Innovation in Healthcare V7

Bringing new healthcare products and interventions to life

West and South Yorkshire and Bassetlaw Commissioning Support Unit

NHS SLCSU

NHS Property

Match4health

NHS WSYBCSU

Good4Health

Community Health Partnerships

Ordnance Survey

leading provider of telehealth

Telehealth

Innovation in Healthcare

Innovation in Healthcare

Innovation in healthcare

Elephant kiosks

Salix

NHS Staffordshire and Lancashire

ANDROID APP ON

NHS Central Southern

Patient Access

providing innovative telehealth solutions Inno in Healthcare v7 book.indb 1

01/10/2013 15:02

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 “what works� 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

Inno in Healthcare v7 book.indb 1

01/10/2013 15:02

Innovation in Healthcare Hello. Have we met?

We’re Central Southern, and our Not an Option business is in supporting excellence Innovation is no longer an option. It is an urgent priority. Dr Michael Dixon, Chair, NHS Alliance, Interim President, NHS Clinical Commissioners.

is published by:

CLINICAL COMMISSIONING COMMUNICATIONS

We are NHS Central Southern, one of the largest commissioning support units in the country. And we’re proud to be supporting 14 of the most ambitious and driven clinical commissioning groups in England. As you might expect we provide the support, expertise and insight that’s needed to match the determination of our clients: the people who define, structure and ultimately provide healthcare for over 3.7 million people.

•

Driving efficiency in healthcare providers

•

Promoting quality in all healthcare services

•

Helping to run their businesses effectively and efficiently

•

Evidencing everything they do.

When it comes to commissioning health services we know it’s a balancing act. That’s why we’re here to help health commissioners deliver the ambitions they have for patients, pathways, partnership working, QIPP and wellbeing in their area.

Our clients know that their commissioning landscape and the drive towards integration of health and social care services provides a unique opportunity to diagnose, plan and execute whole system change. They have a strategic focus on health outcomes, understand root causes of system failures and recognise the need to work in partnership with local authorities and other providers of care, and recognise the value of planning service changes with greater public and patient involvement. They also know that programmes of work like this may take many years to complete unless previous ways of commissioning are challenged.

Suite 25, Hurlingham Studios, Ranelagh Gardens, London SW6 3PA T: +44 (0) 20 7386 6100 F: +44 (0) 20 7381 8890 E: inbox@mar-media.com

It’s an exciting time for us - we’re supporting clients whose vision and quest for innovation requires us to be flexible, adaptable and open to adventure. We’re working in new ways which means looking at things in different ways too.

Yes we’re technically a young organisation but we’re proud that we have serious NHS mileage on our clock. (After all, it’s that mileage that’s made us who we are). The commitment we have to the enduring values of the NHS is fundamental to our purpose. It is the cornerstone of our values and how we work: •

We listen to our customers so that we can create a solution specific to their needs

•

We invest in our people to ensure they can meet our customers’ expectations of them

•

We invest in services which ‘do the right thing’.

THE CHALLENGE AND THE PROMISE

Publisher

So we love the NHS, but that doesn’t mean we can’t see its imperfections. Evidence abounds regarding increasing national demand, sub

W H ROBINSON Associate Publisher

JULIEN WILDMAN

TRANSFORMING SERVICES FOR PATIENTS AND THE PUBLIC

Hello. Have we met?

project management and contract management.

Our progressive commissioning support capability makes us an essential partner for CCGs as they put in place new models of care.

DRIVING UP EFFICIENCY We know that embedding efficiency in acute care is challenging, particularly as the payment system actively incentivises hospitals to do more work.

It’s not surprising, therefore, that many CCGs are investing in strategies to keep people out of hospital, to reduce acute care costs.

Primary Care Trusts made headway in delivering savings through better contract management, but in the main they moved the deficit from commissioner to provider rather than driving real savings from the health economy. We believe that driving sustainable efficiency out of a health economy is a hard task which takes years, not months, and requires precision planning and intelligent implementation.

6

ted Central Southern, and our business is in supporting excellence.

CommitWe’re Delivering higher standards, greater value and better outcomes for patients and professionals

optimal quality of care, increasing costs and rising public and patient dissatisfaction. In fact we were one of the first commissioning support units to publish a response to the Francis Report.

We’re lucky that our customers have the same high ambitions we have to achieve the critical outcomes of higher quality, improved patient experience and reduced costs of care. We believe that successful commissioners will need excellent support in five key areas: •

We are supporting them to meet this challenge by quickly building upon our core capabilities and investing in new capabilities at the leading edge of commissioning support. Using our world class population profiling and risk stratification tool we can support deeper analysis of demand and improved pathways of care for patients. We use evidence based practice and benchmarking to inform on ‘what works’, and advanced healthcare procurement to shape and manage the future provider market. These forward thinking support services build on our strong foundations in robust data management and integration, programme and

4

So we suggest that the health economy must develop incentives across the provider landscape to engage with commissioners to reduce cost of services. Therefore we are looking to develop health economy-wide incentives supported by innovative contractual arrangements.

But it can’t be delivered in isolation, because a pricing or contractual mechanism won’t sustain change. We think it has to be done alongside pathway design, outcome achievement and quality measures to achieve an integrated commissioning strategy that delivers ‘real’ savings through efficient services.

Six months in

10

Transforming services for patients

Keith Douglas, Managing Director of NHS South CSU talks about how things feel six months in.

Magazine article_v2_270813.indd 2-3

27/08/2013 17:34

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

JUSTIN IVES

.co.uk

E: justindesign.co.uk

© Copyright Maritime Media Ltd CCC Limited is a division of Maritime Media Ltd 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.

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.

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.

COVER PRICE: £5.95 ANDROID APP ON

Making it easier for commissioner and private organisations to work together

12

Huw England, Managing Director of Match4health Ltd, discusses their innovative collaboration with South CSU.

Women leading health

13

Lynne Copp, co-founder of The WorkLife Company and Lay Member of NHS South CSU’s executive team, discusses the upcoming Women Leading Health conference.

Working for change

14

NHS Staffordshire and Lancashire Commissioning Support Unit is one of the largest CSUs in the country and covers Staffordshire, Lancashire, Shropshire and Herefordshire.

Supporting excellence in health and care to improve outcomes for patients

19

At NHS South London Commissioning Support Unit, we are proud to be right behind commissioners who are determined to transform health and healthcare for their patients.

Supporting excellence in health and care to improve outcomes for patients Innovation is part of our DNA For page turning technology visit: innovationinhealthcare.org

We have significant experience of working with commissioners and providers across multiple complex health economies and with almost 600 skilled and dedicated staff, strengthened by our innovative industry partnerships, we are ready to support the transformation of services required by the current climate.

Our service portfolio includes commissioning and business support services to clinical commissioning groups (CCGs) that cover all functional areas of support they require. Our packages of support are flexible to adapt to organisations who may need small and specific areas of input, to customers who have chosen to outsource a majority of the commissioning support they need. Our recent acquisition of a specialist Health Informatics Service advances our NHS customer base and has enabled us to broaden our technical excellence and bring these benefits to all of our customers.

Proven track record of delivering effective telehealth solutions Inno in Healthcare v7 book.indb 1

22

Alison managing director At NHS South Hughes, London Commissioning Support Unit, West and South Yorkshire and we are proud to be right behind whoto help our CCGs to innovate.

Bassetlaw CSU. An commissioners opportunity are determined to transform health and healthcare for their patients.

Working in partnership with our existing NHS customers, we have spent our first year of existence building and refining our services so that we are ready to help them and others deal with the challenges faced by the health and care system today. We have also grown into new geographies and sectors and have a growing reputation as a Commissioning Support Unit that is easy to do business with, as well as good value compared to the competition.

INNOVATION IN HEALTHCARE

1

01/10/2013 15:03

138654 ZEAL M8 Wave Advert A4_Layout 1 23/07/2012 12:06 Page 1

SAVE MONEY - FREE-UP DOCTOR TIME Q “We have saved hundreds of appointments.”

Q “This has been one of the best investments in equipment that we have made in the last 20 years.”

Q “Our practice nurses are now great fans of the monitor and encourage their patients to use it regularly.”

Q “Every surgery should have one.”

Q “Rapid pay-back time.”

WITH THE SURGERY HEALTH POD Automatic Kiosk User Friendly Audio & Visual Instructions Unsupervised Monitoring Reduce Unnecessary Appointments Free NO OBLIGATION trial in your practice Two weeks duration

Measures: Q Height Q Weight Q BMI Q Blood Pressure Q Pulse Q Results displayed & printed

Q Ticket options Q Buy or Rent Complies with directive 90/384/EEC (Class III) for non automatic weighing instruments Complies with directive 93/42/EEC (Class IIa) for blood pressure measurement

Healthcare Monitors, Kidderminster, Worcs., DY10 4EU • Tel: 01299 250321 • www.health-monitor.co.uk

Inno in Healthcare v7 book.indb 2

01/10/2013 15:03

E

Good

HEALTH

by JIM WARD Good4HEALTH

IENTS

ENGAGING PATIENTS the Friends & Family Test

26

The Portsdown Group Practice

30

Dorset CCG – Telehealth Project

A Future Healthcare Economy with Real-Time Feedback and Reporting.

s & Family Test

46

Telehealth allows just one nurse to monitor the health of around 200 people at a time.

Economy with Real-Time Feedback and Reporting

s started surveying Patients within 48 hours of discharge rom the Department of Health. Known as the Friends and pected that all patients will be offered an opportunity to ng treatment, by 2015.

Innovation - is designed to reward excellence but is more feared for penalising poorer performance in the FFT. Additional questions and in particular qualitative comments, while not mandated for this first roll-out, will soon become mandated for all. This data will ultimately deliver the most important metrics for Service Improvement. Garnering information from free text patient feedback comments will inevitably amplify issues for any Hospital Trusts currently using only quantitative feedback or for those not gathering comments, aligned to the scoring.

responses, is dealt with in a timely fashion to deliver service improvements.

Good4HEALTH, along with it’s consultancy partners, Inspiration NW and it’s specialist research and technical partners, The 3rd Degree, offer some insight into what the future could hold...

Grow your own Stewart Buller, Director of Communications at NHS Professionals, explains how its Care Support Worker Development Programme is benefiting Trusts.

48

By allowing patients to monitor their own conditions, Telehealth is reducing the need for health appointments.

response rates plus follow up comments will roll out soon for FFT

Two key issues present themselves for Trusts going forward; validating that feedback is being received from a genuine patient or their representative and ensuring that patient feedback, especially that from the follow-up comment

Ordnance Survey

32

Central Central data agreement from data agreement from Ordnance Survey proves Ordnance Survey proves tonic in delivering joined-up healthcare. just just thethetonic in delivering joined-up healthcare NHS reform has sparked fierce debate among healthcare professionals, politicians and patients.

Now that the changes are in force, one thing is clear; close cooperation between the newly-created organisations will be crucial in delivering high quality care for people across England. With many new bodies taking responsibility for the commissioning of services and public health, it is a major, but by no means new challenge.

‘Mapping really helps people to visualise and understand complex data by providing a geographic context for a wide variety of information’, says Iain Goodwin, PSMA Relationship Manager for Health, Ordnance Survey.

‘We are seeing some innovative uses of mapping in the health sector as a result of the PSMA. From carrying out public health analysis and service planning to emergency response and estate management, the availability of open and shared geographical data is having a significant effect on the way in which the NHS works.

A risk to research?

What’s the elephant in your room?

52

An elephant in the room describes an obvious truth that is being ignored or going unaddressed.

Community Health Partnerships 10 years of delivering Public Private Partnerships

Community Health Partner 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 As the Health Socialclinical Care Act takes effect, better shapeand to conduct Dr Jonathan Sheffield, chief research than it has ever beenexecutive of the before.

Whereas, in theNetwork. past, NIHR Clinical Research research was largely confined to LIFT impact now the large teaching hospitals, it is widespread with 99 per cent of NHS Trusts conducting studies.

This is a huge achievement, and Onto1believe April this year, the NHShas passedasince new pledge It’s hard that a decade the to use anonymised it has come about because of the This 8,700 list practice inofSalford changed.

Health and Social information to support clinical formation theThe firstwas LIFTstruggling Company inwith East stressed London. investment government has made Care Act, which hadof been the research and improve care for LIFT Investment doctors unable There to meet the demands frustrated patients. is much to celebrate within the past 10 years and in the infrastructure for research subject of much debate as it went others. as thethrough nationalParliament, LIFT Programme lead, we wanted to in the NHS. Through the National came into force, It’s hard to believe that a decade has passed since the Institute for Health Research explore theClinical impactCommissioning of the Programme duringThere that time and Groups is a very good reason why formation the first LIFT Company in East London.

Clinical of Research Network, NHS – groups of GPs responsible for the core clinical research should occupy in more detail, recognising that whilst rationale Trusts receive funding for more than acute of care - took up this behindcommissioning LIFT is the delivery more effective andcentral space in the provision 10,000 trained research nurses their new responsibilities. of NHS care, which isO’Connell, – simply – Improved Health Facilities Dr Sue accessible health services, there are also many other who work on our hospital wards, that it makes a huge difference to Chief Executive, Community Health Partnerships potential benefi ts and impacts. and in our doctors’ surgeries.

There has been a great deal of patient care. Take for example the These clinical professionals are comment about the introduction of case of Danielle Manley, a teenager This report is the result of independent research carried out by AMION responsible for identifying patients Clinical Commissioning Groups, who was left wheelchair-bound and Consulting earlier this year. who may be suitable to take part in and many column inches devoted needing morphine as a result of particular research studies, as well to the possible effects of GPimpact of the LIFT severe arthritis. Standard treatment The research explored the socio-economic Programme See how one practice, like dozensonofthe others around the as carrying out the clinical activities commissioning healthphases options during both its construction and operational over the past 10had been exhausted, but Organisational Community Bu Service user UK, has solved years. theirDuring problems of patient access and GP involved conducting theStreet. research service as a314 whole.

But there is one Danielle opted to take part in a Health hubsinon the High that time buildings have opened or are currently under impacts impacts im impacts itself. workload at theconstruction same time. aspect of the change that has not clinical research study to test the and, as this report demonstrates, these developments bring with them a host of additional benefits in terms the socialuse and economic yet hit the headlines: the effectofof of the drug tocilizumab as a Service Service qualityof effi ciency Linkages It is through the efforts this impact that have within localresearch communities, in areasfor Systemic Juvenile thethey changes on their clinical in particularly treatment that are amongst theand mostour deprived in the research workforce – and other the NHS, ability to country. gather Idiopathic Arthritis. As a result clinicians across the NHS in the robust evidence we need on she has now been able to leave The LIFT Programme has also supported a number of the requirements that England – that the research picture “what works”, so we can keep the wheelchair behind and live have been key features of NHS policy over recent years. Many of these are for patients has been transformed.

Improved Social Bu improving treatments and the care a normal life. Other patients on embodied in the Department of Health’s Quality, Innovation, Productivity Whilst 208,000 patientsservices took part inclusion gr we give to patients. thebestudy had similarly positive and Prevention (QIPP) Strategy and in many respects LIFT can seen as Improved outcomes. The research study a capital investment arm of that strategy. health – care minister Norman Lamb’s comments about Clinical research is - and always showed that after one year of has beenand - part of the core business taking new treatment, 89 per CloserStill. A new event, Health+Care has been The achievements, the outcomes highlighted in this report, are the shared achievements. the heart the LIFT Programme Public of the NHS, andofthis isGroup. no more are long-term cent of patients achieved a 70 per created by adding new conferences to popular John Dyson Chairman of At The Medvivo Private Partnerships, and I’d like to thank everyone been improvement, – and than common sense.

How else who hascent making a huge Commissioning Show. indeed still is – involved in the Programme. could we respond to innovations difference to their lives. in the development of medicines This is, of course, just one or devices, or understand how Financial Economic to administer treatments to best anecdote, but there are similar benefits benefits effect? stories across the whole range of therapy areas about the ability Dr Sue O’Connell The fact that clinical is of clinical research to transform Chief Executive, Community Healthresearch Partnerships a fundamental activity is reflected treatment, and achieve real With telehealth systems, are increasingly able in the patients fact that it features in the benefits for patients. No wonder Chris Deighton, consultant rheumatologist and president of the to monitor and treat NHS theirConstitution own conditions.

