Innovation in Healthcare by Maritime Media

Innovation in Healthcare

NHS I Challe

Innovation in Healthcare

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13th & 14th, March 2013, ExCeL, London

Expo 2013 - Europe's largest, healthcare innovation event Don't miss your opportunity to see the most exciting and innovative ideas, products and services in healthcare. "Our ambition is for an NHS that is a global leader in innovation, demonstrated both in its support for research and its success in the rapid adoption and diffusion of the best transformative, most innovative ideas, products and clinical practice. A real commitment to innovation will support us to get the very best outcomes for our patients."

Confirmed Speakers Earl Howe Parliamentary Under Secretary of State, Department of Health

Professor Malcolm Grant Chair, NHS Commissioning Board

Sir David Nicholson - Chief Executive of NHS Commissioning Board and NHS Chief Executive

Healthcare Innovation Expo is the must-attend event for healthcare professionals in 2013. The third Expo will showcase the very best innovations in healthcare and the life sciences, including the latest technologies, medicines, products and care pathways. • Over 10,000 delegates from the public, private, academic, scientific and business communities • Over 250 UK and international organisations showcasing what is brightest and best about innovation in healthcare • Dynamic and inspiring speakers from some of the world’s most innovative organisations • Dedicated seminar streams to understand the priorities of each of the NHS Commissioning Board Directors

Innovation Health & Wealth delivering innovation, research and growth for the UK. Clinical Commissioning Groups championing innovation through commissioning.

Chief Executive of NHS Commissioning Board and NHS Chief Executive

Professor Dame Sally Davies Chief Medical Officer, Department of Health

Professor the Lord Darzi of Denham, Head of Surgery, Imperial College, London

Baroness Tanni Grey-Thompson DBE One of Britain's greatest Paralympic athletes

Jane Cummings

NEW for 2013 3millionlives - ensuring people with long term conditions and/or social care needs can benefit from telehealth and telecare.

Sir David Nicholson

Chief Nursing Officer, NHS Commissioning Board

Ian Dalton CBE Academic Health Science Networks establishing a more systematic delivery mechanism for the spread of innovation. Healthcare Apps Zone – showcasing the best healthcare apps transforming the quality of patient lives. Innovator’s Den – pitch your idea to our panel of experts for funding and support.

Chief Operating Officer / Deputy Chief Executive, NHS Commissioning Board

Dame Barbara Hakin National Director: Commissioning Development, NHS Commissioning Board

Bill McCarthy National Director: Policy, NHS Commissioning Board

Professor Sue Hill Chief Scientific Officer, Department of Health

Sir David Reid Former Chief Executive, Tesco

Book now and benefit from our “Early Bird” price at www.healthcareinnovationexpo.com IFC DOH AD.indd 2

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CONTENTS Integration, integration integration Innovation in Healthcare

Michael Dixon, Chair NHS Alliance, examines the role of integration within the NHS

is published by:

CLINICAL COMMISSIONING COMMUNICATIONS LIMITED The Diary House Rickett Street London SW6 1RU Tel: +44 (0) 20 7386 6100 Fax: +44 (0) 20 7381 8890 E-mail: inbox@mar-media.com

Our vision

‘New NHS Alliance’ chief executive Rick Stern describes the Alliance as a voice for the future. He explains how it is developing and extending its reach – and why it’s time for a new manifesto for primary care

Big on benefits

Carl Atkey, Head of Appello Telehealth, explains the importance of raising awareness of the full benefits of telehealth – and how the Telehealth Forum aims to do just that

Phoenix rises

Publisher

Paul Smith, CEO of Phoenix Medical Supplies, discusses how innovation in wholesaling has led to a more patient-focused approach

W H ROBINSON Associate Publisher

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

JUSTIN IVES

South Devon and Torbay CCG

Close working with secondary care colleagues improves services for patients

.co.uk

E: justindesign.co.uk

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Get connected

Robert Bosch Healthcare explains why technology-enabled integrated care offers maximum benefits for patients and NHS alike

Corby CCG

How one CCG is tackling the key issue of referrals successfully

Kettering locality of Nene CCG

How a local solution to a problem was identified that improved access for patients

Supporting healthcare practitioners

Treating heart failure patients in the community

Supporting healthcare practitioners

Bassetlaw CCG

At the heart of change: management of heart and circulatory disease as a long-term condition

CCGs can bring down prescribing costs while also improving patient care

For page turning technology visit: innovationinhealthcare.org

for heart health Ordnance Funding Survey

Do you spend a significant amount of time working with cardiac patients? We offer funding to healthcare practitioners and those involved in educating people affected by heart disease. We provide:

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professional development Mapping leads the way to improved health services

INNOVATION IN HEALTHCARE

• financial assistance for education opportunities • Funding access to conferences andhealth events for heart • access to BHF courses professional development • members only website and resources youmembership spend a significant amount of time working • Dofree to our Heart Matters programme

05/11/2012 11:11

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Medicines optimisation

Crawl, walk, run

We believe that the ever changing needs of healthcare today require a shift in focus, for the industry we helped launch more than thirty years ago

NHS reforms have the capacity to dazzle and confuse – the challenges are many and the opportunities for new thinking are even greater. Stakeholders, commissioners and patients need to adapt new ideas and find solutions to age-old health problems. The adage crawl, walk, run was never more appropriate as the clinical community finds its way through the storm.

Clever technology

Innovation, including the use of technology, has been widely cited by Government health leaders as the way forward. These new technologies, intelligently applied to progressive initiatives such as Telehealth can, and will, in the opinion of NHS Direct help deliver the efficiency gains needed in the health sector.

First step

Many health system commentators are suggesting we could have a perfect storm circling above the NHS. They cite an aging population with unprecedented numbers drifting into long term health conditions (mostly linked to lifestyle and obesity) at the very time the NHS is trying to make £20 billion in efficiency savings.

While many prizes reward past achievements, challenge prizes are different. They provide an incentive for meeting a specific and significant challenge. Winning these prizes can mean making a lasting impact on society and, in some cases, the world.

A Catalyst for Some of Mankind’s Greatest Breakthroughs

At the heart of it all is the overarching need to provide the clinical community with an end-to-end view of the patient’s health record over their full care pathway. While that holistic patient record platform may be some way off, NHS Direct believes that Telehealth operators can make a substantial first step by building part of that jigsaw now: An open (agnostic) Telehealth platform that enables physiological patient data from any Telehealth device in any format to be pulled-in and then made visible centrally via a clear graphical interface.

Putting research on the radar

In the first year, there were seven challenges, ranging from Earlier Diagnosis of Cancer through to Increasing Independence for People with Kidney Failure. The aim is to encourage, recognise and reward innovations that address some of the toughest issues in healthcare today. Substantial prize money is awarded to winning submissions to help fund further essential improvements in patient care.

Other notable prizes included a prize of $25,000 ($291,500 in today’s money) offered by Raymond Orteig in 1919 to the first pilot who could fly an aircraft nonstop from New York to Paris. No-one had attempted anything so dangerous before, and the prize was won in 1927 by a young US airmail pilot called Charles Lindbergh, who, later, became one of the fathers of modern aviation. In 1961, President Kennedy issued an historic challenge to land a man on the moon and return him safely to earth before the end of the decade. NASA fulfilled that challenge on 20 July 1969 and the organisation continues to respond to new space challenges to this day.

Now in their third year, the challenges have grown in profile each year and so, too, has the prestige associated with winning and being highly commended. The NHS Innovation Challenge Prizes have recognised and acted as a catalyst for some truly remarkable innovations that are making a real and significant difference to patients across England. For example, the invention of a cytosponge screening device by the MRC Cancer Cell Unit in Cambridge that enables patients to be screened simply and cost-effectively in a primary care setting as an alternative to undergoing an endoscopy. And, a new nursing bag design, devised in NHS East Riding of Yorkshire that is helping to reduce the risk of infection.

Health economics The other clear winner is the budget holder. PCTs are currently transitioning to CCGs. In turn the CCGs are clustering and consolidating. That’s a lot of activity to bed down by the April 2013 target. But when the dust settles, and CCGs start trying to properly assess the cost of medical outcomes, the data captured by an agnostic Telehealth platform (and securely stored and backed-up centrally) will be of immense value as budget holders work to minimise A&E admissions and the associated spiralling costs.

See us on Stand 52 at the NHS Alliance, Bournemouth. For further info email: ltcteam@nhsdirect. nhs.uk

10/10/2012 12:18

Find the perfect MATCH

Shirley Davey, Michael Brennan, Simon JE Taylor, Hiran Basnayake and Brian J Meenan on how healthcare companies can target their business focus to associated opportunities with a new online resource

Dr Jonathan Sheffield OBE, chief executive of the National Institute for Health Research Clinical Research Network, explains why clinical research underpins the development and adoption of innovation in the NHS

Bradford CCGs

The need for an agnostic Telehealth platform has never been greater – and NHS Direct aims to take the lead.

Sarah Armstrong-Klein RGN, a National Improvement Lead, NHS Improvement, examines early stroke detection

NHS Innovation Challenge Prizes

The practice of offering cash prizes to incentivise breakthrough innovations is nothing new. In 1714, the British Government offered a sum of £20,000 (over £1.3m in today’s money) to help British seamen to overcome the problems of navigating at sea. The prize was prompted by the huge number of voyages ending in tragedy and it led to the creation of the first marine chronometer by an English watchmaker called John Harrison.

Sooner, not later, social media and digital marketing will galvanise an army of patients who will start demanding Telehealth services to maintain independent living. This is as certain as the ebb and flow of the tide itself.

Preventing unnecessary strokes in patients with Atrial Fibrillation

Helping Us to Meet Our Toughest Healthcare Challenges Today

Innovation Health and Wealth, the NHS Chief Executive’s Review of Innovation, set out a compelling argument for the NHS to radically transform the way that services are delivered. In order for innovation to become core business for the NHS, an environment is needed that recognises, celebrates and rewards innovation. These are the ambitions of the NHS Innovation Challenge Prize programme.

In simple terms it means that manufacturers of health monitoring equipment (and proprietary monitoring software) now have the opportunity to plug into a single unified Telehealth platform, primed by NHS Direct. While that’s great news for the vendors as a means of extending their sales reach, it is also fully aligned with NHS’s patient-centric health strategy: Tailor the service to the patient, rather than force a proprietary solution upon them. More plainly, it’s a win for the patient.

Toby Knightly-Day, Managing Director of Fr3dom Health, explains why the primary care sector must interact with the Friends and Family Test

Across the world, safe, effective and affordable healthcare remains one of the greatest challenges facing mankind and, in December 2010, the Department of Health and the NHS Institute for Innovation and Improvement launched the NHS Innovation Challenge Prizes Programme.

Agnostic platform

* The Daily Express – Tuesday October 2, 2012

PSUK’s innovative approach to sexual health and family planning procurement

Prizes can be powerful motivators for innovation. Across many different sectors, challenge prizes are incentivising people to develop ground-breaking new initiatives. The rewards are two-fold: substantial sums of money, coupled with considerable prestige.

One final thought. The front page headline on one national paper in early October reads ‘Diabetes crisis to hit 4.4m Britons. Experts warn of NHS disaster*’. This is only one of many headlines of that flavour in recent months. But, alongside those ominous warnings we should not forget that individual’s are becoming better informed and more engaged in self-management of their health.

Testing times

NHS Direct Advertorial_aw.indd 1

Cleankeys Inc. is harnessing the power of technology to improve infection prevention activities

Incentivising Innovation

No holding back the tide

Is a perfect storm circling above the NHS –NHS Direct

Making the change

NHS Direct has risen to this challenge and has adopted the UK’s first purposebuilt agnostic Telehealth platform. But why now and what does that mean to the clinical community and the patient?

The perfect storm

NHS Direct sees this as a critical first step in the delivery of consistent, properly diagnosed medical triage.

Invisible invaders

To achieve this we must transition from the current model of proprietary health monitoring devices and proprietary monitoring software and this will require collaboration from all parties.

NHS Innovation Challenge Prizes HealthEast CCG

CCGs are using innovative methods to understand patient needs and behaviour – and are involving them in redesigning services

GP engagement with integrated care can drive projects forward and will benefit patients

Air products The power of touch

Fully managed telehealth Fully managed telehealth Patient focused home monitoring service with no up-front costs, from the experts in homecare

How using touchscreen technology improves patient engagement

Newcastle West and Newcastle North and East CCGs 66

Rushcliffe CCG

How CCGs are tackling pathways for long-term condition sufferers

How GPs’ understanding of problems and clinical involvement can lead to better care

Patient power

West London CCG

Not to be missed...

Stephanie Varah, CEO of the National Association for Patient Participation and a co-founder of the Telehealth Forum, explains how the forum aims to focus on what the person using telehealth actually wants

Access all day, every day Rapid access to your own GP is a dream for many, but a growing number of practices are making it happen with a simple innovation

How CCGs are identifying groups that fall between the cracks of existing services and are redesigning services to meet those needs

From Hospital Directions to Health+Care, make sure you save the date for some of health profession’s most informative shows

Encourage, recognise and reward... 102 74 Communication cords

Good practice makes perfect

Stephen Watkins, Director, NHS Benchmarking Network, explains how the group promotes good practice

From Hospital Directions to Health+Care, make sure you save the date for some of health profession’s most informative shows

INNOVATION IN HEALTHCARE

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NHS Alliance

Integration, integration integration Michael Dixon, Chair NHS Alliance, examines the role of integration within the NHS

Integration is the concept of the moment. Like mothers and babies, it is difficult to argue against. Not surprising then that the Health & Social Care Bill, which started off with a focus on competition, should have ended supporting both competition and integration. Indeed, with Norman Lamb joining the Health Ministerial Team, we should expect to see integration taking an ever higher profile in policy and implementation. A good thing too. Two questions need an urgent answer. The first is: “Exactly what do we mean by integration?” The answer is that integration needs to occur at all levels in the NHS. At GP practice level, there needs to be an integrated approach by the whole practice team towards improving the health of patients on the GP practice’s list.

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In primary care, more generally, there needs to be better integration between what general practice does and what community services do more widely. Then there needs to be better integration between primary and secondary care that stops patients falling between the gaps in the hope that this might eventually, one day, lead to abolition of the words “primary” and “secondary”. Finally, there needs to be much better integration between health and social services and, indeed, all health-related areas of local authority work. Few would argue against all these being in the right direction when it comes to looking after a population, where the incidence of long-term disease is rapidly rising and where the care of an elderly population demands better integration as a means of improving NHS cost-effectiveness and enabling its long-term sustainability.

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NHS Alliance

Our apparent inability to integrate in this way appears to be a factor of the professional and organisational silos within which most of us work, possibly not helped by internecine professional rivalry and organisational separation by mechanisms such as Payment by Results. It’s not surprising, then, that many see the solution as organisational change and the creation of integrated care organisations bringing together different providers at local level to offer a far better organised and co-ordinated service. The end of the road in terms of this thinking will be something similar to a US-style Health Maintenance Organisation, but one that looked after all the population (not just the more wealthy or insured) and where savings/ profits could ideally be ploughed back into improving local health rather than distributed to shareholders. The passage of the Health & Social Care Bill saw a passionate and largely pointless debate between those in favour of competition and those in favour of integration. The two are not, of course, mutually exclusive. It is quite possible, for instance, to have integrated organisations, which may compete at their geographical borders or even to have different integrated providers within one locality. Comprehensive integration might make competition more difficult. Equally, rampant competition might cause fragmentation, overproduction and increased demand. Clinical Commissioning Groups, going live in April 2013, will have a duty to promote competition and integration as well as a whole host of other duties, which will include innovation, respecting NICE guidelines and

keeping within budget. The latter, however, will be their overarching duty and possible only if CCGs can make the necessary savings by four means: decommissioning services that are not a priority; redesigning appropriately the services that they do offer; limiting inappropriate demand for them; and extending the reach of such services by “co-production” with local patients and people (for example extending self-care individual health and supporting “Health Creating Communities”). Integration will be a means of achieving the last three, while competition will has a role to play in the second. When it comes to integration and competition, if it has to be one or the other then integration wins hands down. That is because the very title “National Health Service” is a misnomer if the NHS is to survive. It is really a National Health Partnership – poor and wealthy combining forces at national level to ensure that everyone can access a service when they are ill. This now needs to be reflected in a partnership at all levels, all the way down to the individual clinician, patient and citizen. It is something the NHS has spectacularly failed to achieve. Instead, some politicians in the past have promised everything, described the NHS as a consumer service and implied that the role of patients is simply to get the most that they can out of it. Meanwhile, it has been quite apparent to most managers, clinicians and patients that they have responsibilities as well as rights. This concept of partnership has more in common with integration than with competition. Nevertheless, it is not a question of either/or but one of ensuring that the new clinical commissioners have the freedom to decide how much of each.

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Salix

Our vision ‘New NHS Alliance’ chief executive Rick Stern describes the Alliance as a voice for the future. He explains how it is developing and extending its reach – and why it’s time for a new manifesto for primary care

I believe connections, integration and innovation are the bridge between the NHS Alliance of the past and the Alliance of the future and I’m delighted to have this opportunity to describe our vision at such an important juncture in its journey. It is my privilege to take the Alliance forward, building on the history and values of an organisation that has fought long and hard to put clinicians at the forefront of service design and commissioning. As it extends and develops, I sense a new energy and purpose and believe that today’s NHS Alliance is an organisation as critical to the successful implementation of clinical commissioning as it was to its adoption in the first place. In the future, NHS Alliance will be the place where patients, front-line staff and providers across all disciplines come together as the voice

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of the future for providers in primary care, bound by the common values of the NHS to campaign for a fair deal for everyone. Our intention is to work collaboratively to improve health and care, facilitating new and better ways of delivering services through our networks and campaigns – vibrant threads that interweave to form a fully integrated, patient-centred, focused canvas of care. NHS Alliance has always welcomed organisations and individuals of all disciplines, who embrace the core values of the NHS, representing them to government and its agencies to influence policy in the interests of all its members. This won’t change and while we remain a firm supporter of clinicallyled commissioning, our focus today is on the provision of high-quality primary care

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Salix

“Our focus today is on the provision of high quality primary care services that fully meet the requirements of the new commissioners” services that fully meet the requirements of the new commissioners. Our vision is to connect and speak for those at the heart of service delivery and ensure they are fully supported to become valued partners to the new commissioners. Our belief is that clinical commissioning is unlikely to succeed unless providers can demonstrate a true partnership approach and commissioners are open to integration. Good commissioning groups can only achieve so much. Beside them they will need highquality providers with an NHS ethos, who can work by their side to deliver their vision.

A voice for the future. Be part of the conversation.

This will also need the encouragement and support of patients and local people, who are equally signed up to the aspirations of their doctors, nurses and wider health professionals, prepared to be co-providers of health and self-care and catalysts in supporting health creating communities.

Patients: a place where you can help shape an NHS fit for your future.

A first statement of our new intent, “A manifesto for primary care”, will set out a positive vision for the future based on our guiding principles of connecting, integrating and innovating. Due for publication in April 2013, this is your opportunity to shape the future.

Commissioners: a place for responsible and responsive commissioners to interact with those delivering and receiving services within the community.

Providers: a place where you can influence commissioning and are supported to meet the new commissioning challenges with practical advice and tools.

www.nhsalliance.org

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Salix

Big on benefits Carl Atkey, Head of Appello Telehealth, explains the importance of raising awareness of the full benefits of telehealth – and how the Telehealth Forum aims to do just that

pioneering nurseled system to monitor patients’ conditions

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Appello uses a

Being at the heart of the business – and having been here for most of the past 26 years – I’m encouraged by the fact that the telehealth debate has now entered the mainstream. But I think advocates of telehealth may risk losing some power to their argument if the benefits to the patients are not fully understood by everyone – including the patients themselves. I am frequently struck by the way telehealth providers seem to focus on the features of a particular system rather than the benefits. I think this is largely down to the heritage of telehealth, which has its roots in telecare. It’s the world from which I came, so I can speak with some experience about the way in which we have placed great emphasis on the latest technology and equipment and not, perhaps, as much on the benefits to the end user, the patient. It is also, I think, because as providers we are technicallyorientated but the constant referral to bits of kit reflects some of the limitations of telecare.

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It became increasingly worrying to me that the telecare systems available and the data that they provided were not really delivering as much as they promised. For example, someone with diabetes may suddenly have an episode in which their health deteriorates dramatically and quickly. A traditional telecare system would enable them to alert the appropriate person or service to help them. But the fact that their condition had reached this critical point without warning was a matter of great concern to me. Frequently, a patient would have to be admitted to hospital to stabilise their condition, an experience that is both disruptive for them and costly for the local health economy. The data on the patient’s episode would be there for all to see – but only after the event. It seemed to me that while telecare did deliver a degree of care, it didn’t always deliver the best outcomes in terms of health.

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Salix

Back to basics Sometimes, it helps to go right back to basics and one of the universal truths about health is that prevention is better than cure. It set me thinking about how we appeared to be shoehorning our understanding of telecare systems into what actually needed to be a telehealth service. As head of business at telecare provider Careline UK, I set about looking carefully at the trends from patient data we had available and attempting to identify what services could be provided to prevent exacerbation of someone’s condition. How could we harness what technology was available – and even some that wasn’t – to make an intervention in time to avoid someone having a sudden and distressing episode and an unplanned hospital admission? And so it was with these questions that Appello was created. I set out with two clear founding principles: the first was that our new service should exist to provide people with active advice and guidance specific to their condition; the second was knowing there was limited and often means-tested funding for some telecare equipment, our telehealth service should be a wholly affordable resource. Appello is made up of an alliance comprising four member organisations – Careline UK, Numera, Centrihealth and Volt Delta – which together provide all the technical elements and expertise that we need to provide the end-to-end, patient-centred service we were determined to create. Importantly, the partners also share my desire to create the best possible service around the needs of the person using it. Appello uses a pioneering nurse-led system to monitor patients’ conditions This means patients are receiving qualified advice from health professionals, who understand the importance of providing continual support and education to help their patients retain their valued independence. All Appello nurses believe that, although their work is less ‘hands on’, it makes just as big and important an impact on patients’ lives.

