Aristotle features a built-in pseudonymisation tool which, in combination with role-based security, ensures that access to Personal Confidential Data is limited only to those with a legal right to view. Aristotle’s primary purpose is to support the commissioner through the commissioning cycle of strategy formulation, resource allocation, planning, delivery and management of healthcare services for the population they serve. Aristotle products support commissioners in evidencing value for money in the healthcare services they commission. However, Aristotle is not just limited to commissioners, but can also be used by NHS and independent healthcare providers in the management of their service delivery to commissioners.

to tablet devices such as the iPad, retaining full functionality throughout. The frequently expanding range of products in Aristotle includes reports tailored specifically to meet the requirements of Clinical Commissioning Groups, General Practices and Commissioning Support Units. Indeed, via a commitment to develop products in partnership with our customers, many reports and tools are the result of collaborative enterprise with existing Aristotle users. The Aristotle product range already includes tools to support Contract Management, Benchmarking, Performance Monitoring/Management, Prescribing and Patient Profiling and with new tools being released each month the benefits realised through the application continue to grow. Aristotle has been deployed live to all 8 of the Clinical Commissioning Groups in Lancashire serving a population of 1.5 million people. The popularity of the ‘one stop shop’ approach enabled by Aristotle has resulted in rapid growth in its user base with the number of Aristotle account holders increasing by 130% in the last six months to over 600 registered accounts, including GP and clinical commissioners, as well as business intelligence specialists. As well as providing functionality to support CCGs and General Practice, Aristotle incorporates functionality that can support commissioning support organisations, including other CSUs, NHS England and healthcare providers to meet their business requirements.

Stewart Bond, Senior Executive for Business Intelligence and IT

The innovative business intelligence system can be rapidly deployed to a new customer using web based access over the NHS N3 network with no geographical boundary limitations. It supports access from multi device platforms, from a standard workstation or laptop

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CONTRACT MONITORING & BENCHMARKING Nick Lewis, Programme Manager for Aristotle said: “Over 320 GPs and GP practice staff are ‘live’ users who are taking advantage of Aristotle’s functionality which is giving them real-time and detailed intelligence about patients and services which they commission. Rapid deployment and sustained user support have been key factors in the success of Aristotle to date”. One of the unique aspects of Aristotle is the close working relationship between the development team at the CSU and Aristotle customers. Mark Saul, Head of Business Intelligence (Development), has been at the forefront of driving this relationship: “We have been consistent from the outset that we wish Aristotle development to be customer driven and that we will fail if we try to develop the portal in isolation of those customers. This has resulted in a user friendly suite of products enabling intuitive access to key information in seconds. The outcome is a self-service application which doesn’t necessitate technical BI skills or intensive, time consuming training for users.”

Using Contract and Activity Monitoring, Aristotle offers a collection of reports designed to provide insight into contract monitoring outcomes and trends. The integrated analysis functionality developed within Aristotle enables users to link directly between activity monitoring reports and benchmarking tools for Clinical Commissioning Groups (CCGs) and GP practices. Mark Youlton, CCG Chief Finance Officer at East Lancashire Clinical Commissioning Group (CCG) is delighted with the analytical capability that Aristotle brings to his work at the CCG, he said: “Aristotle is on a par with the financial ledger in terms of importance for the CCG - all CCG executive members need access to Aristotle.” Aristotle Benchmarking tools present users with the ability to benchmark CCGs and Practices and deliver intelligent analysis in areas such as referral patterns viewable at CCG level, CCG Locality, GP Practice and Practice Taxonomy. Sharon Rourke, Senior Commissioning Manager for Acute & Service Redesign at Blackpool Clinical Commissioning Group (CCG) said: “As a Commissioning Manager responsible for acute services and service redesign I find Aristotle an excellent support tool to obtain real time data to support evidence based commissioning decisions.

The tool is user friendly and well laid out which makes it easy to find the right datasets. The NHS Staffordshire and Lancashire CSU Business Intelligence team has also been instrumental in designing ad hoc bespoke reports for me which I can use to monitor services, this provides me with the ease of being able to monitor in a selfsufficient way which reduces inefficiencies in terms of business intelligence and commissioning time.”

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PERFORMANCE MONITORING Aristotle delivers a comprehensive performance data warehouse to customers which enables rapid, detailed trend and activity analysis to support CCGs & CSUs to monitor performance. Previously onerous tasks have, through automation, become simple and efficient for end-users, saving time and expense. Analysts are able to devote their time to improving insight for commissioners regarding performance against national and local metrics. This has enabled a cultural change towards the use of data, ensuring that it is brought alive as actionable intelligence orientated towards service assurance and improvement. Spotlight reports provide in depth detail for specific performance topics including Daily Winter SitReps Reporting, 18 Weeks Referral to Treatment and Diagnostics Analysis Reporting. David Manion, CCG Business Analyst at Lancashire North Clinical Commissioning Group (CCG) said: “I have been using the Diagnostic Spotlight reporting in Aristotle for several months to update CCG scheduled care reporting. It provides a quick, useful snapshot of current provider performance and I can see instantly where any failed targets may be occurring, by individual diagnostic test, for the CCG”

PATIENT PROFILING Profiling patient health service activity, and harnessing the power of predictive modelling is rapidly becoming a sought after area of expertise at individual patient level for GP Practices. The patient profiling tool in Aristotle provides a directory of patients with a summary of healthcare activity and a primary care long term conditions register checklist. The directory can be filtered by age, gender and risk group and linked directly to comprehensive individual patient profiling. The tool also delivers an overview of costs and modelled estimated savings for CCGs. This powerful tool allows lawful CCG investigation of this incredibly rich data set for both clinicians and commissioners. A key aspect of the patient profiling tool is the ability to stratify and target “at risk” patients in primary care. By identifying their risk profile and health service usage, GPs and clinical commissioners can improve individual patient experience and outcomes, while utilising pseudonymisation of patient identifiers, the data can inform, influence and improve CCG commissioning initiatives, care pathway redesign, service transformation and healthcare delivery management. Dr Amanda Doyle, GP, CCG Chief Clinical Officer and Co-Chair of the Leadership Group of NHS Clinical Commissioners said: “As a GP, the Aristotle Risk Stratification Tool allows targeting of at-risk patients in my Practice. Emergency hospital admissions can be extremely upsetting for patients and their families. Aristotle helps to reduce these and enables us to deliver integrated care to individual patients, improving both their health and healthcare experience.

In Blackpool we face some of the most complex health challenges in the country. As a CCG Chief Clinical Officer Aristotle helps inform service planning and commissioning. I want to ensure that the services we are commissioning are the sort of services I’d want for me and my family.”

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About NHS Staffordshire and Lancashire CSU We are one of the largest CSUs in the country. We provide commissioning support services to 17 CCGs in four counties, supporting a population of 3.2 million. Our reach extends along the M6 from Morecambe in the north, to Hereford in the south, covering over 4,000 square miles. We provide services to CCGs with a diverse range of commissioning challenges and pressures. For example, we support clinical commissioning to those CCGs which commission services in dense urban cities and towns, industrial conurbations, rural countryside, and coastal towns. We operate at scale to bring our customers the benefit of economies, yet we retain a strong local approach with patient outcomes at the heart of what we do. We fully understand the complexities and opportunities of diverse local health economies and can deliver a tailored commissioning support service to you. We can draw on the best learning and experiences from each of our customers and capitalise on these to give you new insights, and ways of working. From April this year, NHS Staffordshire and Lancashire CSU joined forces with NHS Central Midlands CSU in a merger that will offer commissioning support services to 24 CCGs across the Midlands and Lancashire areas. We would be delighted to discuss how Aristotle could help transform your health economy.

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www.wsybcsu.nhs.uk

Combined for Innovation and Benefit Yorkshire and Humber Commissioning Support (YHCS) is a new organisation formed from a merger between North Yorkshire & Humber CSU (NYHCSU) and West and South Yorkshire & Bassetlaw CSU (WSYB CSU), bringing the benefits of scale and scope to 5.6m people living in an area covering more than 6000 square miles. The Yorkshire and Humber region already has a global reputation for innovation gained over 200 years and by combining our strengths from a broader pool of talented, expert and creative staff, we will be able to work in partnership with our clients to deliver truly transformational change. Innovation in Healthcare provides us with an opportunity to showcase our work with 23 CCGs in our region. We share a common aim with our clients - to achieve the best of sustainable, patient-focused solutions. Our current work in the transformation and innovation arenas includes: • Specialist support work for CCGs addressing the Better Care Fund (BCF) challenges, bringing visibility of innovative models of care from around the world and supporting implementation of best practice solutions. • Working with partners and using robust programme management expertise to develop outcome-based models in acute and primary care locations. • Sharing evidence-based models for unplanned care to help health professionals to deliver easy-access and informed treatment plans, early discharge when appropriate and reduced numbers of patients admitted with ambulatory care sensitive conditions or requiring long term care. • Working with CCGs and providers to design shared longterm strategies to develop safe, high quality health and social care systems. • Providing expert resource in the tightest of timescales to support negotiations and project development.

Maddy Ruff Managing Director NYHCSU

In these pages you can read more about our scalable innovation tools that help professionals access the information they need, when they want it. We have digital solutions for people working with children at risk, for GPs navigating local Map of Medicine information, web-based good practice guidance for care providers and a virtual dashboard Delivering joined up solutions for joined up healthcare, we have the capacity to work nationally and we will be happy to speak with you at Stand K250, and afterwards, about any aspect of commissioned services.