– and even then that every consumer poll that British Society for Rheumatology, explains how even the simplest more strongly in the newly-revised has ever been conducted on the tasks can be overwhelming for sufferers of rheumatic conditions. version that was published earlier subject shows that patients are this year. Now, not only do the overwhelmingly in favour of clinical principles of the NHS include a research, and want the NHS to commitment to promote, conduct keep offering opportunities to and use research, but there is also participate in high quality studies.

Many of these new bodies including NHS England and the Clinical Commissioning Groups (CCGs) are increasingly considering the use of digital mapping and address data as the basis for sharing information and informing evidence-based decision making.

This growth in the use of location and address as a means of linking a variety of information is enabled by data supplied under the Public Sector Mapping Agreement (PSMA). This agreement makes Ordnance Survey geographic data free at the point of use for all local authorities, central government departments and all qualifying health organisations in England and Wales. When budgets must be carefully balanced without compromising services, it is playing a key role in helping the NHS to do more for less – for example, by identifying where new resources could be targeted more effectively or pinpointing areas of low uptake of services.

Around 100 hospital trusts, all 12 ambulance trusts and more than two thirds of NHS authorities have signed up to the centrally-funded licensing agreement which also allows data sharing with contractors delivering services on behalf of members. Now the new CCGs, which came into effect on 1 April 2013, are also being encouraged to join.

D10617_0513 Healthcare advertorial.indd 1

Even if CCGs contract services to Commissioning Support Units (CSUs), they should still sign up to the PSMA as common licensing terms enable them to share mapping data with third parties delivering services on their behalf.

As a result they will be able to collaborate and partner on projects more easily, which helps to meet targets, avoid duplication and increase efficiency through joined-up working.’

Collaborative working is clearly a key aim of the NHS changes. Commenting on the reforms, Lord Howe, Health Minister said: ‘Health and care services will be better joined up by bringing together the NHS, local councils and patients. Through these changes, the health service will improve, work smarter and importantly, build an NHS that delivers high quality, compassionate care for patients’.

As the momentum for collaboration and using Geographical Information Systems (GIS) in the NHS continues to grow, it is vital that all the organisations responsible for providing healthcare work together aided by common, consistent mapping and address data. By becoming a member of the PSMA, CCGs will be joining almost 3,000 public sector organisations who benefit from a wide range of Ordnance Survey mapping including highly-detailed OS MasterMap® data, Road Networks, authoritative address and boundary information; and backdrop mapping at various scales.

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.

CHANGE inIntroduction General Practice – what one surgery has done 16/05/2013 16:08:22

A risk to research?

56

Introduction

58

Health hubs on the High Street

68

37

Totally transformed

Continuously improving

Engagement

If Telehealth is the answer, what is the question?

42

Improving the patient pathway

44

Employment

Facilities

Service accessibility

Service quality

“Something people SHOULD go to”

70

Simple Tasks – raising the profile of rheumatology

74

The impact of the Local Improvement Finance Trust Programme

Enabling healthy independence through telecare and telehealth solutions

Joined up pathways

The impact of the L

CHP5526 Amion Report Summary_v2.indd 1-2

Inno in Healthcare v7 book.indb 3

Turnov

INNOVATION IN HEALTHCARE

3

01/10/2013 15:03

Not an Option Innovation is no longer an option.

It is an urgent priority. Dr Michael Dixon, Chair, NHS Alliance, Interim President, NHS Clinical Commissioners

Innovation is no longer an option. It is now an urgent priority. As the NHS approaches the “scissors of doom” with increasing demand and costs and comparatively decreasing income, it is only innovation that can lead us out of the mire. That means getting more for less – something that we cannot deliver with innovative ideas and leaders.

All this is part of the landscape of the NHS as winter approaches. Primary care, however, is now firmly in the spotlight of NHS change and seen to be the answer to many of the NHS’s long term problems with quality and cost. Only through innovation will primary care be able to deliver on the tasks that have now been set it.

Those tasks remain the same undone tasks of previous years. How can we deliver more care outside hospital and in communities? How can we enable patients and communities to better look after themselves, where possible, and improve their health? How can we conserve precious professional, specialist and technological resources only for when they are really needed?

4

Primary Care and General Practice must now step up to the plate. This autumn will need to see both delivering more innovative solutions, especially for our frail elderly and those with long term conditions, thus enable us to get that “more for less”. Our ambitious new clinical commissioners and changes in the GP Contract are likely to get things moving in the autumn. These are likely to be supplemented by initiatives within general practice and primary care to provide integrated care for our patients “at scale”. Expect new thinking and new contractual models that will enable those in the vanguard to start meeting their own vision and the expectations of patients.

Never before in my career has primary care and general practice been under the spotlight in this way. Never before, in my memory has the Government so committed itself to general practice being the NHS solution rather than the side road or even the problem. Never before has there been such opportunity, potentially, for those wanting to innovate.

Innovation, ultimately, however cannot be

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 4

01/10/2013 15:03

done by Government or senior management. It has to come from within, from frontline clinicians and managers supported by patients wanting to do things in a different way. An NHS that has previously and steadfastly stood in the way of change and innovation looks set, this autumn, to encourage it. For those, who are already innovators, life should become better and easier as the brakes are removed.

For the rest of us, however, it means that we will need to get our brains and our organisations ready as soon as possible to meet the future opportunities for innovation or get trampled in the crowd. Innovation, this autumn, is the only solution for the NHS. It is also the only survival plan for any GP practice or primary care provider that wants to thrive in the new world.�

It is only innovation that can lead us out of the mire

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

INNOVATION IN HEALTHCARE Inno in Healthcare v7 book.indb 5

5 01/10/2013 15:03

Hello. Have we met?

We’re Central Southern, and our business is in supporting excellence We are NHS Central Southern, one of the largest commissioning support units in the country. And we’re proud to be supporting 14 of the most ambitious and driven clinical commissioning groups in England. As you might expect we provide the support, expertise and insight that’s needed to match the determination of our clients: the people who define, structure and ultimately provide healthcare for over 3.7 million people.

When it comes to commissioning health services we know it’s a balancing act. That’s why we’re here to help health commissioners deliver the ambitions they have for patients, pathways, partnership working, QIPP and wellbeing in their area.

It’s an exciting time for us - we’re supporting clients whose vision and quest for innovation requires us to be flexible, adaptable and open to adventure. We’re working in new ways which means looking at things in different ways too.

Yes we’re technically a young organisation but we’re proud that we have serious NHS mileage on our clock. (After all, it’s that mileage that’s made us who we are). The commitment we have to the enduring values of the NHS is fundamental to our purpose. It is the cornerstone of our values and how we work: •

We listen to our customers so that we can create a solution specific to their needs

•

We invest in our people to ensure they can meet our customers’ expectations of them

•

We invest in services which ‘do the right thing’.

THE CHALLENGE AND THE PROMISE So we love the NHS, but that doesn’t mean we can’t see its imperfections. Evidence abounds regarding increasing national demand, sub

Magazine article_v2_270813.indd Inno in Healthcare v7 book.indb 6 2-3

d e t t i m Com

Delivering higher standards, greater value and better outcomes for patients and professionals

optimal quality of care, increasing costs and rising public and patient dissatisfaction. In fact we were one of the first commissioning support units to publish a response to the Francis Report.

We’re lucky that our customers have the same high ambitions we have to achieve the critical outcomes of higher quality, improved patient experience and reduced costs of care. We believe that successful commissioners will need excellent support in five key areas: •

Transforming services for patients

01/10/2013 15:03

•

Driving efficiency in healthcare providers

•

Promoting quality in all healthcare services

•

Helping to run their businesses effectively and efficiently

•

Evidencing everything they do.

TRANSFORMING SERVICES FOR PATIENTS AND THE PUBLIC Our clients know that their commissioning landscape and the drive towards integration of health and social care services provides a unique opportunity to diagnose, plan and execute whole system change. They have a strategic focus on health outcomes, understand root causes of system failures and recognise the need to work in partnership with local authorities and other providers of care, and recognise the value of planning service changes with greater public and patient involvement. They also know that programmes of work like this may take many years to complete unless previous ways of commissioning are challenged.

We are supporting them to meet this challenge by quickly building upon our core capabilities and investing in new capabilities at the leading edge of commissioning support. Using our world class population profiling and risk stratification tool we can support deeper analysis of demand and improved pathways of care for patients. We use evidence based practice and benchmarking to inform on ‘what works’, and advanced healthcare procurement to shape and manage the future provider market. These forward thinking support services build on our strong foundations in robust data management and integration, programme and

Inno in Healthcare v7 book.indb 7

project management and contract management.

Our progressive commissioning support capability makes us an essential partner for CCGs as they put in place new models of care.

DRIVING UP EFFICIENCY We know that embedding efficiency in acute care is challenging, particularly as the payment system actively incentivises hospitals to do more work.

It’s not surprising, therefore, that many CCGs are investing in strategies to keep people out of hospital, to reduce acute care costs.

Primary Care Trusts made headway in delivering savings through better contract management, but in the main they moved the deficit from commissioner to provider rather than driving real savings from the health economy. We believe that driving sustainable efficiency out of a health economy is a hard task which takes years, not months, and requires precision planning and intelligent implementation.

So we suggest that the health economy must develop incentives across the provider landscape to engage with commissioners to reduce cost of services. Therefore we are looking to develop health economy-wide incentives supported by innovative contractual arrangements.

But it can’t be delivered in isolation, because a pricing or contractual mechanism won’t sustain change. We think it has to be done alongside pathway design, outcome achievement and quality measures to achieve an integrated commissioning strategy that delivers ‘real’ savings through efficient services.

27/08/2013 01/10/2013 17:34 15:03

3.6m

14 ACUTE

PEOPLE

HOSPITALS

456

12 LOCAL

PRACTICES

AUTHORITIES

By investing in clinical leadership, and armed with an in depth understanding of our CCG’s priorities, Central Southern ensures that patient safety, clinical effectiveness and patient and carer experiences guide the CCG’s approach to quality. We also respond rapidly to quality issues with local healthcare providers and national initiatives such as the Francis Inquiry.

We’re already working with clients to ensure they are “Francis compliant”.

HELPING OTHERS RUN THEIR BUSINESS

PROMOTING QUALITY We are proud to support our clinical commissioning groups in performance-managing the quality of care they commission for their populations. We support them by drawing on a wealth of data and benchmarking information on both local and national quality standards. We use this data to build a sophisticated and intelligent picture of the quality of care experienced by their patients.

Magazine article_v2_270813.indd Inno in Healthcare v7 book.indb 8 4-5

The need to maximise resources for the delivery of services to patients, and the prospect of tight control over public expenditure for many years to come, is a responsibility felt by all health commissioners. So we’re helping our clients to secure the most cost effective way of running their business operations. Some of our customers simply want assurance that these activities are efficient, robust and legally compliant, without having to manage the detailed day to day operations.

If you’re looking to drive up the cost of behindthe-scenes services then a multiplicity of systems and ways of working will do the trick. We’d rather commissioners spent every penny that they can on their patients. So we standardise processes as widely as possible to save every penny we can through economies of scale. And while we’re doing that we’re making sure our behind-the-scenes processes are developing through new technologies that make life easier for our customers.

01/10/2013 15:03

We cherry-pick the best expertise from across our patch, rather than working in geographical silos. This way we can seamlessly combine internal resources and specialist subcontractors for the benefit of our customers.

As a result our customers receive competitively priced business support services and have access to leading edge tools and systems. Everyday activities are delivered professionally and without fuss. When something more specialist is required, customers have access to bespoke advice and a deep pool of talent.

EVIDENCE EVERYTHING WE DO Just as excellent clinical practice must be evidence-based, we strongly believe that outstanding commissioning will be driven by information and evidence. This means putting data and information in the hands of referrers. It also means benchmarking to enable commissioners to identify and learn from best practice and remove unwarranted variation. We provide advanced analytics and modelling to help

target scarce resources to best effect.

We have a strong Health Informatics function and will continue to invest in developing our capabilities, whether in integrated data management or providing more advanced analytical and reporting tools to help commissioners make the right decisions.

RESPONDING TO YOUR NEEDS These are the five key things that Central Southern aims to be famous for. We know though that commissioners’ real challenges don’t come neatly wrapped to match our service descriptions. We are committed to developing key solutions that meet your needs by deploying the best of our knowledge and people in a multidisciplinary way. We are keen to talk to you about two things in particular: developing a clinically-driven, iterative approach to Planning that improves drastically on old approaches; and secondly a multidisciplinary approach to get the best value and outcomes from the contracting round and provider performance management.

Get in touch with our team to find out how our excellence can support yours.

NHS Central Southern Commissioning Support Unit • www.cscsu.nhs.uk • @cscsu #supportingexcellence • contact.cscsu@nhs.net

Inno in Healthcare v7 book.indb 9

27/08/2013 01/10/2013 17:34 15:03

NHS South CSU

Six months in Keith Douglas,, Managing Director of NHS South CSU talks about how things feel six months in

“It’s been a very busy and exciting time for NHS South CSU. We commenced formally providing services on the 1st April 2013. During this time, our key focus has been on working with our customers to assess whether the service specifications and performance indicators we agreed are the right ones and, more importantly, on delivering services to our customers to the best of our ability. We have generally managed this well, although there are of course areas where we have needed to make adjustments to ensure we deliver what our customers want. For example our HR recruitment services needed work, as did our business intelligence offering. Where this has happened we have agreed a plan with our customers and worked with them to improve services. So overall we’ve had a successful first 6 months, which has seen us grow and develop as an organisation.

“On the growth front we have been lucky enough to win some additional business following the decision

by NHS England to internally tender the services previously provided by the Surrey and Sussex CSU. We were delighted to win the business for providing comprehensive support to Coastal West Sussex

10

CCG, Crawley CCG, Horsham and Mid Sussex CCG and Brighton & Hove CCG. In addition, Eastbourne, Hailsham and Seaford, Hastings and Rother and High Weald Lewes Havens CCGs are all buying financial management services from us, so growth overall of about 25% in both customer base and income. In addition, we have moved to formalise links we have with five other CSUs across the country. These are South West CSU, Staffordshire and Lancashire CSU, Cheshire and Merseyside CSU, North of England CSU and North and East London CSU. Together the six have formed the Elis Group which has a stated aim to work together on service delivery, development and innovation to improve services to our customers and to the patients they look after. The potential for other delivery and innovation partnerships exists and we have met and had early discussions with a number of national and international companies about possible future partnerships. These discussions are in the very early stages and will be governed to a large extent by what we are allowed to do under the hosting arrangements with NHS England, however we believe that there could be real benefits for customers and patients in these partnerships in the long term.

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 10

01/10/2013 15:03

NHS South CSU

It’s very exciting for us to be looking at new ways of supporting our customers

“As we go forward, we will be examining in detail options for becoming more autonomous from NHS England, in line with national policy. We will investigate the vehicles that might be available to us and what the pros and cons of these would be for ourselves, our customers and the patients they look after, as well as for the NHS in general. Given our progress so far, we are very keen to continue on our current path, look for opportunities to extend what we do and who we do it for and continue to deliver high quality cost effective support to our customers.

“Finally, it’s very exciting for us to be looking at new ways of supporting our customers and spreading the word about excellent services available to the NHS. Two specific programmes spring to mind here; firstly we are working with Match4Health Ltd to create a web-based platform which helps organisations with something innovative to offer to link up easily with commissioners who are looking for what they are offering and thus create a perfect match. We expect to launch this in the next few weeks and hope that CCGs and others will find it hugely beneficial. In addition, we are working with The WorkLife Company to put on a conference in November entitled ‘Women Leading Health’. This will focus on the role that women play in running the health service in the UK and will feature talks from many eminent speakers including Judith Halkerstone, Vice President for BT Global Health, Dr Patricia Oakley from Kings College and Caroline Taylor, European Vice President of Marketing and Communications at IBM.