I mentioned that I was heartened by the fact that telehealth has entered the mainstream and is creating considerable debate. I still feel passionately that we must keep raising awareness of telehealth and educating patients and health professionals about the potential benefits of the service. As a patient-focused organisation, it is vital that Appello ensures it is at the forefront of this discussion. Forum for change This is why I am very pleased to be a founding partner of the Telehealth Forum, along with the British Lung Foundation, and the National Association for Patient Participation. The forum brings together patients, carers, GPs, commissioners, nurses, academics, charity representatives and industry, with the purpose of developing information and educational materials that are shaped from the perspective of patients and carers. It is essential that we keep patients at the heart of telehealth, focusing on their needs and empowering them to live independently, rather than just talking about technology. Readers will be familiar with alarming predictions for the number of people who will have long term conditions in the future. Combined with the requirement to make extensive efficiencies within the health and social care economies, commissioners will be looking for a solution that combines safe, good-quality care at an affordable cost. I believe telehealth has a major role to play in providing a significant part of that solution – but it’s vital that further development of the services that are on offer are undertaken with the full involvement and support of the people who matter most in the equation: the patient.

www.appello.co.uk

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PSUK LTD

Phoenix rises Paul Smith, CEO of Phoenix Medical Supplies, discusses how innovation in wholesaling has led to a more patient-focused approach

With the NHS in the throes of major reform, Phoenix has embraced change to meet the requirements of our institutional processes. Although we provide full UK distribution coverage as part of the largest pharmaceutical wholesaler in Europe, far from being a traditional wholesale operation, we have evolved and made sound strategic decisions to drive the business forward. Innovation at this level has ensured that our role in the supply of medicines is concentrated on providing healthcare customers not only with the support they need to meet the demands of reform, but also the needs of the patient. The Phoenix portfolio encompasses market leaders Numark, a membership organisation for independent community pharmacy, and PSUK,

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a purchasing and service provider for GPs and family planning and sexual health providers. It also includes Rowlands’ Pharmacy, voted 2010 pharmacy retailer of the year by industry leaders, as well as our fast-growing dedicated national hospital service. The era of reduced and single channel distribution continues to evolve, with established contracts being reviewed and renewed and new ones starting up. As a result, the greater value for manufacturers is in access to customers, how they target knowledge and product, as well as remaining patient focused. The benefits of belonging to PSUK and Numark, or signing up to Rowlands’ brand support deals, are transparent to a ever-increasing number of supply partners. They already see value for their customers’ patients, offering

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PSUK LTD

innovative and interesting ways to market and engage with the patient journey. PSUK has adapted to the changing market, holding a unique position within the industry. Traditionally a buying group servicing dispensing doctors, it now supplies GP practices, family planning clinics, private healthcare providers, podiatrists and ambulance services, offering not only product, but purchasing advice, education and contract implementation. Taking these developments in conjunction with the changing needs of the healthcare industry, Phoenix is proud to be at the forefront in meeting the service requirements of the manufacturer, healthcare provider and patient through our market exposure. Put simply, Phoenix provides a joined-up and patientfocused solution for the delivery of medicines to the NHS. For more information on the Phoenix group of companies, contact the group business development team: Tel: 01928 750575

www.numarknet.com

www.psuk.co.uk

www.rowlandspharmacy.co.uk

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Clinical Commissioning in Action

South Devon and Torbay CCG Close working with secondary care colleagues improves services for patients

Men who have had raised prostate specific antigen levels usually need regular follow up monitoring, even if they have not had any treatment for prostate cancer. That can mean trips to a hospital outpatient clinic and a wait for blood test results - only to be told they need only come back in six months time for another test. South Devon and Torbay CCG was keen to avoid these visits which could involve a lengthy journey to hospital and a worrying wait for results for often elderly patients. And for the CCG it meant substantial costs for outpatient appointments, many of which did not result in any treatment. Working with secondary care clinicians, the CCG set about looking at other methods of providing safe follow up for these patients. And it has now adopted a model pioneered in Bath which enables the men to have blood tests locally and be contacted with the results. They only need to go to hospital if their tests are outside the expected range or if they are concerned about symptoms. 12 Inno 3 book.indb 12

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Clinical Commissioning in Action The CCG estimates this may save 1500 outpatient appointments a year, offering substantial potential financial savings and freeing up appointments for other patients. CCG co-chair Dr Derek Greatorex says: ‘It was a no brainer. It was by far the most convenient robust approach and it meets the needs of the patient.’ The new service was designed by secondary care doctors and GPs working together in a clinical pathway group for urology. The consultant decides if the patient is suitable for this monitoring and, if so, the patient’s details - including any ongoing care and expected PSA levels - are entered onto a PSA tracker computer system. Using the information on this system, a specialist urology nurse ensures the patient is contacted when they need a blood test to measure PSA levels. This tests can be carried out at a GP surgery and the patient is then informed of the result by the specialist nurse, and whether they need additional follow up or monitoring or will just be contacted again in a few months for another test. Dr Greatorex says the involvement of the specialist nurses provides a ‘safety net’ which ensures patients are recalled and are chased if they don’t have the blood tests. Only a small handful of patients have said they want to continue with the hospital-based follow up and they have been able to do so. ‘The whole impetus of our clinical pathway groups is to improve collaboration and get over the gulf between primary and secondary care. Sometimes it does not take much of a change to make a difference,’ he says

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Specialist nurses provide a safety net that ensure patients are recalled and chased

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BOSCH

Get connected Robert Bosch Healthcare explains why technology-enabled integrated care offers maximum benefits for patients and NHS alike

2012 is turning out to be a defining year for integrated care strategies that incorporate telehealth and telecare technologies. In the past year, ambitious goals have been set for the deployment of these models including, most notably, the 3 Million Lives campaign on the back of the initial results from the Whole System Demonstrator Project. The goal of the campaign is to bring technology enabled integrated care to three million UK citizens by 2015. It is an exciting and interesting time in the UK as key stakeholders work together to move telehealth and other enabling technologies into accepted care management practice. Currently, the NHS spends 70% of its budget on the 15m people who have one or more long-term conditions. With our ageing population, patient numbers are expected to grow by 23% over the next 20 years. This volume coupled with resource and financially constrained systems will be the synergistic drivers of transformation in the delivery of healthcare to chronically ill citizens.

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BOSCH Commissioning and deploying telehealth and telecare at scale is a critical element of the solution required to meet quality and cost savings goals for patients and the NHS. There is now extensive evidence – in the UK and worldwide – that provides the business case for widespread implementation of telehealth and other technologies in care co-ordination programmes. Deployment of care management interventions using Bosch Healthcare telehealth solutions produces significant improvements in quality and clinical outcomes in global health systems including the NHS, the US Veterans Administration (22 million veterans), Medicare (the US programme that covers healthcare costs for 44 million persons over the age of 65) and major insurers in the Netherlands, Japan, Germany and Spain, by using a unique approach to telehealth that creates connections between patients, their carers and GPs. These connections are bi-directional and go far beyond the more traditional vital signs measurement modalities.

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Technology enabled integrated care to three million UK citizens by 2015

Our experience shows that effective deployment and scale of telehealth-enabled integrated care can be attributed to attention to the following: 1. Pre-existing integrated care strategy that telehealth should enable and scale to thousands of patients – telehealth cannot drive the creation of these programmes, it is merely a tool to enable scale and deployment. 2. Pre-defined quality, clinical and financial targets to measure the success of the programme – telehealth deployment is only a component of the strategy that drives these outcomes. 3. Understanding of how the programme costs can be covered through direct and indirect reimbursement methods, such as minimising tariff and reimbursement penalties, while driving payment incentives through adherence to NHS programmes such as QIPP and CQUIN.

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4. Clinician engagement strategies that drive an understanding of how telehealth-enabled care management saves lives, improves quality and extends their reach to hundreds of patients, while saving time and improving their efficiency. 5. GP practice engagement strategies that highlight how telehealth can improve patient care, practice efficiency and financial outcomes especially for persons with chronic conditions or frailty. Providing a managed service that is targeted at supporting their long term condition programmes while assisting them to maximise their practice revenue is critical. 6. Predictive modelling that highlights the populations that can benefit most from the intervention. The ultimate success of the programme deployment to scale is in reaching patients before they join the upper 5-10% of those that drive cost. Continuous assessment by the system of the health and social status of the patient will facilitate clinicians timely intervention to prevent exacerbations that will drive admissions to hospital or long term care settings. 7. Interfaces to the solution for both patients and carers that are comfortable, effective and easily accessible, including messaging units, mobile devices (mobile phones, Smartphone, PCs and Tablets) and other familiar products

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found within the typical home. One size does not fit all and patient preferences must be considered. 8. Design of a clinical infrastructure that facilitates communication and collaboration between the person and their carers that considers many more factors than just the simple vital signs and systems that most systems track. Clinical algorithms should evaluate patient responses to simple surveys, track vital signs input (through the devices/or self report), compare to NICE compliant clinical pathways and the patientâ&#x20AC;&#x2122;s historical data, and guide the patient and clinician to suggested actions to drive adherence to care plans. The system should also prompt patients to avoid behaviours that could cause changes in their condition that could lead to exacerbations. 9. Integration strategies that provide a single view of the personâ&#x20AC;&#x2122;s attributes, vital parameters, goals and strengths to provide the platform for integrated care planning and collaboration by the person and their carers. Bosch Healthcare provides the tool set that will redefine the perceived definition and goal of integration. This integration tool set should allow detailed reporting parameters for both the person and clinicians. The results of our phased UK implementations demonstrate the value that a content-based,

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BOSCH

telehealth-enabled integrated care pathway can provide to chronically ill persons. Guidelinebased interventions should deliver comprehensive patient education to improve self-management skills and provide algorithm-guided actionable data to inform clinical decision making. Simply focusing on vital signs and symptom monitoring is not going to transform the healthcare system from a quality and cost perspective. Most readers are familiar with the WSD study, which continues to attract significant attention, particularly over the issue of cost savings (or lack of them). The trial was a breakthrough study for telehealth/telecare in the UK, but there are several mitigating factors that do need to be considered when judging the study impact. For example, telehealth devices and monitoring solutions varied among the study sites. These

differences could lead to significant variations in implementation and operations cost, which could impact on cost-savings data. In addition, our experience with similar populations also shows that the optimal impact of a telehealth programme is observed between 18 months and two years, while this study looked at a follow-up time of just one year. Core integrated care interventions should be powered by a company with documented and validated experience in: 1. Large-scale implementation: Bosch Healthcare has implemented some of the largest telehealth care co-ordination global programmes (more than 50,000 patients are connected and monitored daily), stratifying and analysing complex data trees and sending back contextual and individualised feedback for specific patient populations and their carers.

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BOSCH

3. Providing integration of telehealth data to systems and processes to facilitate assessment, intervention, analytics and reporting: integration of patient history, vital parameters, subjective data and vital signs, patient cultural/individual goals, which provide the basis for holistic care planning, facilitating adherence leading to improved outcomes. To help drive the policy debate forward, Robert Bosch Healthcare has launched a new campaign this year called Connecting Communities. The campaign is focused on bringing together progressive thinking to take a widespread look at what the

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barriers for uptake to telehealthenabled integrated care models currently are and, importantly, highlight what is being done well in local settings. The central focus of the campaign has been a series of roundtable discussions with NHS commissioners, clinicians, policy makers, journalists and charities. These discussions have helped draw attention to the role that telehealth can play in delivering improved care for patients with a range of longterm and chronic conditions. So what needs to happen in 2013? At Robert Bosch, a key message is that all industry partners – as well as the Department of Health and the emerging NHS Commissioning Board – need to understand that the benefit of using telehealthenabled integrated care strategies is not about just collecting vital sign data and symptoms. For telehealth technology to work, it must be embedded in care pathways that are designed for and with persons with long-term conditions. It should comprise of a range of interventions - including coaching and telecare. Our experience has reinforced our beliefs that improved clinical outcomes and quality improvements for patients are driven by better informed clinicians and improved patient self-management skills.

Robert Bosch Healthcare has launched a new campaign this year called Connecting Communities

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2. Understanding clinicians and patients who use the system and how to promote adherence using the system: patients learn selfmanagement skills, which is a key outcome of the Bosch Healthcare Telehealth Plus (TH+) System; clinician work is streamlined and facilitates management of larger populations without additional resources. Bosch Healthcare continues to assess system data to determine what factors engage people with the system and what makes them comply with its use and will be using this information in its future implementation efforts.

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I think that understanding the complexities and variables within care pathways is central to delivering this â&#x20AC;&#x201C; and this is what Connecting Communities is helping us to decipher. The NHS Commissioning Board has a significant role to play in ensuring that technology is widely adopted as an extender of accepted and standard practice. Robert Bosch Healthcare will continue to reinforce that message to the Commissioning Board and other stakeholders and we hope that commissioners and healthcare providers are given clear messages that telehealth-related services are a key driver of quality, co-ordinated care for persons with long-term conditions.

â&#x20AC;&#x153;

Connecting Communities is helping us to decipher what works

about understanding care pathways and delivering a tailored model of care that incorporates technology as required. This requires the full support and consent of the NHS for patients to receive maximum benefit. Therefore, Connecting Communities is also engaging directly with the healthcare community to ask them what is needed in order to achieve these goals. The latest news and ways to get involved are available at www.boschhealthcommunities. co.uk and I urge you all to get involved and be part of a conversation that is helping to shape the debate.

I have never believed that telehealth is simply about purchasing kit and installing a device. Instead, it is

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Clinical Commissioning in Action

Corby CCG How one CCG is tackling the key issue of referrals successfully

GP referrals in Corby have been cut by 25 per cent in a year - making substantial cost savings and saving patients unnecessary trips to hospitals. When GPs in Corby started to work together in an embryonic CCG, the area had the highest referral rate in the county but many patients did not require any procedure once they were referred into the hospital system. This high referral rate was leading to a large overspend on the shadow CCG budget. â&#x20AC;&#x2DC;Prospective reviewâ&#x20AC;&#x2122; of all hospital referrals - except for time-dependent ones such as termination of pregnancy and suspected cancer cases - was introduced in September 2010 after one of the six practices within the CCG had used the approach and seen it reduce its referral rate significantly. Each practice has a different method of reviewing referrals. In some a multi-disciplinary team will discuss all proposed reviews once a week to decide whether they need to go ahead or could be treated within primary care. In the largest practice in the CCG - which covers 45,000 patients - GP specialists in a number of areas will discuss referrals with the originating GP. 20 Inno 3 book.indb 20

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Clinical Commissioning in Action

As well as ensuring all the referrals are appropriate, it enables GPs and also GP registrars to learn from their colleagues. Unjustified variation in practice has been reduced by calling on the expertise available in primary care. In 2011-12 the number of referrals was reduced by 25 per cent compared with the previous period, although savings from this was partly offset by increases in consultant-to-consultant referrals within the acute sector. Nevertheless, the CCG saw a £300,000 saving on referral costs.

The CCG is now looking at whether consultants could be employed to assist in the review process, discussing cases with GPs before a decision to refer is taken. Ms Price says this could add to the learning experience for GPs. In some cases, GPs and consultants could call in the patient for a joint appointment or talk to them on the phone to elicit more information. Even with the referral review currently in place, around 40 per cent of patients seen by hospital consultants don’t need a procedure, she says, so there may be scope for more savings. The CGG is also looking at the reasons for the rise in consultant-to-consultant referrals and has asked for all cases to be discussed in primary care before they are approved. Referral management has been tried by many PCTs over the last decade but often through a team external to the originating practice examining referrals and with little opportunity for GPs and other staff to learn from the experience.

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Around 40% of patients seen by hospital consultants don’t need a procedure

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Nicki Price, the CCG’s chief operating officer, says that research in one practice suggests that patients like their case being discussed by a team of healthcare professionals. Many patients will also be saved journeys to the local DGH in Kettering for appointments.

But by keeping the referral review within the practice and encouraging it to be a learning experience for all involved, the CCG has ensured clinician ‘buy in’ to the scheme. ‘We have fantastic clinical engagement,’ says Ms Price. ‘This came as a bottom up approach, as we had one practice in particular which started this and had good results.’ INNOVATION IN HEALTHCARE 2 1 Inno 3 book.indb 21

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Clinical Commissioning in Action

Kettering locality of Nene CCG How a local solution to a problem was identified that improved access for patients

Patients with minor injuries can put pressure on A&E units, face long waits and are costly for the NHS. A clinical commissioning group is tackling these problems by training practice nurses to treat minor injuries and to order X-rays without the involvement of a doctor. The Kettering locality of Nene CCG has now seen practice nurses in six out of its eight practices trained to offer minor injuries care. The training has varied according to the nurses’ previous experience and knowledge of this area - those with no previous training have needed three days while others have needed much less.

she says. The aim is to reduce A&E attendances and pressure on staff in the department, but also to improve patient access to the service and save many people a trip to the district general hospital. She expects many of the injuries to be sprains, cuts and bruises but some may require further investigation. By allowing practice nurses to order X-rays, they hope to avoid patients then having to see a GP as well and speed up the process for them.

Locality chair Dr Raf Poggi says the practices are now rearranging nurses’ rotas to offer minor injuries cover. The service will also be publicised so that all patients in the area know how to access minor injuries care.

She highlights the close working between clinicians as important to get schemes like this off the ground. ‘In a large CCG like Nene Commissioning what is important is what is happening at locality level. In my locality with eight practices and a local DGH, I can get clinicians round a table. We are aiming to bring changes in within a couple of months rather than a couple of years.

‘There is a lot of collaboration between practices. Patients who are in a practice which doesn’t offer this will be able to access a practice that does,’

‘Changes like this which have a huge impact on patient care can be made very quickly just by engaging the right people.’

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Is research within reach of your patients? Clinical research is vital to the improvement of patient treatments in the NHS - that’s why a commitment to research is part of the NHS Constitution. Research is also a priority for patients. According to a 2012 national consumer poll, 82% of the public believe it is “important” for doctors to offer their patients the chance to take part in suitable research studies. So with research high on the policy and patient agenda, shouldn’t you know your Trust’s clinical research performance?

Sponsored by the Department of Health, the NIHR Clinical Research Network is part of the “research arm” of the NHS. We offer practical, hands-on support and resources, to enable NHS organisations to engage in high-quality clinical trials for patient benefit. We also publish data to help NHS Trusts to get a clear picture of their clinical research performance, and consider their research offer to patients.

To discover your NHS Trust’s research performance, visit: www.crncc.nihr.ac.uk/nhs-performance

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

Supporting research to make patients, and the NHS, better

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At the heart of change: management of heart and circulatory disease as a long-term condition Innovation is paramount if patients are to continue to receive the best services The British Heart Foundation (BHF) is often seen as an organisation focused on patients. This is true, but along with funding major research projects and supporting the delivery of new models of service delivery, supporting healthcare professionals is a vital part of our role. Karen Sweeney, RGN, BSc (Hons), Head of Healthcare and Innovation, British Heart Foundation

We are currently delivering a range of programmes to support healthcare professionalsâ&#x20AC;&#x2122; continuing professional development and to build capacity to effectively manage the increasing number of people affected by cardiovascular disease (CVD). We are also striving to drive forward improvements in patient care and greater efficiencies in service delivery through innovative new services.

The need for education in primary care is increasing, so we have recruited practice development coordinators around the UK. These are cardiac specialist nurses who will be seconded for half the week to provide training to primary and community healthcare professionals, free of charge. They are accredited trainers who can deliver sessions themselves, as well as organising other events. We know that in the past there has been limited continuing professional development available at a local level. Increasing pressures of time and money mean it can be difficult for staff to get time away from practice to attend courses. That is why we want to deliver training as locally as possible.

Innovation in service delivery We are committed to becoming the driving force for innovation and change in the management of heart and circulatory disease as a long-term condition. By funding innovative pilot projects and evaluating them, we will provide the evidence necessary to drive changes and improvements to services that will improve health outcomes for people living with heart disease across the UK.

T f a a s

O B e a w a

W w r i

Support for education

W a a c

At the BHF, our focus is rightly expanding to include primary and community healthcare professionals as well as those in secondary care because we recognise that they can play a vital role in managing patients with cardiovascular disease.

ÂŠ British Heart Foundation 2012, registered charity in England and Wales (225971) and in Scotland (SC039426)

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W e m a i

W o

Our intention is to invest in innovative models of service redesign consistent with the Department of Healthâ&#x20AC;&#x2122;s improvement agenda. We want positive clinical outcomes for patients while also demonstrating greater productivity, a better patient and carer experience and the most cost-efficient use of increasingly pressured NHS resources.

lear

W a h C S d

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Improving Knowledge, Improving Care

Next steps

We are also investing £170,000 in a pilot project to support and deliver education to primary and community-based healthcare professionals. The Improving Knowledge, Improving Care pilot project is being set up in six regions across England, Scotland and Wales. It focuses on areas that may not seem deprived in overall terms but have pockets of deprivation.

This article describes just some of our new projects in primary and community care. We are working on many more. We are still in the early stages of some of this work, and no doubt we have more to learn. But we hope that our initiatives will improve your working lives, and bring benefits to your patients. If you have any thoughts or suggestions, or if you want to find out more about the BHF Healthcare & Innovation Team’s projects, evaluation findings or recommendations for service redesign, please contact us at bhfhi@bhf.org.uk.

We are working with ten practices in each area, delivering staff education on CVD focusing on prevention and risk, diagnosis, maintenance and monitoring, and promoting self-management and end-of-life care. This is a 12-month project, and if the pilot is successful, we would like to roll this out across the UK. Integrated Care Awards This year saw the first of our Integrated Care Awards – grants for projects for the long-term treatment of patients with heart and circulatory disease. The grants follow the King’s Fund and Nuffield Trust report published earlier this year, which stressed the need to remove the barriers to integrated care. We distributed £1.2m in all, for projects that focused on integrated care in community settings. One of the grants was £189,000 for a heart failure project in Bristol. The city has dedicated heart failure services, but not everyone is getting the care they need, especially in deprived areas where a higher than average number of people are living with heart disease. The aim is to increase rates of diagnosis and develop new services that support continuity of care. Support for healthcare professionals We are looking to support more healthcare professionals with an affiliated package that will give access to our resources. These include a best practice library, and invitations to local events and regional conferences. Where we have evaluated work we have funded, we will be adding it to the national Quality, Innovation, Productivity and Prevention (QIPP) collection of resources, so that NHS colleagues can make use of the lessons learned.