Alison Hughes Managing Director WSYB CSU

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Yorkshire & Humber Commissioning Support

INNOVATION IN PRACTICE In a busy clinical environment, immediate access to vital regulatory and risk focused information is critical. Creative use of digital technology delivers powerful solutions and the latest innovations combine ease-of-use with sustainability. Mobile App for Professionals – Safeguarding Children at Risk Developed by the North Yorkshire and Humber CSU (NYHCSU) web and quality team, and described by customers as “the first of its kind within the NHS and a brilliant example of innovative practice using available technology” the app provides up-to-date guidance and contact information at the touch of a screen for professionals in contact with children at risk. Available for iPhone and iPad, the app contains information native to itself and accessible at all times, even in the absence of a Wi-Fi or 3G signal. With the ability to host specific messaging and advertising, the app can be customised for rollout in any region. Phase 2 will see the app developed for Android platforms and the creation of more apps to support training, clinical and service delivery programmes for customers throughout the UK. Sidebar for Accurate and Relevant Map of Medicine® Information Work to develop a system of integrated links with online GP systems, including a sidebar for the Map Of Medicine® is ongoing at YHCS. The sidebar integrates with System One, Vision and EMIS Web, through a CCG’s Map Of Medicine® local view, allowing a seamless, one-click contextual search of local information. Referral forms, patient guidance leaflets and national care pathways are accessible from within patient records, saving time and ensuring relevant and accurate care guidance.

Training programmes are in place to enable GPs and their staff, including Practice Nurses, to use the sidebar, effectively supporting clinical decisionmaking. A single-point-of-contact IT Servicedesk helps to resolve issues with installation or use of the system. Agile Performance Monitoring in the Business Intelligence Zone A new web-based Business Intelligence Zone (BIZ) to aid CCG staff in performance monitoring is in use across three CCGs in the Yorkshire region. This innovation provides swift access to the most up-to-date performance information, combining business intelligence generated reports and information that flows directly into the CCG from various performance management leads. Each BIZ tool can be tailored to specific CCG needs and phase two of rollout is already being developed. Safer Medicines Management in Social Care Settings To assist care managers in meeting medicines management regulations on quality and safety standards, a Resource Centre hosting national and local good practice guidance documents, sample policies and recording templates, together with NICE Guidance about the Management of Medicines in Care Homes has been created by NYHCSU. Hosted on the NYHCSU website, the Resource Centre contains information about quality-assured training courses and a link to an Innovation Hub where customers can buy refresher training materials and audit tools. The next phase will update the sample policy for care homes in line with national guidance and provide more recording and risk assessment templates.

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Flexible working for a flexible NHS NHS West and South Yorkshire and Bassetlaw CSU’s (WSYB CSU) Virtual Desktop Infrastructure (VDI) is changing the way in which NHS organisations work for the better, implementing cost-effective, flexible working practices that benefits patients and service users. Today’s businesses rely on flexibility. Whether you’re in healthcare or hospitality, a GP or a geologist, technological advances and the ‘bring-your-own-device’ revolution means we can make the most of our time by working almost anywhere. Hot-desking no longer means touching down anywhere in a specific office; it means working from home, on the train, or anywhere we can. Laptops, tablets, smartphones and the Cloud allow us to work more flexibly than ever before, but this is only viable as long as effective security measures are in place to keep sensitive information out of the wrong hands. Healthcare is an area in which technology can play a huge role in enabling flexible working, not just for convenience, but so services can be built around patient requirements and healthcare staff can work effectively where they’re needed most. This is what drove Bradford and Airedale Primary Care Trust to develop their VDI (which was later inherited and developed by WSYB CSU), liberating staff and allowing instant roaming access anywhere, on any device. Since October 2012, WSYB CSU’s IT team have undertaken the largest implementation of a VDI in the NHS to date, covering 5,000 desktop terminals at over 100 sites. Around 6,000 members of NHS staff are currently using the system, including staff from over 80 GP practices.

The CSU worked closely with VMWare, specialists in Cloud and virtualisation software services, to develop a VDI to replace the existing ageing NHS IT infrastructure around the Bradford and Airedale region of West Yorkshire. The VDI system is an extremely cost-effective solution; given that remote desktop terminals cost a fraction of the price of PCs and running desktop services via a central server allow most issues to be dealt with centrally, reducing travel costs. The reduced costs associated with the CSU’s VDI make it an attractive solution in these times of economic constraint, but it’s the associated freedoms this system brings that have been its major selling point. Remote working levels are game-changing. Staff can log on to the system using any appropriate device, allowing services to be taken directly to patients, in locations such as community clinics, schools, care homes and residences. Security is assured via a robust two-factor authentication system, much like that used in online banking services, so staff and service users can be sure that confidential information remains just that, regardless of where it’s accessed. This IT infrastructure allows the NHS to provide the right care at the right time by the right people in the right place. WSYB CSU’s VDI is helping to change the way that the NHS works across Yorkshire and beyond, and as the merger with North Yorkshire and Humber CSU develops, this is just one example of how the NHS is changing with the times in order to remain a contemporary healthcare organisation that puts patients first.

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www.nyhcsu.org.uk

Positioned to meet General Practice needs Increased regulation, rising patient demand and squeezed funding have brought challenges to GP practices. Yorkshire and Humber Commissioning Support is at the heart of innovative, joined up solutions for joined-up healthcare, supporting general practices in developing new services and growing income in a rapidly changing healthcare system. In October 2013 the Prime Minister announced a new Challenge Fund to improve access to general practice. NYHCSU Managing Director Maddy Ruff is a member of the expert group tasked with advising on how the Challenge Fund can best support practices in transforming services and creating sustainable, highquality care services for the future. The expert group will initially focus on helping identify how innovation can be stimulated and supported at pace and scale within the pilot programme. Part of the group’s work will be to advise on innovative ways of commissioning and contracting. Yorkshire and Humber Commissioning Support works with GPs across the areas of practice performance, practice business support and practice development. Practice Performance Improving practice performance involves looking at all aspects of the business. YHCS has specialists with in-depth, relevant experience across: • Clinical governance, quality standards and CQC compliance • Practice business planning and financial management • Training, education and staff development • Management of complaints and serious incidents • Medicines management • IT, peer review data, social media, web design and patients access to records

Practice Business Support Ensuring a practice stays efficient, safe and productive is a challenge requiring superb processes in a range of non-clinical areas: • Recruitment, workforce and organisational development, performance, disciplinaries, skill mix reviews, practice level pay scales and computer based learning • Management of premises and estates • Legal services for partnership agreements and employment law • External media, communications, marketing and patient engagement • Financial services across payroll, accounts payable, asset management and procurement Practice Development Understanding and accessing new sources of income will become ever more important for general practitioners as the demands of the Better Care Fund for community-based care start to impact. YHCS can deploy experts to deliver high-value inputs including: • Marketing the potential of primary care to deliver commissioning priorities • Horizon scanning and monitoring commissioning plans for opportunities to provide enhanced services • Business case development and bid management for local tendered services The recently announced merger of North Yorkshire and Humber and the West and South Yorkshire and Bassetlaw CSUs brings 1200 specialists together with the scale and scope to deliver solutions nationwide. YHCS today offers unique experience in urban and rural areas, with single-handed and multipartner practices, as well as access to expert partners and connectivity to policy makers at the highest levels. Come to Stand K250 today to discuss how Yorkshire and Humber Commissioning Support can help your practice face the future with confidence.

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FRIENDS & FAMILY TEST // SPOTLIGHT

Good

Jim Ward, Good4HEALTH www.good4health.co.uk

LISTENING TO THE VOICE OF THE MANY Patient experience monitoring with the Friends & Family Test Effective delivery of the Friends & Family Test presents service providers with a number of challenges. Perhaps one of the most significant yet to affect many providers, is that of processing large volumes of patient feedback comments that seek to better understand the FFT scoring and the real experiences of patients. Collecting feedback data in sufficient volume to meet the completion requirements, fast and efficient processing of potentially large volumes of feedback data and finally extracting enough value from the data to implement positive change so that patient experience and in turn, FFT performance improves are all key challenges to service providers.

Synapta is enabling service providers to not only capture the voice of the many but to also listen and act.

For many, achieving the appropriate levels of response rate has been a significant challenge, and for those where targets are being achieved, taking the time to understand the responses and quantify the follow-up data, has posed its own challenges. Working together, Good4Health, Inspiration NW and The 3rd Degree have delivered arguably the optimum service for FFT, solving the three key issues by using the best technology solution for the collection, processing and actionable insight so that providers can listen to the voice of the many. Using the Synapta patient engagement platform, our clients are gathering their data using a â&#x20AC;&#x2DC;mobile firstâ&#x20AC;&#x2122; approach with access to real-time data and report generation, as well as open comment text analysis, utilising a knowledge based system for categorisation of verbatim text. Not only are our clients achieving far beyond the required targets for completion, they are also leading the field in utilising the follow up question and using automated analysis to direct focus on the key areas for improvement. Synapta is enabling service providers to not only capture the voice of the many but to also listen and act.