INNOVATION IN HEALTHCARE 1 1 Inno in Healthcare v7 book.indb 11

01/10/2013 15:03

NHS South CSU

Making it easier for commissioner and private organisations to work together Huw England, Managing Director of Match4health Ltd, discusses their innovative collaboration with South CSU

“Match4health is an innovative platform built to support the NHS in searching and sourcing services and products, building effective partnerships and delivering on commissioning outcomes.

“All the restructuring within the NHS means that positive outcomes for patients are achieved in a completely different way. CCGs and CSUs are undertaking new projects that often need some input from private industry.

Likewise, there are enormous numbers of private companies that want to offer solutions, products and services to the NHS – but don’t really know where to start.

“Mark Smith, NHS South CSU’s Director of Performance and Development, and I have established a collaboration called Match4health. Match4health will offer a platform for NHS organisations to search and source private industry partners for a variety of services and products that support their organisational commissioning strategy. What is so special about this space is that private industry organisations will benefit from being able to clearly identify their target market, and publicise their products and services in areas that showcase their organisation to the customers they want to connect with, in a way their customers want.

“This is far more than just a dating agency for the NHS and the private sector.

We have built a sophisticated matrix that makes it easier for organisations to match requirements with products, and vice versa. In addition to that, Match4health will showcase opportunities - areas such as category posting and organisation advertising - and we will promote webinars and presentations for customers. We will be showcasing organisations that support certain commissioning priorities. The idea is that we will do some of the leg work needed to get products and services in front of the people and organisations that the private sector is currently targeting. We are also investigating how we can add value through including opinion and review within the featured solutions.

“As you can imagine, we are hugely excited by this – we’ll be bringing together organisations that can make a real difference to patients’ lives.

Go to www.match4health.co.uk and start making connections that can and will turn into lasting partnerships.”

12

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 12

01/10/2013 15:03

NHS South CSU

Women leading health Lynne Copp,, co-founder of The WorkLife Company and Lay Member of NHS South CSU’s executive team, discusses the upcoming Women Leading Health conference

Lynne Copp is one of the most highly regarded OD Consultants and public speakers in the UK. Relaxed and full of enthusiasm, she is keen to talk about her latest project, Women Leading Health.

“The world of work is changing, and many leadership practices that were upheld as ‘great’ during the last century, are no longer relevant to today’s workplace.

Organisations must begin to adapt to new ways of working that will create sustainability and a great NHS for future generations of patients. That’s why Women Leading Health is the key conference in 2013.

“Women in, and aspiring to, leadership roles, play a key part in facilitating this necessary and fundamental change – for good. The NHS is experiencing radical change, and I believe that women across the health sector are poised to influence the future of healthcare and its related services.

The essence of Women Leading Health is about creating a platform for inspiration, exploration and discussion: how can we consistently achieve best practice in leadership across the Health Sector? With that in mind, the conference focuses on a number of key themes: changing the way that work, works; innovation in the workplace; and how women lead.”

Lynne believes – and has the research and evidence to prove it – that women, when allowed to lead authentically, do so in complementary and yet different ways to men. “It’s about more than working collaboratively,’ she explains. ‘Women focus on different aspects of business and success, and generate strategies and relationships that benefit more than just stakeholders”.

The conference agenda is not just focused on supporting women to be successful; but also on the changes that must happen in the workplace if we are to create an NHS that spans future generations with a positive legacy. ‘It’s not just about women getting to the top. It’s about inspiring people to consider different ways of working that are relevant, appropriate and focused on today’s world.

The conference, whilst aimed at women, does not exclude men who are also eager to be a catalyst for change. Ultimately, it’s about achieving what’s best for patients – and sometimes that means changing the way we operate, lead and inspire others.’

Women Leading Health takes place on Thursday, 21st November, Botley Park, near Southampton and includes keynote speakers from IBM and the King’s Fund. Women Leading Health is sponsored

by NHS South CSU, in partnership with The Worklife Company – www.womenleadinghealth.co.uk

INNOVATION IN HEALTHCARE 1 3 Inno in Healthcare v7 book.indb 13

01/10/2013 15:04

NHS Staffordshire and Lancashire CSU

Working for change NHS Staffordshire and Lancashire Commissioning Support Unit is one of the largest CSUs in the country and covers Staffordshire, Lancashire, Shropshire and Herefordshire

Derek Kitchen Managing Director of NHS Staffordshire and Lancashire Commissioning support unit talks about transformational change, partnerships and integration of services.

With over 750 staff, we provide a host of high quality commissioning support services to 17 CCG customers, as well as the Staffordshire and Shropshire NHS England Area Team.

Our overall approach to commissioning support must be flexible and responsive to support our customers and staff, due to the following factors: the geographical spread of our area, and the challenges of diverse populations; the balance between areas of deprivation, as well as affluence; and, the contrast between wide, rural areas and dense urban populations.

Transactional as well as transformational services As of 2013, the NHS is 65 years old. A time to celebrate, but also a time to reflect on the past and look to the future. If the NHS is to survive for another 65 years, it must change. However, this is not about unnecessary structural change; instead, it’s about finding ways of doing things differently.

It’s about harnessing technology to fundamentally improve productivity, putting people in charge of their own health and care, integrating more health and care services, and much more besides.

It’s about transformation – moving from an NHS that was set up to provide episodic care, to an NHS that supports people closer to home and achieves the best possible value for money; thus, a transformational NHS that can support and drive the integration with social care.

14

High quality approaches to transformation services are key to integration. CCGs will be looking for commissioning support services that will: • Provide break-through improvement, moving away from micro-targets and incremental steps • Fulfill the need for real transformation • Identify the large-scale opportunities that will realise meaningful and tangible benefits • Define sustainable improvement, innovation and best practice • Enact system-wide change through local ownership and co-development • Develop knowledge and skills transfer for sustainability • Develop a focus on improved patient outcomes • Provide a pragmatic approach to ensure delivery Our ethos as a CSU is to work with our CCGs to develop our partnership approach to transformational services – our role is pivotal in the wider integration agenda.

Our CCG customers also need transactional services, such as contracting, quality, finance, HR, business intelligence, communications and engagement, governance, procurement medicines management and individual patient activities – these are part of our core service offer.

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 14

01/10/2013 15:04

NHS Staffordshire and Lancashire CSU

As well as these services, CCGs need a flexible matrix-management approach to integration, with multi-functional teams coming together to deliver programmes of work that will enable long-term sustainable change.

•

Our Cross Economy Transformation Team (CETT) is already undertaking work using these principles.

The team is employing diagnostics used across the health economy to redesign services within a single county, single health economy and across health and social care. This work is supported by local patients and the public using our awardwinning approaches to insight and involvement.“

•

Stoke-on-Trent and North Staffordshire CCGs are using our transformational services and, via our matrix-management approach, have produced the transformational changes outlined:

•

• •

•

•

•

214 fewer beds in University Hospital North Staffordshire (UHNS) Around 26,700 fewer acute (UHNS) occupied bed days per year Average length of stay targets (for March 2013) partially achieved and on trajectory Sustained reduction in delayed discharges from 6.7% Oct 2010 to 1.9% present 83% of complex assessments are now done outside acute hospital, in surroundings more conducive to need eg in community hospitals, or at home Increased productivity of community hospitals now roughly 350 patients per month, an increase of around 120 Reduced length of stay in community hospitals – average 10 days fewer Around 130,000 outpatient appointments delivered in the community.

Working in this way comes with its challenges and the role of the CETT team is to work across NHS, local authority, community and voluntary sector organisations, to influence and challenge the organisational cultures that create barriers, such as: Barriers

Solutions

“We don’t have time”

Advanced planning, structured meetings and events, ‘short burst’ principle

“ It’s been tried before”

Understand why ‘it’ didn’t work and learn the lessons

“It won’t work here”

Ask “What needs to be done so that it will work here?”

“The data is rubbish”

Data cleansing. Point prevalence, process audit

“It won’t be sustained”

Transfer skills and deploy sustainability model

Early failure identified in a single provider causing them to withdraw from the process

Overcome by agreeing, up front, rules of engagement, principles of partnership and accountability; acceptance that all parties can improve

I am committed to an NHS that puts the patient at the heart of its transformation agenda, and which supports CCGs to fundamentally change their approach to care provision. My role allows me to support patients and CCGs and to work with expert colleagues in a flexible way to deliver this exciting and challenging transformation agenda.

INNOVATION IN HEALTHCARE Inno in Healthcare v7 book.indb 15

15 01/10/2013 15:04

NHS Staffordshire and Lancashire CSU

Case Study Business challenge – UHNS Urgent Care Centre The planned move to a new site, and patient care improvements, required changes to current processes in four key areas: Acute Medicine, Fracture Clinic, Imaging and A&E Reception.

Solutions • • • • • • •

The Lean Action Weeks were organised with the requisite attendees identified Data was gathered and analysed for each of the four areas and the patient pathways were understood, including the physical routes taken around the hospital Lean Action Weeks were held in order to understand the current situation, capture issues with the process, identify the ideal state and implement changes Acute Medicine: Changes in the layout, staffing and support systems were negotiated and implemented Fracture: Changes to organisation of clinic, staffing, booking and running were discussed and planned Imaging: Improvements in equipment utilisation, portering, staff communication and the process were implemented A&E Reception: Improvements were made to the physical environment, the booking-in process and allocation of work among the team.

Benefits • • • •

16

Improved flow through the Emergency department, Acute Medicine and support areas Reduction in queues in Emergency Department Rapid recognition and elimination of problems by staff members Improvements in communication with staff.

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 16

01/10/2013 15:04

NHS Staffordshire and Lancashire CSU

Lesley Goodburn Head of communications and engagement, NHS Staffordshire and Lancashire

Commissioning Support Unit Patients and the public should be at the heart of decision-making processes within the new structures of the NHS. We have worked with our emergent CCGs to achieve this and we have developed a systematic approach to public and patient involvement that has its roots in the systemic review of cause and effect.

Our ‘Insight’ database is used to record all types of patient-experience feedback, including feedback from focus groups, consultations, surveys, social media, patient opinion, NHS choices, media, MP letters, PALS and complaints. The database categorises the feedback under five domains of patient experience and allocates it to the provider of the service. This allows a picture of provider performance via real-time patient experience dashboards, making the information available to CCGs, contract management and quality staff within the CSU, as well as colleagues at the NHS England local area team.

INNOVATION IN HEALTHCARE Inno in Healthcare v7 book.indb 17

17 01/10/2013 15:04

NHS Staffordshire and Lancashire CSU

All data is reported by CCG through a data-sharing agreement, with all nine CCGs in Staffordshire able to share data at a practice or provider level. This data can be integrated at the level of the organisation, department, service, specialty, ward or individual.

The Insight model is supported by a model of involvement where a strategic patient congress works in partnership with the CCGs to provide support, advice, challenge and scrutiny of public and patient involvement in commissioning. The congress is chaired by the PPI lay member and reports directly to the governing body.

The Insight model has been transformed into a quality system by entering clinical feedback from GPs and by reporting incidents at primary care level. All data comes together and is reported in real time to identify themes and trends across the quality spectrum.

This holistic approach has been pioneered by Stoke-on-Trent CCG and has been rolled out to all 54 GP practices.

Work is now underway to roll out to the GP practices in Telford & Wrekin and Shropshire, with the other six CCGs to follow. This will see 260 practices using the system to improve services for patients and the public.

If you want to talk to Lesley about the models of involvement and insight please e-mail: Lesley.goodburn@ staffordshire.css.nhs.uk

Website: www.staffordshirelancashirecsu.nhs.uk G30 in the CSU Pavillion

18

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 18

01/10/2013 15:04

Supporting excellence in health and care to improve outcomes for patients At NHS South London Commissioning Support Unit, we are proud to be right behind commissioners who are determined to transform health and healthcare for their patients.

We have significant experience of working with commissioners and providers across multiple complex health economies and with almost 600 skilled and dedicated staff, strengthened by our innovative industry partnerships, we are ready to support the transformation of services required by the current climate.

Working in partnership with our existing NHS customers, we have spent our first year of existence building and refining our services so that we are ready to help them and others deal with the challenges faced by the health and care system today. We have also grown into new geographies and sectors and have a growing reputation as a Commissioning Support Unit that is easy to do business with, as well as good value compared to the competition.

Inno in Healthcare book.indb Ad.indd 19 SLCSU Innovation v7 In Healthcare 1

Our service portfolio includes commissioning and business support services to clinical commissioning groups (CCGs) that cover all functional areas of support they require. Our packages of support are flexible to adapt to organisations who may need small and specific areas of input, to customers who have chosen to outsource a majority of the commissioning support they need. Our recent acquisition of a specialist Health Informatics Service advances our NHS customer base and has enabled us to broaden our technical excellence and bring these benefits to all of our customers.

01/10/2013 20/09/2013 15:04 12:33

“SLCSU has taken a consistent approach to involve and engage with us in the design of services throughout the year” NHS Croydon CCG

A great example of where we are already bringing scale benefits to our customers is with our Business Intelligence services. These underpin the successful delivery of our contracting, performance and quality services as well as providing CCG colleagues with the tools they need to successfully redesign local patient pathways.

Our Business Intelligence Portal CCGs told us that one of their biggest problems was being unable to access the data they need to make informed commissioning decisions.

Much of the data was already available from national data sets and contract reports – but it wasn’t easy to access or manipulate to help answer common questions such as ‘How many patients are waiting over 4 hours in A&E’, ‘what are the overall Accident and Emergency waiting times and discharge routes’.

Our Business intelligence portal (which is available as a standalone product or as a part of our contracting and performance bundle) has been designed to make it easy to access and interrogate data from CCG down to practice level.

It is ‘self-service’ and intuitive, so with the minimum of training, CCG staff and clinicians can create bespoke reports, access dashboards and the performance data that they need to inform their service improvement work. As these reports are dynamic, the source data is updated automatically, so customers can always be confident they are getting the best-available picture of service usage.

“Because I can access our most up-to-date reports at any time, I feel confident that our decisions are better informed and will have a real impact on improving outcomes for patients”

Inno in Healthcare book.indb Ad.indd 20 SLCSU Innovation v7 In Healthcare 2-3

01/10/2013 15:04

Another area where our technical excellence is already delivering benefits is in specialist information tools for CCGs and GPs. CCGs have told us our risk stratification tool is…

“Essential for delivering integrated care and transforming primary care” “Already helping them avoid one unplanned admission per practice per month*” *in month 1

We believe that inefficient care is poor quality care and results in poor outcomes for patients.

By understanding the ways that patients use health services we can help clinicians and patients consider how they can be improved. To do this we have deployed industry-leading software solutions that link to the data that we already hold and that is held at practice level. Using this we are able to help CCGs understand where pressure is being put on local services in terms of avoidable admissions and inefficient patient pathways. Our specialist information products help CCGs and GPs identify high risk patients so that high quality and appropriate care

can be targeted to improve their outcomes and reduce unplanned illness. Our software suite also enables CCGs to review progress against their targets and benchmark against other primary care providers.

Our toolkit for CCGs and GPs includes Adjusted Clinical Group (ACG) risk stratification, developed by clinicians and John Hopkins University and a corresponding acute activity dashboard. The reports produced start at CCG level and continue to practice level.

Clinicians can use the data to have open conversations with their peers about service quality and approaches to managing cohorts of patients with specific needs.

If you are interested in finding out more about how NHS South London Commissioning Support Unit can help you, please look at our website www.southlondoncsu.nhs.uk, email slcsu.info@nhs.net, follow us on twitter @southlondoncsu or visit us at stand J31 at Best Practice 2013

Inno in Healthcare v7 book.indb 21

01/10/2013 12:33 15:05 20/09/2013

West and South Yorkshire and Bassetlaw CSU

Innovation is part of our DNA Alison Hughes,, managing director An opportunity to help our CCGs to innovate

These are exciting times for clinical commissioners and commissioning support providers. I am increasingly aware of a different, problem-solving approach being taken by commissioners. Often, I am amazed by the creativity that comes out of conversations with clinicians about some of the NHS’s thorniest issues. This is fantastic news for the NHS, for patients, and for us in commissioning, as we support an opportunity to help our CCGs to innovate and genuinely transform services.