Know Your Heart: online learning tool for your patients Presented by Dr Hilary Jones, this resource uses interactive tasks and quiz questions to help anyone who wants to understand their cardiovascular system and know how to look after it. It’s suitable for newly diagnosed CVD patients and helps them understand their condition and learn more about their heart health. The first topic looks at what the heart does and how it works, the second topic covers cardiovascular disease, and the final topic focuses on the risk factors associated with developing cardiovascular disease. Patients get a personalised certificate if they complete all topics. Access this free resource online at bhf.org.uk/knowyourheartHCP To keep informed about our latest healthcare resources for you and your patients, sign up to our new resources e-newsletter, email newresources@bhf.org.uk

We hope that our initiatives will improve your working lives, and bring benefits to your patients

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The importance of Arrhythmia Care Coordinators More than one million people a year in the UK experience arrhythmias, and they are among the top ten reasons why patients go to hospital. Patients may be at increased risk of stroke and certain types of arrhythmia can cause sudden cardiac death, which kills 100,000 people a year in the UK. In 2005 an extension to the National Service Framework (NSF) for coronary heart disease recommended that arrhythmia patients should have access to a named Arrhythmia Care Coordinator (ACC). The British Heart Foundation responded by funding and evaluating 32 of these posts in 19 NHS Trusts across England and Wales. We contracted the University of York to complete an independent evaluation of the project, published in 2010. Benefits were recorded in reduced patient anxiety and increased health-related quality of life, improved patients’ satisfaction with the NHS and the efficiency of clinics, and a reduction in readmissions. The benefits of commissioning Arrhythmia Care Coordinator posts were found to include: •

money saving: the NHS saves £29,357 per year over and above the costs of employing an ACC, by avoiding readmissions due to the ACC service

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efficiency: nurse-led rapid access arrhythmia clinics and pre and post procedure clinics have led to freeing up of valuable consultants’, registrars’ and GPs’ time

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preventing illness: ACCs diagnose atrial fibrillation (AF) in people previously unaware they had the condition, and so reduces numbers who may go on to suffer and die from a stroke saving lives: ACCs are trained to monitor AF, plan the patient care pathway and prescribe appropriate medication, further reducing the risk of stroke management of a cardioversion service: ACCs manage a caseload of cardioversion patients, undertaking pre and post procedure clinics, patient assessment and titration of anticoagulation therapy prior to performing direct current cardioversion

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advice on ICDs: ACCs provide education and support to patients with implantable cardioverter defibrillators (ICDs). ACCs provide education, support and reassurance about what physical activity is safe, what to do when the device fires and practical advice on travel and insurance

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joined-up patient care: ACCs are key to ensuring a co-ordinated approach to integrated, holistic patient care. Based in primary, secondary or tertiary care they deliver clinics and act as a specialist resource for GPs, other HCPs, patients and carers

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less patient anxiety: ACCs have specialist knowledge and advanced communication skills, they are well placed to reduce patients’ and carers’ anxieties in relation to their condition

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patient education: ACCs increase patients’ knowledge and confidence, helping patients manage their health and navigate services more effectively

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supporting patients and carers: Patients and carers find telephone support from ACCs very reassuring and this can contribute to early intervention and reduce patient anxiety.

Further information: The Arrhythmia Care Coordinator evaluation report can be found at bhf.org.uk/publications (search for “arrhythmia evaluation”).

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Treating heart failure patients in the community A pilot project delivering IV diuretics at home is already showing positive results for patients Heart failure is a debilitating disease that affects more than 750,000 people in the UK. This number has been increasing, partly due to an ageing population and also because of new procedures and better use of drugs, which mean that more people than ever are surviving a heart attack. Therefore, more and more people are living with heart failure in the community – there are more than 27,000 new cases of heart failure every year.

Guidelines have been developed by a BHF-led steering group and expert panel. Specialist nurse teams have been trained to administer the IV medication safely and effectively out of hospital, closely monitoring patients’ responses to treatment, and adjusting dosage as necessary. An independent evaluation of the project is also being conducted.

People with heart failure often experience breathlessness and as the condition worsens, fluid accumulates in the lower limbs, and eventually in the abdomen. Diuretic tablets help reduce fluid retention, but as the disease progresses, oral diuretics are not enough to control symptoms. To relieve symptoms at this stage, the patient is admitted to hospital and treated with intravenous (IV) diuretics, usually involving a stay of several days or longer. However, with the right infrastructure and resources, this service can be delivered in patients’ homes, which is in line with current UK health policy to move care closer to home where this can be achieved. A community-based service has the potential to reduce hospital admissions, support early discharge and provide a better experience for patients and carers.

Every site delivers care slightly differently, as this new aspect of patient care is integrated into existing local services. Interim evaluation reports have been produced and will help teams develop business plans for sustainable services. A final evaluation will be available in late 2013.

Integrated care

This project will allow the specialist teams to develop new best-practice guidelines and protocols for community-based IV diuretic treatments that can be rolled out on a wider scale. Administering IV diuretics in community settings should help improve patients’ quality of life and reduce hospital admissions.

Developing the business case Currently, the British Heart Foundation (BHF) is funding a two-year pilot programme to assess safe and effective ways for specialist nursing teams to administer IV diuretics at home or in a daycare setting. Our funding supports heart failure specialist nurses to develop and introduce community-based IV diuretic services as part of existing heart failure services.

“Developing this pilot has really helped us to develop cross- team working and relationships – we understand each other” – Heart failure nurse

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Initial findings Karen Sweeney, Head of Healthcare and Innovation at the BHF, says: “It’s still early days but the analysis we’ve done so far shows patients unanimously prefer staying in their own home. The evidence suggests the treatment is safe, effective and a viable alternative to hospital-based care, and it has the potential to be much more cost-effective too.” Our pilot project to provide intravenous medication in patients’ homes began in September 2011. Most trusts spend six months developing our service before offering it to patients, during which time they offer training or refresher courses to nurses in administering intravenous diuretic medication. A total of 11 NHS trusts are involved in the pilot and nurses have started seeing a total of 35 patients from seven trusts. Feedback given by patients in the interim report has been unanimously positive, with all patients stating they would opt for the treatment at home again in the future. Feedback from patients and carers suggests they were reassured by the dedicated treatment provided, and particularly satisfied with the information they were given about the scheme, which helped them understand what would be required of them and who to contact in an emergency. Staff involved have said that the time they need to spend in the patient’s home whilst administering the IV diuretics gives them more time to discuss the treatment and wider condition management with the patient and carer. Chris Watson (pictured), a BHF heart failure nurse who lectures at the University of Brighton, is leading the BHF pilot project for East Sussex Healthcare NHS Trust. She said: “Patients are so much more comfortable in their own home. It means the treatment is less stressful. It also means they retain their independence and can avoid the problems that are sometimes associated with hospitalisation such as infections and falls.” Challenges and solutions The evaluation has identified key challenges, practical learning and solutions across the sites. A challenge from the outset has been that the pilot areas have been developing the new service against a backdrop of major NHS

restructuring which, in addition to variation in services between and within localities, is providing a challenge in terms of working collaboratively and securing buy-in from commissioners, service leads and consultants. Despite this, support for the pilot has been growing, helped by good communication and influencing skills. Offering a seven-day-a-week service has sometimes been a challenge. Solutions for this vary across the sites and include setting up an on-call system, or partnership working with other teams who can provide the weekend service, or reverting patients to oral diuretics over the weekend and bank holidays. The process of prescribing and administering drugs has been another hurdle in some cases. The Nursing and Midwifery Council (NMC) states that one nurse prescriber should not both prescribe and then administer the same drug. Different solutions to this are being worked on, such as having a community colleague check the dosage, or GPs prescribing the diuretics in advance. There have been issues of equipment in some areas. For example, one site is unable to use pumps and is looking at slow drips as an alternative. Staff capability is a further challenge. Refresher training is being delivered in pilot areas for staff to increase their competence levels, but maintaining this may be a challenge if patient numbers are low. A solution includes staff regularly inserting cannulas for patients, either within hospital wards or with paramedic teams. One site has opted to use single-use butterflies instead of cannulation as a solution.

We hope that our initiatives will improve your working lives, and bring benefits to your patients

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, s

Safety and clinical effectiveness The clinical effectiveness of the treatment is based on a reduction in oedema, weight and the maintenance of the patients’ renal function. Twelve out of 15 interventions across the two sites were deemed clinically successful by the pilot’s lead healthcare professional. Eleven out of the 18 interventions were completed without admitting the patient to hospital. Of the seven people admitted to hospital, two failed to respond to IV diuretics and several of the others were for reasons not directly related to their IV diuretics.

Case study

Hastings: Norah Taggart Norah Taggart (pictured) has had heart failure for more than two years. On two occasions her body has retained a significantly high amount of excess fluid - a symptom of her condition. The first time, she spent three weeks in hospital and was connected to an intravenous drip to treat the problem. But in June this year when she stopped responding to her usual tablets, she received a second intravenous treatment regime – but this time in the comfort of her own home.

None of the complications were particularly different to those experienced from providing IV diuretics within the hospital. Phlebitis around the cannulation site can be a problem with

Mrs Taggart, 83, who lives in Bexhill-on-Sea with her husband Gerard (pictured), said: “It was just so much more comfortable. It’s all the little things, like being able to go to the loo when you want without waiting around, or being able to go to bed when you like.

“Patients are so much more comfortable in their own homes. It means they means they retain their independence and can avoid the problems sometimes associated with hospitalisation such as infections and falls” – Chris Watson

“I used to feel guilty about my husband visiting me each day in hospital too. He’s 84, he’s had his hips done, so it’s not easy to get around, and trying to park at the hospital is a nightmare. I feel much better knowing he doesn’t have to cope with all that too.”

IV treatments. Only one intervention led to a patient having phlebitis, with a score of 1 (ie minimal inflammation) and this was only for one day of the intervention. Avoiding hospital admission may also have the advantage of reducing exposure to infections. Cost-effectiveness Patient numbers have so far been small, but analysis of one site, which has a service model based on the IV Diuretics provision being managed by the Heart Failure Nurse Service, allows us to tentatively suggest the programme could save them more than £50,000 a year. This is a conservative estimate, based on 44 patients per year using the service. At this early stage the findings indicate that there is potential for significant cost savings from patients being treated at home rather than in hospital, but this is dependent on there being sufficient numbers of patients involved in the scheme.

Tackling heart failure is a key challenge for the BHF. At the moment, there’s no cure for heart failure. But the BHF’s Mending Broken Hearts Appeal is funding research to find a cure, bringing hope to millions worldwide. You can find out more about this vital research at bhf.org.uk/mbh

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Clinical Commissioning in Action

Bassetlaw CCG CCGs can bring down prescribing costs while also improving patient care

Ensuring that best practice is followed in prescribing is a complex task - and one which many NHS organisations have struggled with. But Bassetlaw CCG has been able to improve prescribing practice and reduce costs - allowing it to reinvest the money it has saved in better services for patients. The CCG has done this with the consent of its constituent practices. In 2011-12 prescribing dropped by close to 10% with a £1.5m saving which has allowed for investment in other services such as paediatrics locally. This does not mean patients are being denied medicines they need - the aim has been to ensure that prescribing is appropriate and efficient. Chair Stephen Kell says that providing practices with information on how their prescribing compared with both their peers and practices nationally has proved a great motivator for change. ‘Comparing ourselves with where we should be really got hearts and minds together,’ he says. Prescribing leads were appointed from among practices and they led work on where prescribing could be more efficient and better quality.

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Clinical Commissioning in Action

“

The levels of Prescribing of some drugs such as statins has actually increased

‘It is about clinical engagement. Having a meaningful practice-led discussion was really important. By meeting together and sharing good practice we have been able to drive down prescribing costs. Unnecessary prescribing is inefficient prescribing and not beneficial for patients.’ And this is not just about reducing prescribing, he points out - the levels of prescribing of some drugs such as statins has actually increased, as GPs have been convinced of the evidence base of their efficacy for more patients. One area which has real benefits for patients is around cephalosporin and quinolone prescribing. These powerful antibiotics are important in the treatment of some infections but can leave patients vulnerable to clostridium difficile - so should be prescribed sparingly. By working with practices and reviewing the evidence base with them, the CCG has reduced the prescribing of the drugs by 60 per cent. And it has seen a decrease in the number of community-acquired clostridium difficile cases which suggests the change in prescribing habits is having some impact. Dr Kell puts part of the success down to a relatively small CCG 110,000 population and 12 practices - and good personal relationships. ‘Size is always an issue in terms of running costs but it does enable change,’ he says. ‘The key driver for GPs is undoubtedly patients. Everything they do should be with that in mind.’

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Local government

Cutting teenage Mapping leads pregnancy rates in Hull

the way to improved health services

services through mapping. With 20 out almost twice the national average. In Hull, teenage pregnancies of 22 wards in Hull recording higher Repeat pregnancies among teenage have reduced by 35 percent over Ordnance Survey is Great Britain’s national mapping agency, providing the most than average levels of deprivation – girls were also high; over 20 percent of the course of the life of the often an indicator of high conception all under 18 conceptions – again, 12-year strategy. Ordnance Survey geographic accurate and up-to-date data, relied on well by government, business and rates in females less than 18 years of above national figures. Teenagers in digital maps were used to plan its individuals. Geographic datatheiscity atwere the failing heartto of the delivery ofage many public services – it was a challenging task. heed warnings contraception and community-based about under-age sex and services well as increasing the digital andasOrdnance Survey maps are used inlocal a wide range of settings throughout The solution policymakers agreed that new action targeting and impact of services. the NHS and the wider health sector. Data on conceptions among those under was needed to tackle the problem. the age of 18 was initially poor and it was The challenge some time before the council and PCT On the back of a government Just over a decade ago, national able toSector breakdown the information reduceeasier soaring numbers statistics singled-out digital Hull as having Accessing maps hasstrategy nevertobeen thanks to thewere Public Mapping to postcode and ward level, in order to of unplanned pregnancies among one of the highest teenage pregnancy Agreement (PSMA) – a licensing agreement andandOrdnance look for trends achieve a city-wide teenagers nationally, Hullbetween City CouncilGovernment rates in the country, with 384 reported view. Presenting the launched an initiative Hull Primary pregnancies among females belowgeographic Survey which allows data to bewith used and shared between all information, public visually on a map immediately revealed the Care Trust (PCT) to cut rates locally, 18 years of age in 1998 – equating to a acrossfocusing England and Wales. A record 2500 public hotspots to target,sector with high teenage on improving sex education rate ofsector 84 per 1organisations 000 conceptions. The rates emerging in a all number accessincluding to contraception statistics made grim reading, bodies have now being registeredand forincreasing the PSMA, aroundpregnancy 100 hospital trusts, of different postcodes and at 6 of the 12 ambulance trusts and more than three quarters of Primary Care Trusts. 14 local schools. Analysis revealed that while there were and knownstrategies problem areas north and Ordnance Survey geographic data is used to inform decisions which east of the city centre, when the data are helping the NHS to achieve real improvements in services, such down as reducing was broken by postcode and presented on a map it showed teenage pregnancy rates in Hull, targeting drug and alcohol treatment centres in that teenage conception rates were also Bristol and effective planning of patient services in Birmingham. can read about high onYou one estate to the west of Hull. It was clear that services had to be them on the following pages. targeted to all of these areas. Further investigation showed that while

For further information or to find out if you’re eligible to join the PSMA, 14 000 young people were receiving advice on contraception in schools visit the public sector section of the Ordnance Survey website at: and youth centres, only 2 000 www.ordnancesurvey.co.uk/psma of them were making it to clinics

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D09370 Teen pregnancy Inno 3 book.indb 32 in Hull.indd 1

because they were concerned about confidentiality or there were barriers to them accessing the clinics in their current sites. Other research revealed

02/07/2012 15:22:52 05/11/2012 11:15

Health

Effective planning of patient services in Birmingham Ordnance Survey digital mapping data is making a major difference to the effective planning of patient services at the Heart of England NHS® Foundation Trust in Birmingham. The challenge The Heart of England NHS Foundation Trust is one of the country’s largest health care organisations, with a

patient population of over one million. The trust serves a diverse area across the Midlands, stretching from Birmingham to South Staffordshire and includes three hospitals, a specialist chest clinic and a comprehensive range of community health services. With such a large area to cover, defining the trust’s catchment area is a complex process, particularly when the NHS landscape is changing so

rapidly. Having access to up-to-date and accurate geographic information is essential both to plan future health services and to monitor their quality and efficiency. An expansion of the trust’s medical laboratory facilities, based at Heartlands Hospital in Bordesley Green, created an opportunity for the organisation to offer a better service

Punchstock/Creatas

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to patients, and encourage more GPs to use the new testing services. The 18-month building programme has created world-class clinical support facilities, including a state-of-theart fully-automated laboratory with specialist testing facilities, including a molecular diagnostics suite. As a result, the Heart of England NHS Foundation Trust wanted to promote the new centre to local GPs, who were unaware of the increased capacity and the expertise available. The solution The Public Sector Mapping Agreement (PSMA) introduced in April 2011 allows all public sector organisations across England and Wales to use a wide range of geographic datasets, including OS MasterMap® and OS VectorMap® Local. Most of the information is available online and as the PSMA is a nationally-negotiated centrally-funded agreement, there is no additional cost for individual agencies to subscribe. The Heart of England NHS Foundation Trust was one of the first health care organisations to register for the PSMA and has been taking full advantage of Ordnance Survey resources to accurately plan its services.

The benefits • More accurate planning of trust services to GPs in a correctly-defined catchment area. • Ensure the increased capacity of LabMed is fully utilised by local GPs. • Better value for money and use of resources. • More GPs referring tests to the trust. • Quicker and more efficient results for patients.

‘Geographical analysis has allowed us to visually identify the locations of GP practices in relation to our Trust and their practice size, which has enabled us to predict the volume of activity from these areas.’ Steve Waller – General Manager Pathology

‘Online mapping has made a significant difference to the effectiveness of all our new projects. Before we kick off a major piece of work, the project is defined with all the necessary accurate information we need right from the start and any intervention is developed from this, not from anecdotal evidence.’ Joanna Hodgkiss – Head of Planning and Development. This map shows the location of GP practices under NHS Birmingham East and North PCT that have referred tests to Laboratory Medicine at the Heart of England NHS Foundation Trust, but that have a ‘Test to Patient Ratio’ below the average of their PCT (rounded ratio). The practices have been colour-coded by their ‘Test to Patient Ratio’ (please see key).

Using geographic information, the trust’s planning and development policy team pinpointed the organisation’s catchment area to a 20 minute drive time around each of its three acute centres. The team then identified the current GPs who were referring tests to LabMed and went on to map surgeries that were in the hospital’s catchment area but not using the medical testing facilities. By analysing the results, the trust was able to promote LabMed services more widely and, more importantly, more accurately.

Data products used: • Code-Point® • 1:250 000 Scale Colour Raster • OS MasterMap • OS VectorMap Local

‘Geographical information systems (GIS) has enabled us to carry out detailed analysis on where our activity comes from. Identifying the location of GP practices, distances to the hospital sites and surrounding road networks provides vital supporting information when developing a service.’ Claire Jones – Project Analyst

General information

General enquiries

Textphone

www.ordnancesurvey.co.uk/contactus

+44 (0)8456 05 05 05

+44 (0)23 8005 6146

visit our website www.ordnancesurvey.co.uk/health

Ordnance Survey, the OS Symbol, OS MasterMap, OS VectorMap and Code-Point are registered trademarks of Ordnance Survey, the national mapping agency of Great Britain. Ordnance Survey acknowledges all trademarks. Ordnance Survey © Crown copyright Images: The Heart of England NHS Foundation Trust and Punchstock/Creatas D09841

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Health

Improving drug and alcohol treatment provision in Bristol Ordnance Survey geographic information is helping to improve the planning and delivery of drug and alcohol treatment services in Bristol as well as increasing joint working between the city council and local primary care trust (PCT). The challenge Avon IM&T Consortium provides information management and technology solutions to four PCTs in South-West England â&#x20AC;&#x201C; NHSÂŽ Bristol,

NHS North Somerset, NHS South Gloucestershire, and NHS Bath and North-East Somerset. The agency has recently developed HealthGIS Maps, a unique interactive online tool to help NHS decision-makers analyse information and plan services more accurately. In May 2011, Avon IM&T Consortium was asked to provide information for a joint-working initiative between NHS Bristol and Bristol City Council

!VON )- 4 #ONSORTIUM

to improve local drug and alcohol treatment services. Commissioning managers wanted to map where people who use drug and alcohol services live and know who goes where to access the services. The aim was to identify geographic gaps in service provision and to help with the future planning of treatment centres across the city.

Walking times to needle exchange locations in Bristol.

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The solution The first step was to track down the data to support the project. There are currently more than 5 000 people using drug and alcohol services in Bristol, and responsibility for those services is shared between the PCT and local authority. The new Public Sector Mapping Agreement (PSMA) introduced in April 2011 allows all public-sector organisations across England and Wales access, free at the point of use, to geographic data provided by Ordnance Survey. The agreement widens access to Ordnance Survey digital mapping products and enables more collaborative working between partner organisations. Using geographical information systems (GIS), Avon IM&T Consortium was able to pinpoint the locations of treatment centres and determine where people using drug and alcohol services live. Thanks to the PSMA, the team was able to use data provided by both the PCT and local authority to calculate the accessibility of local treatment centres, include hospital statistics on alcohol-related admissions and analyse the current provision of services. The information was presented using their HealthGIS Maps tool, allowing decisionmakers to easily interrogate the data.

Return on investment

Data products used:

‘GIS mapping will be used as part of the drug treatment needs assessment process. It will allow us to map where people with drug and alcohol problems live, where our services are and who goes where to get their services. It will help us identify geographic gaps in service provision and help with future commissioning of services. We will also use it in conjunction with other maps available showing public health indicators such as areas of deprivation and admission to hospital. HealthGIS Maps will be a very useful tool to improve the Joint Strategic Needs Assessment.’

• 1:250 000 Scale Colour Raster • 1:50 000 Scale Colour Raster • OS Street View® • OS MasterMap® Integrated Transport Network™ (ITN) Layer • ITN Urban Paths theme

Sue Bandcroft, Substance Misuse Manager Bristol City Council

‘Now that the PSMA datasets are available across multiple partner organisations in the NHS, social services and public health, we are now able to develop this type of project where data is sourced from both the NHS and the council and presented alongside Ordnance Survey mapping. This wasn’t possible before the new agreement and will now allow much better partnership working between us and the council.’ Trevor Foster, GIS and Primary Care Team Leader

The benefits • More accurate planning of drug and alcohol services. • Better value for money and use of resources. • Improved partnership working. • A useful tool to improve the Joint Strategic Needs Assessment – the means by which PCTs and local authorities work together to plan health and social care services for their community. • More flexible and visual tool for decision makers to work with.

General information

General enquiries

Textphone

www.ordnancesurvey.co.uk/contactus

+44 (0)8456 05 05 05

+44 (0)23 8005 6146

visit our website www.ordnancesurvey.co.uk/health

This document has been screened in accordance with the requirements set out in Ordnance Survey’s Equality Scheme. If you have difficulty reading this information in its current format and would like to find out how to access it in a different format (Braille, large print, computer disk or in another language), please contact us on: +44 (0)8456 05 05 05. Ordnance Survey, the OS Symbol, OS Street View and OS MasterMap are registered trademarks and Integrated Transport Network is a trademark of Ordnance Survey, the national mapping agency of Great Britain. Ordnance Survey acknowledges all trademarks. Ordnance Survey © Crown copyright D08938

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Health

Geographic information improves health service planning in Bromley Ordnance Survey geographic information is playing a major role in raising awareness of the health needs of people in the London Borough of Bromley and informing recommendations to improve health services in the borough.

A project team comprising of decision-makers from health and social care organisations and representatives from patient groups was set up to review the provision of existing services and assess the health needs of the local population.