Sally Burley, The 3rd Degree

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Friends and Family Pathfinder Pilot

CUSTOMER STORY 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 collaborated with Greater East Midlands (GEM) Commissioning Support Unit (CSU) to pilot 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 provider of health care, finding a 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 patient-identifiable data, is taken from the practice 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, fourteen pioneer practices and an urgent care centre are testing out the SMS solution. Practice leads were identified and information and

Our experience in acute and specialist settings has identified 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’

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.

life s happen on mobile

Find out more about the pilot; Visit us at Stand P50 at the Commissioning Conference Excel 25/26 June 2014

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FRIENDS & FAMILY TEST // SPOTLIGHT

Good

Jim Ward, Good4HEALTH www.good4health.co.uk

HOW ARE WE DELIVERING FFT RESULTS? Exceeding service provider’s expectations for FFT performance Using a mobile first approach and some of the world’s most sophisticated machine learning tools, we are delivering a best of breed solution for FFT that delivers full scalability for the future...

Delivering a Systematic, Validated Approach that Minimises Impact on Clinical Staff

Such a large-scale operation needs to be automated with minimal reliance on staff. We are also ensuring that qualitative data can be collected and automatically categorised so that staff can focus in on key issues without an additional workload burden. Using SMS Text Messaging Survey Delivery and Completion

The world’s first and most widely used App! There are many benefits to using the Synapta platform to garner patient feedback through automated SMS. It is familiar, fast, convenient, private and secure, delivers incredible completion rates and high quality, instant data. Using the Right Technology to Ensure Higher Levels of Engagement

Pennine Care NHS Foundation Trust and Bridgewater Community Healthcare NHS Trust, both rated SMS 10 out of 10 as a highly engaging way of gathering patient feedback using the Synapta platform.

to open, read & reply by It takes on average MINUTES just

but up to

SMS

Ensuring We Collect High Quality Data

HOURS for an email!

of mobiles handle SMS

of adults in the UK have a mobile

of us use

SMS

each day

Survey participants are more candid and honest when they participate in surveys via SMS or our mobile Cloud-App, than they would be if they were surveyed at the point of experience in person, or in a situation where they may need assistance to participate. It’s also easier for people to think about their experience objectively, once they are out of the hospital environment. That’s why we advocate “within 48-hours” rather than “at/before discharge”

Making Sure Participation is Free

We use free-to-text shortcode numbers that guarantee participants won’t be charged at any stage of their mobile interaction with a Provider. Achieving the Highest Response Rates

In work with PWC and Inspiration NW, we have already achieved response rates between 35% and 58% for SMS-based surveys – even when the survey is not expected by the service user. Higher response rates mean more robust data for a provider to accurately monitor their performance. In addition, we also achieve on average 65% of responders leaving a free-text follow-up question. Using Free-Text Analysis to Automatically Monitor and Categorise Follow-Up Questions

Using state of the art machine learning we are able to categorise the follow-up responses given by patients and allowing staff to see a graphical representation of the types of feedback being provided as well as allow them to drill down to the individual responses in a structured way. This enables key issues to be understood and tackled immediately thus delivering service improvement.

We realised that we now live in a fast-moving, changing age, where the mobile device is a central communications tool. Almost everyone in the UK have mobile phones, although, less than half of those are smartphones. Even in the over 70’s age group, it's the fastest-growing area of ownership. Mandy Wearne, Inspiration NW

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FRIENDS & FAMILY TEST // SPOTLIGHT Find out more about automated text analysis and to see IDA in action, visit us at Stand P50 at the Commissioning Conference Excel 25/26 June 201

AUTOMATING PATIENT COMMENT ANALYSIS Making sense of free text responses with artificial intelligence Automated analysis enables providers to harness the wealth of information patients are willing to give when asked what was good and bad about their experience. Rather than simply ‘why’ they gave the FFT score they did, we aim to learn more abdout both the positive and negative aspects of teh service. We instantly empower providers to make rapid and valuable change by categorising open text comments in a manageable way. Often only a small change can deliver the greatest improvement. Synapta allows providers to find the needle in the haystack and to see clearly the patterns within feedback that shed light on their FFT score and how to improve it.

of patients give a response to the free text follow-up question with synapta

Unstructured text can provide a rich source of information about how customers are feeling, their likes and dislikes, any unmet needs and so on. It is easy and inexpensive to collect this kind of data today, yet much of the value is lost because of the time it takes to read and interpret this textual data manually, and the high cost for the effort involved. Automated analysis of free responses solves these issues by automating the process of assigning textual responses into categories, which are then easy to review and report on by ‘reading’ the answers and making judgements on your behalf, based on training about how you prefer responses to be classified and categorised. Not all automatic analysis tools are equal. Many systems simply look for phrases or particular words popping up in feedback in order to categorise it. This is pretty unintelligent and makes for fairly useless categorisation, the sentiment is lost along with much of the meaning. Synapta’s text analysis module is different, it considers the context of the entire piece of text and can understand the sentiment, so its not foxed when someone says ‘the nurses were great but the food wasn’t up to scratch” and gives you positive and negative feedback in one sentence.

Good

For More Information:

In our experience, examples of open feedback in the follow up question of the Friends and Family Test received by text message can be as simple as a couple of words or a couple of hundred words. Synapta’s text analysis module is trained on real world examples so that it can infer meaning for new feedback so it is able to make coding decisions as well as the human coder that has trained it, making it much more accurate and reliable. Its decisions are made based on over 100 different elements within a sentence and it considers the sentiment and meaning behind the response. We call this Intelligent Dialogue Analysis or IDA. Using IDA, providers are able to categorise thousands of comments automatically and view instant charts and reports that make sense of the comments and identify trends. Realworld IDA Coding Examples...

“Best - thorough examination and good advice...Worsewaiting time” Wait Time Negative, Communication Positive

“Lovely caring staff, cluttered depressing room.” Comfort Negative, Staff Positive

Patient Engagement Solutions

the 3rd degree

(e) jim@good4health.co.uk

Working Together for Service Improvement

(t) 01555 666344 (w) www.good4health.co.uk

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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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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.

For more information, case studies and how to do it see

www.patient-access.org.uk

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

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Mapping the way to better healthcare Graham Hughes Health Sector Manager Ordnance Survey

Today, we are seeing that our data and services are more

populations, deliver targeted health campaigns and even

relevant than ever before and they are increasingly being

justify investment from developers to secure capital funding

used across the NHS commissioning community to help

for the new services.

professionals rise to the challenge of eff iciently planning, securing and monitoring the commissioning of high-quality

• Monitoring of services

health services. In order to ensure everybody leads longer

The ongoing efficient delivery and access to services can be

and healthier lives, our data and service can specifically help

analysed using detailed mapping to monitor gaps in service

commissioners in the:

provision and pinpoint hot spots for low uptake of services. For example, immunisation and vaccination, analysis of patterns

• Planning of services

in cause and spread of disease and use of travel time analysis

By linking NHS and demographic data to Ordnance Survey

to ensure equal access to services. Additionally, mapping may

mapping, NHS commissioners can ensure the right services

be used to plot GP referral patterns, adjust opening hours

are in the right location, providing equal access to services

of collection centres (optimising staff resources) and share

to meet the needs of the local population. It can also map

information with key stakeholders such as local authorities,

demographic changes, define catchment areas, including

public health bodies and ambulance services.

out-of-hours doctors’ areas, plan for the impact on NHS services from new developments and analyse the impacts of

Through the Public Sector Mapping Agreement (PSMA), over

moving services out of hospitals and into the community.

220 health sector organisations, including NHS England, Public Health England, all 10 ambulance trusts and over 120 NHS Trusts

• Securing of services

have joined the PSMA and are using geographic analysis to

The detailed evidence base underpinned by Ordnance Survey

ensure that healthcare services are located and resources are

mapping can be used by commissioners to visualise complex

targeted exactly where they are needed.

information regarding service provision. This helps them to understand and share decisions regarding the eff icient

It is making a real difference to healthcare planning across the

locating and contracting of services. Additionally, it may

whole spectrum of NHS bodies and since April 2013, 60 Clinical

be used to communicate planning decisions with local

Commissioning Groups (CCGs) have also joined the agreement. INNOVATION IN HEALTHCARE

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Mapping the way to better healthcare

my assets’

Estate and Facility Manager

‘I know where there are gaps in services’

‘I never realised there was a GP so close!’

Member of the public NHS Commissioner 34

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‘During flooding, I know where vulnerable patients

Emergency Planner

better target my health campaigns’

Public Health Director

‘I can plan my route and see more patients’

Community Nurse

The Public Sector Mapping Agreement (PSMA) provides the NHS with free access to Ordnance Survey products. Our mapping data is used across the health sector to plan and deliver health services. Please come and meet the Ordnance Survey health team on stand O56 on 25–26 June 2014, to find out how your organisation could benefit from mapping. Or find out further information at: www.ordnancesurvey.co.uk/health

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Mapping the way to better healthcare

As a result of the PSMA, Ordnance Survey data is being used today right across the health sector to help develop policy, plan and deliver services and monitor their success. Our data is delivering real benefits in terms of efficiency gains, optimisation and access to services and health gains for our citizens. Over 220 organisations are already taking advantage of these outcomes. Our challenge is to ensure that every health professional within the sector is made aware of these benefits!