We have 15 CCGs across our patch, which covers a diverse population with huge health inequalities: from the rural Yorkshire Dales, to former mining towns, from some of Yorkshire’s richest cities, to some of the poorest. There is no ‘one size fits all’; there are no easy solutions.

Find out more: www.wsybcsu.nhs.uk Tel: 0845 111 5000

22

This is why innovation and our problemsolving approach are so important.

I am filled with optimism about this new world, because I know that we can change the game. We’re fortunate to have a large team of creative, talented people and we have built a culture that empowers all our staff to put forward ideas, many of which are amazingly inventive. One of our tenets is that innovation is part of our DNA, and I truly believe that. So, for example, as a CSU we can support a reconfiguration; also, we have developed an innovative approach to the insight, planning, public consultation, technology, staffing, contracting and delivery through programme management that is required. We ensure that we drive through the benefits of change to deliver outstanding and measurable value for money.

West and South Yorkshire and Bassetlaw Commissioning Support Unit

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 22

01/10/2013 15:05

West and South Yorkshire and Bassetlaw CSU

Bradford needle exchange: reducing harm, saving lives ‘Innovation through partnership working’ characterises NHS West and South Yorkshire and Bassetlaw Commissioning Support Unit (WSYB CSU). The CSU’s software developers work alongside clinical partners and frontline services to develop applications that can make a measurable difference to the quality of life of some of the region’s most vulnerable people. A striking example is the Needle Exchange application, used by pharmacies and drug services throughout Bradford and Airedale.

developed an electronic scoring system that looks at each user’s risk-taking behaviour, such as re-using equipment and co-use of other drugs or alcohol, alongside behaviour that potentially reduces their harm score, such as whether they’re already in touch with drugs treatment services or their GP. Specialist needle exchange services in local drug agencies take each user through the questionnaire that gives them the score and, by regularly reviewing this score, they are able to work with the user to help them to reduce it.

First steps Bradford had the world’s first pharmacy-based needle exchange for injecting drug users. Launched in 1987, the initiative was aimed at preventing the spread of HIV, Hepatitis and other infections through injecting drug use.

In 2005, a joint project between the NHS and Bradford Council was set up to look at the system and at collecting data electronically in the pharmacies.

From there, the first database giving real-time data was launched in 2007 - a big step forward.

Reducing harm The art of the possible became probable: but how could the information be used to reduce harm? The next phase of the project was for our software development team to further develop the database to measure risky behaviour and enable more targeted and more effective intervention. Working with the needle exchange coordinator, John Bolloten, the software team

The reporting functionality is also vital. John is able to see any trends in street-drug use that are emerging, geographical trends across the district and the prevalence of each risk behaviour. This information is then shared with drug services, the local pharmacy committee and the health service to inform local interventions.

It also provides important evidence about the type of drugs that are being injected; for example, over the last five years, the use of performance and image-enhancing drugs (PIEDs) has exploded, particularly among young men, and users now account for over a third of all injectors in the district.

The application has been developed using Microsoft Silverlight, backed by a WCF web service and Microsoft SQL Server. Using Silverlight means the application can handle the complexities of the required user interface while still looking good, being quick, interactive, and cross-platform/ browser-compatible.

INNOVATION IN HEALTHCARE Inno in Healthcare v7 book.indb 23

23 01/10/2013 15:05

West and South Yorkshire and Bassetlaw CSU

GP revalidation: freeing-up time to care Another major success has been the GP appraisal and revalidation application, used throughout Yorkshire and the Humber area, currently covering 3,500 GPs. In this postFrancis era, the need to assure ourselves of the quality of care throughout the health service is paramount – this application gives us a powerful tool to achieve this goal in primary care.

The application, which sits on the WSYB CSU secure servers, manages the appraisal process from end to end, and provides a traffic-light dashboard of each GP’s trajectory towards revalidation.

For GP appraisers, the application has been a boon. They are better informed, as they are able to view the revalidation summary of the key Medical Appraisal Guide statements and outputs, which leads to better engagement with the appraisal process. The system also shows positive improvement against any concerns or development needs, and the appraiser can see at a glance each GP’s journey to revalidation – as can the GP themselves. Fundamentally, it makes the appraisal system much simpler which, in turn, frees-up both the GP’s and the appraiser’s time to care.

For the revalidation’s responsible officer, the application allows them to: easily assess each GP’s readiness for revalidation; quality assure the appraisers and appraisal process; and, have easy access to documentary evidence and GP records.

Beyond Yorkshire This is a proven and tested application that is already delivering measurable benefits

24

“

“

Initiative to prevent the spread of HIV, Hepatitis and other infections

to clinicians – and we are working with NHS England in other parts of the UK to roll out the system more widely. We are also developing a direct link between the application and GMC Connect, which will provide that final link for responsible officers.

This application isn’t just for primary care; wherever revalidation is required, there are obvious synergies, for example, secondary care consultants and doctors working in private healthcare. The application is a webbased system, with no software installation required and is compatible with mobile devices.

The CSU provides a dedicated support and service desk team.

Other IT innovations Partnership working between the CSU and GPs/ CCGs has led to some ground-breaking WSYB CSU software developments. The software development team at WYSB CSU has experience in developing web-based applications, using a variety of technologies, depending on the requirement. The applications produced range from totally bespoke applications, through content-rich WordPress sites, and collaborative SharePoint sites. Applications that manage local enhanced services, risk stratification, time recording, premises valuations and running costs have been developed and are now in use across our range of clients.

If you’re interested in any of the systems mentioned, please contact Pete Thomas, commercial director, on 01274 237 411 or peter. thomas@wsybcsu.nhs.uk. For more information about the Bradford Needle Exchange, please speak to John Bolloten, needle exchange coordinator on 01274 434 206.

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 24

01/10/2013 15:05

West and South Yorkshire and Bassetlaw CSU

Stop Press!

We are delighted to announce that, jointly with Bradford District Care Trust (BDCT), we’ve won the award for Patient Safety in Mental Health at the 2013 Patient Safety Awards.

The award was won by our pioneering joint ‘Living IT’ project. The initiative improves the physical health of patients with severe mental health problems through the use of a simple dataentry template that allows GP practice staff to complete annual health checks on these patients in a thorough and accurate way. The template was developed in response to evidence suggesting that patients on the serious mental health register are dying of preventable diseases 20-25 years younger than the general population. Also, other research indicated an inconsistency of approach in primary care towards annual health checks.

The template has been rolled out to all practices locally, alongside training on how to use it and education to help practice staff understand the particular issues affecting people with severe mental health problems. Kate Beedle from the WSYB CSU Data Quality team explains: “It’s simple – 30 minutes’ staff training in surgery makes a real difference. A GP or practice nurse completes the early detection guide with the patient during an appointment. This means a person with a serious mental illness will have a high quality annual physical assessment. With the right care, they could expect to live a healthier life, have reduced hospital stays, and ultimately, live longer as a result. It’s a simple approach, but now it’s in place, it’s making a difference – we’re getting outcomes evidencing that it has improved patient health.”

Other parts of the country are now showing interest in the initiative and, last month, WSYB CSU and BDCT leads rolled out the project at eight GP pilot practices for NHS South East Partnership Trust.

West and South Yorkshire and Bassetlaw Commissioning Support Unit

INNOVATION IN HEALTHCARE Inno in Healthcare v7 book.indb 25

25 01/10/2013 15:06

Synapta : The Patient Engagement Platform

Good

HEALTH

by JIM WARD Good4HEALTH

ENGAGING PATIENTS the Friends

& Family Test

A Future Healthcare Economy with Real-Time Feedback and Reporting In April this year, Hospitals started surveying Patients within 48 hours of discharge following new guidelines from the Department of Health. Known as the Friends and Family Test (FFT), it is expected that all patients will be offered an opportunity to give their feedback following treatment, by 2015.

The FFT has potential to provide an effective management tool to report patient feedback and prioritise improvement, but the challenge for Trusts is not only the collection of large scale FFT data but also the effective application of feedback for positive change. The landscape has already proved problematic for many Trusts. The Department of Health’s increased requirement of a minimum 20% response rate from discharged patients, along with mandatory follow-up questions to understand patient scoring will require Trusts to apply the best methods to meet demands.

The joint Metrics of Response Rate and FFT Score are already being published nationally each month and have led to much controversy regarding the interpretation of these results.

Hospitals find themselves having to justify ‘poor’ returns or ‘scores’ to patient bodies, staff, boards and local media. CQIN - the NHS Commission for Quality and

Inno in Healthcare v7 book.indb 26

Innovation - is designed to reward excellence but is more feared for penalising poorer performance in the FFT. Additional questions and in particular qualitative comments, while not mandated for this first roll-out, will soon become mandated for all. This data will ultimately deliver the most important metrics for Service Improvement. Garnering information from free text patient feedback comments will inevitably amplify issues for any Hospital Trusts currently using only quantitative feedback or for those not gathering comments, aligned to the scoring.

responses, is dealt with in a timely fashion to deliver service improvements.

Good4HEALTH, along with it’s consultancy partners, Inspiration NW and it’s specialist research and technical partners, The 3rd Degree, offer some insight into what the future could hold...

response rates plus follow up comments will roll out soon for FFT

Two key issues present themselves for Trusts going forward; validating that feedback is being received from a genuine patient or their representative and ensuring that patient feedback, especially that from the follow-up comment

01/10/2013 15:06

Synapta : The Patient Engagement Platform

Steps to a Better FFT Experience SYSTEMISING THE FFT From pilots and work within Acute and Community Health, we recognise the need for key methodological practices...

Feedback 2 Validated Patients are more concerned

Approach 1 Systematic Such a large-scale operation

Centric 3 Patient Presently, many providers

needs to be automated with minimal reliance on staff. Starting by targeting the majority of patients and then bespoking solutions for any not responding or unable to respond.

about confidentiality than providing anonymous feedback.

Trusts need to know who, when, where and why so they can understand what is happening in their organisations, make improvements and understand which groups of patients are not responding.

conduct totally anonymous, unvalidated feedback. This does not allow further interrogation of data such as demographics, nor does it allow a patient-centric approach to linking to their health pathways. Confidentiality may be more important than pure anonymity!

Minimal Impact on Clinical Staff They should not be the ones to elicit or collect feedback but to receive the feedback and implement improvement.

4

Hours After Discharge 5 48Rather than on discharge or

before as patients need time to recover and provide considered opinions.

6 Real-Time Information gathered and

reported weeks or even months later to staff, does not allow appropriate intervention.

Getting facts to staff as they happen, in as simple a way as possible, allows proper, considered approaches to be planned, as well as recognising important timely intervention in areas such as safety. to Patients 7 Feedback Closing the 360 degree loop by

informing patient of the scores received, as well as “You said….

We did ….” Is an important part of continued partnership with the patient body and participation in future surveys. This can also be automated, at minimal cost and low impact.

Mandy Wearne, Inspiration NW...

Synapta gets a

60%

respons e

Inno in Healthcare v7 book.indb 27

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. We knew from previous work with SMS, that every phone could use it and it could be used to trigger other feedback methods. That's why we decided to work with Good4HEALTH and their mobile engagement platform ‘Synapta’.

They had previous experience with the NHS and had successfully garnered feedback from Community Trusts.

01/10/2013 15:06

Synapta : The Patient Engagement Platform

Mobile First

the FFT METHODOLOGY that works Taking a mobile first approach to delivering FFT has a number of key benefits for Provider and Patient. Two-thirds of the human race rely on SMS text messaging to connect with a growing network of family, friends, businesses, organisations - even governments. Text messaging is the most widely-used data application on the planet. It is critical then, to make sure that mobile communication channels are leading the way in our conversation with patients to understand and monitor their experiences as well as engaging them throughout their NHS journey...

SMS: Text Messaging 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.

Cloud Hosted Apps Synapta has already created a number of instances of Cloud-Apps – cost-effectively produced they can also offer the benefits of SMS. In fact, we use an SMS message, that allows the patient to respond either through SMS, or through a Cloud-App that is customised to the Individual Patient and Provider and can be responded to with familiar radio buttons, lists and text-boxes. This way, we validate the patient, and store their individual results in a way that can be interrogated by their healthcare professionals.

Speed & Effectiveness The average time taken to read and respond to a text message is around 4 minutes, compare this to email (assuming it made it past the spam filters) and it’s around 48 hours. Patients can respond quickly and easily to

Inno in Healthcare v7 book.indb 28

give near real-time data on their experiences.

Private & Secure Mobiles are highly personal devices so they are a great way of life s happen ensuring you n o contact the mobile individual you intend. People also feel confident that when participating via SMS or Cloud-App, that their responses are private and confidentially handled. This encourages them to be much more candid in their responses.

High 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.

High Quality Data Survey participants are more candid and honest when they participate in surveys via SMS or 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” Free Participation We use free-to-text shortcode numbers that guarantee participants won’t be charged at any stage of their mobile interaction with a Provider.

Response Rates It is a requirement for FFT data to achieve a minimum 15% completion rate on surveys. (and 20% at the end of the year) In work with PWC and Inspiration NW, we have already achieved response rates between 46% 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 Provider to accurately monitor their performance.

In addition, we also achieve on average 65% of responders leaving a free-text follow-up question response.

Environmentally Responsible Mobile is a zero-wastage model for performing research. No paper and our environmentally responsible hosting, creation and management of the Synapta platform, means mobile ticks all the right boxes.

01/10/2013 15:06

Synapta : The Patient Engagement Platform

Using IDA it is possible to automate the process of interpreting open responses in a fraction of the time it would take a human coder and with the same or better coding accuracy.

Analysing Free-Text Responses Reliably and Automatially with Synapta Synapta comes with a feature-rich research module.

This lets you design and launch surveys ultra-quickly.

There’s also optional verbatim coding (IDA) that can identify sentiment and automatically code open responses.

Not only does giving participants an opportunity to give an open response signify that their opinions are cared about, the NHS are also able to garner information that would otherwise be lost in the straight-jacket of a closed response type. However, with the average hospital discharge around a quarter of a million patients a year, it is easy to see how the task of coding and classifying large volumes of text could appear to be unworkable.

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

but up to

SMS

HOURS for an email!

Unlike some products that ‘text mine’ or search for words or phases in order to attempt to categorise responses, IDA extracts linguistic patterns from each response in order to code it.

Traditionally the price paid for including open response feedback opportunities in surveys reflect that the collating and theming of responses is time consuming, and requires both skill and consistency in the human coder.

In the NHS, managers are interested in comments relating to key areas relating both to transactional and relational aspects of care. For more information about measures and metrics relating to patient experience go to www.Inspirationnw.co.uk.

IDA can effectively support the NHS to interrogate data, produced automatically, from millions of individual comments. The payback is real-time improvement based on evidence. of mobiles handle SMS

of adults in the UK have a mobile

OVER of us use

SMS

each day

arethe the are fastest fastest growing growing group of group mobileof mobile owners owners

Trusts Can’t Afford to Make Paper Their Primary Collection Method for FFT

Paper is by far the most popular way of currently delivering the FFT. It is a well-understood and simple methodology, that appears very cost-effective but response rates are often very low. Paper suffers from the inability to cost-effectively process free-text response, meaning that valuable patient thoughts are perhaps lost in archived filing cabinets. It is also not real-time, nor is it actually that effective in situations, such as A&E, Clinics, Drop-In facilities, nor will it prove to be in Community and Primary Care.

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

Good

HEALTH

Inno in Healthcare v7 book.indb 29

01/10/2013 15:06

NHS Professionals

Grow your own Stewart Buller,, Director of Communications at NHS Professionals, explains how its Care Support Worker Development Programme is benefiting Trusts

Camilla Cavendish’s review into healthcare assistants and support workers in the NHS and social care made a number of recommendations to ensure they are providing care to the highest standard. This review has propelled this somewhat forgotten group of healthcare workers into the spotlight and has highlighted the importance of their role.

Care Support Workers (CSWs) are a vital part of the healthcare team and provide essential nursing care for patients’ personal needs. NHS Professionals recognised that, while there are lots of people with a desire to work in this field, they don’t necessarily have the skills or experience required.

