Innovation in Healthcare vol 6 by Maritime Media

Bringing new healthcare products and interventions to life

Innovation in Healthcare

COMMISSIONING SUPPORT UNITS Innovation Vol 6.indb 1

Turni Commissinog Innovation ning in Reality to 24/05/2013 17:25

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

Supporting research to make patients, and the NHS, better

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

Innovation Vol 6.indb 1

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Time for change

Innovation in Healthcare

Dr Michael Dixon, Interim President, NHS Clinical Commissioners, discusses the need for transformational change

is published by:

CLINICAL COMMISSIONING COMMUNICATIONS

Innovation in the NHS

Professor Sir Bruce Keogh Medical Director, NHS England

Suite 24, Hurlingham Studios, Ranelagh Gardens, London SW6 3PA T: +44 (0) 20 7386 6100 F: +44 (0) 20 7381 8890 E: inbox@mar-media.com

Strong support

Bob Ricketts, Director of Commissioning Support Services Strategy & Market Development, NHS England, looks at what effective collaboration means

Publisher

W H ROBINSON

Hello. Have we met? We’re Central Southern, and our business is in supporting excellence

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

It’s an exciting time for us - we’re supporting clients whose vision and quest for innovation requires us to be exible, adaptable and open to adventure. We’re working in new ways which means looking at things in different ways too. Yes we’re technically a young organisation but we’re proud that we have serious NHS mileage on our clock. (After all, it’s that mileage that’s made us who we are). The commitment we have to the enduring values of the NHS is fundamental to our purpose. It is the cornerstone of our values and how we work: •

We listen to our customers so that we can create a solution specic to their needs

•

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

•

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

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

.co.uk

•

Driving efciency in healthcare providers

•

Promoting quality in all healthcare services

•

Helping run their businesses effectively and efciently

•

Evidencing everything they do.

project management and contract management. Our progressive commissioning support capability makes us an essential partner for CCGs as they put in place new models of care. DRIVING UP EFFICIENCY

Committed

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

optimal quality of care, increasing costs and rising public and patient dissatisfaction. In fact we were one of the rst commissioning support units to publish a response to the Francis Report. We’re lucky that our customers have the same high ambitions we have to achieve the critical outcomes of higher quality, improved patient experience and reduced costs of care. We believe that successful commissioners will need excellent support in ve key areas: •

Magazine article_150513.indd 2-3

TRANSFORMING SERVICES FOR PATIENTS AND THE PUBLIC

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

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

Primary Care Trusts made headway in delivering savings through better contract management, but in the main they moved the decit from commissioner to provider rather than driving real savings from the health economy. We believe that driving sustainable efciency out of a health economy is a hard task which takes years, not months, and requires precision planning and intelligent implementation. So we suggest that the health economy must develop incentives across the provider landscape to engage with commissioners to reduce cost of services. Therefore we are looking to develop health economy-wide incentives supported by innovative contractual arrangements.

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

Transforming service for patients

17/05/2013 11:39:01

Practising what we preach

E: justindesign.co.uk

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

A risk to research?

The opinions expressed in this publication are not As the the Health and Social Act necessarily those of publisher. The Care publisher effect, Dr Jonathan Sheffield, has tried to ensuretakes all information is accurate, but chief executive of the NIHR Clinical emphasises it cannot takeNetwork, responsibility any Research looks at for the possible effects on clinical research and the mistakes or omissions. The publisher does not development of new treatments for accept responsibility for the advertising contentNHS patients, and argues that CCGs could in this publication.help to protect a research-active culture

We know that embedding efciency in acute care is challenging, particularly as the payment system actively incentivises hospitals to do more work. It’s not surprising, therefore, that many CCGs are investing in strategies to keep people out of hospital, to reduce acute care costs.

We’re Central Southern, and our business is in supporting excellence

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

THE CHALLENGE AND THE PROMISE

JUSTIN IVES

Hello. Have we met?