Before making any decisions, the project group responsible for coming up with recommendations to improve health provision in the area had to look carefully at the health needs of the people of Bromley. This project is ongoing.

The desire to improve local services and make the best use of NHS速 resources, including a local hospital building, led to a project being established that would look at the future of health services in the Orpington area of the borough.

The challenge Uncertainty about the future of health services, especially when it involves a hospital, always generates strong opinions and plans to revitalise health services in the Orpington area of Bromley have been no exception.

The group is considering a wide range of options for the future, which are being reviewed, amended and added to on an ongoing basis as more feedback is received. Viewing the information on maps rather than in vast spreadsheets is easier to understand and supports more accurate health service planning.

Beckenham Beacon Beacon Beckenham ZONE 11 ZONE

PRUH PRUH

Orpington Hospital Hospital Orpington ZONE 22 ZONE

Hospital Selected Boundary

ZONE 33 ZONE

Super Output Area

Geriatric Medicine Admissions by Super Output Area (LSOA) 40 to 50 (2) 30 to 40 (7) 20 to 30 (15) 10 to 20 (69) 1 to 10 (100) None (4)

The solution To help assess the health needs of the local population, the group turned to the public health intelligence team at NHS Bromley, which uses Ordnance Survey digital maps to help visualise the complex data required to inform service decision-making. As part of the needs assessment, hospital admissions data was used as the focus for analysis and each medical speciality was mapped. Using information on patient postcodes and borough boundaries, analysts were able to find out exactly who was using the hospital, where they lived and what conditions they were being treated for.

Geriatric Medicine Admissions by Lower Super Output Area (LSOA).

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Taking this a step further, the team divided the borough into three zones and overlaid the maps of each zone with demographic information on age, ethnicity and indicators to determine levels of deprivation. By putting all the data together, it was possible to see at a glance which zone had the highest health needs, whether there was an older population or a projected growth in population, and where the highest emergency admission rates were coming from, as well as many other trends. As a result, the needs assessment was able to include recommendations for the project group about the level of service required in each area of the borough. For example, it was clear from the assessment that services supporting chronic heart disease, diabetes and cancer are needed throughout Bromley, while services targeting the reduction of teenage pregnancy should be concentrated in only one of the mapping zones where the need is greater. Ordnance Survey geographic information has been essential to the process and analysts believe they would not have been able to provide

such accurate recommendations on the future provision of services without the use of maps. The team in Bromley has taken full advantage of the Public Sector Mapping Agreement (PSMA), a licensing arrangement between the Government and Ordnance Survey that allows all public-sector organisations across England and Wales to use centrally-funded geographic data provided by Ordnance Survey to help plan and deliver their services. It replaces all previous collective mapping agreements and has the potential to achieve major savings throughout the public sector as a result of more accurate planning of services and a better use of resources.

The benefits • More efficient, effective and accurate planning of health services in Bromley. • Visualisation of complex information on maps, which everyone can understand. • Accurately describes where patients live and the services they need. • Enables sharing of information between the primary care trust (PCT) and local authority encouraging more joint working. • Provides great value for money as the information is available through the PSMA, which is centrally funded.

The benefits of the PSMA are significant for the health and social care sector. Not only does the agreement improve joint working, but the innovative use of maps can help achieve public health targets, streamline patient transport services and support effective estate and asset management. A key benefit, as shown in Bromley, is that the PSMA enables a wide range of data to be visualised on maps that everyone can understand.

Return on investment ‘Ordnance Survey geographic information has been really important to raising awareness of plans to change health services in Bromley. The use of maps helps people to visualise and understand what is often complex data. It is a way of accurately describing where services are located and helps people to see easily any proposed change. We would not have been able to provide such accurate recommendations on the future provision of services in Bromley without the use of maps.’ Sarah Seager, Senior Public Health Intelligence Analyst, NHS Bromley

Data products used: • Code-Point® • OS Street View® • 1:10 000 Scale Raster • 1: 25 000 Scale Colour Raster • 1: 50 000 Scale Colour Raster • Boundary-Line™ All Orpington Hospital activity by Lower Super Output Area (LSOA).

General information

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Textphone

www.ordnancesurvey.co.uk/contactus

+44 (0)8456 05 05 05

+44 (0)23 8005 6146

visit our website www.ordnancesurvey.co.uk/health

This document has been screened in accordance with the requirements set out in Ordnance Survey’s Equality Scheme. If you have difficulty reading this information in its current format and would like to find out how to access it in a different format (Braille, large print, computer disk or in another language), please contact us on: +44 (0)8456 05 05 05. Ordnance Survey, the OS Symbol, Code-Point and OS Street View are registered trademarks and Boundary-Line is a trademark of Ordnance Survey, the national mapping agency of Great Britain. Ordnance Survey acknowledges all trademarks. Ordnance Survey © Crown copyright Images: London Borough of Bromley D09384

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Local government

Cutting teenage pregnancy rates in Hull In Hull, teenage pregnancies have reduced by 35 percent over the course of the life of the 12-year strategy. Ordnance Survey digital maps were used to plan its contraception and community-based services as well as increasing the targeting and impact of services. The challenge Just over a decade ago, national statistics singled-out Hull as having one of the highest teenage pregnancy rates in the country, with 384 reported pregnancies among females below 18 years of age in 1998 – equating to a rate of 84 per 1 000 conceptions. The statistics made grim reading, being

almost twice the national average. Repeat pregnancies among teenage girls were also high; over 20 percent of all under 18 conceptions – again, well above national figures. Teenagers in the city were failing to heed warnings about under-age sex and local policymakers agreed that new action was needed to tackle the problem. On the back of a government strategy to reduce soaring numbers of unplanned pregnancies among teenagers nationally, Hull City Council launched an initiative with Hull Primary Care Trust (PCT) to cut rates locally, focusing on improving sex education and increasing access to contraception

services through mapping. With 20 out of 22 wards in Hull recording higher than average levels of deprivation – often an indicator of high conception rates in females less than 18 years of age – it was a challenging task. The solution Data on conceptions among those under the age of 18 was initially poor and it was some time before the council and PCT were able to breakdown the information to postcode and ward level, in order to look for trends and achieve a city-wide view. Presenting the information, visually on a map immediately revealed the hotspots to target, with high teenage pregnancy rates emerging in a number of different postcodes and at 6 of the 14 local schools. Analysis revealed that while there were known problem areas north and east of the city centre, when the data was broken down by postcode and presented on a map it showed that teenage conception rates were also high on one estate to the west of Hull. It was clear that services had to be targeted to all of these areas.

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D09370 Teen pregnancy Inno 3 book.indb 39 in Hull.indd 1

Further investigation showed that while 14 000 young people were receiving advice on contraception in schools and youth centres, only 2 000 of them were making it to clinics because they were concerned about confidentiality or there were barriers to them accessing the clinics in their current sites. Other research revealed

02/07/2012 15:22:52 05/11/2012 11:15

Snapshot of North and West Hull

Teenage conception rate 2009 – Hull residents aged 15–17 Based on conceptions between 01/01/09 and 31/12/09. Girls with estimated age at conception of 15–17 years. Postcode rates are based on the home address of the girl. The conception rates are compiled from maternity (not from registration) and termination data (local and out of town providers), and do not include miscarriage and illegal abortions. Postcode conception rate per 1 000 girls 35.13 – 44.99 45.00 – 54.99 85.00 – 94.88 Secondary School NB: Figures for Hull are not the total of those for the selected postal districts. Hull conception rate @ 65.48 © Crown Copyright. All rights reserved Kingston upon Hull City Council 100023372 2010

that teenage boys preferred to discuss sexual health issues with men rather than women. As a result of these findings, the council and PCT jointly funded contraception outreach nurses to visit young people at a range of locations – apprentice centres, youth clubs, children’s homes and schools – in effect, taking the service directly to them. A service specifically aimed at boys and young men was also commissioned including a street-based outreach programme and work with vulnerable young men and boys displaying sexual behaviour in schools. Further analysis of data revealed that repeat conceptions among teenage girls in Hull were also higher than the national average. Seeing this as a significant issue, the local authority and PCT also commissioned the contraception outreach nurses to work in partnership with midwifery and to visit young mothers at home within four weeks of having their baby, to prevent repeat conceptions. The service proved to be successful and repeat conceptions among those under 18 years of age are now down to 8.9 percent in the city, compared to 20 percent nationally. Both the local authority and PCT have put substantial effort into collecting the correct information from

The benefits • 35 percent drop in conception rates among those under 18 years of age, compared to 24 percent achieved nationally. • Five out of the six schools involved in the programme saw a reduction in teenage pregnancies, with the sixth remaining static. • Savings of more than £8 million by reducing teenage pregnancy rates and preventing children from going into care (based on Department of Health calculation of cost efficiency saving). • Improved partnership working. • Visual tool for decision-makers to see quickly where services are having an impact.

a variety of sources, helped by the Public Sector Mapping Agreement (PSMA), which allows all public sector organisations across England and Wales to use centrally funded digital maps provided by Ordnance Survey. By showing the maps to young people to obtain their views on the proposed locations of services they were able to tell us more about the unofficial boundaries that exist in the city and where they would go to access contraception advice. Using the information from the mapping exercise, the council and PCT decided to adopt a ‘hub and spoke’ model for teenager contraception services. This included a more anonymous drop-in centre at Conifer House, in the heart of the city, and a selection of outreach services located in schools, youth centres and other venues the teenagers frequented on a regular basis. While there is no magic solution to tackling teenage pregnancy, the strategy has had a major impact on reducing rates locally. Figures recently published by the Office of National Statistics show that Hull recorded a 35 percent drop in conception rates among those less than 18 years of age, compared to 24 percent achieved nationally. Five out of the six schools the council has been working with have seen a reduction in rates, with the sixth remaining static.

‘Hull spends £800 000 a year on the programme but saves more than £8 million by reducing teenage pregnancies and preventing children from going into care, both of which have huge cost implications. Mapping is critical to the process, not only to ensure that contraception services are located in the right place but also to help communicate complex data to different audiences and to provide evidence that the strategy is effective. The visual format means that commissioners, councillors and other partners can see at a glance where services are having an impact and providing value for money. We plan to use the same methods in other local health campaigns to reduce smoking and obesity levels.’ Gail Teasdale, Integrated Services Manager, Children and Young People’s Services, Hull City Council.

Data products used: • Code-Point® with Polygons • 1:50 000 Scale Colour Raster

General information

General enquiries

Textphone

www.ordnancesurvey.co.uk/contactus

+44 (0)8456 05 05 05

+44 (0)23 8005 6146

visit our website www.ordnancesurvey.co.uk/health

This document has been screened in accordance with the requirements set out in Ordnance Survey’s Equality Scheme. If you have difficulty reading this information in its current format and would like to find out how to access it in a different format (Braille, large print, computer disk or in another language), please contact us on: +44 (0)8456 05 05 05. Ordnance Survey and the OS Symbol are registered trademarks of Ordnance Survey, the national mapping agency of Great Britain. Ordnance Survey acknowledges all trademarks. Ordnance Survey © Crown copyright D09370

D09370 Teen pregnancy Inno 3 book.indb 40 in Hull.indd 2

02/07/2012 15:22:54 05/11/2012 11:15

INTRODUCING MEDICINES OPTIMISATION First Databank’s innovative new Primary Care product, providing: • Improved prescribing practice • Better patient outcomes • Medication cost savings • Medicines use analytics

Find out more about the drug knowledge that helps thousands of healthcare professionals make efficient and precise medication-related decisions.

fdbhealth.co.uk First Databank Europe Ltd is a subsidiary of Hearst Corporation Swallowtail House, Grenadier Road, Exeter Business Park, Exeter EX1 3LH Tel +44 (0) 1392 440 100 • Fax +44 (0) 1392 440 192 • info@fdbhealth.com

1468 A4 Advert Inno 3FDB book.indb 41 AW.indd 1

27/01/2012 05/11/2012 13:58 11:15

First Databank

Medicines optimisation We believe that the ever changing needs of healthcare today require a shift in focus, for the industry we helped launch more than thirty years ago

The Challenge McKinsey’s 20091 report to the previous government identified that changes in drug spending could deliver 10-15% of the overall savings and indicated that this might be achieved by reducing variation in prescribing practice and increasing the use of generics over branded products. In 2011, The King’s Fund The quality of GP prescribing’2 report highlighted the need to address variation in prescribing practice variation and encourage adherence to best practice. Earlier in 2012, the GMC PRACtICe3 study into the prevalence and causes of prescribing errors in UK general practice revealed prescription drug errors for one in six people, with the elderly and young being almost twice as likely to experience an error. Bruce Guthrie’s recently published study in The Lancet4 found that the number of morbidities and the proportion of people with multi-morbidity 42 Inno 3 book.indb 42

increased substantially with age so that by the age of 50, half of the population had at least one morbidity and by age of 65 years, most were multi-morbid with physical and mental health comorbidities. In 2011, First Databank (FDB™) undertook extensive independent research to drill deeper into the current suite of clinical decision support available to understand: • • •

why GPs reject the clinical decision support alerts available why GPs don’t always adhere to best practice what extra support is required to assist the new CCGs and their component GP practices to achieve their saving targets.

The research showed that currently available technology and tools did not specifically address the issue of deviation from best practice and, most importantly, none were clinically sensitive at a patient level – making recommendations without reference to current ‘problem’ and comorbidities or polypharmacy issues.

INNOVATION IN HEALTHCARE 05/11/2012 11:15

First Databank

The Solution

FDB’s Medicines Optimisation analytics provides a current view on prescribing behaviour across CCGs providing access to:

FDB has developed its new Medicines Optimisation solution specifically to help CCGs and GP practices manage their medications budgets and improve patient outcomes through better quality prescribing and adherence to best practice guidelines, such as NICE.

• •

FDB’s Medicines Optimisation at the point of prescribing helps GPs and patients by providing: • • •

•

population level analytics, which can be drilled down into the individual patient record to allow interventions best practice guidance – reducing prescribing variations the information required to build condition specific formularies.

These tools will free up medicines management team time for direct clinical care or local initiatives. The next generation of medicines related active clinical decision support is here now, complemented by unique patient level analytics capabilities. For more information: E-mail: sales@fdbhealth.com Website: fdbhealth.co.uk

patient-specific drug recommendations (with polypharmacy and comorbidities taken into account) timely, evidence-based best practice (prompts to follow relevant guidelines, with links to source documents) price comparisons for safe drugs, in line with best practice for a specific patient.

‘Achieving World Class Productivity in the NHS 2009/10 – 2013/14: Detailing the Size of the Opportunity’, McKinsey & Co, March 2009.

The Kings Fund – ‘The Quality of GP Prescribing’ A study by Dr Martin Duerden, Professor David Millson, Professor Anthony Avery and Dr Sharon Smart, 2009

’Epidemiology of multi-morbidity and implications for healthcare, research, and medical education: a cross-sectional study’ Karen Barnett, Stewart W Mercer, Michael Norbury, Graham Watt, Sally Wyke, Bruce Guthrie www.thelancet.com Published online May 10, 2012 DOI:10.1016/S0140-6736(12)60240-2

‘Investigating the prevalence and causes of prescribing errors in general practice: The PRACtICe Study’, May 2012 Professor Tony Avery1, Professor Nick Barber2, Dr. Maisoon Ghaleb3, Professor Bryony Dean Franklin2,4, Dr. Sarah Armstrong5, Dr. Sarah Crowe1, Professor Soraya Dhillon3, Dr. Anette Freyer6, Dr Rachel Howard7, Dr. Cinzia Pezzolesi3, Mr. Brian Serumaga1,Glen Swanwick8, Olanrewaju Talabi1

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Invisible invaders Cleankeys Inc. is harnessing the power of technology to improve infection prevention activities

The intruders slipped into the hospital unnoticed and with the intent to harm. Passing through the main corridor, they spread out…heading to the ICU, the maternity ward, casually stopping for coffee in the cafeteria. Not one doctor or nurse noticed them; no patients were alerted to their presence. It was as though they were invisible. They are. The reality of the hospital environment is that it is routinely invaded in this way. Intruders capable of deadly harm slip in the doors and spread throughout the hospital all day every day. Their journey is helped along by each one of us – staff, visitors, and patients. The contamination and transmission cycles in hospitals are challenging to interrupt because the activities are ongoing. Everyone entering the hospital is bringing in a fresh supply of germs – some of which can be deadly. These germs are carried on the hands and other items and are transferred to surfaces throughout the hospital (e.g. lift buttons, door handles, telephones, keyboards, etc.). Through their journey on the hands of healthcare workers they also travel directly to patients during care procedures or to patient care devices (e.g. stethoscopes, blood pressure cuffs, etc.) and from there to patients. The key to ending this seemingly never-ending cycle of contamination, cross-contamination, and transmission is through appropriate hand hygiene in conjunction with diligent environmental hygiene. Although hands are the most common vector for transmission of infectious agents, hand hygiene rates remain around 40%. The demands on healthcare worker’s time also limit their hand hygiene compliance. It’s estimated that washing their hands at all of the required hand hygiene moments would take a healthcare worker approximately 16 hours…on a 12 hour shift. A critical step in reducing the amount of contamination carried on hands is to reduce the amount of contamination carried on environmental surfaces. The critical role of the environment in harboring and transmitting pathogens cannot be overlooked. Yet in numerous hospitals and healthcare facilities there is an inadequate focus on the importance of cleaning and disinfection in infection prevention. In many hospitals, reviews of the quality and extent of cleaning and disinfection conducted have shown areas and activities that are overlooked. A significant number of surfaces in the patient environment are not cleaned at all or are ineffectively cleaned regardless of the room type (patient room, operating room, etc.). Such short-comings have often resulted in the spread of infections and various hospital surfaces have been identified as culprits when outbreaks have occurred. Why does this happen? 44 Inno 3 book.indb 44

INNOVATION IN HEALTHCARE 05/11/2012 11:15

“

It’s estimated that washing their hands at all of the required hand hygiene moments would take a healthcare worker approximately 16 hours…on a 12 hour shift

“One well-trained, conscientious hygiene specialist (i.e. Housekeeper, Matron, etc.) given the proper tools, time and cleaning chemistry can prevent more infections than a room full of doctors can cure.”

Budget cuts can lead hospitals to decrease the environmental cleaning services. Hospital Environmental Services departments (i.e. Housekeeping) can be faced with reduced numbers of staff, high staff turnover, and poor training resources. The result can be very tight timelines for conducting all cleaning and disinfecting activities, poor training in correct procedures and policies, and insufficient resources for monitoring and auditing the effectiveness of these activities. The staff has large areas to cover and multiple surfaces in each room that must be both cleaned and disinfected. Similarly, this large and broad physical area to cover poses challenges for auditing and monitoring activities as well. Current tools for monitoring cleaning and disinfection activities require that the auditor (generally an infection control practitioner) physically visit each surface and mark it (e.g. with fluorescent gel) and revisit the site at a later time for the second check or test on the first visit with a more automated system (e.g.

ATP detection). The requirement to physically visit every site to be cleaned is not one that most hospitals have the capacity to meet; the time requirement is too large. Instead a subset of sites is usually visited and used as an indicator for overall reach and effectiveness of the environmental hygiene activities. Currently in most hospitals, infection control and prevention tasks are primarily tracked manually by direct observation and reporting via checklists. A study conducted by the Association of Professionals in Infection Control (APIC) in the US estimated that an infection control practitioner spends almost 50% of their time manually tracking and entering data. Conducting infection control activities in this way has been shown to be inefficient, labour-intensive and error-prone. The amount of time that an infection control practitioner spends on manually conducting surveillance activities can be reduced by as much as 65% with the help of automated infection surveillance approaches. INNOVATION IN HEALTHCARE 4 5

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Making surfaces easier to clean reduces the time required to clean them. Making surfaces “smarter” ensures that they actually DO get cleaned.

Technology is advancing to allow the development of surfaces that resist microbial growth, surfaces that are active anti-microbials, and robots that disinfect entire rooms in a short period. These are all technologies that have the potential to reduce the time required for environmental hygiene while simultaneously improving the effectiveness of these activities. However, these advances do not alleviate all cleaning and disinfection activities and the requirement to monitor and audit the effectiveness remains a resource challenge. What if the hospital environment surfaces could monitor and audit themselves? Why not make surfaces “smarter”? The first surface designed in this way is the newest version of the Cleankeys keyboard. Making surfaces easier to clean reduces time required for cleaning. However, making any given hospital environment surface easier to clean isn’t enough. Making the surface sensored allows it to report on the cleaning activity. The new Cleankeys keyboard is a sensored surface that can report on its clean/dirty status and whether or not it has been cleaned. This information is collected in the new CleanSweep software application. Sensored devices that can track their own status can also provide alerts when cleaning activities are required.

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Improving environmental hygiene requires modifying staff behaviour through education, training, monitoring, reminding, and motivating. Healthcare workers are committed to the care of their patients and no one intends to do harm. Challenges to successful environmental hygiene are staff training and compliance with hospital cleaning requirements. Often, poor compliance is a result of inadequate training, over-tasked workers being forgetful, and a lack of clarity as to who is responsible for cleaning/disinfecting a given surface or area. Notably, the cleaning and disinfection of computer hardware is often overlooked in hospitals due to a lack of clarity as to responsibility for that task. Through an automated monitoring, prompting, auditing, and reporting system staff can be reminded to conduct specific cleaning and disinfection activities. “Smart” hospital environment surfaces make it easier for staff to remember to clean them. Cleaner hospitals mean safer patients. Currently, compliance with cleaning policies in most healthcare facilities is poor, but hospital facilities with automated monitoring have a significant improvement in compliance. In recent years, a number of technologies have been developed to automate surveillance and feedback of hygiene events/activities.

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“

What if the hospital environment surfaces could monitor and audit themselves?

The Cleaning alert ‘pops up’ to alert front-line users to tell them that it’s time to clean the keyboard. This alert is customized according to policies in place at each facility.

The CleanMap guide provides a real-time visual guide to ensure thorough cleaning coverage of the entire keyboard surface.