The Care Support Worker Development Programme (CSWDP) was created and officially launched in January 2012, and is now running across 17 of NHS Professionals’ client trusts. The programme is a good way of gaining entry to the NHS and is aimed at those candidates who don’t meet NHS Professionals’ current minimum experience criteria - six months in a care setting in the preceding two years. For many, the programme also provides trainees with a route into substantive employment in a trust and can be a gateway to a career in the NHS.

30

There are several reasons why trusts implement the programme. Most notably they may have exhausted the supply of experienced CSWs in their local area and need a new approach to recruit people to fill these roles.

The programme has been a success for both the trusts involved and the trainees who have taken part: •

For the trusts, this programme incurs lower cost with lower risk compared to direct recruitment.

•

Trainees are engaged on a flexible basis with NHS Professionals.

•

The trainees have had a significant impact on improving shift fill rates, with over 35,000 shifts filled through the programme between January 2012 and July 2013.

•

Most of the CSWs continue to work with NHS Professionals and the trust once they have completed their training. In Portsmouth Hospitals NHS Trust, 37 had completed the programme by May 2013, all of whom are working around 30 hours a week.

D

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 30

01/10/2013 15:06

NHS Professionals

The CSW Development Programme has been mapped against the National Minimum Training Standards for Healthcare Support Workers and Adult Social Care Workers in England (Skills for Care and Skills for Health 2013).

In order to develop the programme to meet client trust’s needs, NHS Professionals values their feedback and continually reviews the programme.

As a new initiative, NHS Professionals stipulated that the length of the placement required must be six months. However, the feedback received from those client trusts that have implemented the programme indicates that the length of the placement can be reduced as candidates have achieved the required competency levels within three months. Therefore, NHS Professionals will be piloting a shorter three month placement programme later this year.

One significant recommendation of Camilla Cavendish’s review was the introduction of a minimum certificate of fundamental care, which should be launched by summer 2014. NHS Professionals is currently working with a university provider towards accreditation of the current programme, aligning the standards with this proposed certification.

Following the government’s announcement that all applicants for student nurse training should undertake a minimum of one year of care work, NHS Professionals is exploring the potential of a one year, Level 3 pre-nursing programme. This also fits in with the second of Cavendish’s recommendations, providing a higher level certification for experienced health care support workers.

www.nhsp.co.uk

Dedicated to providing excellence in the delivery of care Inno in Healthcare v7 book.indb 31

INNOVATION IN HEALTHCARE 3 1 01/10/2013 15:06

Central data agreement from Ordnance Survey proves just the tonic in delivering joined-up healthcare NHS reform has sparked fierce debate among healthcare professionals, politicians and patients.

Now that the changes are in force, one thing is clear; close cooperation between the newly-created organisations will be crucial in delivering high quality care for people across England. With many new bodies taking responsibility for the commissioning of services and public health, it is a major, but by no means new challenge.

Many of these new bodies including NHS England and the Clinical Commissioning Groups (CCGs) are increasingly considering the use of digital mapping and address data as the basis for sharing information and informing evidence-based decision making.

This growth in the use of location and address as a means of linking a variety of information is enabled by data supplied under the Public Sector Mapping Agreement (PSMA). This agreement makes Ordnance Survey geographic data free at the point of use for all local authorities, central government departments and all qualifying health organisations in England and Wales. When budgets must be carefully balanced without compromising services, it is playing a key role in helping the NHS to do more for less – for example, by identifying where new resources could be targeted more effectively or pinpointing areas of low uptake of services.

Around 100 hospital trusts, all 12 ambulance trusts and more than two thirds of NHS authorities have signed up to the centrally-funded licensing agreement which also allows data sharing with contractors delivering services on behalf of members. Now the new CCGs, which came into effect on 1 April 2013, are also being encouraged to join.

D11055_0913 Innovation in Healthcare Inno in Healthcare v7 book.indb 32 advertorial.indd 1

‘Mapping really helps people to visualise and understand complex data by providing a geographic context for a wide variety of information’, says Iain Goodwin, PSMA Relationship Manager for Health, Ordnance Survey.

‘We are seeing some innovative uses of mapping in the health sector as a result of the PSMA. From carrying out public health analysis and service planning to emergency response and estate management, the availability of open and shared geographical data is having a significant effect on the way in which the NHS works.

Even if CCGs contract services to Commissioning Support Units (CSUs), they should still sign up to the PSMA as common licensing terms enable them to share mapping data with third parties delivering services on their behalf.

As a result they will be able to collaborate and partner on projects more easily, which helps to meet targets, avoid duplication and increase efficiency through joined-up working.’

Collaborative working is clearly a key aim of the NHS changes. Commenting on the reforms, Lord Howe, Health Minister said: ‘Health and care services will be better joined up by bringing together the NHS, local councils and patients. Through these changes, the health service will improve, work smarter and importantly, build an NHS that delivers high quality, compassionate care for patients’.

As the momentum for collaboration and using Geographical Information Systems (GIS) in the NHS continues to grow, it is vital that all the organisations responsible for providing healthcare work together aided by common, consistent mapping and address data. By becoming a member of the PSMA, CCGs will be joining almost 3,000 public sector organisations who benefit from a wide range of Ordnance Survey mapping including highly-detailed OS MasterMap® data, Road Networks, authoritative address and boundary information; and backdrop mapping at various scales.

30/09/2013 12:27:00 01/10/2013 15:06

The following case study from South West Commissioning Support demonstrates how the PSMA is already delivering benefits to commissioners in the health sector. To sign up to the PSMA or find out how it can benefit your organisation, please visit www.ordnancesurvey.co.uk/health

Health

Putting GIS on the NHS map across the South West and beyond

GIS and mapping services for CCGs in Bristol, North Somerset, Somerset and South Gloucestershire are provided by South West Commissioning Support.

South West Commissioning Support (SWCS) is established to support CCGs in the South West, and is one of only nine accredited Data Management and Integration Centres (DMICs). Clients include GP practices, community and primary care health teams and the South of England Specialised Commissioning Group - South West, as well as some organisations outside the South West region including Anglia Support Partnership (Serco) and NHS Shropshire.

Informatics support is provided by the award-winning Avon Information Management and Technology Consortium (AIMTC). Now part of SWCS, the team – which has pioneered the use of GIS and digital mapping within the NHS – offer a wide range of services, including GIS support to underpin the Somerset GP Out of Hours service review for the Bristol, North Somerset, Somerset and South Gloucestershire area team.

‘Without mapping, it was hard for people to visualise the extent of the service’s coverage or exact locations’, says Trevor Foster, GIS Manager, SWCS. ‘Once data is given a geographic context it becomes much easier to spot patterns and make appropriate recommendations’.

D11055_0913 Innovation in Healthcare Inno in Healthcare v7 book.indb 33 advertorial.indd 2

The reputation of SWCS means that many public sector clients also ask it to manage GIS and associated services on their behalf.

‘This enables them to improve efficiency by concentrating on providing care for their patients whilst benefiting from our expertise in business intelligence and GIS’, explains Trevor Foster. ‘There is no extra cost for geographic data as we have the appropriate licence to host mapping from Ordnance Survey and the mapping is provided free under the terms of the PSMA. For other clients, such as charities, we use OS OpenData™ which makes GIS an attractive and cost-effective option for those operating on tight or diminishing budgets.’

As the creator of HealthGIS, an interactive online portal for visualising and analysing data, and provision of hard copy mapping for reports and presentations, SWCS uses digital map data to deliver a wide range of services. Benefits include improved access to information to support clinicians delivering patient care; better inter-organisational working; and greater efficiency through effective use of time and resources.

30/09/2013 12:27:01 01/10/2013 15:06

GP Practice Maps show practice boundaries, location and population

Pinpointing patients and practice areas Understanding the distribution of patients within a practice area is vital for planning the effective delivery of services to improve healthcare whilst making efficiency savings.

GP Practice Maps show practice boundaries, location and population spread against a range of Ordnance Survey backdrop data including electoral and administrative boundary information and street-level mapping. This helps GPs and other Clinical Commissioning Groups (CCGs) to understand where their patients are located in relation to their practice

D11055_0913 Innovation in Healthcare Inno in Healthcare v7 book.indb 34 advertorial.indd 3

boundaries, providing evidence to support primary care contract monitoring, service development and patient registration.

As a definitive source of practice boundaries, the map acts as a single shared point of reference which reduces the amount of time spent responding to contractual enquiries as well as questions about registration from the potential patients. Other information, such as hospitals, can be included on request and the maps are available on demand for those using the HealthGIS portal.

30/09/2013 12:27:04 01/10/2013 15:06

Walking times to needle exchange locations in Bristol

Targeting specific services to areas most at need By identifying gaps in drug and alcohol service provision, data supplied under the PSMA has helped with the future planning of treatment centres in Bristol to provide better value for money and use of resources.

Information presented in HealthGIS was used with other maps showing public health indicators, such as areas of deprivation and hospital admissions, to show where people using drug and alcohol services live, and pinpoint the treatment centres they attend. Used as part of a joint-working initiative between NHS Bristol

D11055_0913 Innovation in Healthcare Inno in Healthcare v7 book.indb 35 advertorial.indd 4

and Bristol City Council, it played a key role in the drug treatment needs assessment process.

‘We were able to develop this type of project, where data is sourced from both the NHS and the council and presented alongside Ordnance Survey mapping, as a direct result of the PSMA’, says Trevor Foster. ‘This allows much better partnership working and accurate planning of services as the Ordnance Survey data used within HealthGIS provides a more flexible and visual tool for decision makers to work with’.

30/09/2013 12:27:05 01/10/2013 15:06

The GP Finder enables users to quickly and confidently identify practices in relation to other services

A self-service to seek and find GP practices quickly and easily Available from any computer with access to the NHS network, the easy-to-use self-service HealthGIS GP Finder has streamlined response times to queries about patient registration.

GPs are contractually required to provide primary care services to patients living within their catchment boundaries so support services and administrators often need up-to-date information on the areas each practice serves. By entering a patient’s postcode, the GP Finder tool uses the latest GP contractor data and GP practice areas to identify all practices where they are eligible to register. Search results are displayed with other information, such as hospitals or pharmacies, on Ordnance Survey mapping at a range of scales. Addresses are pinpointed using AddressBase® Plus and travel access analysis is

D11055_0913 Innovation in Healthcare Inno in Healthcare v7 book.indb 36 advertorial.indd 5

carried out using OS MasterMap® Integrated Transport Network™ (ITN) Layer.

The GP Finder enables users to quickly and confidently identify practices in relation to other services using the map interface, allowing them to provide added value when dealing with the public and other healthcare professionals.

To find out more about SWCS’s GIS service please visit http://www.healthgis.nhs.uk/ or call Trevor Foster on 01179 002490.

To find out more about Ordnance Survey data and the PSMA, please visit www.ordnancesurvey.co.uk/health

30/09/2013 12:27:05 01/10/2013 15:06

Latest from Clarendon Medical Practice, Salford

19 minute median response time from a GP 90% of patients choose to be seen same day Continuity climbs 15% to 85%, among the best GPs stress reduced, free slots nearly every session Patients love it - 76% say it’s better From NHS choices: I think the service Clarendon surgery offer is brilliant, I can ring and get a Dr’s telephone consultation virtually straight away and if needed an appointment that same day... a big thank you to you all for all your hard work and commitment, please dont change!!

Read on to see what they changed

Anne Robinson

Inno in Healthcare v7 book.indb 37

01/10/2013 15:06

Patient Access

CHANGE in General Practice – what one surgery has done This 8,700 list practice in Salford was struggling with stressed doctors unable to meet the demands of frustrated patients.

Receptionists were stuck in the middle, taking abuse from patients and unable to help them. Then they changed.....

19 minute median response time from a GP 90% of patients choose to be seen same day Continuity climbs 15% to 85%, among the best GPs stress reduced, free slots nearly every session Patients love it - 76% say it’s better

Clarendon practice is located in an area which is the 14th most deprived in the country. Alcohol admissions are the highest in UK, 49% of the population live in poverty with pensioner poverty being 55.8% and unemployment is 7% (higher than the England rate of 5.1%).

Life expectancy is 63.9 years for women and 67.8 years for men (lower than the national average).

Before the change, the practice was experiencing a high demand for their services where patients had to wait over three days to get an appointment with their doctor. There was often a mad rush on the practice telephones at 8.00am as soon as the phone lines were switched over from the out- of- hours service, as well as patients waiting outside the surgery hoping to get one of the spare appointments available that

38

day. Patients were having to phone back day after day to secure an appointment.

Generally within the first hour of the surgery opening all the pre-bookable appointments were taken leaving the patients frustrated. This had a knock on effect on the reception staff who were at the receiving end of abuse from unhappy patients, leading to increased stress for the doctors and the tarnishing of the practice’s reputation.

In the autumn of 2012 Dr Jeremy Tankel, GP principal at Clarendon, together with his two partners and three salaried GPs decided to do something about the increasingly worsening situation. They and the rest of the practice team embarked on a transformational journey with the help of Patient Access to improve their working lives and their patients’ experience.

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 38

01/10/2013 15:06

Patient Access

Average days wait to see a GP falls off a cliff.

All data from Clarendon, charts by PA Navigator

The practice changed the way they handled the request for appointments by patients. The new system was simple: • The patient wants the doctor • The doctor phones the patient • Together they resolve the problem Through this change the practice has been able to achieve remarkable results.

Patients can now speak to their doctor on the same day they contact the practice. The graph shows the average number of days wait has fallen off a cliff.

They now measure the wait in minutes. Median is about 30.

As the GPs phone all the patients, 56% of the problems are resolved on the telephone leaving 44% to be seen as a face-to-face appointment. The doctors are able to respond quickly telephoning patients back within a median of 30 minutes and which has recently reduced further to 19 minutes median. There is now flexibility in the face-to-face appointments to allow the GPs to spend the right amount of time with each patient, in some cases up to 20 minutes or more if needed.

Patients are more likely to see the same doctor, with 85% continuity – up by 15% from before the change. This has had a dramatic effect on DNA rates which have dropped by 60% right from day one of the changeover.

“

We are now on top of our workload Dr Jeremy Tankel beams

“

What was the change?

All data from Clarendon, charts by PA Navigator

INNOVATION IN HEALTHCARE Inno in Healthcare v7 book.indb 39

39 01/10/2013 15:06

Patient Access

What is the overall effect of the change on the practice?

“

Although patient demand continues to be high, it is stable and the practice staff are feeling on top of the workload. There are free slots in most sessions and the waiting room has become a ‘no-waiting’ room as patients are seen promptly for their appointment.

As patients know that they can ring the surgery at any time during the day and have an opportunity to speak to their doctor, the need for the 8.00am rush has gone.

The practice staff feel less stressed and the level of abuse from patients has gone.

All the patients who need a face-to-face appointment are able to have this on the same day (around 90%) whilst the remaining 10% chose to wait for their own convenience.

40

Phoning my doctor is far better as I find it hard to go out, definitely a better system!

Excellent

“ “

“ “

I like it. Keep it

“

Patient quotes:

The system has worked so well for the practice that it has now been able to save one clinical session.

So what do the patients think?

The patients themselves have responded well to the new system.

In the most recent survey of patients 8 months since the change. 76% said the new system was better and only 8% said worse, with the remaining 18% saying the same. This has been driven by rapid response and a choice of doctor.

As the response time of the doctors telephone calls has improved, the proportion of patients saying that the service is ‘better’ has changed little while those saying ‘worse’ are halved.

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 40

01/10/2013 15:06

Patient Access

What is Patient Access?

Patient Access is a social enterprise that is transforming primary care across the UK. Invented

by GPs who wanted to develop and make known their discovery of a better way to provide access for patients to their doctors, it now serves over 500 000 people. We are now working with over 80 practices across the UK and have an ongoing research programme.

The structured change programmes are tailored to each practice and includes products and services such as: • Pathfinder – which through informed consensus on changing the system allows partners to discuss the options with the benefit of precise knowledge on current practice performance • Launch – which involves a whole system change, completed, working and evaluated over 12 weeks • Navigator – an analysis suite which supports the above programmes

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

www.patient-access.org.uk

INNOVATION IN HEALTHCARE Inno in Healthcare v7 book.indb 41

41 01/10/2013 15:07

Telehealth

If Telehealth is the answer, what is the question?