To find out how you can benefit please get in touch with the Ordnance Survey health team: Graham Hughes Health Sector Manager Ordnance Survey

graham.hughes@ordnancesurvey.co.uk 023 8005 5897 07917 244807

PSMA health membership in England:

Clinical Commissioning Groups

Central Shared Other Government Services NHS Trusts

Iain Goodwin Relationship Manager Ordnance Survey

iain.goodwin@ordnancesurvey.co.uk 023 8005 5154 07920 846773

Ian Bennett Health GI Consultant Ordnance Survey

ian.bennett@ordnancesurvey.co.uk 023 8005 5545 07795 603589 36

Ambulance Trusts

www.ordnancesurvey.co.uk/health

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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 From December 2014 all practices will be 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 the current minimum required response rate at 15% of eligible patients and monthly reporting, it’s a huge challenge to implement. The challenges for CCG commissioners and GP providers, both faced with engaging their patients, will be 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. 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 the FFT 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.

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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.

•

11 different languages in text and audio

•

British Sign Language video

•

Colour contrasts and text magnifiers

•

Easy-read version

•

Multi-channel delivery

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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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 itâ&#x20AC;&#x2122;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 â&#x20AC;&#x201C; or look us up on www.elephantkiosks.co.uk

A FEW OF OUR CURRENT CUSTOMERS NHS Durham Dales, Easington and Sedgefield CCG North Durham CCG Islington CCG NHS Salford CCG North Lincolnshire CCG Bradford District Care Trust Dorset HealthCare University NHS Foundation Trust Pennine Care NHS Foundation Trust Staffordshire & Stoke-on-Trent Partnership NHS Trust Worcestershire Health and Care Trust Peterborough and Stamford Hospitals NHS Foundation Trust Portsmouth Hospitals NHS Trust South Devon Healthcare NHS Foundation Trust

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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 40

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NIHR Clinical Research Network

A risk to research? As the Health and Social Care Act takes effect, Dr Jonathan Sheffield, chief executive of the NIHR Clinical Research Network, looks at the possible effects on clinical research and the development of new treatments for NHS patients, and argues that CCGs could help to protect a research-active culture for the future. On 1 April this year, the NHS changed. The Health and Social Care Act, which had been the subject of much debate as it went through Parliament, came into force, and Clinical Commissioning Groups – groups of GPs responsible for commissioning acute care - took up their new responsibilities. There has been a great deal of comment about the introduction of Clinical Commissioning Groups, and many column inches devoted to the possible effects of GP commissioning on the health service as a whole. But there is one aspect of the change that has not yet hit the headlines: the effect of the changes on clinical research in the NHS, and our ability to gather the robust evidence we need on “what works”, so we can keep improving treatments and the care we give to patients. Clinical research is - and always has been - part of the core business of the NHS, and this is no more than common sense. How else could we respond to innovations in the development of medicines or devices, or understand how to administer treatments to best effect? The fact that clinical research is a fundamental activity is reflected in the fact that it features in the NHS Constitution – and even more strongly in the newly-revised version that was published earlier this year. Now, not only do the principles of the NHS include a commitment to promote, conduct and use research, but there is also

a new pledge to use anonymised information to support clinical research and improve care for others. There is a very good reason why clinical research should occupy this central space in the provision of NHS care, which is – simply – that it makes a huge difference to patient care. Take for example the case of Danielle Manley, a teenager who was left wheelchair-bound and needing morphine as a result of severe arthritis. Standard treatment options had been exhausted, but Danielle opted to take part in a clinical research study to test the use of the drug tocilizumab as a treatment for Systemic Juvenile Idiopathic Arthritis. As a result she has now been able to leave the wheelchair behind and live a normal life. Other patients on the study had similarly positive outcomes. The research study showed that after one year of taking the new treatment, 89 per cent of patients achieved a 70 per cent improvement, making a huge difference to their lives.

In recent years, our ability to carry out studies such as the one just mentioned, has dramatically improved. In large part this is due to the fact that the NHS is now in better shape to conduct clinical research than it has ever been before. Whereas, in the past, research was largely confined to the large teaching hospitals, now it is widespread with 99 per cent of NHS Trusts conducting studies. This is a huge achievement, and it has come about because of the investment government has made in the infrastructure for research in the NHS. Through the National Institute for Health Research Clinical Research Network, NHS Trusts receive funding for more than 10,000 trained research nurses who work on our hospital wards, and in our doctors’ surgeries. These clinical professionals are responsible for identifying patients who may be suitable to take part in particular research studies, as well as carrying out the clinical activities involved in conducting the research itself. It is through the efforts of this research workforce – and other clinicians across the NHS in England – that the research picture for patients has been transformed. Whilst 208,000 patients took part

This is, of course, just one anecdote, but there are similar stories across the whole range of therapy areas about the ability of clinical research to transform treatment, and achieve real benefits for patients. No wonder then that every consumer poll that has ever been conducted on the subject shows that patients are overwhelmingly in favour of clinical research, and want the NHS to keep offering opportunities to participate in high quality studies. INNOVATION IN HEALTHCARE

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NIHR Clinical Research Network in studies back in 2007/8, the figure in 2011/12 had risen to more than 595,000. It is still rising and 2012/13 looks set to be another record-breaking year in terms of patient participation in clinical research studies. So with research enshrined in policy, and demonstrable success both at an organizational level in the NHS, and at an individual level for patients, you may question why anyone could possibly consider clinical research “at risk” as the introduction to this article suggests. The answer lies in the Health and Social Care Act and the opening up of healthcare provision to “any qualified provider”. Clinical Commissioning Groups are tasked with sourcing cost-effective and high quality NHS care from “any qualified provider”, and many have argued that this opens the door to new private sector providers entering the healthcare market and providing services that have traditionally been delivered by NHS hospitals. Of course private sector provision of care is not new. A number of treatment services are already delivered by private sector providers, but many commentators have suggested that the Act opens the door to new providers on an altogether bigger scale. In terms of clinical research, this raises a number of questions: what level of interest will new or private sector providers have in conducting clinical research studies? Will they want to confine their activities to provision of the contracted treatment alone, or will they buy-in to the idea that they should also participate in clinical studies in order to contribute to improving treatments for the future – even if those treatments may turn out to be different from the ones they provide? Will new healthcare providers consent to participate in research if they are not obliged to do so as part of their contractual arrangements? And are CCGs (who have a statutory duty to promote and support research) aware of these issues and working to ensure that their commissioning decisions protect the research infrastructure that has been so 42

carefully built up in the NHS over the last decade? The questions can’t yet be answered, but there hopeful signs that forward-thinking CCGs are starting to engage with the debate. And there practical things that CCGs can do to ensure that clinical research continues to be a part of day-to-day healthcare operations – regardless of who is carrying out the treatment. One way is to ensure that new service specifications and procurement documents include an active engagement in clinical research activity as part of their requirements. This would then oblige providers of NHS services to take part in research studies so that we can continue to gather the evidence necessary for improving the service overall. A more lasting solution will be for research to feature in the standard NHS Contract, and there are moves to look at this for the future, but CCGs can affect the present meantime by looking at their own procurement routes. The benefits of doing so could be great – not only to patients, but on the public purse. In 2010/11, the

Kent and Medway Cancer Research Network looked at the cost of delivering research across its whole geographical area, set against the savings made as a result of that research activity. It found that the “excess treatment costs” involved in carrying out research was £138k, but that the research generated cost savings of £540k – an overall saving to that local health economy of £400k or £15k+ per trial. This is no isolated example, and the economic arguments for keeping a strong research culture speak for themselves. It is still early days for the “new” NHS, and it will take time for CCGs and Commissioning Support Units to embrace the complexities of their remit. Nonetheless, for the sake of the half a million patients who have participated in clinical research, and the millions more who will benefit from the treatments shaped by studies, research should not be forgotten amongst the many responsibilities that CCGs now face. My hope is that we can start a constructive dialogue between CCGs and the research delivery community, so we can understand how to work better together for the good of the NHS, and for patients.

For more information on the NIHR Clinical Research Network, visit: www.crncc.nihr.ac.uk To view an online presentation on the role of CCGs and research visit: www.bit.ly/crnbrighttalkccgs

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A collaborative approach to Strategic Estate Planning: The Urgent Care Centre at Widnes Health Care Resource Centre

To reduce the pressure on the acute sector, Clinical Commissioning Groups (CCGs) have been tasked with cutting Accident and Emergency admissions by 15 per cent over five years. The redevelopment of the Health Care Resource Centre at Widnes in Halton, which is currently in the design phase, will do just that, improving patient care and saving the health system £150,000 a year in the process. The project is the result of carefully considered strategic estate planning and a close collaboration between Halton CCG, Halton Borough Council, Renova Developments Ltd (the LIFT Company covering St Helens, Knowsley and Warrington), Community Health Partnerships and NHS Property Services.

The local picture Widnes Health Care Resource Centre (HCRC) had been identified by the CCG as a key site to support commissioning plans in Halton. With the closest Accident and Emergency department eight miles away and one of the lowest levels of car ownership in the country, the redevelopment of the centre to create the new Urgent Care Centre will answer the need for a real primary care-facing alternative to A&E, while also integrating services like mental health, providing wellbeing services, social activities and opportunities for evidence-based brief interventions. The centre, which has been open for about eight years on a 25-year lease, is a busy building that is popular with patients. However, the site had lots of available capacity so the CCG wanted to put more services in there, get best value and use it to its full potential.