“

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These technologies include video monitoring, activated badges, electronic checklists, and timed cleaning-alert lights on equipment. The successful application of automation to surveillance and prompting has been credited for increasing hand hygiene compliance. Automated checklists for environmental cleaning protocols have improved compliance in those activities as well. The automated surveillance of care delivery and follow-up protocols through checklists has also shown success. Feedback systems for surveillance of facility-wide infections as well as specific types of infections (e.g. surgical site infections) have been shown to be effective in reducing rates and generating cost-savings. Providing infection control and prevention practitioners with real-time compliance data allows them to target their educational interventions for the maximum impact. Targeting of educational interventions is important for their success as the impact of feedback and training declines and must be repeated as needed. A review conducted by the Agency for Healthcare Research and Quality (AHRQ) in the US concluded that reminders alone were insufficient to improve compliance with protocols, but systems that combined education, audit, and feedback with reminders were more successful.

the environmental cleaning compliance information with data on patient infections provides 360 degree coverage of infection prevention and containment opportunities. This allows real-time response to critical events. Monitoring patients for infection can help prevent the infections from spreading, but a cleaner hospital environment can prevent infections before they start. Regular and thorough cleaning of surfaces in the hospital environment reduces cross-transmission risk. The CleanSweep software monitors and alerts users to the need for cleaning and decontamination activities, which helps prevent the transmission of infection. CleanSweep lets you know that your keyboards are getting cleaned. We take the guesswork out of keyboard cleaning, monitoring, and auditing/ reporting. Cleankeys helps you provide a healthy environment for patients, staff, and visitors.

Healthcare systems need to know how well their facility is performing and where improvement is needed. Automating the monitoring and reporting of compliance with environmental cleaning compliance provides this information. Combining

Cleankeys in the United Kingdom mike.hensman@cleankeys.com www.cleankeys.com t: +44(0) 1404 861113 m: +44 (0) 7836 731333

The On-Screen Cleaning gauge enables the front-line users to know, in real-time, the cleanliness status of the keyboard they are using.

Article authored by Dr. Sharon Barker (Manager Business Development, Cleankeys). Visit our website for references from this article as well as additional data, literature reviews, clinical studies, and product information or contact us:

Visit Clea nkeys an d try out the a w a rd w inn keyboard s on Stan ing d 280 at the Hosp ital Direc ti ons Show West Hall , , Olympia on 21st and 22n d Novem ber.

About Cleankeys: Cleankeys Inc is a world leader dedicated to providing technology-based infection prevention and infection control solutions to the healthcare industry. These solutions include commonly-touched devices such as computer keyboards that are easy to clean and disinfect whilst having in built software that ensures that the keyboards cleanliness is continuously monitored.

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INNOVATION IN HEALTHCARE 05/11/2012 11:16

PSUK LTD

Making the change PSUK’s innovative approach to sexual health and family planning procurement

Among the many changes taking place within the NHS, those occurring in the sexual health and family planning arena will allow a greater freedom of budgetary control for individual clinics, groups and community health services. From April 2013, local authorities (as part of public health) will be mandated to commission and ensure appropriate access to sexual health services. GPs, as primary care providers through the GP contract, will be commissioned to provide contraceptive care. This will give clinicians and clinical commissioning groups the prime opportunity to review their current purchasing arrangements and make real and significant savings by partnering with organisations who have the commercial expertise and knowledge required to help. A collaborative approach Many primary care organisations have already begun redesigning the process of procurement and are looking to access products through a one-stop purchasing solution. PSUK, the UK’s largest supplier of pharmaceutical products to primary care providers, now finds itself in the unique position of being a key contractor of sexual health products and provisions through the partnerships it has forged with pharmaceutical, private commercial and NHS organisations. The PSUK model of supply seeks to remove the inefficiencies that exist within current methods of purchasing – the duplication, wasted time and overcharging from trusted suppliers – and replace this with a global solution that has been developed strategically with commercial partners to offer access to all provisions required within a sexual health and family planning service:

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• • • • • •

Oral contraceptives LARC – injection, implant, IUDs and IUCDs Condoms Pharmaceuticals Disposable instruments Consumable products, including paper products and gloves

Pricing PSUK strives to be the most competitive supplier in the market without compromising quality or service. Over the past few years, it has won contracts with major pharmaceutical companies including Pfizer, MSD and Bayer, whose focus has turned to offering reduced pricing and enhanced services directly to the prescriber, rather than the hospitals or the pharmacies that would historically receive the discount. In ensuring that the discount is given directly to the service provider, PSUK has begun to completely revolutionise the traditional supply route for sexual health and contraceptive supplies. Now, the products are delivered and invoiced to the organisation providing the service, as opposed to via a third party. The products are sold at a net price, which has an immediate benefit for the budget as it ensures transparency, profitability and improved cash flow. PSUK also negotiates and implements contract pricing for peace of mind regarding the longevity of the discounts available. Furthermore, the enhanced discounts apply not only to pharmaceutical companies. PSUK‘s product portfolio encompasses the ancillary items required to provide a complete service. Working with brand leaders including Robinson

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PSUK LTD

and Daray PSUK offers continuity of quality supply at reduced prices.

Case study: PSUK – a specialist sexual health partner of Durex

Vitally, PSUK promotes efficient data management through management reports that provide a clear view of the purchasing data of the whole organisation – the delivery points, the products, manufacturers, quantity and frequency.

In a move to ensure that valued NHS customers received a more tailored service, in May 2012 Reckitt Benckiser reduced the number of distributors it used to deliver Durex to the market. PSUK was delighted to be chosen as a specialist sexual health partner of Durex and offer improvements to customers in the form of better pricing, service and delivery.

In keeping with the QIPP agenda, this reporting structure aids with a streamlined back office function and increased productivity, and has made a significant difference in the monitoring and assessment of expenditure for both existing and expanding sexual health services.

PSUK is working closely with Durex to offer competitive pricing and promote the added support received from Durex as a chosen brand.

Benefits Ultimately this innovative approach and the resulting partnerships with manufacturers and suppliers have led to reduced pricing to the customer and better service for the end user – the patient. In the case of GP surgeries, the ability to buy product into the practice at a discount and then be reimbursed the NHS price by the PPD has ensured the service is profitable and has taken away the perceived need to send a patient and prescription the local pharmacy or in the case of LARC, the local GUM clinic. The diminished bureaucracy that is a consequence of collaborating with people with the right expertise has freed up valuable time and resources. Placing one order with one supplier and receiving discounts organised and implemented by PSUK has streamlined the ordering, delivery and invoicing process for service providers. This strategic commercial approach has enabled PSUK to deliver a cohesive message to the CCGs – buy centrally, reduce pricing and offer better patient experience as a result.

For more information, contact Heidi Barrett, Primary Care Manager, PSUK Tel: 01904 558350 E-mail: enquiries@psuk.co.uk

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Case study: promoting LARC through CCGs PSUK is trialling pilot schemes with a distribution partner to several blossoming CCG groups. Although yet to control their own budget, the CCGs, in preparation for April 2013, have begun to sign practices in their locality to a scheme to ensure LARC supply is available at the right price directly into the practice. The invoice is paid by the PCT –and later the CCG – while the practices order and receive products. The public health budget already absorbs the cost of providing LARC advice and provision in the community, but by offering what is essentially a locally enhanced service payment and working with the GPs in the area to provide more LARC services in general practice, CCGs can work to offer better patient care and reduce duplicate service costs.

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Incentivising Innovation Prizes can be powerful motivators for innovation. Across many different sectors, challenge prizes are incentivising people to develop ground-breaking new initiatives. The rewards are two-fold: substantial sums of money, coupled with considerable prestige. While many prizes reward past achievements, challenge prizes are different. They provide an incentive for meeting a specific and significant challenge. Winning these prizes can mean making a lasting impact on society and, in some cases, the world.

A Catalyst for Some of Mankind’s Greatest Breakthroughs

Helping Us to Meet Our Toughest Healthcare Challenges Today Across the world, safe, effective and affordable healthcare remains one of the greatest challenges facing mankind and, in December 2010, the Department of Health and the NHS Institute for Innovation and Improvement launched the NHS Innovation Challenge Prizes Programme. Innovation Health and Wealth, the NHS Chief Executive’s Review of Innovation, set out a compelling argument for the NHS to radically transform the way that services are delivered. In order for innovation to become core business for the NHS, an environment is needed that recognises, celebrates and rewards innovation. These are the ambitions of the NHS Innovation Challenge Prize programme.

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New £1m Breakthrough Challenge Prizes Following on from the success of the NHS Innovation Challenge Prizes, this year saw the launch of an entirely new set of challenges. The NHS recognises that it needs to radically change service delivery and patient quality in three core areas: • Dementia • Diabetes • Stroke The new NHS Breakthrough Challenges offer prize money of up to £1m for organisations or individuals who put forward a breakthrough solution that meets these awards’ exacting criteria. The challenges won’t be easy or quick to implement. Therefore, NHS Breakthrough Challenges will be open for a minimum of three years to give health communities and organisations wishing to enter an opportunity to develop and test out their solutions, with the prize awarded to the first application within this period that provides evidence of meeting or surpassing the objectives. Organisations striving to achieve these challenges need to register an interest so that they can be kept up to date with any developments. www.challengeprizes.institute.nhs.uk/the-challenges/breakthrough-challenges

Dementia Breakthrough Challenge Improving the diagnosis, treatment and care of people with dementia is a key priority for the NHS and the Prime Minister announced his Dementia Programme at the end of March 2012. The £1m Dementia Challenge sets out to achieve a dramatic reduction in the proportion of people who have undiagnosed dementia, with evidence of a step change in the diagnosis rate and a strong service response.

Diabetes Breakthrough Challenge This £1m challenge is to demonstrate a clinically safe treatment to maintain or enhance functioning beta cell mass long-term in people with Type 1 and/or Type 2 diabetes. Beta cell mass is important because it has an impact on an individual’s ability to make their own insulin, which in turn helps glucose control.

Stroke Care Breakthrough Challenge This £1m challenge is to demonstrate an intervention that reduces the extent of clinically significant brain damage following acute stroke in 50% of patients admitted within 24 hours of onset of symptoms.

NHS Innovation Challenge Prizes

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NHS Innovation Challenges Prizes Success Stories These inspiring examples of our previous winners demonstrate the vast pool of innovation that exists within the NHS and the high calibre of entries that these challenges attract. Our most recent cohort of winners were presented with their prizes at an Award Ceremony in June 2012, hosted by Andrew Lansley, former Secretary of State for Health, Sir David Nicholson, NHS Chief Executive and Sir Bruce Keogh, NHS Medical Director.

With our current round of Innovation Challenge Prizes now open, it is hoped that the experience of these winners will inspire many more innovators who can help to transform the experience of patients and end users, and contribute to a stronger NHS for everyone. Case studies from all the finalists are on our website: www.challengeprizes.institute.nhs.uk/the-finalists/ round-3-finalists

Julie Grimmer Winner

Care Plus Group, NHS North East Lincolnshire Community Engagement Project for the early detection of cancer – awarded £50,000. This Community Engagement Project involves the use of 50 volunteers drawn from the local community in deprived wards to act as agents in helping people understand, feel able to talk about and therefore seek help for early symptoms of cancer – essentially tackling a taboo subject. Formally known as the Early Presentation of Cancer Symptoms Collaborative Programme, this is an innovative community-led model combining social marketing community involvement and community action. The result has been a substantial increase in two week wait referrals and cervical screening uptake rates. The bowel screening uptake is 57%, versus a national rate of 30%.

Dr Dean Harmse Winner Plymouth Hospitals NHS Trust

Histopathology Laboratory Turnaround Times to improve work flow – awarded £50,000. This project demonstrated a remarkable turnaround in the performance of a Histopathology Laboratory. This was achieved by radical changes in workflow and other systems, coupled with staff and consultant engagement, all at no extra cost and at a time when the lab had to reduce staff as part of hospital efficiency savings. In a three month period they removed over 500 backlog cases, as well as increasing the 7 day turnaround time from 38% to 90%.

Dr Rebecca Fitzgerald Winner MRC Cancer Cell Unit, Cambridge

Invention of the cytosponge to screen for cancer of the oesophagus, food pipe or gullett – awarded £50,000. The cytosponge is a simple and cost effective screening device that can be applied in primary care settings. It is a capsule the size of a vitamin pill that is attached to a string. After swallowing, and once in the stomach, the capsule dissolves to release a spherical mesh sponge which collects cells during removal. The device could revolutionise the detection of cancer of the oesophagus by acting as an alternative to endoscopy. If the cytosponge was adopted as the routine alternative to an endoscopy, it would save in excess of £10m per annum nationally.

Dr Sandip Mitra Winner Manchester Royal Infirmary

Creation of a Home Haemodialysis service for patients in the Manchester area – awarded £100,000. The team developed an innovative approach to redesigning the existing dialysis provision to allow patients to haemodialyse at home, dramatically increasing the patient’s quality of life. The effect has been that between 10 and 15% of dialysis patients now perform haemodialysis at home compared to a national rate of between 1% and 2%. The new service also saves the trust in the region of £1m per year.

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John Hayhurst and ScriptSwitch Winner ScriptSwitch, NHS Bristol

Innovative use of an IT system to reduce prescribing waste – awarded £35,000. NHS Bristol, working with ScriptSwitch, used a software programme that is readily available in the NHS to work in an innovative way with GPs to shape their prescribing behaviours, specifically in terms of prescriptions for nutritional supplements. These changes could save £156,000 a year in the NHS Bristol area alone.

Dr David Swann Highly Commended

University of Huddersfied in partnership with NHS East Riding of Yorkshire and the Royal College of Art Dr David Swann, a principal lecturer at The University of Huddersfield’s Department of Art, Design and Architecture, led the creation of the 21st Century Nurse’s Bag in response to evidence showing district nurses very rarely cleaned their traditional leather bags, potentially spreading infection. A study conducted at the Royal College of Art and supported by the University of Huddersfield and NHS East Riding of Yorkshire as part of the NHS at Home project found that one third of a sample of bags used by nurses in the community carried the MRSA bug. Over half (55%) were never cleaned and only 6% underwent a weekly clean. As community nurses in the UK visit up to 17 patients a day, mostly for wound care, the risk of cross-infection, therefore, is high. Dr David Swann, came up with the idea of creating a new nurse’s bag. His new design is made from non-permeable polypropylene white plastic and has easy-to-clean drawers and a hard surface that can be transformed into a hygienic treatment area. It is entirely free of zips, pockets, fasteners and folds. The bag could save 1 second per treatment, spread nationally; this would save £314m per annum. The bag will be commercialised next year.

Laurence Wood Highly Commended University Hospitals of Coventry and Warwickshire The effect of nutritional supplementation rates of extreme prematurity of birth. The team has developed an innovative Intervention Package to reduce pre-34 week deliveries. The package, offered to all pregnant women, addresses some of the key risk factors for pre-term delivery. The intervention consists of: nutritional supplements, improved screening/treatment for urine infection, and selective screening for bacterial Vaginosis/Chlamydia. Improved screening/ treatment, and use of nutritional supplements, resulted in a 46% reduction in pre 34-week deliveries.

Dr Peter Thomas Highly Commended Red Bank Group Practice Personal List GP Telephone Triage System. The practice implemented a personal list system, which resulted in up to 90% of patient appointments being held with their usual GP. The new approach enables each individual GP to manage urgent/routine calls by assessing every request for an appointment with an initial telephone consultation. Access to fully computerised medical records enables the GP to advise and arrange urgent/routine appointments (on the day), or direct the patient to the most appropriate health professional. Urgent telephone assessment, as an alternative to a visit, has resulted in a 40 – 50% reduction in GP home visits. NHS Innovation Challenge Prizes

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Current NHS Innovation Challenges As well as the new NHS Breakthrough Challenges, there are nine NHS Innovation Challenges that are currently open for application. The aim across the entire Challenge Prize programme is to encourage, recognise and reward innovations in delivering care and promoting healthy living, which can achieve new levels of performance within more immediate time frames. While the Breakthrough Challenges represent the first ambition, the NHS Innovation Challenges for 2013 fall into the latter category. The current challenges are: • Better management of pregnancy - achieve a 10% reduction in numbers of pre-term births through the better management of risks. • Reducing avoidable medicines waste - reduce avoidable medicines waste by 50% and increase adherence to high cost and critical medicines regimens by 30%. • Control of infection - reduction of MSSA (Methicillin-sensitive staphylococcus aureus) and/or E.COLI Bactraemias across a health economy by 30%. • Earlier cancer diagnosis - achieve a step change in the proportion of patients diagnosed with cancer at stages 1 and 2 rather than at the later stages (3 and 4). • Emergency care – right place, first time - increase the number of people who receive emergency care in the right place and complete their care in the first location. • Reducing avoidable use of primary care - reduce avoidable attendances occurring in a primary care setting (GP, Dentists, Pharmacists, AHP or Optician) by 20% with no reduction in the care and quality of the service. • Reducing falls and falls injuries - use collaborative approaches to achieve, for residents in Long-Term Care Settings, at least a 20% reduction in each of the following five measures: falls; falls injuries; falls-related hospital admissions; falls-related ambulance call outs; and the number of fallers who have a subsequent fall within 12 months. • Improving diagnostic investigation - introduce innovative redesign of services, coupled with newer uses of technology, to enable the right diagnostics to be performed first time and be acted upon faster to: improve patient pathways, experience and outcomes; reduce diagnostic turnaround times to action by at least 50% or reduce inappropriate demand by at least 20% and/or enable at least 25% of appropriate tests to be provided in the community or by direct access. • Identification and diagnosis of chronic obstructive pulmonary disease (COPD) use newer technology and other innovations to redesign services to improve identification and diagnosis of the disease by 25% or reduce the current misdiagnosis level to below the current 30% or reduce admissions and readmissions by 33%. Further information about entering is available at: www.challengeprizes.institute.nhs.uk/the-list-of-challenges

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The Expert Panel A team of leading medical scientists, academics, industry experts and innovators have been appointed to set the parameters of the challenges, assess the entries, and put recommendations forward to the Secretary of State for Health.

Alasdair Liddell CBE Chair, NHS Innovation Challenge Prizes Expert Panel & Independent Health Strategy Consultant I’d like to take the opportunity to introduce the NHS Innovation Challenge Prizes Expert Panel and to thank them for their help in shaping the Challenge Prize Programme; assessing the great innovations which are submitted to us and recommending the prize winners. Our discussions are always stimulating and we enjoy our ‘challenge’ in selecting the best of the many applications we receive.

Members – NHS Innovation Challenge Prizes Expert Panel Professor Alan Barrell Chair, Health Enterprise East Ltd Larry Billett Chair of Pret A Manger Keith Chantler Director of Innovation and Enterprise, Central Manchester University Hospitals Foundation Trust Nina Desai Deputy Director of George Partners Dr Mike Durkin Medical Director, NHS South of England Peter Ellingworth Executive of the Association of British Healthcare Industries (ABHI) Dr Elizabeth Foot Chief Executive for London Genetics

Professor Peter Homa CBE Chief Executive, Nottingham University Hospitals NHS Trust Dr Jan Kovac Consultant Cardiac Surgeon, University Hospital Leicester Professor Jackie Oldham Director, Manchester Integrating Medicine and Innovative Technology (MIMIT)/Director, Centre for Rehabilitation Science Dr Kiran Patel Consultant Cardiologist and Honorary Senior Lecturer, Sandwell and West Birmingham NHS Trust, Medical Director, NHS West Mercia Professor Howard Rush Professor of Innovation Management, University of Brighton

Ira Gaberman Vice President, A.T. Kearney

Professor Sunil Shaunak Professor and Consultant Physician in Infectious Diseases, Imperial College London

Professor Sue Hill OBE Chief Scientific Officer, Department of Health

Professor Hilary Thomas Associate Partner, KPMG

Contact the Team New challenges are planned to be launched soon. To be kept informed of developments, or to find out how to apply for the existing NHS Innovation and Breakthrough Challenge Prizes, please contact the team at challengeprizes@institute.nhs.uk or visit www.challengeprizes.institute.nhs.uk You can also follow us on Twitter @ChallengePrizes

NHS Innovation Challenge Prizes

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Clinical Research Network

Putting research on the radar Dr Jonathan Sheffield OBE, chief executive of the National Institute for Health Research Clinical Research Network, explains why clinical research underpins the development and adoption of innovation in the NHS

Innovation is something of a buzzword in the NHS right now. This has come about through the launch of Sir David Nicholson’s innovation strategy last December and the work that is being done to set up Academic Health Science Networks – partnerships between the NHS, the lifesciences industry and academia, to ensure that innovation is deployed rapidly across the NHS. But in all this talk about adopting innovative practice, we shouldn’t forget that the journey starts with sound clinical research. Clinical research provides the evidence we need to show whether a treatment is more effective for patients – and more efficient for the health service. Without a healthy clinical research culture in the NHS, innovation cannot flourish and we can’t distinguish best practice approaches from those that are merely “different”. So what can NHS Trusts do to encourage a research culture and provide fertile ground

for innovation? Last year, the NIHR Clinical Research Network sought to answer this question by producing some case studies featuring Trusts that have made a concerted attempt to develop a clinical research culture across their organisations. Some extremely interesting common themes emerged from their experiences. First, NHS Trusts with a research culture had all made sure that their research strategy was endorsed and supported at board level. Putting research “on the radar” for the board helped to focus strategic attention on research performance and ensured that senior leaders got behind organisation-wide initiatives to promote and embed research activity. Second, research-active Trusts worked hard to engage clinicians and took time to build a dialogue with senior managers on the importance of research. This collaborative approach prevented research from being seen as “just another initiative” – always a danger in the NHS where the only constant is change.

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National Institute for Health Research

Finally, all research-culture-exemplar Trusts had very clear objectives for their research programme, and could clearly articulate the link between research activity and patient outcomes. This helped with motivation and commitment across the whole organisation. Those Trusts with a strong focus on research all agreed that clinical research drives innovation, generates additional income and gives rise to more effective and cheaper treatments. So it begs the question, why don’t more Trusts take an interest in their research delivery performance? One reason might be that, historically at least, it has been difficult to benchmark activity levels against those of other similar NHS Trusts. However, that is no longer the case. In July 2012, the NIHR Clinical Research Network launched league tables for all the NHS Trusts in England, showing the number of research studies undertaken by that Trust in the previous year and the number of patients recruited into clinical trials. The league tables could be sorted by Trust type, allowing Trusts to see their research activity levels in comparison with other Trusts of a similar nature. In addition to this, the Clinical Research Network also published more detailed statistics, showing how the number of studies undertaken by each Trust split down into the different therapy areas. This allowed Trusts to get an overview – for the first time in some cases – of their relative strengths and weaknesses in research activity. So why is this important? The answer lies with patients. A 2012 national consumer poll showed that 82% of the public believe it is important for the NHS to offer patients the chance to take part in research studies. So if patients value research opportunities per se, that would suggest that they expect to be able to access

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these opportunities across the whole spectrum of healthcare conditions. By increasing transparency around research performance, we wanted to give NHS Trusts the chance to discover the therapy areas where they are researchactive – and, more importantly, the areas where they are not. Armed with this information, Trusts are better placed to consider whether they are truly delivering on the commitment contained in the NHS Constitution, which states that all NHS Trusts will promote opportunities to take part in clinical research to patients. Clinical research should be core business for NHS Trusts and while great strides have been made in recent years to make it so (for example, 99% of Trusts now undertake some level of research activity), there is more to do if we want to fuel innovation and encourage better, more efficient treatments. Some Trusts will undoubtedly claim that it is a question of resources, but with support available through the Clinical Research Network – and with the life-sciences industry keen to form effective partnerships on a cost-contribution basis – this is no excuse. As the case studies we gathered prove, it is possible to build a strong research culture in NHS Trusts of all types and sizes. What’s needed is the will to make it happen.