John Dyson Chairman of The Medvivo Group

For those of us who have reached retirement age, the above question may be reminiscent of the general paper taken with university entrance exams. There, we were given a set of questions we hated and to which we had no idea of the answer.

But of course, the point of the paper was to find out how much a candidate could think on their feet.

In strict terms, there is no question to which the answer would be, “It’s Telehealth, stupid”.

It was around ten years ago when I started looking at the potential for technology to provide a solution to the rising cost of providing better and more care to people at home. This has always been a very different challenge to adopting other advances in technology, such as new drugs, new equipment or new surgical procedures. At the beginning, it did seem that applying new gadgets for home-based patients would magically be adopted in the same way as the other examples described above. Simple observation tells us that there has been almost no universal adoption of Telehealth in spite of the benefits that can be realistically anticipated.

One can only conclude that we failed to identify,

42

set and answer the correct question, and may still be failing in that regard. The truth is that, unlike a new drug or surgical procedure, providing a technology-based method to improve care at home has little to do with the technology as such. It is all to do with changing the way clinical providers and professionals regard their patients and their own working way of life. I having spent much of my working life with highly intellectual electronics engineers. On the one hand, these individuals were inventing the most extraordinary products – modems, multiplexors, games machines, memory and microprocessors – but on the other, they were utterly incapable of playing properly when it came to improving their own working practices. The classic example of procrastination was provided by a group of prestigious engineers who took nine months in failing to come up with a mission for their continuous improvement team.

This procrastination has partly contributed to the fact that they way healthcare is delivered around the world has hardly changed over the last fifty years. It is a fine example of a failure in Darwin’s principle of survival of the fittest, made possible by supremely exercised restrictive practices and redrawing of

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 42

01/10/2013 15:07

Telehealth

entry qualifications to ensure that the professionals can safeguard their way of life. In the end, however, all animate bodies collapse and die, leading to a process of renewal.

“

“

A fine example of a failure in Darwin’s principle of survival of the fittest

Fifty years ago, the health professionals may indeed have been able to lord it over their patients as a consequence of their superior knowledge. This is no longer the case. In the internet world, we all have access to more and better information. Patients expect and deserve to be at the centre of their care.

So, maybe here is the question: How can we enable patients to take more responsibility for their own care and well-being? How can a patient get to be the focus of attention, as a reality and not as a Power Point slide?

The answer is Telehealth. Why? Because the patient can say to their Telehealth care team that today they feel worse than yesterday. They can expect a clinical expert to get back to them in a few hours and discuss what would be the best way forwards. The patient benefits are improved confidence, better selfrespect, more freedom to get about. They no longer have to pitch up at A&E unless a benefit will result and don’t have to negotiate with the GP practice for the next appointment. It’s a liberating experience and very few patients who have received Telehealth as a service want to go back.

This is an improvement on the failed yet correct questions: how to reduce patients attending GP practices, how to reduce patients pitching up at A&E, how to reduce the 60% of acute beds that are used by patients with long-term conditions, how to reduce cancelled acute procedures following the lack of a bed, how to reduce the need for community matrons to make routine visits to patients. All of these questions require a change in the way people work, and it will never happen without the driving force coming from the patients. Once the patients make their views clear, the way opens up for politicians to realise the goal – of providing a better service to more and more people, without bankrupting the system.

INNOVATION IN HEALTHCARE 4 3 Inno in Healthcare v7 book.indb 43

01/10/2013 15:07

Telehealth

Improving the patient pathway With telehealth systems, patients are increasingly able to monitor and treat their own conditions

NHS Ayrshire and Arran have been improving the patient pathway for Chronic Obstructive Pulmonary Disease (COPD) with the use of telehealth self-management. The service was piloted in the Dalmellington area of East Ayrshire in conjunction with clinics set up in Dalmellington Medical Practice with the GP, practice nurse and community nursing team monitoring the telehealth readings.

The HomePod enables patients to self-monitor at home, using a touchscreen tablet with paired medical devices, such as blood pressure monitor, pulse oximeter and weight scales. These readings are sent in real-time for the clinician to review and to take the appropriate action if necessary.

Evaluations have shown a 26% reduction in GP appointments, 70% reduction in emergency admissions to hospital and an 86% reduction in Ayrshire Doctors On Call (ADOC) contacts. Not only does this represent a reduced cost pressure to the local health service, but it also represents significant benefits to the patient as they experience less inconvenience from needing to attend the GP or hospital.

Telehealth has also shown to stabilise patients’ health, as their health professionals are easily able to monitor their condition daily.

Another benefit has been the facilitation of a much closer working relationship between NHS Ayrshire and Arran and Local Authority staff in the joint management of COPD. This has streamlined the pathway as awareness has been increased and duplications of assessments are likely to reduce.

One of the most significant benefits of this service is the empowerment of patients to self-manage their condition, by helping them recognise their symptoms and giving them confidence to go about their daily lives. Medication adherence has also improved as the impact of their treatment on their condition is evidenced.

A cost-effectiveness analysis by NHS Ayrshire and Arran has shown that, over 5 years, the telehealth service could save 40% compared to ‘usual care’, a sum of over £100,000.

To find out more information on setting up a similar service, visit Medvivo at www.medvivo.com or email info@medvivo.com. We have a wealth of experience in supporting numerous telehealth projects across the UK.

44

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 44

01/10/2013 15:07

Telehealth

Patient

“

Patient

“

“I used to be really bad at taking my medication and quite often would end up very ill or even having to go into hospital. Since I’ve had the equipment I get a phone call from one of the girls and they tell me to start taking my antibiotics. I haven’t been in hospital since this started”

“

“

“

Patient

“

“

“

“I think it is brilliant. I have learned how to recognise my own readings and if I think I have been a bit too active before I do them, I don’t send them. I relax and do them again before sending them”

“I think it is really excellent. I haven’t seen my GP since I started doing this but I know I am being monitored every day so I don’t have to worry”

“Since the first patients have had the equipment in their homes I have had less need to see them in surgery. Patients seem to be more in control of their condition”

“

Clinician

“Because we check the alerts daily, we have managed to contact a number of patients showing early signs of exacerbation of COPD and advised them to start their medicines in reserve, possibly averting a hospital emergency admission”

“

Clinician

INNOVATION IN HEALTHCARE 4 5 Inno in Healthcare v7 book.indb 45

01/10/2013 15:07

Telehealth

The Portsdown Group Practice Telehealth allows just one nurse to monitor the health of around 200 people at a time

The continuing debate over the effectiveness of Telehealth is plaguing the NHS. Clinicians, commissioners and providers alike have a myriad of opinions and experiences of Telehealth and its applications. Medvivo believe that Telehealth, when intelligently deployed, improves clinical outcomes for patients, achieved efficiency savings and is cost-effective. In order to gather robust evidence in a real-world environment, The Medvivo Group, a leading Telehealth provider, has been working with Professor Nick Bosanquet at Imperial College London to assess the effectiveness of Telehealth interventions.

Initial findings from research based on 71 COPD patients who have been using the service for six months has yielded the following results: • 85% reduction in GP home visits • 67% reduction in GP appointments • 57% reduction in unplanned hospital admissions • 52% reduction in A&E attendance This study is on-going and is being run with support from the senior partners at The Portsdown Group Practice. The practice operates across

46

four surgeries and covers Portsmouth and the surrounding areas. Of the 30,000 patients, 14.5% of the practice population is aged over 65.

Dr Julian Neal, senior partner at the Portsdown Practice explains: “Long-term health conditions are becoming an increasing problem in general practice. These patients will inevitably need extra attention after the initial diagnosis and during more challenging periods of their diseases. This means that a significant proportion of our patients will benefit from Telehealth at one time or another.”

Portsdown Group Practice is an innovative practice that wanted to improve and increase the services offered to patients through efficiency savings and by empowering patients to self-manage their long-term conditions.

Using Medvivo’s wealth of experience, the services that traditional services find hardest to offer have been identified: • Composition of clinical protocols reflecting the input and approval of senior specialists • Support in patient recruitment

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 46

01/10/2013 15:07

Telehealth

• • • • •

Scheduling and performing installations Training the patient in how to use the equipment Nurse-led clinical case management De-installation and cleaning of equipment to pass on to the next patient Support of data analysis – both quantitative and qualitative

These elements reflect the most effective and efficient model of Telehealth delivery.

Additionally, robust project management should be in place to support the initiation and expansion of Telehealth services, supporting the NHS teams to deliver the high-quality services they want for their patients.

A key component of an effective Telehealth intervention is having dedicated specialist nurses managing Telehealth patients.

This not only ensures the scalability of the service but also the guarantee that effective, meaningful interventions are taking place, keeping patients healthy and in the comfort of their own homes.

The aim of ‘The Complete Telehealth Solution’ (the service being delivered to The Portsdown Group Practice) is to reduce hospital admissions for patients with conditions such as COPD and CHF thus reducing the acute care costs for these patient cohorts.

“Working in partnership with Medvivo has given us the opportunity to support our patients while enabling our clinicians to focus on the most complex cases. The Complete Telehealth Solution is the only viable option to ensure high standards of care are met and maintained during this time of efficiencies. It actually represents improved care pathways for long-term conditions through selfmanagement.

savings can only be generated if a central nurse-led case management service is at the heart of any Telehealth service,” explains Dr Julian Neal, senior partner at The Portsmouth Group Practice.

Using Medvivo’s HomePod, patients record their vital signs and answer pertinent questions about their health. This allows nurses to gain a greater insight into their disease and enables them to optimise their treatment. This allows for much needed support during difficult times, empowering them to take greater control and gain understanding about their conditions.

Dr Julian Neal explains, “Telehealth is about doing things differently. At the moment, the NHS is facing a deluge of work, most of which is actually to do with an ageing population with long-term conditions. You simply cannot allow the triaging of every individual patient who has a Telehealth system in their home to be done by people who are currently working in the community. All that does is add to their current workload rather than improving it. So central case management is the way that you get the financial and the efficiency gain.

“For example we see diabetic patients three times a year on average, so we are getting three snapshots a year of how they really are. With Telehealth we can measure their blood pressure, their pulse, their blood glucose levels, how they are feeling on a daily basis – all without involving any of the current partners or practice staff by monitoring this remotely by a specialist nurse that we trust. This nurse can look after between 200 and 300 patients quite easily every day.

And that is a revolutionary new way of delivering healthcare to people living with long-term conditions.”

“It is clear that Telehealth is good for patients. Clinical outcomes are improved, lives are saved and admissions are prevented.

Patient engagement with their long-term condition also increases. My own experience of Telehealth suggests that significant cost

INNOVATION IN HEALTHCARE 4 7 Inno in Healthcare v7 book.indb 47

01/10/2013 15:07

Telehealth

Dorset CCG – Telehealth Project By allowing patients to monitor their own conditions, Telehealth is reducing the need for health appointments

Staff and Service The key service outcomes are: to improve the quality of life for patients with long-term conditions including, but not limited to, Chronic Obstructive Pulmonary Disease (COPD) and Chronic Heart Failure (CHF) through self-awareness and self management of their condition; and, to reduce non-elective/ unplanned hospital admissions for patients, offer care closer to home and assist with directing clinical resources where they are most beneficial/ required.

The main aims of providing the Telehealth service are: 1. Provide individualised technological support for patients to enhance their care management within a community setting; personalised care planning; patient-focused interventions across the disease trajectory from health promotion and disease prevention to intensive monitoring and support 2. Measure the impact of Telehealth on emergency admissions and acute care within a small controlled group receiving Telehealth.

3. Ensure robust system management including: • patient co-ordination and progress updates • clinical advice • supported discharge from hospital and/or patient referral to other services • prevent/reduce unnecessary/inappropriate hospital admissions.

3. Assist in the clinical decision-making, providing patient empowerment and autonomy 4. Test the impact of new technology on case load/work load of community teams.

Prior to the launch of the service in February 2012, meetings were held with key clinicians to engage them and encourage Telehealth as “another tool in the toolbox” for patient management. It will help reduce case loads, cut the carbon footprint, reduce hospital admissions, and assisting patients with selfmonitoring and management of their conditions. Training was given on the Clinical User Interface prior to patient recruitment. Each Health Care Worker would then identify and carefully select those patients who they felt would benefit. Demo pods were sent to those who required them in order to assist in patient recruitment/selection. Leaflets were also distributed to surgeries.

48

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 48

01/10/2013 15:07

Telehealth Patient Perspective – Case Studies

Brian Hutchings – Shaftesbury, North Dorset

Albert Fudge – Poole

“I was diagnosed in 2001 with COPD and was admitted to hospital quite often. Since having Telehealth, this is the first year I haven’t needed any admissions.

“I was diagnosed with COPD in 2009 and Telehealth was recently suggested to me by my practice nurse.

My community matron introduced me to the idea of using Telehealth, he explained what it was and I agreed this would be a useful tool to help me manage my health.

Telehealth is an absolute god-send to me as it gives a warning if things aren’t right and I know when I need to talk to my GP. Telehealth even helps my wife as she is also reassured everything is okay.

The gentleman who came to set up the equipment showed that it is so easy to use. Once you get used to it it’s so simple and others shouldn’t be afraid to give it a try.

I believe I am now meeting my ‘goal’, which was to gain a better understanding of my health and reduce hospital admissions.

I can control my health now and have clearly seen benefits and would certainly recommend it to others.”

Carol Foulkes – Christchurch “I was diagnosed with COPD in 2007 and was having bouts of pneumonia and chest infections.

I was back and forth to the GP and hospital for chest X-rays.

When you’re feeling poorly, the last thing you feel like doing is going outside and so Telehealth is ideal as you can use it in my own home.

Telehealth was introduced to a group of us at a local meeting and I spoke about the use of this to my community matron who felt I could benefit.

My first reaction upon seeing the equipment was that it looked easy to use and the text was very clear.

I was a bit sceptical at first as I wasn’t sure how a piece of equipment could do what my nurse does!

Since I’ve started using it, Telehealth has been a god-send. I have had no admissions to hospital and I haven’t needed to attend my GP practice for routine appointments or tests. I can now do these in my own home, in my own time and at my own pace.

I feel so comfortable knowing my results are being picked up and looked at by the people who know me and understanding my condition.

I don’t take up appointments that other people need and I know I can just pick up the phone if I do need to speak to someone.

I would definitely recommend Telehealth – it’s my lifeline!”

Telehealth gives me confidence in myself and in what I can achieve – this is one aspect I didn’t expect.

I do understand my condition more now that I’m using Telehealth and it gives me peace of mind.

Contact with my GP and hospital has considerably reduced as I no longer need to visit as often due to my use of Telehealth and being able to monitor my health remotely.

I also regularly view my own ‘history’ to check how I’m doing each week.

I would absolutely recommend it to others. It’s so easy to use and is such a useful tool to help with your health.”

INNOVATION IN HEALTHCARE 4 9 Inno in Healthcare v7 book.indb 49

01/10/2013 15:07

Telehealth

Clinician Perspective Case Studies Pearl Lesson, community heart failure specialist nurse “I have referred over 80 patients to Telehealth since July 2012. Feedback from patients has been very positive. Many of them have said that when they do have appointments, they feel more involved in the planning of their care as they take the Homepod along with them and are able to give the team an accurate history of their blood pressure, weight and pulse.

My initial user of Telehealth was an elderly gentleman who I was reviewing on a weekly basis as he remained short of breath, fatigued, and lightheaded, which meant it was hard to optimise his medication. Prior to referral the gentleman also had frequent appointments with his GP and some lengthy hospital stays. I also took into consideration the effects of travelling, as he was reliant on others for transport. As a result of the installation of the Telehealth equipment, the gentleman reports he feels safe and less anxious at home as there is someone ‘keeping an eye on him’. It gives him the confidence to go for a short walk, as he can see his blood pressure has improved. This has reduced the number of clinic appointments he needs to attend. Instead, I was able to make a short phone call and intervene proactively. From the service point of view, Telehealth has freed up my time to see new referrals quicker, both at home and in the clinic.

This has the potential to improve patient care and reduce unnecessary hospital admissions.”