A clear vision Over the last year, the CCG and Renova have worked hard to establish a collaborative approach and a strong working relationship. Together they have developed an estate plan for Halton, overlaying the NHS and Halton Borough Council plans. These also allow the CCG to meet the public drive priorities and fit with the CCG’s drive to improve health and wellbeing in the area. Dave Sweeney, Director of Transformation at NHS Halton CCG and Halton Borough Council, is responsible for driving the project forward: “We had the opportunity to reduce unwanted NHS estate, reconfigure the remaining space and improve patient care, and that just made perfect sense to me. We came together very quickly, set our stall out and established our joint vision.” The thinking behind the development of the centre is very clear, as Damian Nolan, Commissioning Lead for Urgent Care Services at NHS Halton CCG, says:

A clear goal, but a complex development, as Dr Neil Martin, a GP Principal and the Clinical Lead for Urgent Care for NHS Halton CCG, explains: “This development has been complicated by the fact that the population of Halton is split into two towns, separated by the River Mersey and with differing identities. Following a period of consultation with the public, it became clear that there is a need to provide an Urgent Care Centre in both towns. “In order to do this we have had to work closely with a number of providers, including Warrington & Halton Hospitals NHS Foundation Trust, St Helens & Knowsley NHS Trust, Bridgewater Community Healthcare NHS Trust, Halton Borough Council and Unplanned Care 24. “This has been a challenging but fruitful exercise so far. We have had to keep a balance between providing a good level of service in both centres, but not replicating some services that would be better provided in one Centre of Excellence.”

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Plans for a 21st century health hub Truly meeting local need is only possible through collaboration and sharing information. Nicola Goodwin, Community Development Manager at Halton Borough Council, explains the role played by the local authority: “Halton has been developing and strengthening collaborative working to support an integrated approach to health and wellbeing in the borough. In doing so we developed Health & Wellbeing profiles bringing together demographic data, public health data, performance indicators and local intelligence in a single document for each of the borough’s seven Area Forum areas. These documents provide a broad context of information, from grass roots activity to local positioning with national indicators to provide a contextual document for each ward in the borough.” The redevelopment is being implemented in phases, with the first new facilities due to be up and running in autumn 2014. The top floor of the building was previously home to 25 administration rooms and offices. These were underused and inefficient, so the plans include returning them to clinical use with sinks and beds, which provides the best value accommodation and responds directly to need.

Planned work at the site also includes: • A single new reception and waiting room, consolidating the previous six spread throughout the building • New X-ray facilities with leaded rooms • Imaging and ultrasound facilities • Diagnostics and an on-site pharmacy • Widening doors and corridors to accommodate trolleys • Children’s areas with soft play equipment In addition, the space has been redesigned so it adapts to future needs. Mike Hill is Head of Technical and New Projects at NHS Property Services in Merseyside: “We have been in consultation with people who use the building to ensure everything we do makes it better. The CCG wanted X-ray equipment on-site and diagnostics but the rest of the space has been made to be multifunctional, so it can be used by different services, providers and organisations and can continue to be flexible and usable as needs change.”

LIFT Company, Renova, opened my eyes to how we could integrate commissioning with estate planning and delivery to ensure our estate is used in the most efficient way, isn’t a drain on resources, and actually improves patient care.” Becky Caffrey, General Manager at Renova, is responsible for delivering the project on the ground. She supports Dave’s view, saying it would not have been possible without the integrated approach: “Estates are often seen as something that will stop change from happening, but it’s essential to use the estate as an enabler to commissioning plans. It’s costly so it needs to contribute. It’s about combating unnecessary costs and maximising the value.”

Delivering real savings and service improvements The projected impact of the development is impressive. Evidence suggests that by offering these services locally, along with a robust marketing plan to encourage local people to use them, the Urgent Care Centre will help deliver:

Bringing commissioning and estates together

• £150,000 savings to the health system annually

So what’s made these ambitious plans possible? Dave Sweeney is convinced that the strategic use of NHS estate from a commissioning perspective has long been overlooked:

• 15% reduction in A&E attendances over five years

“In Halton, we were heading down the same old road until a presentation from the

• 15% reduction in non-elective admissions through A&E • 23% reduction in A&E attendances over time

“

Estates are often seen as something that will stop change from happening, but it’s essential to use the estate as an enabler to commissioning plans. It’s costly so it needs to contribute.

”

Becky Caffrey, General Manager, Renova Developments Ltd

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The keys to success

“

”

Dave Sweeney, Director of Transformation, NHS Halton CCG and Halton Borough Council

Many are convinced that the future success of CCGs will be based on taking a broader view of the wider benefits of estate planning. “Good relationships are key to this. Forget old school commissioning and think ‘fizzy’ people – put the best people in the room and let them get on with it,” says Dave Sweeney. “We have challenged all the providers of primary, community and secondary health services to work collectively to achieve this project in a time of change and uncertainty,” adds Damian Nolan. “And they are rising to the challenge, creating networks of collaboration and producing innovative ways of working, to get this centre up and running.” Community Health Partnerships (CHP) is providing important links with the NHS and other public services, helping to create the conditions needed for successful estate planning with the aim of reshaping the community and primary care estate to support commissioners’ needs and deliver better value to the NHS and its partners. Mike Chambers is Area Director for CHP in the North West: “We’re well known on the patch and provide that bridge between public and private sectors,” he says. “Rather than implementing plans from above, our partners rely on us to lead from alongside them. In Halton, success is down to

energy and enthusiasm of the CCG. We have a local authority that is naturally collaborative, and a LIFT Company with a great track record. Trust and co-operation are earned and those are the ingredients that give real cause for optimism, because the resulting projects are ‘owned’ by local organisations and local people.” Of course, good relationships result in other benefits too. Renova’s local networks have allowed Becky Caffrey and her team to realise cost efficiencies by securing the best, mainly local, contractors at the most competitive rates. “It’s been a challenging project,” she says. “But there’s a real drive and a belief that this is the best thing for the local economy.” And for local people. “The aim of the redevelopment of urgent care in Halton is to bring the management of urgent care closer to patients homes, in an appropriate safe setting and in a timely manner,” says Dr Neil Martin. “Patients will benefit from the knowledge that when they are ill, they do not need to travel outside the Borough of Halton in order to receive an excellent level of care.”

“Halton is an area where there’s a real need. People are recognising that things will be better when we work together,” says CHP Area Director, Mike Chambers. “Merseyside as a wider area is setting the pace in linking strategic planning with the provision of estate and infrastructure. The Merseyside Property Partnership (MPP) has completed an assessment of the estates capacity to serve current and anticipated needs. “Approaches have been modelled in each of the CCG areas to get the best out of existing estates provision both now and in the future, and to support scenarios that may see services being routinely delivered for longer hours, on more days from local facilities. The MPP brings CCGs together with NHS Property Services, CHP and the LIFT Companies to develop plans and deliver savings in both CCG localities and the wider area. “In the case of Halton, I’m sure the energy, shared commitment and combined expertise will get us there.” For more information visit www.communityhealthpartnerships.co.uk.

The first wave of work on the Urgent Care Centre at Widnes Health Care Resource Centre is on track to be complete in autumn 2014 and the process is also underway for the centre to hopefully become the first NICE (National Institute for Health and Care Excellence) accredited centre. INNOVATION IN HEALTHCARE

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Key players

NHS Halton CCG and Halton Borough Council

Community Health Partnerships Mike Chambers, Area Director, North West

Dave Sweeney, Director of Transformation for NHS Halton CCG and Halton Borough Council Damian Nolan, Commissioner of Urgent Care Services Dr Neil Martin, GP Principal and Clinical Lead for Urgent Care Halton CCG is made up of representatives from each of the 17 practices across Runcorn and Widnes and is responsible for planning NHS services across the borough.

www.haltonccg.nhs.uk

Renova Developments Ltd LIFT Company Becky Caffrey, General Manager Renova is an awardwinning development company that specialises in providing primary care and community facilities. www.renovadevelopments.co.uk

Halton Borough Council Nicola Goodwin, Community Development Manager

The Urgent Care Centre at Widnes HCRC • 4,016m2 • 180 people use the centre every day, plans will double that • £800,000 investment • £150,000 savings to the health system annually • 15% reduction in A&E attendances • 15% reduction in nonelective admissions through A&E • 35% reduction in A&E attendances over time

NHS Property Services (Merseyside) Mike Hill, Head of Technical and New Projects www.property.nhs.uk

Halton is the local borough council covering Runcorn and Widnes. www3.halton.gov.uk

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mapofmedicine.com

Map of Medicine: standardising referral activity Addressing the challenges of the referrals process

Map of Medicine has worked extensively with clinicians and managers in the NHS to develop a tool that solves the challenges presented during the referrals process. The result is a product which clinicians understand and value, enabling care to be delivered in the right setting, first time. Map Referrals optimises the existing Map of Medicine software by linking the clinical and administrative sides of healthcare referrals. For the GP’s clinical role, Map Referrals provides access to locally relevant referral guidance to determine the most appropriate route for the patient. Variations in care are reduced as GPs work to the same locally tailored guidelines. Commissioners can rest assured that their GPs are delivering quality care, while reducing delivery costs associated with inappropriate referrals. Using the Map Referrals system, the GP saves a significant amount of time, releasing capacity to spend engaging with and caring for the patient. Giving GPs the right information and support at the point of care The entire system is available at the point of care, integrated into EMIS Web, INPS Vision and TPP SystmOne, which means that the clinical workflow is seamless and efficient. The administrative benefit comes from all practice staff having access to stand¬ardised referral

form templates, which are updated centrally across a CCG. In one click, these referral forms are opened and auto-populated with the patient’s demographic and clinical information, eliminating errors. A local directory of services ensures that patients are referred to the appropriate providers of care, first time, reducing needless and expensive bounce backs. Commissioners can also use Map Referrals to monitor local performance by tracking the volume and cost of individual GP referrals. Simplifying the referrals decisionmaking environment Map Referrals allows the GP to consider the patient’s symptoms, views and medical history, using their own experience. Having instant access to the relevant care pathway and up-todate referral criteria makes it easier to involve the patient in decisions about their care. All the information can be collated during the consultation if required and recorded in the patient’s record, ready for referral immedi¬ately, or later. With Map Referrals, GPs also have the confidence that a local team of clinicians has adapted evidence-based guidance to meet rec-ommended local best practice, evolving the referrals process from decisions taken in isolation to a team function.