Access the NHS Trust research league tables at: www.crncc.nihr.ac.uk/nhs-performance

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Clinical Research Network Case-study: United Lincolnshire Hospitals NHS Trust

Case-study: Portsmouth Hospitals NHS Trust

In 2004, this district general was conducting just 12 clinical trials and research was viewed negatively. The Trustformed partnerships with academic organisations and engaged with clinicians working in areas where research funding was available.

In 2008/9, Portsmouth Hospitals undertook just 40 studies. By 2010/11 this had risen to 200 open studies.

Lincoln County Hospital is now a top recruiting centre for certain therapy areas and the Trust attracts consultants keen to participate in clinical studies. By 2010/11 the NHS Trust had developed its research portfolio to180 trials, employed almost 40 research staff, and increased its research income to £1.4m. Dr Tanweer Ahmed says: “We set up a programme of workshops to highlight the benefits of research to patients, and the importance of clinical trials for the future of the NHS. Our first priority is to continue improving health and patient care.”

Fit-for-purpose pharmacy facilities help research at United Lincolnshire Hospitals

Now 29 clinical specialties conduct research and income from research activity has significantly increased. Research money is reinvested back into departments, allowing research-active teams to procure extra staff and equipment. The Trust has built a high-quality team of research nurses and is developing their career pathways. Professor Anoop Chauhan says: “We have a Trustwide policy to reward clinicians who get involved with conducting research.”

Specialist research nurses are driving delivery at Portsmouth Hospitals NHS Trust

Case-study: Tees, Esk and Wear Valleys NHS Foundation Trust This mental health Trust had limited research activity only a few years ago. However it built its portfolio from three to 30 research studies in just three years and expanded the number of patients recruited on to clinical trials fivefold.

Dr Hilary Allan, R&D Manager, Tees, Esk and Wear Valleys NHS Foundation Trust

R&D manager Dr Hilary Allen says: “High performing organisations must not only access emerging knowledge, but also be part of creating it, in order to influence future treatment in the NHS. The key to our success lies in senior level buy-in and their belief in research as core business. We have a clear research strategy endorsed by our board and supported by an integrated team.”

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Clinical Commissioning in Action

Bradford CCGs GP engagement with integrated care can drive projects forward and will benefit patients

GPs in Bradford are working together to develop an integrated care model which could transform care for adults - and save on NHS costs. Like many areas, Bradford had talked about integrated care before but the arrival of clinical commissioning groups and the greater engagement of clinicians has helped to drive the project forward. Instead of focusing simply on elderly people and intermediate care, the new model - drawn up with the support of CCGs - aims to cover all community and social care services for adults. A number of pilots serving populations of around 25,000 people are being set up - typically based around four to six practices. These will have teams

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of staff - community nurses, social services and the voluntary sector - working together with a single point of access. Patients will be case managed with the aim of providing whatever is needed to prevent them needing acute care or long-term residential care, or unnecessary dependence on the health and social care system. While those involved in their care will remain employed by different organisations, there is an expectation that they will work together to provide a seamless service. It is envisaged support workers will work across nursing, therapy and home care tasks - potentially reducing the number of people a patient has to deal with. And services will need to be available 24/7 to avoid patients being admitted to acute care out

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Clinical Commissioning in Action

“

Those involved in their care will remain employed by different organisations

of normal hours - a major cultural shift for many individuals and organisations. However, proactive intervention could stop patients deteriorating and becoming an emergency. GPs are seen as the lynchpin of this model. Business manager Nick Nurden, of the Ridge Medical Practice, says GPs often feel frustrated when dealing with patients who may have social care needs as well as health ones. GPs find it difficult to refer people into the system and when they do so, there are often layers of bureaucracy to go through before the patient gets the help they need. The integrated care pilots should speed up that process and ensure that help quickly,

regardless of who is involved. ‘What we are doing is getting people to work together,’ says Mr Nurden, whose practice is in the second wave of pilots. ‘The vision is to provide right care, right place, first time. There is a real determination and buy in from all organisations to make it work. The work had been started by the PCT but it was the arrival of CCGs which had really moved it forward. ‘The leadership team of the CCG are really driving it. The CCG structure is getting people together,’ says Mr Nurden. ‘If we are going to achieve what we want to achieve as a CCG then we have to break down barriers.’

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05/11/2012 11:16

Elephant Kiosks

The power of touch How using touchscreen technology improves patient engagement

The challenge of patient engagement Healthcare providers are expected to engage, listen to and involve patients. The Care Quality Commission (CQC) demands that healthcare services “provide service users with appropriate information and support”, enable patients to “express their views” and “involve service users in decisions”. Clinical Commissioning Groups (CCGs) are required to have “meaningful engagement with patients, carers and their communities” and The Patients’ Association recommends that CCGs “actively gain and publish patient feedback on the services they are providing”. Meanwhile, the Quality and Outcomes Framework (QOF) and Directed Enhanced Services (DES) reward GP practices for having a patient participation programme and measuring patient experience. Beyond the formal requirements, patient engagement goes much further. In a world of greater patient choice, it’s vital that healthcare services put patients at the centre of everything they do, encouraging service design that gives patients what they need and want. This means providing patients with the right information at the right time, asking them questions and listening to what they say.

Interactive kiosks and tablets allow patients to leave instant feedback or complete surveys about their experience of NHS services

However, patient engagement is not easy. It takes time, effort and money. Patients can be isolated, disadvantaged, and disengaged. They come from different backgrounds, face different challenges and have different needs. The great challenge is to have an effective patient engagement programme that’s inclusive and accessible for patients, while being costeffective and easy to manage for healthcare providers.

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Elephant Kiosks

What is interactive technology? • Touchscreen kiosks • Handheld tablets • Touchscreen tables • Interactive window displays • Touch-sensitive floors • Motion sensitive displays

A real-time system allows NHS managers to act quickly on patients’ opinions and implement changes quickly and effectively

Interactive technology – driving an engagement revolution Interactive technology is driving an engagement revolution. From touchscreen kiosks and handheld tablets to touch-sensitive windows and tables, this intuitive technology is being used to increase patients’ access to information and enable them to leave feedback on services. With a combination of accessible hardware, bespoke software and related engagement services, Elephant Kiosks is at the forefront of this revolution, enabling patients to leave feedback in new ways and helping the NHS extend the reach of information to patients who may otherwise not have the opportunity or knowhow to access it. Measuring patient experience Touchscreen kiosks and handheld tablets enable service providers to run electronic patient surveys. Patients simply complete the survey by touching the screen, giving service providers instant access to real-time reports. Pennine

Care NHS Foundation Trust recently launched 49 touchscreen static kiosks across the boroughs of Bury, Rochdale, Oldham, Stockport and Tameside & Glossop, delivering one of the most accessible surveys in the NHS. The survey is available in 10 languages, with automated audio, large text and pictorial symbols. Staffordshire and Stoke-on-Trent Partnership NHS Trust utilises the technology in a different way, with over 50 handheld devices running a selection of surveys, used out in the community by health workers. It ensures patients being treated in the community get the same opportunity to have their say on services as those in health centres and hospitals. Unlike paper surveys, results are submitted securely and privately by the patient, with no manual data entry or analysis required. Service managers are able to view realtime, online reports at anytime, keeping a daily or weekly track of patient experience across seven service teams. “The size of our project,” says Liam Norcup, project lead, “demonstrates the power of touchscreen technology to improve patient engagement on a large scale, while also saving money and staff time.”

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05/11/2012 11:17

Elephant Kiosks

You don’t need to be technically savvy to use touchscreen kiosks and information can be provided in many different languages

Touchscreen surveys also facilitate instant alerts to staff. So if a patient leaves feedback about an unclean waiting room, for example, an email is instantly sent to the senior sister. As explained by Barking, Havering and Redbridge University Hospital NHS Trust’s, this system means managers “can access results regularly, so can act on patients’ opinions to implement changes quickly and effectively”. Accessible patient information Interactive technology provides a unique opportunity to ensure patients access vital information at the right time. Whether it’s a kiosk based in a pharmacy like at Cambridge and Peterborough NHS Foundation Trust, or out in the community and at GP surgeries as with C4G (Canterbury and Coastal CCG), the technology means information can be delivered at the point of service, in multiple languages, audio and video. It can act as a staff resource and patients can print information or email it to a personal email address. Making engagement inclusive In addition to kiosks and tablets, Elephant Kiosks already provide touchscreen windows, floors and tables, and interactive holographic displays. With the opportunities this presents for service innovation, the biggest opportunity is to make services inclusive; to involve patients young and old, technically savvy or not, no matter what their language, literacy level or disability.

For more information, contact: Mark Worger Business Development Manager Elephant Kiosks 22 Signet Court Cambridge CB5 8LA Tel: 01223 812737 Email: mark@elephantkiosks.co.uk

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Elephant Kiosks Case study

by Shahid Islam, service user & carer involvement project manager, Bradford District Care Trust Around 18 months ago, we installed touchscreen and handheld technologies across our organisation to collect feedback about specific teams and individuals, relating to performance from the service users’ viewpoint. Data is collected in real-time and centrally collated by Elephant Kiosks, which, among other things, ensure the technical elements run smoothly. The anonymised data is made available to individual clinicians, teams and wards. Graphical illustrations show how service users score a number of topics, ranging from quality of food to how well treatments were explained. Labour intensive tasks such as analysing data are automatically taken care of, saving a great deal of time and mental energy. Results show most respondents rate care in a very positive way. Where there are trends that deviate from the high standards, we can investigate further through inspection, audit or evaluation exercises, or rectify the issue immediately if it’s more straightforward. For example, we noted that 28% of inpatients were not provided information about the ward routine. A flyer was therefore produced in a participatory way, with information about the ward, including meal times and activities. This is now provided to all patients on admission. There are many further examples of small changes that have had a ‘drip-drip’ effect leading to service improvements, which are not always easy to quantify. This is exemplified by one doctor who stated: “By virtue of creating a system where people can score performance, one can’t help but ensure that standards are always high”. We have found e-feedback to be a powerful tool and a useful ally in our quest to increase the amount and quality of data. In an age where a great deal of activity is turning towards technology to improve convenience and outcomes, it’s only logical for feedback to follow.

“

I started Elephant Kiosks five years ago after seeing the opportunity for accessible touchscreen kiosks to deliver vital information out in the community. We designed the UK’s first manually height-adjustable kiosk, accessible to wheelchair users and people with other disabilities. Since then, interactive technology has developed rapidly and so have we, but I never forget our founding principles – that technology should empower people to access information and directly engage with public services. Annette Walker MBE, Managing Director, Elephant Kiosks

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Bradford District Care Trust

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Clinical Commissioning in Action

Newcastle West and Newcastle North and East CCGs How GPs’ understanding of problems and clinical involvement can lead to better care

Staff in care homes in Newcastle are being offered training, support and input from local GPs to help keep residents out of hospital. The scheme has been initiated by the two CCGs in Newcastle, after an audit by a hospital doctor showed three care home residents were admitted as emergencies on an average day, at a cost of £8225. One third of these patients were discharged the same day and half within two days but 18 per cent died - many within five days of admission. This suggested that some of these patients were being ‘admitted to die’ – often as an emergency which could contribute to a lack of dignity and lead to interventions which would be unlikely to make a difference to the final outcome. The work by consultant Chris Stenton also

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showed that the peak time for admissions was Friday afternoon and evening - patients were going into hospital just at the point where other health services stopped for the weekend. This could mean that care home staff found it difficult to cope with patients without help. The CCGs in Newcastle West and Newcastle North and East felt some of these admissions could be avoided if care home staff felt better equipped and supported to deal with patients who deteriorated. In some cases, this could allow patients to die in familiar surroundings, being cared for by people they knew rather than in hospital. For others, it could avoid short, disruptive and potentially unnecessary admissions to hospital. Each care home was given a link GP who would make regular visits and care home staff were invited to a number of educational events covering topics of particular interest to them.

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Clinical Commissioning in Action

The link GP works with the home to support adoption of best practice guidelines within the home, discuss concerns with staff and simply act as a point of contact. Crucially, they build relationships with key members of staff within the homes. The educational events have covered topics such as wound management and falls, but also looked at care planning at the end of life with the aim of supporting residents who wanted to die in their care home and equipping staff to help them do this, where appropriate. Link GPs have worked with patients and care home staff to develop anticipatory care plans to record patients’ preferences around dying. The scheme has led to a nine per cent reduction in unplanned admissions from care homes, despite bed numbers having increased, same day discharges being reduced by 25 per cent, and 27 per cent fewer patients dying within one day of admission to hospital. David Thorne, chief operating officer of Newcastle West CCG, believes the clinical engagement of GPs has been vital in developing the scheme. GPs

“

The scheme has led to a nine per cent reduction in unplanned admissions from care homes

are acutely aware of the problems around caring for elderly, frail patients because they will see them every day in their work. In contrast, PCTs are more remote and their staff are unlikely to have this first hand experience. If they have access to data, it may not show the full picture - such as the reasons behind the peak in admissions on Friday. This has enabled the CCG to tackle the problem with GP engagement and a real understanding of both the issues and how they could be tackled. GPs instinctively ‘get it,’ he says, ‘I have not met a GP yet who doesn’t say that this is really important work.’ Funding to set up the scheme came initially from practice-based commissioning groups savings: although it cost £250,000 in the first year, this includes set up costs and ongoing costs will be lower. But the savings are at least as substantial; and there are qualitative improvements for patients who are less likely to go through the trauma of an inappropriate admission and should receive better care in the home.

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05/11/2012 11:17

Salix

Patient power Stephanie Varah, CEO of the National Association for Patient Participation and a co-founder of the Telehealth Forum, explains how the forum aims to focus on what the person using telehealth actually wants

It’s very easy to forget how often there is little patient understanding around terms that we use every day, and take for granted. Take telehealth, for example. If you asked someone, let’s call him Bob, living with diabetes what he thinks telehealth is, what do you think his answer would be? I doubt that he would know the answer. But this shouldn’t be the case, as he is exactly the type of person who could be benefiting from the technology, for example, by using telehealth to monitor his blood sugar levels from the comfort of his own home. The Telehealth Forum asked patients earlier this year what they thought telehealth was. Of the 2,000 people surveyed by YouGov, less than 10% thought they knew what ‘telehealth’ or ‘telecare’ was and even those that did provide an

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answer were far from clear of its real meaning. Answers included: “health education via videos on the internet accessible to the general public” and “direct feedback to surgery”. Many simply thought that telehealth and telecare were exactly the same thing. What we actually mean by telehealth is the use of remote monitoring devices in people’s homes to measure biometric signs such as blood pressure, pulse, temperature or blood oxygen levels. Patients then send their measurements electronically to a monitoring service, which triggers reactions at given levels, for example a telephone call or home visit from a nurse. This type of care can help to prevent emergency admissions to hospitals, as well as frequent, and costly trips to the GP.

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Salix

Tele terms

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Patients are at the heart… remember that

On page 8 head of Appello and a co-founder of The Telehealth Forum, Carl Atkey, describes how telecare users inspired his vision for a patient-informed, nurse-led home monitoring service that is transforming lives. “It has been a privilege to work so closely with Stephanie and colleagues at influential organisations like Diabetes UK, Carers UK, and the British Lung and Heart Foundations.”

Telecare: Using sensors around the home linked to a home unit and monitored 24 hours a day, 365 days a year by a monitoring centre, allowing swift action to be taken should an incident occur, which impacts on the patient’s health. Telehealth: Using remote monitoring devices in people’s homes to measure biometric signs such as blood pressure, pulse, temperature or blood oxygen levels. Patients send their measurements electronically to a monitoring service, which triggers reactions at given levels, for example a telephone call or home visit from a nurse. Telemedicine: Delivering medical services using remote technology, for example video conferencing between patients and healthcare professionals, as well as the use of remote viewing of x rays by clinicians.

The National Association for Patient Participation (NAPP) co-founded the Telehealth Forum with the British Lung Foundation and Appello in March this year, to address this lack of engagement with patients like Bob. It is so important that patients understand exactly what telehealth is, how they can use it and how it allows them to lead more independent lives. To do this, we need to sit down and listen to Bob, as only then can we know with absolute certainty that we are giving him the information that he needs. How can we provide patients with an effective and personalised service if we don’t know what they want?

centred, willing to sit down with real people like Bob and listen to what they have to say.

Many new telehealth companies tell us about their newest advanced technology, but what we should really be focusing on is what the person using it wants. That’s why I find it so refreshing to be part of an organisation proud to be patient-

Find out more about how to talk to Bob at: www.telehealthforum.org

Only by working with patients will we be able to create clear and useful information, with language that is universally accessible. Patients are at the heart of the healthcare system – we just need to make sure we remember that. It’s simple really; telehealth is all about Bob. NAPP is uniquely placed as the only UK-wide umbrella body for patient-led groups in primary care.

To find out more about NAPP, visit: www.napp.org.uk

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05/11/2012 11:17

Patient Access

Access all day, every day

Rapid access to your own GP is a dream for many, but a growing number of practices are making it happen with a simple innovation

Patients in Liverpool are receiving better care and doctors are enjoying more control over their work, thanks to Patient Access, a revolutionary access method that is being launched in practices across the UK. Patient Access is bringing a ray of hope to practices struggling to meet the demands of patients, while faced with funding cuts from cash- strapped commissioners. “Sorry, nothing left, phone back tomorrow” is the response patients dread to hear and receptionists hate to say. Building on primary care as the bedrock of the NHS, Patient Access offers a programme of change for practices. It is a practical way to deliver unmatched quality of service, while saving time and taking away the causes of stress under which many staff suffer. Invented by independent GPs, the method was discovered in use by Harry Longman, now the chief executive of Patient Access. In partnership with some of the pioneering GPs, he formed a social

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enterprise with the vision of transforming access to medical care. Longman says: “As an engineer working in the NHS, I was seeking a solution to stop everincreasing A&E demand. It seemed that whatever we tried in the PCT, nothing worked. I wondered whether it could have anything to do with access to primary care. That is when I discovered a small number of GPs around the country using a similar method. We came together under the new name of Patient Access only last year Patient Access means patients get the care they need, always on the day if they want it and helps avoid unnecessary visits to the practice or to hospital A&E departments. Doctors benefit as they experience less stress, more contact time with less patients and more time for paperwork and personal development. And the NHS also benefits, as the evidence shows that improved access and continuity reduce the use of resources in secondary care.

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Patient Access

What is Patient Access? Patient Access is a social enterprise with a vision “to transform access to medical care”. It works by offering a programme of change to practices around a well proven method and system of operation in general practice. At the core of it, the GP phones the patient at the start of every new case. Focused on primary care in the NHS, Patient Access provides a data-rich system that enables practices to help all their patients, all day, every day. Outcomes include reducing A&E visits by 20% and patients’ waiting days to see their doctor by over 80%. An integral part of the launch programme is PA Navigator, which gives precise analysis and feedback on the practice operation, before, throughout and after the change. This is offered as an optional subscription after the programme. Medical practices are supported throughout the transformation to the Patient Access system with bespoke training, expertise and data, which provides evidence of the benefits, including improved practice efficiency, patient experience and clinical outcomes.

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Patient Access

Case study: The Elms Medical Centre, Liverpool The Elms Medical Centre, based in Liverpool, is the latest practice to change over. With a staff of 25 including six doctors, the Elms is a mediumsized practice with a challenging case load supporting the needs of a demographic leaning heavily towards deprived inner city Liverpool, serving a population of 8500 (weighted population 9700). Chris Peterson, GP Principal at the Elms since 1990, said the impact of Patient Access is taking effect just five months after introducing the new system in April 2012. “Since the days of Practice Based Commissioning there has been a belief within Liverpool that the basis for a successful health economy is good primary care. That primary care workforce must be appropriately skilled, properly resourced, and committed to managing patients within primary care up to that point at which secondary care becomes necessary.

to satisfy the demand. The vast majority of our patient complaints related to access issues. So we explored further investment in clinical capacity. “My practice introduced Patient Access in April. Rather than simply ‘running faster’ we have discovered a very real solution to the appointment issues that confronted our practice. We now have a zero day waiting time to see a doctor. “The Patient Access system has allowed us to map out very clearly our need for clinical capacity throughout the week. Of course, clinical examination is an essential part of reassurance for some patients and this is an entirely valid use of a GP appointment. We do not need more doctors to service the demand of our patients; we just need to manage that demand differently.

“The old fashioned appointment system is reliant on patients and receptionists deciding who gets an appointment with the doctor. Couple that with ever-increasing patient demand and expectation, and you have GPs struggling to deliver enough appointments to satisfy patients.

“The vast majority of our patients prefer the system as they can get sorted out that day. Our doctors enjoy the system because they are able to use their time efficiently and ensure that people seeing the doctor really needed that eye to eye contact. Because we are sifting and sorting patients’ needs via the telephone we can ensure that the patient gets to see the same doctor when possible, hence our continuity has risen to about 90%. Our receptionists love Patient Access because they can always offer a solution to patients’ requests for help.

“By the beginning of 2012, my own practice was in exactly this position. Despite increasing numbers of clinical sessions, we seemed never to be able

“We have cancelled planned investment in capacity as we have realised that it would have been misplaced”

“In Liverpool, we do not believe in having secondary care do our work for us and we do not believe that the NHS is sustainable if they do. As such, the access to a GP is paramount.

To find out more about Patient Access contact Harry Longman on: Tel: 07939 148618 Website: www.patient-access.org.uk

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Patient Access

Making the change Chris Peterson said that making the change to the Patient Access system is relatively easy. “Having advised our staff and patients of our pending change, we stopped booking appointments after our agreed start date. After five months of the new system, I now believe it is the future for GP appointment systems. “We have discovered that less than 50% of our calls result in the need for a face-to-face consultation.” Shortly after the Elm’s conversion, doctors noticed that the persistent patient complaints about access stopped, with 70% of patients stating they preferred the Patient Access system. While Peterson is a strong advocate of the Patient Access system, having experienced the benefits first hand, he acknowledges that it is a very different to traditional appointment systems in UK General Practice. It is his belief that triage is most effective when performed by the most experienced clinician. “We have discovered that some GPs are less fond of telephone consulting than others and we have tried to accommodate the wishes of the GP workforce by actively managing this situation. “There is an element of uncertainty to the day’s work load and doctors need to flex up with the demand. However that demand becomes quite predictable after a while. “For the Patient Access system to be effective, practices need to have a good understanding of their telephone demand and telephone answering capacity must match demand.” Chris concludes: “The sustainability of Patient Access lies in the control regained by the practice.”