•

Pearl looks after a huge area of Dorset and has a caseload of over 100 patients. To date, she has referred around 86 patients, 70 of whom still actively use telehealth.

•

She sees 10 patients each day on average, which is 120 per month.

•

Pearl says: “By referring patients to Telehealth to take their own readings, it has saved around 20 visits to patients each month”. In financial terms, that’s an average £400 per month in savings to the NHS.

50

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 50

01/10/2013 15:07

Telehealth Melanie Abel, practice nurse, The Adam Practice “I have 21 patients using Telehealth.

Feedback from patients is always positive. The equipment is easy to use and it gives them re-assurance that their condition is being monitored and they are involved in the management of their own care/ condition.

I initially referred a patient with high anxiety levels associated with his COPD and frequent exacerbations. As a result of this, his contact with the health community was high. He welcomed the opportunity to participate in Telehealth and says he felt immediately reassured that he could monitor his condition more closely. Subsequently his anxiety levels have reduced greatly and contact time with health professionals has also decreased.

Other patients have been pleased as it has reduced contact time with health professionals, and helped improve their own self-management and awareness of their condition. It is reassuring to know for both patients and clinicians that if there are any technical difficulties the freephone helpdesk is available to offer help and support.

I feel Telehealth equipment can have real benefits to patients and the health community. Analysis of patients’ use of the health system before and after the installation of Telehealth shows a significant reduction in the number of admissions and visits/calls from GPs and nurses.”

Where we are now 400 referrals received to date with 300 patients currently using.

The project has seen the expansion to other areas such as oncology, mental health and the start of a diabetes pilot.

Regular clinical reference groups and patient feedback sessions are held for networking and sharing best practice on ways of working while always looking at ways to improve the service.

Dorset CCG has been shortlisted for an HSJ efficiency award for the implementation of Telehealth across Bournemouth, Poole and Dorset.

INNOVATION IN HEALTHCARE 5 1 Inno in Healthcare v7 book.indb 51

01/10/2013 15:08

Elephant kiosks

What’s the elephant in your room?

An elephant in the room describes an obvious truth that is being ignored or going unaddressed. Ask any healthcare professional for an example and they’ll probably cite the obvious truth about our national health service – which is that it simply can’t go on growing in a way that will meet the needs of the future. Our population is growing (in all senses) and, as we’ve got better at curing people and extending life, it’s getting older. The fact is, there are many more of us who now have to compete for health services, but as the demand for those services keeps rising, it’s also a time when resources are at best static, but realistically shrinking.

Add to this the Government’s relentless focus on service quality and choice; to ensure people get both, they will need to be able to compare providers.

And, providers are therefore going to have to create the means to generate meaningful feedback from their patients. It’s potentially a big problem – but Elephant has a ample solution.

52

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 52

01/10/2013 15:08

Elephant kiosks Engaging your patients The recent NHS reforms rightly demand that patients are at the centre of their treatment and that their views should be taken into account as never before. The new landscape now demands exchanges of information between clinician and patient on a significant scale. The positive side to this is the growing evidence that someone who is properly informed and engaged in their care makes for a much better patient – that is, someone who not only takes up less time and costs less to treat but who will also benefit from improved health.

Everyone wins but the question is, how do you go about giving patients the opportunity to be more engaged?

A Friends and Family test in primary care?

The NHS is becoming a more competitive and commercial environment. A patient’s experience is going to be an increasingly important metric for commissioners faced with doing more with less.

The Friends and Family Test was introduced earlier this year to measure patients’ experiences in hospitals and there is every likelihood of something similar being extended to primary care settings.

Patient engagement and experience – why you need to take notice CQC requires Provide service users with appropriate information and support…. …enable patients to express their views… …involve service users in decisions…

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. The whole process must be as simple and painless as possible for everyone involved.

CCGs required … to have meaningful engagement with patients, carers and their communities…

Patients Association recommends

INNOVATION IN HEALTHCARE Inno in Healthcare v7 book.indb 53

53 01/10/2013 15:08

Elephant kiosks What will it mean in practice?

An Elephant Kiosk ensures that obtaining and using patient experience data 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.

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 dashboard presents the information you need in a form you can analyse easily. The feedback is instant with real-time alerts if you want them and you can compile weekly, monthly or quarterly reports.

54

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 54

01/10/2013 15:08

Elephant kiosks How do you spot an Elephant?

The technology behind Elephant means you can interact with your patients in a number of formats from touchscreen static kiosks, handheld tables and touchscreen tables to interactive window displays, touch-sensitive floors and motion-sensitive displays.

For a full demonstration of all these, take a look on the Elephant website: www.elephantkiosks.co.uk

Charging Elephant The purchase and running costs are not huge either.

Once you’ve chosen the style of kiosk, we’ll work with you to configure the software to suit you.

There’s a one off purchase cost for the kiosk and whatever software you choose so you’re not tied into an expensive lease or high service and maintenance costs. And that’s it.

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@elephantkiosks.co.uk INNOVATION IN HEALTHCARE Inno in Healthcare v7 book.indb 55

55 01/10/2013 15:08

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 56

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

Inno in Healthcare v7 book.indb 56

01/10/2013 15:08

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

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 INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 57

57 01/10/2013 15:08

Community Health Partnerships 10 years of delivering Public Private Partnerships

Introduction It’s hard to believe that a decade has passed since the formation of the first LIFT Company in East London.

There is much to celebrate within the past 10 years and as the national LIFT Programme lead, we wanted to explore the impact of the Programme during that time in more detail, recognising that whilst the core rationale behind LIFT is the delivery of more effective and accessible health services, there are also many other potential benefits and impacts.

Dr Sue O’Connell, Chief Executive, Community Health Partnerships

This report is the result of independent research carried out by AMION Consulting earlier this year.

The research explored the socio-economic impact of the LIFT Programme during both its construction and operational phases over the past 10 years. During that time 314 buildings have opened or are currently under construction and, as this report demonstrates, these developments bring with them a host of additional benefits in terms of the social and economic impact that they have within their local communities, particularly in areas that are amongst the most deprived in the country.

The LIFT Programme has also supported a number of the requirements that have been key features of NHS policy over recent years. Many of these are embodied in the Department of Health’s Quality, Innovation, Productivity and Prevention (QIPP) Strategy and in many respects LIFT can be seen as a capital investment arm of that strategy.

The achievements, and the outcomes highlighted in this report, are shared achievements. At the heart of the LIFT Programme are long-term Public Private Partnerships, and I’d like to thank everyone who has been – and indeed still is – involved in the Programme.

Dr Sue O’Connell Chief Executive, Community Health Partnerships

The impact of the Local Improvement Finance Trust Programme

Inno in Healthcare v7 book.indb 58 CHP5526 Amion Report Summary_v2.indd 1-2

01/10/2013 15:08

Community Health Partnerships 10 years of delivering Public Private Partnerships

LIFT impact

LIFT Investment

Improved Health Facilities

Organisational impacts Service quality

Service efficiency

Linkages

Improved services

Community impacts Engagement

Employment

Facilities

Social inclusion

Service user impacts Service accessibility

Service quality

Joined up pathways

Improved health

Financial beneďŹ ts

Business impacts Turnover

Productivity

Business growth

Commercial impacts Environment

New investment

Image

Improved property market

Economic beneďŹ ts

The impact of the Local Improvement Finance Trust Programme

Inno in Healthcare v7 book.indb 59

01/10/2013 27/09/2013 15:08 09:49

Community Health Partnerships 10 years of delivering Public Private Partnerships

Achievements over the past ten years LIFT Investments

Improved capacity to provide quality services

Reduced and changing demand for health and community services

Improved health of local population

The developments to date provide employment opportunities for approximately

30,000 people

Improved health and community services

Improved local economic, social and environmental conditions

Estimated

ÂŁ1.31bn

injected into the SME sector

Over

ÂŁ2.2bn of capital expenditure during the past ten years

The impact of the Local Improvement Finance Trust Programme

Inno in Healthcare v7 book.indb 60 CHP5526 Amion Report Summary_v2.indd 3-4

01/10/2013 15:08

Community Health Partnerships 10 years of delivering Public Private Partnerships

Nearly 9 in every 10 LIFT projects are in areas with above average health needs

314 80% An estimate of

of construction spend has been on local businesses (i.e. within 30 miles)

projects have been developed across the country with over 872,000 sq m of new floorspace for health service providers and other partners

40% of all LIFT investment – over £790m has been in the in the 10% most deprived local communities – resulting in over 6,500 person years of work

The construction phase is estimated to have generated over

15,000

person years

of employment (gross) of which a third will have been unskilled. With over a further 1,100 person years arising from projects currently in the pipeline.

The impact of the Local Improvement Finance Trust Programme

Inno in Healthcare v7 book.indb 61

01/10/2013 27/09/2013 15:08 09:49

Community Health Partnerships 10 years of delivering Public Private Partnerships

Supporting 21st century healthcare The LIFT Programme has driven a significant improvement in the quality of health service accommodation, improving working conditions and facilities for a wide range of service providers.

Outmoded and inadequate premises have been replaced with high quality, flexible accommodation conforming to NHS standards.

Occupants of the LIFT buildings include organisations such as GP practices, clinical specialists and other health service providers, alongside local authorities and private and third sector partners.

City of Coventry Health Centre

Increased service integration This co-location of a range of service providers in one building has enabled better service integration and, in turn, facilitated improved joint working as well as better integration of primary and secondary care and specialist services. It has also helped reduce unnecessary hospital appointments and allowed more efficient referrals, avoiding people getting lost in the system.

Inter-agency co-operation is also improved, for example, between health and local authority services such as benefits advice, housing support and specialist advice services on issues including immigration, drugs and alcohol.

Through the co-location of previously separate bodies, LIFT has facilitated broader linkages and a more holistic approach to the delivery of health and community services. The Liverpool LIFT developments include, for example, centres where Citizens Advice Bureau, Sure Start projects and third sector providers in fields such as mental health, smoking cessation and counselling services are all based together.

The impact of the Local Improvement Finance Trust Programme

Inno in Healthcare v7 book.indb 62 CHP5526 Amion Report Summary_v2.indd 5-6

01/10/2013 15:08

Community Health Partnerships 10 years of delivering Public Private Partnerships

Improvements in service efficiency LIFT developments also offer potential financial savings and improvements in service efficiency. For example, shared services, more effective use of space and more efficient buildings can reduce overheads and generate potential income as a result of vacating sites and buildings, enhancing the value of assets.

The Bransholme Health Centre in Hull provides a shared reception service for some 10 GPs and an alternative provider practice, while Finchley Memorial Hospital’s energy running costs are now estimated to be some £46,000 per annum compared to over £120,000 previously.

Dr William Lumb

Kentish Town Health Centre

“The building has been designed so we see people much more, it’s made it so much easier to talk to the district nurse, health visitor, whoever.”

Dr William Lumb GP, Sedbergh Medical Centre

A good example of inter-agency co-operation is provided by the Sparkbrook Centre in Birmingham which, as well as housing three GP practices, also provides accommodation for a range of service providers, including: – Health services such as dental services, physiotherapy clinics, district nursing and health visiting; – Local authority services including a City Council Customer Service Centre, benefits and council tax advice and information, homelessness services, housing repair reporting facilities, adult education services and a library including free IT access; – Third sector and private providers including a legal advice service (immigration), a domestic violence agency, a drugs and alcohol misuse charity and an opticians.

The impact of the Local Improvement Finance Trust Programme

Inno in Healthcare v7 book.indb 63

01/10/2013 27/09/2013 15:08 09:49

Community Health Partnerships 10 years of delivering Public Private Partnerships

Improving the health and wellbeing of our communities LIFT projects have played a key role in providing modern and flexible facilities necessary to meet the diverse health and wellbeing needs of disadvantaged, ethnicallymixed and often rapidly changing populations.

LIFT developments are facilitating much better access to a greater range of services, often in areas where a significant number of residents suffer from socio-economic disadvantage including poor health and wellbeing.

There are three times as many LIFT projects in multicultural areas than would have been expected given an even distribution across all area types, with 60% of all projects either in these areas or in ‘disadvantaged urban communities’.

Sparkbrook, Birmingham

As well as providing modern facilities that are accessible to mixed communities and are necessary to efficiently meet health needs, LIFT project accommodation also enables a flexible response to the varying needs of populations undergoing rapid change.

Bringing care closer to patients Overall LIFT has brought care closer to patients and integrated a greater range of services under one roof, in better environments. It has also facilitated other programmes aimed at promoting healthier lifestyles and more outpatient activity.

In Hull, for example, 75% of the resident population now have access to modernised facilities and improved services – including six additional Alternative Provider of Medical Services (APMS) practices, five of which are located in LIFT buildings.

The impact of the Local Improvement Finance Trust Programme

CHP5526 Amion Report Summary_v2.indd 7-8 Inno in Healthcare v7 book.indb 64

01/10/2013 15:08

Community Health Partnerships 10 years of delivering Public Private Partnerships

“Now our patients can be seen by a range of multi-disciplined health professionals and get all the treatment they need in one visit.”

Su Lennox, Senior Dental Nurse

In Liverpool, the LIFT Programme aims to ensure that every resident has access to a GP and community services within 15 minutes by public transport, and to an NHS treatment centre within 30 minutes. Research found that 84% of patients feel that public transport links to the buildings are “excellent”.

LIFT facilities also tend to be open for longer periods than has traditionally been the case for primary care services. The City of Coventry Walk-In and Healthcare Centre, for example, is open from 8am to 10pm seven days a week, including bank holidays.

Su Lennox

LIFT has provided a quality environment for both patients and staff. Kentish Town Health Centre has won various awards for its design and layout, such as the Best Public Building (2010). It was also nominated for the prestigious Sterling Prize Award (2009). Along with consulting rooms, an observation room and office space, there is also an IT based library, training and conference rooms, a gym and community space.

A patient survey at the Sparkbrook Centre found that 96% of patients rated the facility as “very good” or “good” and that 98% thought it to be “much better” than previous facilities.

LIFT has targeted areas that have the most need for improved access to healthcare. Almost nine in every 10 projects have been in areas with above average health needs.

The impact of the Local Improvement Finance Trust Programme

Inno in Healthcare v7 book.indb 65

27/09/2013 09:49 01/10/2013 15:08

Community Health Partnerships 10 years of delivering Public Private Partnerships

Boosting local economies and creating jobs The construction of LIFT projects has been an important source of economic activity during a period of hardship and particularly important in economically disadvantaged areas.

There has been a deliberate emphasis on investment in new facilities in areas that are amongst the most deprived in the country. LIFT investments have often been by far the most significant investment for many years in such areas, with many far-reaching benefits for local communities. There is some evidence that LIFT developments – not least by virtue of their scale and locations – have the potential to drive regeneration and improve the future prospects of local areas.

In total 119 LIFT projects are based in the 10% most deprived areas in the country.

These comprise 42% of all LIFT floorspace built and have involved 40% of total spend, resulting in over 6,500 person years of work

Kensington Neighbourhood Health Centre, Liverpool

£891 million invested in the 10% most deprived areas of the country

£1.34 billion

invested in the 20% most deprived areas of the country

The impact of the Local Improvement Finance Trust Programme

Inno in Healthcare v7 book.indb 66 CHP5526 Amion Report Summary_v2.indd 9-10

01/10/2013 15:08

Community Health Partnerships 10 years of delivering Public Private Partnerships

As well as employment created during the construction phase, LIFT developments accommodate a significant number of jobs. Many LIFT developments are in areas where there are few other employers and will often be the major source of local employment. While comprehensive employment information is not available for all LIFT projects, using ratios derived from case studies, it is estimated that LIFT project tenants across the Programme as a whole could provide over 30,000 jobs in the buildings.

Projects have also often resulted in an increased market for businesses located in or near the LIFT developments. These include private and third sector providers of health services, pharmacies, cafes and other local retail and lifestyle businesses.

LIFT projects have assisted the provision of a modernised infrastructure and in the removal of dereliction. The buildings promote a better quality environment in their local areas and the generally high quality of design, combined with the evidence that they represent significant investment, tends to promote a sense of pride and a feeling that the area has a future, with the community as an active participant. This can help engender a significant improvement in the overall image – both internally and externally – of an area. Such changes in perceptions are crucial in attracting further investment, with LIFT potentially providing a powerful focus for wider regeneration activities.