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mapofmedicine.com

“

GPs also have the confidence that a local team of clinicians has adapted evidence-based guidance

Understanding how referral activity can be improved Map Referrals’ comprehensive reporting func¬tionality provides CCG leads with the ability to monitor referral activity by practice, by condi¬tion and by cost. It helps to identify areas where problems, such as unnecessary variation, may potentially be occurring, or indeed where referrals are being managed well, and in line with local and national policies, initiatives and demographic data. This information proves invaluable in training GPs to adopt better referral practices, and Map Referrals also supports peer review. Map of Medicine’s expertise Map of Medicine has been working with the NHS for over ten years. Throughout this time we have become experts at developing products with clinicians that solve their front-line problems. This expertise stretches beyond product development into full support for the product roll-out. Our team will work with your CCG to install Map Referrals across your locality. We invest the time to train clinicians and practice managers to use the technology and are on call should anyone encounter any problems. This ensures that a CCG can be up and running in just three months. Rapid deployment, coupled with extensive training ensures a rapid rate of return on investment.

For more information on how Map of Medicine can support your CCG, please contact richard@mapofmedicine.com

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Coming together for integration Health+Care returns to Excel London on 25 - 26 June 2014, with more than 7,000 professionals gathering from all over the country to take part in the UK’s largest social and primary care conference. Essential for all those interested in the integrated care agenda, it includes 14 theatres of world class conference programmes covering integrated care, public health, care commissioning and residential and home care

This must-attend event brings together those involved in care provision with delegates from both commissioning and providing organisations to network and share ideas to improve the quality of care. With more than 300 speakers involved in live debates, case study discussions and keynote sessions, the event will give delegates everything from organisational development and governance advice to new approaches to commissioning for patients with multiple long-term conditions – and everything in-between.

professionals, but you do need to register in advance at www.healthpluscare.co.uk.

Health+Care is the only event to bring together the entire health and social care sector on a major scale, making the event your best shared learning and networking opportunity.

Integrated care The integrated care theatre will feature keynote speeches and interactive debate, bringing you head-to-head with the most influential politicians, leaders, innovators and implementers across health and social care, including the Rt Hon. Norman Lamb, the Rt Hon. Stephen Dorrell, the Rt Hon. Andy Burnham and Lord Victor Adebowale. We will showcase early results from the Integration Pioneers and discuss how this innovation can be spread at scale and pace.

In addition to the 14 theatres of content, there will be two Commissioning Support Theatres, a Public Health conference and a centralised hub for technology - Technology First. There are over 400 exhibitors at this year’s show making it the biggest sourcing floor in primary care. This is a great opportunity for networking and sourcing projects more efficiently as you have the chance to see all the key players in one place, including Taylor Dolman, Mears Group, Lundbeck and Optalis. Complimentary delegate passes are available for NHS, public sector and qualified health

Speaking about last year’s show, Stephen Dorrell MP, Chair of the House of Commons Health Select Committee, said: “What’s important about this conference is that it brings together the CCGs, the NHS and the social care world. It gives people an opportunity to think about these problems outside the traditional silos. Until we start doing that the rhetoric about integration will remain just that.”

Other key topics will include: maximising the impact of the Better Care Fund; whole-system transformation of out-of-hospital care; Labour’s proposals for health and social care and the future role of Health and Wellbeing Boards; achieving – and measuring – parity of esteem for mental health, overcoming system fragmentation to tackle public

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health timebombs, such as obesity and alcohol dependency; pricing to incentivise innovation and improvement, the role of regulation as a quality driver and NHS England’s newly formed Citizen’s Assembly will debate how patients’ can secure their place in the heart of the NHS. Highlights include: • the Better Care Fund – is it better for all?; • unleashing the power of people and technology on the NHS; and • parity of esteem in mental health – are we hotter or colder. Public health and wellbeing Health inequalities continue to blight the UK despite our relative affluence. We’ve lagged behind our European counterparts when it comes to key public health indicators, such premature deaths under the age of 75 and on levels of lung and liver disease. Poor lifestyles persist in many areas of the country and obesity levels continue to rise. The government has sought to radically reform the public health system through the Health and Social Care Act - seeking a more pre-emptive, locally determined approach, with responsibility for public health passing to local authorities and Public Health England. The Public Health stream within Health+Care will bring together public health delegates, GPs,

CCG leads, directors from local government, social care and providers to share ideas and experiences. In particular, it will bring together the key players on Health and Wellbeing Boards from all around the country to share live case studies and examine how to improve health outcomes. Highlights include: • are local authorities embracing a broader public health culture?; • integrating public health, health and social care – lessons from Sweden; and • integrated health and care personal budgets – early leaning; Care commissioning It’s nearly ten years since the implementation of Every Child Matters, which brought children’s services and education together to improve outcomes and safety. But, with mounting financial pressures, times have changed. The future of working with families is uncertain, and there’s a new set of challenges for senior directors and commissioners alike. The care commissioning stream at Health+Care will share ‘live’ case studies delivering innovative, proven and child-centred solutions in the most complex and challenging situations. Speakers will offer practical cost saving ideas for driving

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efficiencies; leading edge projects on putting the service user at the centre of design and improving performance; the latest research and evidence from the academic world, and updates on policy developments and political thinking. There will also be a particular focus on commissioning and contracting issues - how to develop better understanding, long-term planning and sustainable funding and services. Highlights include: • delivering improved outcomes for children and financial savings with better joint commissioning; • strategic transformation of services through evidence based commissioning; and • harnessing the strengths of the community sector in supporting children and families. Residential care There’s a revolution going on in primary and social care. Policy makers want the system to take a ‘whole population’ approach to improving public health and wellbeing and act against the escalation of health and social care needs.as part of this, the Government is seeking a more preventative approach that keeps people in their own homes and, if things go wrong, rapidly rehabilitates them. However, the residential care sector continues to grow with over 21,000 registered care and nursing homes and more than 500,000 residents.

Set against policy drivers and funding constraints are the growing number of vulnerable older and disabled people with complex, long-term conditions and significant support needs. There’s a growing realisation that the UK needs a diverse, high quality care sector that can meet these needs and residential care remains an important part of that. The residential care stream at Health+Care will help delegates to improve the efficiency of their businesses and effectiveness of their care. There will be presentations on business and financial planning, continuity and risk, management and training, and guidance on business development, marketing strategy, and tendering and contract management. Furthermore, this stream will bring together leading organisations that are working with commissioners to transform the sector’s role, offering vital services that balance cost, quality, choice and value-for-money. Delegates will have the opportunity to learn from the trailblazers, and develop the hallmarks of successful, personalised residential care. Highlights include: • the future of residential care; • golden rules for profitable care businesses – the KPIs that count; and • driving innovation in dementia care.

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Home care There are over 6 million hours of regulated home care delivered every week in England and the total home care market is valued at £5.5bn, with public expenditure making up £2.2bn of this. With an ageing and more affluent population, this demand for domiciliary care in its many different forms is set to increase, particularly among self-funders. At the heart of the government’s recent Health and Social Care Act is a drive towards personalised services that promote user control and dignity and enable people to stay in their own homes and communities. But, despite the potential, the challenges to delivering high quality home care services are considerable. It’s a low profile sector, and fees have been slashed as local authority budgets have been squeezed. The home care speaker stream at Health+Care offers delegates advice on how to run, and develop, home care agencies in this evolving market. At a strategic level, experts will offer insight into market trends following the government’s Care and Support Bill and the Health Act. But, at a more practical level, high value advice will be presented on effective business and financial planning, business continuity and risk, effective leadership and management, and workforce development. Furthermore, there will be guidance on sourcing investment for business development, marketing strategy, and best practice on tendering. The home care stream will bring commissioners and providers together to discuss the evolution of domiciliary service provision, and how agencies can make the most of the new opportunities. Highlights include: • raising quality in challenging times; • improving dementia in the home care setting; and • what does personalisation look like in home care?