“

We used to measure the average wait to contact a GP in days. Now it’s in minutes

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05/11/2012 11:18

NHS Benchmarking Network

Good practice makes perfect Stephen Watkins, Director, NHS Benchmarking Network, explains how the group promotes good practice

The NHS is the largest publicly funded healthcare system in the world. Since its foundation in 1948, it has provided services that are hugely valued by patients and staff and are free at the point of delivery. The national service does, though, hide significant variation in demand, provision arrangements, and health outcomes. The NHS Benchmaking Network is the largest global healthcare benchmarking group and exists to understand the reasons for variation and help define and implement good practice in commissioning and healthcare provision. The Network is an independent NHS organisation and exists to serve its members in undertaking benchmarking reviews and identifying good practice.

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What does good look like? This is the question we try to answer. Good can mean a number of things including the best outcomes, best use of resources and optimal patient experience. We look at all these areas and provide insight to members to help support the best possible commissioning decisions and provision arrangements. This brings evidence to the commissioning process and helps to drive ongoing improvements. Take a look at your health system Your local system will have specific characteristics driven by a number of factors, including disease

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NHS Benchmarking Network

Who’s involved in the NHS Benchmarking Network? The NHS Benchmarking Network has a large subscribing NHS member base including • 75 PCTs and Clusters • 129 Clinical Commissioning Groups • 93 Acute Trusts • 47 Mental Health Trusts • 30 Community Trusts • A number of national bodies including Department of Health and Welsh Assembly Government

prevalence, mortality, funding levels, and the shape and number of local providers. Developing confident evidence based commissioning plans against this backdrop can be a challenge. One of the best places to start is to take a look at how your system compares with the rest of the NHS. This identifies your position in the performance league table and scope for realistic performance improvement. Analysis of standardised mortality rates across the NHS in England reveal significant variation around the mean score of 100. Kensington and Chelsea has the lowest with a mortality index of 60 and Liverpool the highest with an index of 131 (figure 1, below). The chart shows all 151 PCTs in the English NHS with North West PCTs highlighted in red and Manchester highlighted in blue with an index of 129.

Reasons behind this variation are numerous, but analysis of the patterns of investment and care utilisation reveal interesting opportunities for considering the appropriate balance of care within health systems. When reviewing the relative capacity of primary care GP services to impact on wider system demand, the baseline level of investment in primary care medical services reveals interesting positions. Investment in primary medical services ranges from £115 per head in the lowest investing health system to £190 per head in those investing most (figure 2, below)

Figure 2 – Primary Medical Services costs

Figure 1 – Mortality Indices

Good primary care clearly plays a key part in managing total system demand. The North West as a whole has lower primary care investment levels than other areas of the NHS. The impact on use of emergency secondary acute services

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NHS Benchmarking Healthcare

is shown below where utilisation rates by PCT show a 100% variation across the NHS. North West PCTs are highlighted in red and most demonstrate usage of emergency care systems at above NHS average levels (figure 3, below). Clearly, health needs and disease prevalence impact on the need for unplanned care, but the lower level of primary care capacity will also impact on demand for emergency secondary care.

department. This uses real data from an East of England CCG and shows how 42% of attendances can be attributed to proximity to A&E. 4"&5)6($7((&)./0)!(-%&8)/)9+%'$"'()9+,:"-"$;)$,)./0)!(1%+$-(&$ +%%

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Figure 4 – A&E Demand versus GP Practice location

Finding out more Figure 3 – Emergency Admissions Activity

The new financial realities of the NHS inform the potential for radical commissioning shifts. Benchmarking evidence can be used to ensure decisions are well thought out and use best available evidence. Understanding local factors within national commissioning priorities will be an important dimension of CCG work. For example, figure 4 shows how A&E demand by different GP practices is driven by proximity to the A&E

The NHS Benchmarking Network is the world’s largest healthcare benchmarking group. We are a not for profit organisation working to improve the quality, value and delivery of healthcare. For more information, contact : Tel: 0161 266 2046 Website: www.nhsbenchmarking.nhs.uk

Benchmarking projects We support a large number of benchmarking projects for members. All of these include comprehensive benchmarking comparisons and good practice examples. • Total system benchmarking • Health outcomes • Emergency Care • Radiology • Therapy services • Community services • Mental health • Intermediate care • Long-term conditions • Corporate functions

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INNOVATION IN HEALTHCARE 05/11/2012 11:18

More than just a health and advice line… For over seven years, NHS Direct has provided a variety of services to support over 11,000 patients manage their long term conditions at home. One successful Telecoaching project run by NHS Direct is Healthy Change. Telecoaching provides tailored support and guidance to enable patients to manage their long term conditions and covers factors such as lifestyle change, medication management and access to appropriate services.

Healthy Change: Improving self care through healthier lifestyle Developed with the Nottingham Public Health team Healthy Change delivers streamlined effective support for lifestyle change. Initially set up as part of the CVD prevention pathway, (CVD is the second most common cause of death in Nottingham City) Healthy Change is widely applicable to improving other health outcomes affected by lifestyle. In its first year over 5,000 residents of Nottingham City have registered with Healthy Change and over 80% of these have been successfully referred to one or more lifestyle change service.

Michael’s story Michael, 51, was overweight and advised by his GP that he was close to developing diabetes. Realising he had to do something, Michael contacted Healthy Change where he was referred to Slimming World. A cynic, he did not believe that he could eat the things he liked and lose weight. However, within eight months he had lost 8st and his blood sugar level was back to normal and medication reduced. “I was in a dark corner; I had recently overcome a heart attack and was battling with apnoea. I felt life was so hard and my life expectation was low. But now I feel transformed and am making long term plans.”

How it works Healthy Change encourages people to improve their self care, addressing lifestyle factors that are key determinants of health inequalities, especially when targeted to deprived areas and those most at risk. 90% of the service is provided by telephone which has proved more productive and safer than face to face meetings and is very popular with clients. People can self refer or via their GP, Health Checks or other health professionals. After referral they are assessed and if suitable enrolled on the programme.

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Once enrolled they receive short programmes of personalised coaching support from specialist staff. They are referred to a range of services depending on their goals. On referral they are booked into their first appointment and followed up to improve attendance.

Success to date: • Over 5,000 referrals in the first year. Including from GP Health Checks • 80% of clients referred to lifestyle change services • Enables over 75% of members to achieve one or more additional goals at the end of the coaching period • Rated as good or better by over 85% of members • Reduces DNA rates for specialist lifestyle services • Integrated service provision

We will leave the last word to another Healthy Change client – Lawrence, 67 “Everything feels brilliant again! I’ve lost 8 inches off my waist and can play football with my grandchildren and great-grandchild. I can’t thank the Healthy Change team enough. Their support and encouragement has been excellent.” For further information on all NHS Direct’s Telehealth and Telecoaching services email: ltcteam@nhsdirect.nhs.uk

10/10/2012 05/11/2012 12:22 11:18

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05/11/2012 11:18

Crawl, walk, run NHS reforms have the capacity to dazzle and confuse – the challenges are many and the opportunities for new thinking are even greater. Stakeholders, commissioners and patients need to adapt new ideas and find solutions to age-old health problems. The adage crawl, walk, run was never more appropriate as the clinical community finds its way through the storm.

Clever technology Innovation, including the use of technology, has been widely cited by Government health leaders as the way forward. These new technologies, intelligently applied to progressive initiatives such as Telehealth can, and will, in the opinion of NHS Direct help deliver the efficiency gains needed in the health sector.

First step At the heart of it all is the overarching need to provide the clinical community with an end-to-end view of the patient’s health record over their full care pathway. While that holistic patient record platform may be some way off, NHS Direct believes that Telehealth operators can make a substantial first step by building part of that jigsaw now: An open (agnostic) Telehealth platform that enables physiological patient data from any Telehealth device in any format to be pulled-in and then made visible centrally via a clear graphical interface. NHS Direct sees this as a critical first step in the delivery of consistent, properly diagnosed medical triage.

To achieve this we must transition from the current model of proprietary health monitoring devices and proprietary monitoring software and this will require collaboration from all parties. NHS Direct has risen to this challenge and has adopted the UK’s first purposebuilt agnostic Telehealth platform. But why now and what does that mean to the clinical community and the patient?

Agnostic platform In simple terms it means that manufacturers of health monitoring equipment (and proprietary monitoring software) now have the opportunity to plug into a single unified Telehealth platform, primed by NHS Direct. While that’s great news for the vendors as a means of extending their sales reach, it is also fully aligned with NHS’s patient-centric health strategy: Tailor the service to the patient, rather than force a proprietary solution upon them. More plainly, it’s a win for the patient.

No holding back the tide One final thought. The front page headline on one national paper in early October reads ‘Diabetes crisis to hit 4.4m Britons. Experts warn of NHS disaster*’. This is only one of many headlines of that flavour in recent months. But, alongside those ominous warnings we should not forget that individual’s are becoming better informed and more engaged in self-management of their health. Sooner, not later, social media and digital marketing will galvanise an army of patients who will start demanding Telehealth services to maintain independent living. This is as certain as the ebb and flow of the tide itself. The need for an agnostic Telehealth platform has never been greater – and NHS Direct aims to take the lead.

See us on Sta nd 52 at the NHS Alliance , Bournemo uth. For further in fo email: ltcteam@nh sdirect.nhs. uk

* The Daily Express – Tuesday October 2, 2012

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10/10/2012 11:18 12:18 05/11/2012

Salix

Testing times Toby Knightly-Day, Managing Director of Fr3dom Health, explains why the primary care sector must interact with the Friends and Family Test

“

Ask not what FFT can do for you, but what you can do for FFT

Since the reforms were first talked about, “putting the patient at the heart of care” has been a consistent mantra. It sounds quite obvious really, but the thing is, by making this commitment, healthcare providers have got to take notice of what people are feeding back to them and, furthermore, they’ve got to react to the things patients say are wrong.

stayed at least one night in hospital and those who have been treated in A&E.

So, it is not surprising that there is considerable focus on patient feedback, exemplified by the recent introduction of the Friends and Family test (FFT), which has now been mandated in the acute sector and will come into force from April 2013.

My starting point is that it could be a case of “ask not what the test can do for you, but what you can do for FFT” – in other words, I think there is definitely a role for primary care to play in the test. The current FFT in the hands of, say, GPs is not necessarily the right tool – unless a practice wishes to use it for a specific marketing or operational improvement strategy – but I would like to see GPs adopt something similar in the future.

We’ve been closely involved in the development of FFT and I’m generally pleased to see the version of the test that will be asked of patients who have

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However, given that, in volume terms, more people actually interact with primary care providers, is there not a place for a FFT-type initiative in this sector? And if the test could, in some form, transfer to the primary care setting, how would it work?

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GPs need to share the FFT data with their patients, talk about it and explain it

“

Salix

For now, however, practices can make a huge difference by impressing upon those they refer, the importance of providing feedback about their experience. GPs will soon gain significant powers to shape the service landscape and, by getting involved with the test, they will understand more about the services they are commissioning.

Yes, FFT-style initiatives could work in primary care. However, the real value GPs can add straightaway is to ensure they advocate that their patients and referrals take feedback seriously. If GPs understand the way the test is implemented and how it is used to effect change in the way providers deliver services, it stands to reason that they will be more able to understand the inherent quality and patient focus of those providers. To be truly patient-centric in primary care, GPs in particular need to start visibly and vocally advocating FFT – not solely because it is needed at a primary care level, but because it adds such weight to making the test meaningful in the eyes of their patients. GPs need to share the test data with their patients, talk about it and explain it – use it in their role as clinician and advisor. GPs are the gatekeepers to the health of their community and with their new commissioning involvement, they also have a pivotal role in getting the test to be accepted by the public. When I spoke to Georgina Craig – co-lead of NHS Alliance’s Public and Patient Involvement Network – about the test, she pointed out that there is emerging evidence that people have such low expectations of NHS services that they

often respond positively to surveys. As a result, there is potential for disturbing stories to be masked and for a false sense of security to develop. At the same time, however, she was sure of the need for an equal focus on improving patient experience across primary as well as secondary care and that this should extend to all primary care providers – not just general practice. Improving patient experience is embedded in the NHS Outcomes Framework and the only way this will be realised is through providers collecting and responding to quantitative and qualitative data. As Georgina Craig rightly pointed out, cultural change sits at the heart of delivering the best possible experience for people and their families. If experience is to be valued as highly by providers as improving the cost effectiveness of care, changes must be made to the way service providers interact with service users. She was again right to say that, from a servicewide perspective, this remains some way off, but the acute FFT has to be a step in the right direction. In conclusion, then, I hope GPs and other primary care providers will take the time to look at the test and encourage their patients to take it seriously. While it might not yet be a question they ask in their own premises, if they value its feedback and encourage service users to interact with it, it can shape commissioning decisions and improve patient experience. In October 2012 Fr3dom Health launched www.friendsandfamilytest.co.uk to help trusts prepare for April 2013.

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NHS Improvement

Preventing unnecessary strokes in patients with Atrial Fibrillation Sarah Armstrong-Klein RGN, a National Improvement Lead, NHS Improvement, examines early stroke detection

Each year, around one in 20 patients with atrial fibrillation (AF) will have a stroke. Detecting AF, identifying those at risk and ensuring they receive the right management is essential to save lives and reduce the suffering and disability that strokes cause. AF is the most common cardiac arrhythmia with a prevalence of approximately 1-2% in the UK. Without effective treatment, approximately 12,500 (one in 20) will suffer a stroke1. Apart from the human and social costs of a stroke, each one costs the NHS an estimated ÂŁ11,500 in the first year alone2. Many AF-related strokes could be avoided through early detection, assessment of stroke-risk and optimum management of the condition. Nurses

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are uniquely placed to develop systems in practice to identify patients with irregular pulses, facilitate their onward referral and diagnosis, and support patients in managing their own AF. By developing or utilising existing information and educational materials, nurses can make a real difference. Taking time to talk to patients will increase their knowledge and understanding of the condition, encouraging a more equal partnership where the ownership of health, management and safety is shared between patient and health professional. Identifying patients with AF Early detection and treatment of AF improves health outcomes for patients and minimises the likelihood of resistance to treatment or the complications of non-detection such as stroke.

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NHS Improvement Prevalence of AF increases with age and is estimated to double by 20503, so building in systems for everyday practice for opportunistic detection of new AF would improve patient outcomes significantly.

benefits and treatment plan is very important as some behaviour modification and lifestyle changes may be required.

Primary care nurses are ideally positioned to reduce stroke risk by identifying and improving ways to include simple pulse checks during routine contact with patients. Regular flu, coronary heart disease or health check clinics may provide ideal opportunities for detection. A patient with an irregular pulse should be referred to their GP for appropriate investigations. Ways to promote self-checks by providing information for patients are also encouraged.

NHS Improvement is providing GRASP-AF (originally developed in West Yorkshire Cardiac and Stroke Network), a simple, downloadable audit tool designed to support GPs in managing their AF patients in primary care. NHS Improvement’s strength and expertise lies in practical service improvement. It has over 12 years of experience in clinical patient pathway redesign in cancer, diagnostics, lung, stroke and heart programmes, and demonstrates leading edge improvement work in England to support improved patient experience and outcomes.

Assessing stroke risk Once identified, the risk of an AF-related stroke can be reduced significantly. On confirmation of diagnosis, AF patients should be risk-assessed using validated tools such as CHADS2 or CHA2DS2VASc. A number of guidelines (NICE 2006, ESC Guidelines 2010, ESC Focussed Update 2012) exist to help practitioners treat patients according to their risk, including recommendations on the introduction of anticoagulation therapy. Despite this, NICE Clinical Guideline 36 (2006) revealed that almost half the patients requiring anticoagulation were either not prescribed it, or were not on optimum treatment. Correct dosing of anticoagulants reduces the risk of stroke significantly (warfarin, for example achieves a 70% reduction of risk). However, their safe prescribing requires careful consideration of the individual patient’s risks and benefits. Healthcare organisations should take steps to manage the associated risks of anticoagulation therapy (The National Patients’ Safety Agency (NPSA) Alert, 2007). Spending time with newly diagnosed AF patients, explaining the risks,

Managing patients with AF using GRASP-AF

Free to NHS England, GRASP-AF uses MIQUEST to interrogate GP clinical systems. Using read codes to identify patients with a history of AF, an individual’s medical history and medication status are used to calculate a risk of stroke using the validated CHADS2 and CHA2DS2VASc scores. Dashboards and patient lists are automatically created, enabling GPs to view their at risk patients at a glance, therefore supporting the methodical recall or reviewing of AF patients to promote correct treatment and safe management. Prescriptions for anticoagulants are likely to increase with the rising numbers of high risk patients being treated for AF. As anticoagulants carry an increase in bleeding risk, individual assessment, support and advice will be needed to ensure patient safety and understanding when taking this medication. Quality Outcomes Framework (QOF) The most recent QOF 2012-13 indicators have been updated and using the GRASP-AF tool will help practices to achieve these. GRASP-AF can

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NHS Improvement

be re-run as often as required, and is recommended at least annually. NHS Improvement has further developed and rolled out the GRASP-AF tool to a quarter of all GP practices across England. AF patients in over 2,200 surgeries are now benefitting from better management and anticoagulation, thus reducing their risk of AF-related strokes substantially. Data uploaded anonymously to CHART Online (a national database supported by PRIMIS+, commissioned by NHS Improvement) suggests that already 210 strokes per year have been prevented as a result of improvements in management. With just modest changes in prescribing noted so far, this already equates to savings of £2.5 million in acute stroke care costs. With bigger changes in prescribing and more general practices using the tool, the potential for saving lives and strokes, and reducing social, healthcare and human costs are enormous. For more information on GRASP-AF and to download the tool, visit: www.improvement.nhs.uk/graspaf/

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“

Without effective treatment, approximately 12,500 (one in 20) will suffer a stroke

Atrial Fibrillation Investigators. Arch Intern Med 1994;154:1449–57;

Department of Health Atrial Fibrillation Cost-Benefit Analysis. Marion Kerr (2008)

Go AS, Hylek EM, Phillips KA et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001;285:2370-5

INNOVATION IN HEALTHCARE 05/11/2012 11:18

MATCH

Find the perfect MATCH Shirley Davey, Michael Brennan, Simon JE Taylor, Hiran Basnayake and Brian J Meenan on how healthcare companies can target their business focus to associated opportunities with a new online resource

Companies and organisations can map their business activities and determine which opportunities are available in line with their current business focus, thanks to a new resource. The Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH) has developed a web-based open business model tool (which can be viewed online atwww.match.ac.uk/OBM) that enables companies to map their current business activities in response to a series of questions, which have a particular focus on innovation. The outcome of this exercise profiles the current business focus of company from which associated opportunities can be determined. The healthcare sector is, of course, complex and consists of many types of contribution â&#x20AC;&#x201C; patients,

customers, professionals, public organisations and stakeholder groups. Expenditure on health continues to increase and this provides on-going opportunities for both new and established businesses to demonstrate value for the technologies and services that will benefit patients. In such a competitive and challenging business climate, focus is crucial. It is the quality and appropriateness of a companyâ&#x20AC;&#x2122;s business focus that will determine future innovation strategies, which are increasingly important in the context of both business growth and benefits to patients. In this context, it is essential that all businesses can demonstrate the value of the technologies and services they provide. A critical aspect for the continued success of healthcare systems in developed nations is managing the adoption of

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MATCH

innovative new technologies and medical devices with the healthcare system. In this regard, a major challenge facing companies developing and marketing innovations for healthcare is gaining an understanding of how best to engage with the sector. Central to this engagement is clarity as to how business can: • Create value • Make best use of resources • Organise transactions. Businesses commonly take their technology to market through a range of venture-based activities. This journey may be part of a business plan or embodied within the development of a strategy to market the innovation. The concept of a ‘business model’ can be used to help make the necessary decisions in small- and mediumsized companies. Currently, business models are useful for companies in a number of ways: • To map current business activities • As a training and development tool to enhance knowledge of an organisation’s business model for all levels of staff • To develop future innovation strategies. Given the complex nature of technological innovations, markets, regulatory and ethical frameworks in the healthcare sector, it is understandable that few individuals understand all the tasks business organisations undertake in their entirety. In general, it is accepted that technical and economic experts know their respective domains, but that neither have significant experience of each other’s activities. However, since the operational aspects of a healthcare company need both of these domains to be fit for purpose, it is important that they have appropriate connectivity between them. An appropriate business model can serve to connect the two domains. In this regard, a business model is a dynamic, multi-directional framework that utilises inputs from both the technical supply side (i.e. those that are developing the technology) and the market economic outputs from the demand side (i.e. users and healthcare providers). Such a model normally draws on a multitude of

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subjects including technical data, market assessment, economics and so on, to illustrate the key operational aspects of the business. The inclusion of technical inputs can ultimately influence the ability to produce a value proposition or offer that meets chosen customer segment needs. The use of the economic outputs has an important influence on a company’s business model as this determines the chosen customer segments. In addition, aspects such as willingness to pay will affect revenue streams and cost structure. In this context, the benefit of the business model tool developed by the MATCH team lies in its ability to provide an effective means to link the supply side technical inputs with the demand side economic outputs. Recently, the concept of an open business model approach has been introduced that allows for the inclusion of aspects of the common experience to be employed alongside the specific details for a given company. The MATCH open business model online tool allows for quantitative and qualitative research and operates in the form of structured in-depth interviews with small- and medium-sized companies operating primarily within the healthcare sector. The data obtained is used to provide a structured assessment of the business in the context of a number of defined activities and to explore and define how this type of business model can be used within the organisation. A workbook has been written to accompany the open business model tool, which is available from the MATCH website at www.match.ac.uk. This workbook can be used by all types of professionals within a company and there is no requirement for previous experience of business strategies or business model knowledge. Acknowledgements The authors acknowledge support of this work through the MATCH Programme (UK Engineering and Physical Sciences Research Council grants numbers GR/S29874/01, EP/F063822/1 and EP/G012393/1)

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MATCH

FURTHER INFORMATION MATCH open business model tool: Contact: Dr Shirley Davey Engineering Research Institute School of Engineering University of Ulster Jordanstown Campus Shore Road Newtownabbey Co. Antrim, BT37 0QB Tel: +44 2890 368925 E-mail: s.davey@ulster.ac.uk MATCH: Contact: Elizabeth Deadman Communications Manager (Healthcare) Brunel University Uxbridge UB8 3PH Tel: +44 1895 266050 E-mail: match@brunel.ac.uk INNOVATION IN HEALTHCARE 8 7 Inno 3 book.indb 87

05/11/2012 11:19

Clinical Commissioning in Action

HealthEast CCG CCGs are using innovative methods to understand patient needs and behaviour â&#x20AC;&#x201C; and are involving them in redesigning services

An innovative scheme in the Great Yarmouth area has tried to understand why many people with long-term conditions were bypassing local health facilities and going to A&E - and then asked them for help in redesigning the system to encourage better use. The Connected Care Gorleston scheme was set up by HealthEast, the CCG for Great Yarmouth and Waveney, and social enterprise Turning Point. Gorleston is a relatively deprived area with an ageing population and high levels of long-term conditions such as arthritis and diabetes. It is also close to the areaâ&#x20AC;&#x2122;s main district general hospital, the James Paget Foundation Trust. HealthEast was concerned that many people were accessing the emergency care system at the James Paget rather than using community health facilities and support. Understanding why this was happening was a prerequisite if behaviours were to change to make more appropriate use of the system. A team of 15 local people with experience of long-term conditions were trained as community advocates. This has enabled them to carry out research among their peers and then work with commissioners and service providers to redesign the services available.