During the construction phase, the majority of spend has been on contracts with SMEs.

A significant proportion (an estimated 80%) of construction spend has been on local businesses (within a 30 mile radius) and the majority of spend (63% to 91% where known) has been on contracts with SMEs. This suggests that approximately

£1.31bn

has been injected into the SME sector.

The impact of the Local Improvement Finance Trust Programme

Inno in Healthcare v7 book.indb 67

01/10/2013 27/09/2013 15:08 09:49

Pharmacy Voice

Health hubs on the High Street Health hubs on the High Street

Restructuring of the NHS, an ageing population, greater emphasis on medicines optimisation, self-care, public health challenges, and recent pressures on A&E services have focussed attention on how the NHS needs to change so it continues to deliver high quality care to patients, while using the limited resources most effectively. Community pharmacy, as an NHS service provider and a health hub on the High Street, has responded to these challenges, and is playing a significant role in the primary care team, by maximising the benefits patients gain from medicines, supporting self-care and promoting healthy living.

Through Pharmacy Voice, the three largest community pharmacy organisations Association of Independent Multiple Pharmacies (AIMp), the Company Chemists’ Association (CCA) and the National Pharmacy Association (NPA), are building consensus around a vision for a sustainable and vibrant future for community pharmacy as a key member of the NHS primary care team.

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. Each day around 1.6 million people visit one of the 11,000 pharmacies in England, to collect prescriptions, purchase medicines or seek advice.

Original pack dispensing, new technologies, and increasing support from registered pharmacy technicians and trained pharmacy assistants, means that pharmacists who traditionally stayed in the dispensary are now more likely to be out at the counter or in a consulting room, using their clinical skills and experience to help people gain the maximum benefit from their medicines, and offering new services such as Medicines Use Reviews (MURs), the NHS New Medicines Service (NMS), as well as public health interventions such as smoking cessation and sexual health screening.

68

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 68

01/10/2013 15:08

Pharmacy Voice

In recent years there have been many innovations in community pharmacy by individual employers or through collaborative approaches at a local level including: • seasonal flu vaccinations; • sexual health screening including hepatitis and HIV; • alcohol screening and intervention; • anticoagulation monitoring; • pneumococcal immunisation; • tuberculosis therapy; • oral contraceptive supply; • phlebotomy services.

Medicines are at the heart of modern healthcare and remain the most common treatment offered to patients. In 2010 the NHS spent approximately £11 billion on medicines with 80% of this in primary care. However, avoidable medicines wastage in primary care is estimated to be in the region of £150 million annually and in the current economic climate this issue needs to be addressed.

As the experts in medicines, pharmacists, supported by a new regulated profession, pharmacy technicians, are best placed to help patients and the public get the maximum benefit from their medicines, and the NHS to get the best return on its investment.

The treatment of long-term conditions is estimated to account for £7 in every £10 of total health and social care spending in England and the number affected is set to rise by 25% over the next 25 years. Medicines, combined with lifestyle changes, effectively manage long-term conditions such as diabetes and heart disease, yet studies show that between 30-50% of patients do not take their medicines as intended by the prescriber with a consequent loss in health gain for patients and benefit for the NHS. Community pharmacists and their teams have the knowledge and skills 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 care, and also create capacity in general practice to take on the management of more complex diseases, currently managed in secondary care, or to allow more active management of high risk patients.

Increasing the public’s awareness of pharmacy as an appropriate first access point for self-care and the management of common conditions, such as coughs and colds, is an effective way of managing demand for other NHS services, particularly general practice, and even A&E services.

In the community where 96% of the population can reach a pharmacy within 20 minutes the community pharmacy network is an easily accessible gateway to good health. Community pharmacies are already delivering a range of public health interventions, which are focused on challenges of obesity, sexual health, alcohol use and smoking related illness. The Government’s vision for improving the health and wellbeing of people in England, set out in Healthy Lives Healthy People, highlights the potential to use community pharmacy teams even more effectively to improve health and wellbeing.

Chief Executive of Pharmacy Voice Rob Darracott says “The Government and other investors need to recognise that community pharmacy is an essential part of the health service front line and that the profession is ready to play an even bigger role at the heart of the changing NHS. The sector 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.”

Clinical Case Management

by Specialist Telehealth Nurses Inno in Healthcare v7 book.indb 69

INNOVATION IN HEALTHCARE 6 9 01/10/2013 15:08

“Something people SHOULD go to” – care minister Norman Lamb’s comments about CloserStill.

A new event, Health+Care has been created by adding new conferences to popular Commissioning Show

With nearly 6,500 visitors, the new show is the largest of its kind dealing with healthcare integration and NHS reform.

Commissioning Show visitors were up 43% on last year.

ExCel Centre is already confirmed for Health+Care 2014, which will be held over 25-26 June.

The new Health+Care show ended last week at ExCel with a ringing endorsement from government minister Norman Lamb MP. Lamb said the show was “something people should go to”. As minister of state for care and support Lamb was one of the show’s keynote speakers and made an impassioned speech on the merits of healthcare integration.

The show itself was created for GPs and healthcare professionals by exhibition specialists CloserStill Media to become a forum for debate and learning around the on-going issues of healthcare integration and NHS reform.

Building on its already well-established Commissioning Show, CloserStill added three new shows: The Home Care Show, The Residential Care Show and the Health+Care Integration conference to complete the line-up. From 12-13 June, nearly 6,500 people visited the new combination show, which now makes it the largest of its kind in the UK. The Rt Hon Norman Lamb MP, minister of state for care and support said: “To have this opportunity to talk to so many hundreds of people is fantastic from my point of view.”

70

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 70

01/10/2013 15:08

It’s just an amazing opportunity away from the front line to have some thinking time, to learn what’s going on and find out what you can do yourself to make your operation better.”

The Commissioning Show saw attendance grow by 43% from last year. The show is now getting more than 4,000 visitors who attend to discuss, share and learn more about the issues of NHS commissioning. Although still in their first year the other parts of Health+Care saw more than 2,000 visitors.

Ralph Collett, director of medical at CloserStill Media, said: “We set out to create a unique event: it brings together our already successful Commissioning Show with the other areas of care that are so important if we are to create a truly integrated healthcare system for the future.

“I believe the team has achieved that and I am absolutely delighted with the results. In particular, I was pleased with the growth in exhibitors and delegates at what was a hugely successful two days at the ExCel.” Other keynote speakers at Health+Care included Labour Party shadow health secretary the Rt Hon Andy Burnham MP, dementia Tsar Professor Alistair Burns and Andrea Sutcliffe, chief executive of Social Care Institute for Excellence. Overall, more than 300 speakers took part in the show, while it was also backed by leading associations including the National Association of Primary Care, the NHS Alliance, the UK Home Care Association and the English Community Care Association.

Health+Care 2014 will be held from 25-26 June, at ExCel, London. It will again include The Commissioning Show. Ten per cent of this year’s delegates have already reserved their passes for next year’s event.

Tom Vine, event director of Health+Care, said: “After a fantastic first year, we are already looking forward to Health+Care 2014. The debates around healthcare integration will only grow louder over the coming years, so we are delighted that Health+Care is now the forum for them to be heard.

“We will make Health+Care 2014 even bigger with even more expert speakers and exhibitors. It will once again provide the stage for the most senior professionals from all the disciplines, backgrounds and organisations involved in both health and care in 2014, to come together to give a 360° approach to delivery.”

INNOVATION IN HEALTHCARE Inno in Healthcare v7 book.indb 71

71 01/10/2013 15:08

Tom Vine, Event Director of Health+Care

72

“

“

After a fantastic first year, we are already looking forward to Health+Care 2014. The debates around healthcare integration will only grow louder over the coming years, so we are delighted that Health+Care is now the forum for them to be heard

INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 72

01/10/2013 15:08

Ralph Collett, director of medical at CloserStill Media

“

“

We set out to create a unique event: it brings together our already successful Commissioning Show with the other areas of care that are so important if we are to create a truly integrated healthcare system for the future

For more information contact: Andrew McLachlan - andrew@mediazoo.tv - 020 7384 6980 / 07931377162 Sion Taylor - sion@mediazoo.tv - 020 7384 6980 / 0776 8372714 About Health+Care 2014: Health+Care 2014 is set to play a pivotal role in enabling the senior decision makers in the commissioning and provision of care to take real strides towards delivering change. It will provide the stage set for the most senior professionals from all the disciplines, backgrounds and organisations involved in both health and care in 2013 to come together to give a 360Ð approach to delivery.

Health+Care 2014 will bring all the stakeholders together, from all around the country to network, share practical advice, uncover real solutions, and engage with the providers who will help them deliver change.

Health+Care 2014, 25-26 June, London ExCeL http://www.healthpluscare.co.uk/ #healthpluscare

INNOVATION IN HEALTHCARE Inno in Healthcare v7 book.indb 73

73 01/10/2013 15:09

British Society for Rheumatology

Simple Tasks – raising the Chris Deighton,, consultant rheumatologist and president of the British Society for Rheumatology, explains how even the simplest tasks can be overwhelming for sufferers of rheumatic conditions

Life-changing, painful, deforming, costly, crippling, deadly - these are serious words to describe serious illnesses. Rheumatic conditions not only cause inflammation and damage to joints, but can also damage other organs of the body, the development of coexisting conditions, disability, and even death.

The British Society for Rheumatology’s two-year Simple Tasks campaign, in association with the American College of Rheumatology, was launched on 3 October to reach policy makers and health professionals, as well as the general public. Working with partners Arthritis Care, National Ankylosing Spondylitis Society, and the National Rheumatoid Arthritis Society, the campaign aims to raise awareness around the wide range of arthritic and lesser known rheumatic conditions, and the work of rheumatology health professionals. It also highlights the significant impact rheumatic conditions have on the economy, the NHS and up to 16 million people, both young and old, who suffer from musculoskeletal pain in the UK.

74

The bent fork represents the simple tasks that can be impossible for people with these conditions.

Late diagnosis and lack of appropriate treatment, particularly for the one million suffering from severe rheumatic disorders, can have serious consequences. Receiving appropriate treatment – as soon as possible, but certainly within the first 12 weeks after the onset of symptoms – can prevent irreversible damage to joints and organs. To limit this impact, patients must be referred to a specialist.

Those afflicted by rheumatic conditions are cared for by rheumatology healthcare professionals.

Uniquely equipped to diagnose and treat them, early and appropriate referral to a rheumatologist not only improves overall health of patients, but avoids potentially unnecessary tests, unnecessary treatments, and increasing pain and disability in the quest for a diagnosis and treatment plan.

It is hoped that the greater understanding of rheumatic conditions and professionals instilled by the Simple Tasks campaign will relieve pressure on the NHS, save the economy lost revenue and improve the lives of millions.

Working in partnerships to develop & deliver innovative telehealth solutions INNOVATION IN HEALTHCARE

Inno in Healthcare v7 book.indb 74

01/10/2013 15:09

British Society for Rheumatology

profile of RHEUMATOLOGY

“

Life-changing, painful, deforming, costly, crippling, deadly

“

For more information, visit: www.simpletasks.org.uk.

You can also support the campaign using #SimpleTasksUK.

Clinically led, quality assured Inno in Healthcare v7 book.indb 75

INNOVATION IN HEALTHCARE 7 5 01/10/2013 15:09

138654 ZEAL M8 Wave Advert A4_Layout 1 23/07/2012 12:06 Page 1

SAVE MONEY - FREE-UP DOCTOR TIME Q “We have saved hundreds of appointments.”

Q “This has been one of the best investments in equipment that we have made in the last 20 years.”

Q “Our practice nurses are now great fans of the monitor and encourage their patients to use it regularly.”

Q “Every surgery should have one.”

Q “Rapid pay-back time.”

WITH THE SURGERY HEALTH POD Automatic Kiosk User Friendly Audio & Visual Instructions Unsupervised Monitoring Reduce Unnecessary Appointments Free NO OBLIGATION trial in your practice Two weeks duration

Measures: Q Height Q Weight Q BMI Q Blood Pressure Q Pulse Q Results displayed & printed

Q Ticket options Q Buy or Rent Complies with directive 90/384/EEC (Class III) for non automatic weighing instruments Complies with directive 93/42/EEC (Class IIa) for blood pressure measurement

Healthcare Monitors, Kidderminster, Worcs., DY10 4EU • Tel: 01299 250321 • www.health-monitor.co.uk

Inno in Healthcare v7 book.indb 76

01/10/2013 15:09

The quality of the healthcare environment has a direct impact on how the NHS delivers care, and our patients’ experience of it. The work environment is also important for staff: the better it is the more efficient they can be.

NHS Property Services manages, maintains and improves NHS properties and facilities, working in partnership with NHS organisations to create safe, efficient, sustainable and modern healthcare and working environments.

Our two roles 1.

Strategic estates management – acting as a landlord, modernising facilities, buying new facilities and selling facilities the NHS no longer needs.

2.

Dedicated provider of support services such as cleaning and catering.

We have responsibility for 4,000 buildings – worth over £3 billion – which were previously owned, leased or managed by Primary Care Trusts and Strategic Health Authorities.

Our objectives •

Maintain continuity of service and keep buildings safe, warm and clean

•

Place patients and the taxpayer at the heart of our business by supporting the NHS and the broader public sector to transform services

•

Use our scale and effective management of our portfolio to keep costs to a minimum and pass back savings to the NHS

•

Establish ourselves as a truly national entity with a single corporate identity and consistent approach

•

To ensure our estate is managed sustainably and that we support wider government initiatives in this area

•

To be recognised as an employer of choice.

Our sustainability Perhaps our biggest challenge is to make this huge estate fit for the future. In partnership with our stakeholders, we intend to sustain the evolving NHS in buildings which are able to withstand the results of climate change and which have a positive impact on our environment as well as patient care.

Our background

We look forward to working with you More information

E-mail: information@property.nhs.uk Call: 020 7972 5255 Visit: www.property.nhs.uk

@NHSProperty Inno in Healthcare v7 book.indb 77

NHS Property Services was created by the Health and Social Care Act 2012. On 1 April 2013, 3,200 NHS staff transferred from former SHAs and PCTs. We work particularly closely with NHS England and the 211 Clinical Commissioning Groups.

We are a private limited company, 100 per cent owned by the Secretary of State for Health, whilst at the same time being an important member of the NHS family.

The financial and service transformation challenges faced by the NHS are ours too. Whilst we own the estate, the scope to redesign or add value will only be realised by co-operation with commissioners and providers.

Working with Community Health Partnerships NHS Property Services works closely with sister company Community Health Partnerships. CHP creates the highest quality primary and community health estate serving the needs of local communities. From April 2013, CHP took over responsibilities for the LIFT estate.

Together we deliver our shared aim of positively contributing to health outcomes through the better use of the NHS estate. In addition, NHS Property Services supplies estate management and financial services on behalf of CHP.

01/10/2013 15:09

FOR NHS COMMISSIONERS Match4health provides a simple and efficient way for NHS organisations, companies and the the voluntary sector who provide or want to provide services to the NHS, to find each other and introduce themselves. It’s a virtual market place. Providers of services to the NHS can display their products and services while commissioners can outline their needs and source potential partners in one convenient place.

For more information, contact the Match4health team on 0330 111 0251 or enquiries@match4health.co.uk Visit us at the Best Practice show on stand H32

www.match4health.co.uk

MATCH4HEALTH – MAKES SENSE WHICHEVER WAY YOU LOOK AT IT... www.match4health.co.uk For more information, contact the Match4health team on 0330 111 0251 or enquiries@match4health.co.uk Visit us at the Best Practice show on stand H32 Provider organisations will be able to use the same matching matrix to post relevant details about their services and products - making Match4health the most comprehensive market place of its type in the UK today.

Using the Match4health matrix, NHS organisations can quickly and easily search for and identify appropriate provider organisations, including the voluntary sector, who match the need they have. Commissioners can also submit a post detailing what they are looking for.

FOR PROVIDER ORGANISATIONS Inno in Healthcare v7 book.indb 78

01/10/2013 15:09