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Outcomes based commissioning: the health sectorâ&#x20AC;&#x2122;s new hope? Outcomes based commissioning is undoubtedly gathering momentum in the health sector and indications are that it can produce the NHS we want, and deserve, more effectively than the old block contract and tariff systems. But we are still some way from understanding what linking contracts to outcomes might involve. Are we prepared, for example, for the outcomes that patients think are important when these diverge from the views of clinicians, regulators and politicians? How do we find out what patients really want and are we asking the right questions of the right people? And is the â&#x20AC;&#x2DC;lead/prime/accountable providerâ&#x20AC;&#x2122; model the right one to deliver the outcomes we want? In the past our health sector commissioning and contracting has tended to focus on input activities; the number of contacts with patients, whether waiting times are met, the number of admissions and the hours of services. Although many of these things are important, they do not answer the most meaningful question of all, which is what is achieved for service users. Outcome based commissioning can be interpreted in a variety of ways, but in its simplest interpretation it may for example replace a block contract to provide 2,000 hip replacements a year with a contract to deliver an agreed level of hip mobility for a defined population in the region, ensuring people are mobile and not in pain. Hip replacements might be the right answer in some cases, but probably in fewer cases than before, and most importantly that decision is directed much more by the outcomes that the patient is seeking. It can of course be much harder to determine and measure the result of the support or intervention, rather than the intervention itself. Outcomes can require change (a reduction in fat, salt and sugar

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consumption, for example) or maintenance, for example to enable someone to continue living at home despite dementia. They can be individual, apply to specific populations (pregnant women, people with high blood pressure) or the local population as a whole. You can begin to see, already, how the conflict between patient and clinician desired outcomes might arise. A clinician may see a hip replacement as a clear, distinct intervention to deliver an immediate benefit. But to a patient, often frail and elderly and their family and carers, the risk of an operation and the long recovery period may not be a better option than good outpatient care, intensive physiotherapy, and effective pain management. When you genuinely consider what patients look for in the care they receive the answers are sometimes surprising. For example we hear examples of commissioners seeking to have the highest cancer survival rates in Europe, and nobody could argue that that’s not highly admirable objective. But, when you ask cancer patients what they want survival rates are rarely mentioned. Instead, they talk about dignity, quality of care, better information, better communication, good pain management, that most humdrum of things, convenience and recognition they still have lives to live while they are being treated. One young, single mother with breast cancer said “It’s like they imagine I have nothing going on in my life but the cancer and treatment for the cancer. But I have kids and a job, too.” And clinicians tell us that even when they recommend referring some patients to the more distant oncology department with the better survival rates, patients still frequently opted for the local hospital where they felt better treated and which was more convenient. Outcomes based commissioning was originally introduced to the NHS in 2004, via GP practices. Aiming to generate front-line clinical engagement with the commissioning process it was designed to complement patient choice of provider, payment by results of provider, and the roll-out of foundation trust status. GPs were provided with an indicative budget with which to commission services for their

patients. It was expected that individual practices or consortia would redesign services to provide better experiences for patients as well as save money, and money saved would then be available for practices, or consortia, to invest in improved patient services. In reality, as the risk is now, services were very often designed around the need to meet targets or what was considered best practice by clinicians. The 2010 White Paper on healthcare and GP commissioning outlined how the current regime would be replaced by frameworks for outcomes covering the NHS, public health and social care, with local authorities given the responsibility to determine how best to secure local objectives. Outcome based commissioning, with an accompanying emphasis on individual choice, is now to be the focus for future social care commissioning across all relevant sectors. Outcomes are perceived as more difficult to measure and monitor in some areas of health. A hip replacement is a tangible intervention with a measurable benefit, whereas an individual being mobile and pain free far more subjective. Emphasis in some areas on inputs, processes and outcomes may afford outcomes a lower priority. Recent changes and the new approach to commissioning signalled in the 2010 White Paper will continue the development of an outcomes focus in health and social care, although there will always be a need for some outcome and process monitoring, as they are likely to be part of the measures needed to manage performance. Service users may be able to help with measuring outcomes and their role will be more central to evaluation and management in future, so systems for their contribution need to be in place. So the outcomes that patients care about are going to challenge the NHS. But first we need to know what those outcomes are and to ensure that we’re asking the right patient groups in order to inform that process. Increasingly users of the NHS are defined in terms of groups such as non users, frequent users and chronic users. In the first group are the healthy, often younger people who rarely use primary and secondary care services, and usually only for relatively minor

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ailments. Frequent users will include those with long term conditions, like diabetes or high blood pressure who need the services of a GP more often but who will require more specialist support if their condition is not properly managed. Finally there are the users requiring the most complex care – often elderly, and people with serious conditions. So when looking at outcomes it makes sense, perhaps, to design around the needs of those requiring complex care, users with long term conditions, and general, preventative healthcare advice around those who make little use of the NHS. But for this to be effective we must establish what outcomes patients require, so that can be factored into the outcomes to be commissioned and compared, if necessary, with the desired clinical outcomes. One of the methods Capita uses to capture what those outcomes might be is user-centred service design. In a recent exercise for a Trust’s musculoskeletal services we engaged with a cross-section of patients and health professionals in the Trust’s region, including people with a range of conditions, GPs, physiotherapists and consultant surgeons. The first phase of activity focused on understanding the problems that people face in using and delivering the service. It consisted of focus groups and one-to-one interviews, and resulted in a catalogue of peoplefocused requirements and a pair of patient personas - fictional individuals based on a conglomeration of real insights - to provide a coherent focus for our solution development. The second phase used co-design workshops and further one-to-one interviews to collaboratively develop and test a solution in partnership with people who will be receiving and providing care within it. Effectively transforming the experience of people affected by a condition requires an approach that first establishes a clear and detailed understanding of who these people are, and then collaborates with them to develop a service that truly meets their varied needs. Once it is clear what patients want, and therefore what outcomes might be appropriate, it will be necessary to test this against clinical, regulatory and local, political

will. It is easy to see how patient wishes might cause conflict and commissioners will not be able to please all interested parties at all times. This tension will be increasingly tested when innovative ideas to dealing with burgeoning health challenges such as dementia continue to emerge. But, when the work in establishing and agreeing outcomes is complete, we then come to the practical question of how best to deliver it. The lead/prime/ accountable provider model is becoming seen as a way forward, drawing on the accountable lead provider models applied successfully in the US. There is much we can learn from it, but can it be lifted ‘lock, stock and barrel’ in to an NHS context. I’d argue not. There are a number of challenges, one being the difficulty of finding any single organisation that is both able to carry the financial risk associated with being a lead provider whilst also being acceptable to patients, the public and other local providers. Is that an impasse? Not really. There are other models used successfully in other sectors in the UK, bringing public and private providers together in partnership, and based on these it seems possible to find an adaption of the US models that works well for the NHS, and more importantly, patients. A partnership approach can cut across many of the issues surrounding lead contractor models. The commercial partner can bring financial discipline, efficiency, experience of delivering customer (patient) contact management and customer (patient) journey management in similar sectors (like local government or private healthcare) and innovations, like user based service design. The NHS provider can bring clinical excellence and rigour, experience and understanding of the local health economy. The partnership can also involve the voluntary sector – particularly in terms of health advice and help in managing long term conditions, like arthritis, diabetes and age-related conditions. If this all this sounds like a headache of planning and preparation then that’s because it is. Listening to what patients want can be quite surprising. And if you give them what they want the results may surprise you. Neil Griffiths, Health Market Director, Capita

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Pharmacy Voice

Dispensing Health on the High Street Prof Robert Darracott, Chief Executive of Pharmacy Voice

Our National Health Service is facing financial challenges as never before, with predicted funding gaps of £30 billion over the next few years. Community pharmacy’s established and accessible services are an ideal mechanism for delivering high quality and relatively low cost health and wellbeing services, which will help the NHS achieve efficiency savings without compromising on patient care. Community pharmacy has a unique combination of strengths: accessible medicines expertise; a bricks and mortar network of premises close to where people live, work and shop; entrepreneurial spirit; a reach into deprived communities; and a willingness to dispense health, not just medicines. Community pharmacists are the most accessible primary care professionals, available without appointment, reaching out to people who might not want to visit their GP or a clinic but are in need of advice and support from a healthcare professional. With around 1.2 million people visiting over 11,500 pharmacies in England every day for health-related reasons, there are nearly half a billion opportunities each year to engage the public about their health and wellbeing.

However, research commissioned by Pharmacy Voice revealed a huge lack of public understanding and awareness of the skills and capabilities of the community pharmacy team. Less than half of the adult population know that community pharmacists can advise on common ailments, and only a third know that the community pharmacy teams can advise on healthy living. Dispensing Health, a major communications and engagement campaign from Pharmacy Voice, is intended to help dramatically reduce the spiralling and unsustainable demand on general practice, and our A&E departments, by actively promoting community pharmacy as an effective alternative to these NHS services. It is also highlighting the many ways community pharmacy is supporting public health initiatives such as reducing smoking rates. First call for common ailments The on-going A&E crisis has been attributed in part to the difficulties some patients experience when accessing GP services – particularly out of hours – combined with patients attending A&E with common

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Pharmacy Voice

ailments that could be treated in primary care. Research suggests that 8% of A&E attendances could be managed in community pharmacy, equating to approximately 1.5 million visits annually. These common ailments also account for one fifth of GP workload, incurring an annual cost to the NHS of £2billlion. Making the most of medicines As experts in medicines, pharmacists – supported by a new regulated profession, pharmacy technicians – are best placed to help people get the maximum benefit from them. However, research commissioned by Pharmacy Voice found that less than half of those surveyed knew community pharmacy could help with medicine management and advise on their proper use. Clearly there is a need to inform the public of the knowledge and expertise that exist in community pharmacy. Avoidable medicines wastage in primary care through non-adherence, changes in prescribing and changes in the patient’s condition is estimated to cost £150 million annually. Not taking medicines correctly has serious consequences for patient outcomes, and studies have found that between 1.4% and 15.4% of hospital admissions were drug related and preventable; the commonest causes being prescribing and monitoring problems (53%) and non-adherence (33%). Medicines Use Reviews (MURs), can help identify any problems people are experiencing with their medicines, and the pharmacist can suggest ways to address these problems. Improving how people take their medicines will reduce wastage but more importantly ensure that patients gain the maximum benefit from their prescribed medicines. Between April 2012 and March 2013 community pharmacists carried out over 2.8 million MURs. Supporting long-term conditions We know that patients with several long-term conditions have a poorer quality of life, poorer experience of care, poorer clinical outcomes, have longer hospital stays, have more post-operative complications and require significantly more health service resources. The treatment of long-term conditions is estimated to account for £7 in every