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Clinical Commissioning in Action

The research was completed in February 2012 and pointed towards a number of ways in which improved or changed services could encourage behaviour change. These included co-locating health and voluntary sector support services at GP surgeries, improving patients’ perspective of the continuity of care between different health and social care agencies, and offering more opportunities for self-management and peer support. How this can be translated into practical changes has been explored through a workshop which brought together community members and professionals in small groups. The community advocates played a key role in this and introduced the findings of the research and its context.

“

This project has enabled us to identify the issues

HealthEast, working with partners such as the local council, is now looking at how services can be redesigned to reflect this. Rebecca Driver, director of engagement for HealthEast said: ‘This project has enabled us to identify the issues that make navigating clinical pathways difficult for our patients with long term conditions. Working with our partners we are using this learning to focus on specific changes to our commissioning arrangements that will make a real difference to patients. Key areas of work in the next nine months include supporting self management of long-term conditions, connecting vulnerable people to information and resources and joining up services.’

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Fully managed telehealth Patient focused home monitoring service with no up-front costs, from the experts in homecare

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A patient-centred telehealth service A carefully managed telehealth service - remotely monitoring patients at regular intervals and providing medical professionals with easy access to the data - has the potential to deliver wideranging benefits for clinicians, patients, and the health service as a whole.

• Nurse led alert verification • Adherence management • Easy-to-use web based portal for clinical management

No capital outlay Asset management Regular reporting Telehealth service consultancy

Payer

Clinician

Air Products’ telehealth service maximises the effectiveness of remote monitoring through a comprehensive support programme designed to heighten patient compliance and improve health service efficiency. By working in partnership with contracting authorities we can develop a telehealth service that achieves high levels of patient satisfaction and sets world class standards.

• • • •

Patient • • • •

Increased quality of life Deeper understanding of care Peace of mind and reduced anxiety levels Only one point of contact for all service elements

As a company Air Products has extensive experience of providing in home clinical services to patients. Since 2006 we have successfully provided this support to over 200,000 patients and their families. Our infrastructure is already tailor made to provide the much needed integrated service model which is now accepted as a critical component of a successful telehealth programme.

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A national infrastructure and comprehensive service We have a team of highly-trained technicians, a national call centre and a centrally located workshop, ensuring all telehealth activities are carried out to the highest possible standards.

Our services cover: 

Equipment provision and installation with no capital outlay



Patient training and motivation



Equipment maintenance



Free 24/7 contact centre



Ongoing monitoring and follow-up



Clinical monitoring to identify at-risk patients and enable early clinical response



Web-based monitoring portal and support for clinicians



Telehealth service development consultancy



Asset management and regular reports

Why should you consider a managed telehealth service?

Why Air Products Healthcare? Experts in chronic homecare •

Focus on healthcare, not just equipment •

Integrated care •

Ensures that investment in telehealth actually delivers better care for patients

Easier for patients and for clinicians to access the right support at the right time

Saves clinicians time •

We take care of the non-clinical burden, enabling clinicians to focus on patient care; we follow up non-compliance or technical issues with the patient, keeping clinicians informed but without taking up their valuable time

Specialist provision •

We understand that telehealth is about health outcomes, and work with clinicians to improve them

Single supplier •

Single point of contact •

We have a deep understanding and many years of experience with delivering services to chronic care patients in the home

Contact with a single organisation ensures consistency for all elements of the service, from equipment installation and patient education, to telephone support and equipment removal

No capital outlay •

We use a per-patient, per-day pricing model, which means you only pay for the time the equipment is with the patient; no capital investment is needed

For more information or to arrange a meeting with our business development manager for telehealth, call 0845 602 0776 or email medsales@airproducts.com

A service delivered by specialists ensures an efficient and cost effective telehealth service for patients, clinicians and the NHS

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Air Products Healthcare 2 Millennium Gate Westmere Drive Crewe Cheshire, CW1 6AP Tel 0845 602 0776 Fax 0800 214709 Email medsales@airproducts.com

tell me more

www.airproducts.co.uk/telehealth ÂŠ Air Products and Chemicals, Inc. 2012

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365-10-103-GB-JAN12

05/11/2012 11:19

Clinical Commissioning in Action

Rushcliffe CCG How CCGs are tackling pathways for long-term condition sufferers

Chronic obstructive pulmonary disease affects up to 4% of the population and is more common in deprived areas. Sufferers frequently have a poor quality of life and are likely to need regular input from healthcare professionals to optimise treatment and reduce the severity of symptoms. All too often, this will manifest itself through emergency admissions to hospital. Ideally, primary and community based care should manage as many of these patients as possible at home, supporting and educating them in the management of what can be very distressing symptoms through to end-of-life care. Rushcliffe CCG has worked to develop an integrated COPD service which covers patients from screening and diagnosis, through management in the community to hospital care. This has included working with a pharmaceutical firm which provided a COPD nurse to work with practices with a high rate of COPD-related emergency admissions. The nurse provided support and improved management of patients identified as high risk, and also worked with practice nurses. In the early stages of the disease, many patients can do a great deal to self-manage. The CCG has worked with practice nurses to distribute self-management booklets to diagnosed patients, and has taken out a subscription to Metcheck, which provides long-range weather forecasts. This meant patients could be warned of weather conditions which could adversely affect their illness.

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Clinical Commissioning in Action

“

In severe cases, a patient will be supported at home

It has also commissioned a consultant clinic held at Keyworth Primary Care Centre, rather than patients having to travel to a hospital inside Nottingham. The patient’s specialist nurse can also attend these consultations to ensure consistency. These specialist nurses work very closely with GPs and community clinicians to monitor patients. Patients who are thought to be at risk of admission to hospital can be supported by a multi-disciplinary team through a ‘virtual ward’ in the community. In severe cases, a patient be supported at home with up to four daily visits for a period of five days by a crisis response team, working with the specialist nurse who will case manage the patient. For many patients whose symptoms have worsened, this will be enough to avoid unnecessary hospital admission. Access to pulmonary rehabilitation services has been improved with the development of a service specification which meets NICE guidelines and includes a specialist physiotherapist. Waiting times for this service is minimal. Patients can also attend exercise classes, led by a respiratory trained fitness instructor, at a local leisure centre. This can help those who have been through pulmonary rehabilitation to improve their lifestyle. Feedback from patients has been very positive especially around reduced anxiety - knowing that there is support available if their condition suddenly worsens. So what has been the outcome? In 2011/12 emergency hospital admissions for COPD sufferers in the area have dropped below 700, whereas in 2010/11 they were over 800 and in 2009/10 900. Dr Neil Fraser, who leads on long term conditions for the CCG, says that the total cost of COPD treatment also seems to have fallen. ‘The expensive thing is often the thing that is bad for the patient as well,’ he says. GPs have championed the improvements to services and have worked closely with specialist nurses, he added. ‘There has been a debate and conversation with GPs about how it has developed.’

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Clinical Commissioning in Action

West London CCG How CCGs are identifying groups that fall between the cracks of existing services and are redesigning services to meet those needs

Patients in Kensington and Chelsea now have access to a range of mental health services - thanks to a ‘single point of access’ integrated service which has been developed by the West London CCG. The integrated service aims to support primary care in looking after patients with mental health problems which are not severe enough to need secondary care intervention. Many patients fall between the gaps of mental health services not needing the intense level of intervention offered in secondary care but needing more than the counselling or anti-depressants typically available through GPs. They may also be referred inappropriately, which can have cost implications. In Kensington and Chelsea, there were around 1800 patients who fell into this intermediate group, while around 2400 with severe mental health problems were treated solely in primary care.

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They can now be referred by their GP into a community-based service. “It is a joined up pathway keeping the GP engaged,’ says Dr Fiona Butler, West London CCG mental health lead. ‘The GP and patient will give a preference for the sort of treatment, then the patient will be given a skilled assessment and be directed to an appropriate part of the service. ‘It is very tailored to the individual’s needs. We find many of them are below the threshold for secondary care services but there has historically been little to support them in primary care.’ Options for treatment include guided selfhelp: cognitive behavioural therapy; and intermediate care and support for more complex cases. More severely ill patients will be case managed by a community psychiatric nurse.

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The integrated service aims to support primary care in looking after patients with mental health problems

“

Clinical Commissioning in Action

The service is provided in partnership with the mental health trust, the community services provider which provides psychological therapies, and the voluntary sector such as Depression Alliance and The Reader Organisation. It works to agreed protocols determining who is suitable for the service. Delivery is through three community hubs - matching the CCG’s locality structure with multi-disciplinary staffing. Each is open into the evening to 8pm although patients can be seen in their GP practice if they prefer. Clinical leadership has been key to developing the service, together with close liaison with GPs. ‘The model has come from the ground to meet what GPs wanted. It’s a model which reduces risk but is strong governance-wise.. A lead practitioner links with each practice – a model developed by GPs”.

One benefit has been to standardise what is on offer for patients - previously practices have had very different models of psychological care. The service is not cheap but is funded in part through money taken out of the secondary care mental health contract, as fewer people need treatment upstream. CPN input has been funded from a planned reduction in secondary care referrals of 25 per cent. But Dr Butler is confident the service will pay dividends long term. Early intervention before people deteriorate has the potential to save money - as does preventing relapses in those with ongoing illnesses. ‘It challenges a lot of ways of working,’’ says Dr Butler. ‘CPNs are used to a certain case load - our service is a challenge as it has higher case load volumes. There’s a big cultural change required.’

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05/11/2012 11:19

Closer Still

Not to be missed... From Hospital Directions to Health+Care, make sure you save the date for some of health profession’s most informative shows

Hospital Directions 2012

The chief executive of the NHS set the organisation a massive challenge to deliver savings of £20bn by 2015, at the same time as the government launched the biggest reform of healthcare services since the inception of the NHS. It has left hospitals desperately trying to manage rising demand against the backdrop of a realterms cut to funding. Hospital Directions will offer senior secondary care managers best-practice advice and realworld solutions through seminars and workshop sessions, plus a tightly focused exhibition space featuring some of the most innovative suppliers to the sector. It will be held at London Olympia on 21 and 22 November 2012. It will run alongside Acute and General Medicine, thereby giving exhibitors the opportunity to engage all the major decision makers in secondary care at a single event.

UK will be able to send up to 10 delegates free of charge, spread across board members and functional heads. The pacey, interactive programme allows delegates to follow their learning needs across eight key areas: patient services, HR, leadership, estate management, outsourcing, technology, information management and infection control. Themes of leadership, innovation and efficiency will unite all the streams. The event will attract senior professionals from chief operating officers; leadership teams; patient services; operations; human resources; finance; IT; quality management; infection control and facilities management. In tough times, when it’s difficult to access highquality training, who can turn down the opportunity for a masterclass in NHS management at affordable prices? For more information, visit: www.hospitaldirections.co.uk

This new event rejects traditional conference models with irrelevant blue sky thinking and embraces the current climate, where every minute and every penny counts. Every trust in the

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Closer Still

Health+Care One event, four conferences, thousands of health and care professionals. Health+Care 2013 is a new macro event, 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 2013, taking place at London Excel on 12-13 June 2013, 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. The four co-located events – Health+Care Integration Conference, The Home Care Show, The Residential Care Show and the well-respected Commissioning Show – will help a wide spectrum of professionals to interpret policy, devise strategy and implement change. Health+Care Integration Conference The ‘business case’ for integrated health and social care has been developed – it has the potential to improve access, reduce waste, and deliver better outcomes for people. And the government wants rapid implementation, at a great scale.

aging population and rising numbers of people with frailty and dementia mean that domiciliary care agencies are supporting people with far more complex conditions in their own homes than in the past. The Home Care Show will bring commissioners and providers together to discuss the evolution of domiciliary service provision, and how agencies can make the most of the new opportunities. The Residential Care Show There’s a revolution going on in primary and social care. Policy makers want the system to take a ‘whole population’ approach to improving public health and wellbeing and act against the escalation of need. The Residential Care Show brings into focus how leading organisations are working with commissioners to transform the sector’s role, offering vital services that balance cost, quality, choice and value-for-money in a developing market. Delegates will have the opportunity to learn from the trail blazers, and develop the hallmarks of providing people with a successful life in care – such as a positive culture and an active, supportive community within the home. For more information visit: www.healthpluscare.co.uk

The Home Care Show The challenges to delivering high quality domiciliary care services are increasing. Our

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Closer Still The Commissioning Show 2012 The who’s-who of primary care gathered in London for the biggest Commissioning Show yet on the 27 and 28 June 2012. Over 3000 healthcare professionals took in sessions, workshops and debates led by some of the leading policy makers and practitioners who are driving forward the delivery of care in England. Commissioning 2012 was also supported by all the major primary care associations and over 200 healthcare suppliers on a sold-out exhibition floor. With a programme packed with unique networking opportunities and facilitated learning, the Commissioning Show catered for a wide and varied pool of delegates from all over the country and assisted them in understanding the future of primary care. “The Commissioning Show has helped my understanding of the future. The sessions have been helpful, especially for me. The productivity through technology sessions has really helped me to see the development of technology and the changes it will make to the NHS,” said Faraz Ali, Assistant Practice Manager from Kings Road Medical Centre. Key speakers at the show included Andrew Lansley, former Health Secretary, and Dame Barbara Hakin, Chief of NHS Commissioning Board who congratulated delegates on how far they’ve come since Commissioning Show 2011. New to this year’s show were the delegate led roundtables, where the agenda and debates were set by the commissioners themselves. Delegates appreciated the opportunity to network: “It’s been great to meet people from all over the country and find out what other practices are doing. It’s a good opportunity to meet with people in a more informal, relaxed setting – you get a lot more out of the experience that way,” said Stewart Findlay, Interim AO and GP from Bishopsgate Medical Centre. Unlike other events dealing with Commissioning, the Commissioning Show managed to bring together experts, policy makers, local authorities and primary care professionals in one place in a unique chance to tackle any issues that surround such major changes. Dr

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Jenny Stephenson, GP and lead for diabetes from Stannington Medical Centre said: “A stimulating and evidence based show. It has given me a can-do feeling. It has a much wider remit than other shows. It builds on what I’ve already learned and I feel it has put diseasespecific learning points into perspective.” An innovative delegate booking platform opened up new opportunities for networking, both in the run-up to the show and beyond. Delegates were able to create a bespoke conference programme for themselves, combining their selections from the formal sessions with facilitated networking and face to face peer meetings. Delegates also had the option to book time directly with expert suppliers for the in-depth discussions of issues faced, giving a valuable opportunity for uninterrupted quality time with prospective partners. New for 2012, the facilitated networking area allowed delegates to build their own programme of meetings around the main conference programme. Our innovative booking platform allowed delegates to identify experts and peers with practical experience in key areas. They were even able to create their own sessions around the topics that mattered most and invite like-minded colleagues to join in the discussion. This social media platform allowed delegates to share their experiences with others and discuss what they have learned. Combined with downloadable content, the value of Commissioning has extended well beyond the confines of a traditional two-day show. The learning continued after the conference. Delegates have direct access to all the educational content and video footage from seminars at the Commissioning Show – the video portal can be accessed from the Commissioning website to catch up on a particular session or to get a taster of what Commissioning 2013 has in store. For more information visit: www.commissioningshow.co.uk

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Closer Still

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Communication cords

“

If patients are to be at the heart of healthcare, everything comes back to their views and opinions

The proposed changes in the NHS are throwing up interesting communication challenges. Potential benefits are as yet unproven, there are still disconnects between the many stakeholders and there is a general sense of waiting for the fog to lift. And although health problems haven’t gone away, the money to communicate them has, therefore health messages will come from new sources and may be more subtle - the advocate and nudge approach. At its best, the NHS remains world class, but as long as there are unacceptable care and safety practices – and increasing pressure on resources – a clinically-led service that encourages peerto-peer accountability is to be encouraged. As the landscape shifts, so will the communications that underpin it. Engagement is

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“

Developing and maintaining the Salix 100 network enables the development of strategies based on insight from the people who are shaping the new NHS landscape – and those who will be travelling through it

embedded in the foundations of clinical commissioning groups (CCGs) and, given that there is now an outright commitment to stakeholder engagement, so a communications ethos should run through provider and commissioning organisations like writing through a stick of rock – and be just as visible and just as palatable. Domain 2 of the CCG Application is entitled “Meaningful engagement with patients, carers and their communities”. It states: “CCGs need to demonstrate that they have included patients, carers, public, communities of interest and geography, health and wellbeing boards and local authorities. They should include mechanisms for gaining a broad range of views, then analysing and acting on these. It should be evident how the views of individual patients are translated into commissioning decisions and how the voice of each practice population will be

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Salix

sought and acted on. CCGs need to promote shared decision-making with patients about their care.”

ingful way means putting proper engagement strategies in place and commissioning the right people to make them work.

How to put it into practice

Effective engagement put into practice

There has to be a change of mindset. In the same way as a clinician refers a patient to an appropriate specialist for treatment, the same should be applied to commissioning nonmedical services.

Salix works with commissioners and providers. In recent months, our most effective communications strategies have combined media and public relations with interactive work at the frontline. Credible advocacy, personal networking and partnerships are crucial factors in the new communications ecosystem.

Creating engagement “mechanisms” means developing a good communications strategy and should be second nature to communications professionals. In fact, health professionals may have more in common with communications specialists than they think. The process of testing, diagnosing, prescribing, adjusting the appropriate medicine and monitoring the results is the same in communications; recognise an issue, consider how best to address it with the resources available to you, design and execute a plan and measure the effect. The challenge, then, is to make engagement an everyday part of working life. The days of healthcare professionals or managers deciding what is best for patients are over. In this new, more financially constrained and demographically changing world, the need to be more efficient about the way healthcare is delivered and/or received is obvious. If patients are to be at the heart of healthcare, everything comes back to their views and opinions. To gather those views in a mean-

Developing and maintaining a network like Salix 100 – a broad spectrum of frontline health professionals, clinical leaders, policy makers and advisers, opinion formers, thought leaders and patient representatives – enables us to develop strategy based on insight from the people who are shaping the new landscape and those who will be travelling through it. Media relations remain key to raising awareness of an issue or positioning an organisation, but third-party endorsement and collateral knowledge will also be integral to success. Personal advocacy, peer power and one-toone conversations – the nudge approach – are likely to feel more relevant than the multimillion pound public health campaigns the government can no longer fund. Communications specialists will have to be nimble to help CCGs and providers negotiate the road ahead. Visit www.salixconsulting.com to find out more about a free communications audit.

Turn to the next page to discover five stages to making patient engagement work

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Salix

Five stages to making patient engagement work

1: IS THERE A PROBLEM HERE? What is the problem that better engagement would solve? High A&E admission rates, high numbers of smokers, high prescribing costs? The data you’ve gathered will need interpreting to give an understanding of how big the problem is, who is involved and why. In addressing the problem, think about what would constitute success at this point. Is it financial? Is it about changing patient pathways? Health outcomes? Think about budgets and take a long term view. Behaviour takes time to change. Speaking to a specialist communications provider is a good idea – as is a dedicated project lead for your organisation. 2: DO I KNOW YOU? Fully understanding the reasons for the target audience’s behaviour(s) determines the best way to communicate to them. This is where the communication specialists will add value.

4: GET INVOLVED It’s important to get buy-in from everyone who has an interest in the activity and a stake in the outcomes. Communications is not something that can stand isolated from everything else that goes on. Everyone – clinicians, HCAs, practice managers, commissioners, local authorities, charities, providers – must be aware and supportive of a campaign.

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3: UNDERSTAND AND DELIVER One size rarely fits all. A comprehensive communications plan will need to address the best method to get the appropriate message across to as many of the target audience as possible.

5: DOES IT MEASURE UP? All too often, the outcomes and value of very innovative and well-meaning communications programmes are lost because nobody thought through how to measure the outcomes. It may be hard to prove financial outcomes, but it’s still possible – and necessary – to have some idea of the efficacy of a programme by conducting research before, during and after the activity.

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Our research.Your business. The perfect MATCH What MATCH does

About MATCH The Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH) is a well-established research collaboration between four leading UK universities (Birmingham, Brunel, Nottingham & Ulster) and is funded since 2003 by the Engineering and Physical Sciences Research Council and partner subscriptions.

MATCH helps improve decision-making for technology

Assesses value …

suppliers and procurement agencies. It enables

…by developing methods and models to assess the value of

companies to identify better products earlier in the

products at each stage of development, from identification of

design process and bring them to market sooner, with

need through to mature offerings in the market.

greater confidence that the value to patients and others

Optimises product development and manufacture…

will be consistently defined and readily recognised.

…by researching processes for improving information and

To this end, MATCH delivers: standardised methods for

decision-making, leading to more effective development and

establishing clinical value; new approaches to capturing

production processes, better clinical integration and improved

user needs for early design and in-use upgrades; best of

provision for users.

breed research into production and decision-making

Engages end users…

processes; and a forum for engaging regulators and

…by employing empirically based valuations of health and

finding better ways forward for all concerned.

related benefits to inform value models and develop methods for engaging with users at the conception and design stages. Focuses on Industry… …by maintaining a strong industrial perspective, and using real industrial problems to drive and ground its research activities.

MATCH Membership MATCH membership will provide you with access to experts to work alongside your staff, helping them transform your company's competitive performance by embedding flagship techniques,

derived from best-practice in healthcare technology assessment and user needs analysis.

For further information please contact Elizabeth Deadman match@brunel.ac.uk 01895 266050 or check the MATCH website: www.match.ac.uk IBC Brunel AD.indd 1

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Supporting healthcare practitioners

Funding for heart health professional development Do you spend a significant amount of time working with cardiac patients? We offer funding to healthcare practitioners and those involved in educating people affected by heart disease. We provide: • • • • • •

financial assistance for education opportunities access to conferences and events access to BHF courses members only website and resources free membership to our Heart Matters programme networking opportunities.

Get in touch if you want to find out more, contact us at bhfhi@bhf.org.uk © British Heart Foundation 2012, registered charity number in England and Wales (225971) and in Scotland (SC039426)

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