£10 of health and social care spending in England, and the number of people affected is expected to rise by 25% over the next 20 years so the future sustainability of the NHS will be closely allied with how it manages patients with long-term conditions. Community pharmacists and their teams have the knowledge and skills to work collaboratively with GPs to support the 15 million people in England who live with a long-term condition to remain healthy and independent, with greater choice and control over their own care. Gateway to good health The public health challenges of obesity, sexual health, alcohol use and smoking-related illness, combined with an ageing population will increase the cost of healthcare by an estimated £1.4 billion a year. Since April 2013 responsibility and funding for public health transferred from the NHS to local authorities, who now have responsibility for commissioning public health services as part of their duty to take steps to improve the health of people in their area. In the community where 99% of the population – even those living in the most deprived areas – can get to a pharmacy within 20 minutes by car, and 96% by walking or using public transport, the community pharmacy network is an easily accessible gateway to good health. Community pharmacy has proved its value as a public health resource with many community pharmacies providing a range of public health information and advice on smoking, sexual health, weight management and substance misuse. A key factor in the success of the Dispensing Health launch was the support from a broad range of organisations across health and primary care – including the NHS Alliance, Royal College of General Practitioners, and National Association of Primary Care. Over the next two years Pharmacy Voice will be strengthening its links at a local and national level with primary care, community care organisations and commissioners. It will be engaging more fully with patients and the public to get a better understanding of what services community pharmacy could and should be commissioned to deliver care for patients and better value for the NHS.

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The largest ever gathering of clinical commissioners is upon us

The Commissioning Show returns to the Excel London on 25 - 26 June. This is a must attend event for anyone involved in commissioning or integration projects, or if you are looking for updates on practice business and managing long-term conditions. More than 7,000 professionals will gather from all over the country for 14 theatres of world class conference programmes, which includes dedicated CCG Business, Integrated Care and Your Practice streams. Over 300 speakers will deliver legislation and policy updates, live debates, case studies and keynote sessions that will give delegates everything from organisational development and governance advice, new approaches to commissioning services for patients with multiple long-term conditions and everything in-between.

There are over 400 exhibitors at this year’s show making it the biggest sourcing floor in primary care. This is a great opportunity for networking and sourcing projects more efficiently as you have the chance to see all the key players in one place, including DAC Beachcroft, Bayer, MSD and First Data Bank. Tickets are free for NHS and local authority teams, but you do need to register in advance at www. thecommissioningshow.co.uk Speaking about last year’s show, Andy Burham MP and Shadow Health Secretary said:

Commissioning is the only event to bring together the entire health and social care sector on a major scale, making the event your best shared learning and networking opportunity.

“It’s essential that people involved in commissioning come to a conference like this because otherwise they can end up just ploughing away in their furrows on their own. That can be quite dispiriting and can make people think that they are the only person in this boat and the only person facing this challenge.”

In addition to the 14 theatres of content, there will be two Commissioning Support Theatres, a Public Health conference and a centralised hub for technology Technology First.

Your Practice The Your Practice stream provides highly practical updates for GPs and practice managers on finance, regulation, contract, workforce and policy matters

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Integrated Care This theatre will feature keynote speeches and interactive debates, bringing you head-to-head with the most influential politicians, leaders, innovators and implementers across health and social care, including the Rt Hon. Norman Lamb, the Rt Hon. Stephen Dorrell, the Rt Hon. Andy Burnham and Lord Victor Adebowale. It will showcase early results from the Integration Pioneers and discuss how this innovation can be spread at scale and pace. Key topics will include: • Maximising the impact of the Better Care Fund; • Whole-system transformation of out-of-hospital care; • Labour’s proposals for health and social care and the future role of Health and Wellbeing Boards; • Achieving – and measuring - parity of esteem for mental health. The next six months will be critical for bringing together plans for formulating how the Better Care Fund (BCF) will transform the lives of those who use health and social care services, says Alan Lotinga, Service Director Health and Wellbeing Directorate for People Birmingham City Council and a keynote speaker at the Commissioning Show in a debate on: “The Better Care Fund – is it better for all?”. Alan says: “The Better Care Fund is a positive development and we should not just talk about the money but make sure we focus on talking about people and achieving better outcomes for them – we shouldn’t forget that. However it is a five year process and we have to balance the books in the meantime,”

of direct relevance to you, your practice and patients. Topics covered will include: implementing the 2014/15 contract and its impact on your practice, including reduction in the QOF, phasing out of MPIG and the commitment of GPs to be responsible for named patients over 75; the implications of NHS England’s Primary Care Strategy; the challenges around online access and care data; preparing your practice for 8 day working; delivering the new DESs cost-effectively; the new-style CQC inspections; key threats to practice profits; practice-led solutions to the A&E crisis; the practicalities and pitfalls of bidding for provider contracts; and a debate on the pros and cons of new models of primary care. Dr Phil Yates, Chair GP Care, explains why people should attend his discussion on the ‘The practicalities and pitfalls of bidding for provider contracts’: “This is a critical topic as there must be a good process internally for meeting deadlines, demonstrating capability and staying in the process successfully. Much is not known at the time of initiation of a bid and any provider has to learn as much as they are able as the bid progresses. Judgment calls have to be made about entering a

bid – What is the chance of success? What is the risk of financial or service failure from implementing a successful bid? Can the organisation risk losing or, indeed, winning?” Long-term Conditions – The patient’s journey This theatre will follow the journey of a single patient with multiple long-term conditions through the NHS from the point of diagnosis to end of life. We will analyse his life-time cost to the NHS and using case studies relevant to each stage of his journey, we will showcase excellent work and new approaches in the management of long-term conditions that have the potential to change the patient pathway, to drive down costs, reduce demand and improve his quality of life. Highlights include: • From diagnosis to death – the challenge of long-term conditions; • Transforming mental health care for patients with long-term conditions; • Living well, dying well – end of life care for people with long-term conditions.

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Stephen Dorrell MP. Chair of the House of Commons Health Select Committee said: “What’s important about this conference is that it brings together the CCGs, the NHS and the social care world. It gives people an opportunity to think about these problems outside the traditional silos. Until we start doing that the rhetoric about integration will remain just that.”

Dr Carole Kaplan, Transformation Programme Director at Northumberland Tyne and Wear NHS Foundation Trust, explains why ‘Transforming mental health care for patients with long-term conditions’ is such an important topic: “The need to increase efficiency in the NHS whilst simultaneously improving quality is a tremendous challenge, which we believe the implementation of the access system has gone a long way to achieve. There is no possibility of achieving and maintaining this without close working with all our partners and an important aspect is that if we do not improve the pathways that service users follow, including their discharge arrangements, then all we will be creating is a bottleneck somewhere in the system.” CCG Business The theatre will provide highly practical updates; expert advice and case-based solutions that address the main priorities and concerns for CCGs in 2014/15, including : how to survive the impact of the changing funding allocation for CCGs; meeting QIPP and efficiency saving targets; implementing operational and strategic plans; working effectively with NHS England Area Teams and other partners to improve quality in general practice. Highlights include: • Key challenges and opportunities for CCGs in year two; • Tackling the A&E crisis – three high impact solutions commissioned by CCGs; • Tips for procuring excellent commissioning support.

Technology First Launching at this year’s show, Technology First is dedicated to making use of the huge amounts of data generated in the NHS to enable CCG’s to make better and more informed decisions when commissioning healthcare services, with a view to improving efficiency, delivery of service and patient outcomes. There will be an opening address from Kingsley Manning, Chair of the HSCIC, focussing upon the need for better use of data analysis within the Integrated Healthcare system. At the centrepiece of the whole event will be The ‘Big Data’ Showcase, supported by NHS England. This will consist of an entire stream of conference presentations designed to highlight how the use of Data Analysis tools can enable the NHS to correctly interpret the data produced. Health & Wellbeing Boards / Public Health The government has sought to radically reform the public health system through the Health and Social Care Act - seeking a more pre-emptive, locally determined approach. Responsibility for public health has been moved from primary care trusts and strategic health authorities to local authorities and Public Health England, with the government providing councils with three years of ring-fenced budget. The Public Health Conference will bring together the key players on Health and Wellbeing Boards from all around the country to share live case studies and examine how to improve health outcomes. Highlights include: • The role of health and wellbeing boards in building strong and inclusive communities; • The vision for public health interventions and the growing evidence behind them; • Tackling obesity in the new system.

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Find out what weâ&#x20AC;&#x2122;re doing about the future of commissioning...

The future depends on what you do today Mahatma Gandhi

www.southcsu.nhs.uk/future or come and see us on Stand J25 at Commissioning 2014

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