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

JULIEN WILDMAN

John Wilderspin, Managing Director of NHS Central Southern Commissioning Support Unit, on the challenge of integrated care

From good to great

NHS South CSU’s Leadership team explain how CSUs are paving the way to further innovation in healthcare through collaboration and partnership

In recent years, our ability to carry out studies such as the one just mentioned, has dramatically improved. In large part this is due theHealth fact that the is now in Act takes effect, Dr Jonathan Sheffield, chief Astothe andNHS Social Care better shape to conduct clinical executive of the NIHR Clinical Research Network, looks at the possible effects on research than it has ever been clinical and before.research Whereas, in the the past,development of new treatments for NHS patients, and research wasCCGs largelycould confined to to protect a research-active culture for the future argues that help for the future. the large teaching hospitals, now it is widespread with 99 per cent of NHS Trusts conducting studies. This is a huge achievement, and On 1 April this year, the NHS a new pledge to use anonymised it has come about because of the This publication is printed PEFC certified paper. changed. TheonHealth and Social information to support clinical investment government has made PEFC Council is an independent, non-profit, non-governmental Care Act, which had been the research and improve care for in the infrastructure for research organisation which of promotes management subject much sustainable debate asforest it went others. North England Support Unit (NECS) is a in the of NHS. Through Commissioning the National through Parliament, came into force, through independent third party forest certification. InstituteNHS for Health Research and Clinical Commissioning Groups There is a very good reason why unique start-up business providing a range of services to Clinical Research Network, NHS – groups of GPs responsible for clinical research should occupy commissioning organisations across the North of England Trusts receive funding for more than commissioning acute care - took up this central space in the provision 10,000 trained research nurses their new responsibilities. of NHS care, which is – simply – who work on our hospital wards, that it makes a huge difference to and in our doctors’ surgeries. There has been a great deal of patient care. Take for example the These clinical professionals are comment about the introduction of case of Danielle Manley, a teenager responsible for identifying patients Clinical Commissioning Groups, who was left wheelchair-bound and who may be suitable to take part in and many column inches devoted needing morphine as a result of particular research studies, as well to the possible effects of GP severe arthritis. Standard treatment as carrying out the clinical activities Phil Verplancke, Product Manager at First Databank, explores the commissioning on the health options had been exhausted, but involved in conducting the research service as a whole. But there is one Danielle opted to take part in a recent study of the prevalence and causes of prescribing errors and itself. aspect of the changeANDROID that has not clinical research study to test the APP ON how to address them yet hit the headlines: the effect of use of the drug tocilizumab as a It is through the efforts of this the changes on clinical research in treatment for Systemic Juvenile research workforce – and other the NHS, and our ability to gather Idiopathic Arthritis. As a result clinicians across the NHS in the robust evidence we need on she has now been able to leave England – that the research picture “what works”, so we can keep the wheelchair behind and live for patients has been transformed. improving treatments and the care a normal life. Other patients on Whilst 208,000 patients took part we give to patients. the study had similarly positive outcomes. The research study Clinical research is - and always showed that after one year of Alison Hughes, Managing Director, NHS West and has been - part of the core business taking the new treatment, 89 per South Yorkshire and Bassetlaw CSU. of the NHS, and this is no more cent of patients achieved a 70 per than common sense. How else cent improvement, making a huge An opportunity to help our CCGs to innovate could we respond to innovations difference to their lives. in the development of medicines or devices, or understand how This is, of course, just one to administer treatments to best anecdote, but there are similar effect? stories across the whole range of therapy areas about the ability INNOVATION IN HEALTHCARE 1 The fact that clinical research is of clinical research to transform a fundamental activity is reflected treatment, and achieve real in the fact that it features in the benefits for patients. No wonder NHS Constitution – and even then that every consumer poll that more strongly in the newly-revised has ever been conducted on the Innovation Vol 6.indb 1 24/05/2013 17:25 version that was published earlier subject shows that patients are

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A risk to research?

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I believe

As managing director of Greater Manchester CSU, I believe that we will support commissioners by identifying, implementing and driving forward innovation

High quality patient experience

Clarendon Practice, Salford, turns around

This 8,700 list practice in Salford was struggling with stressed doctors unable to meet the demands of frustrated patients.

Greater Manchester Commissioning Support Unit (GMCSU) is at the forefront of innovation and best practice and is committed to identifying, implementing and driving innovation in health.

The power of touch

How using touchscreen technology improves patient engagement

PA PA ATIENT TIENT ENGAGEMENT VIA MOBILE

MOBILISING FRIENDS & FAMILY “Achieving 20% response rates for the Friends & Family Test isn’t a problem if we use technologies which are familiar and accessible to patients...”

Jim Ward, Good4HEALTH www.good4health.co.uk

Minimum response rate targets will imminently increase from the current 15% to 20% for the Friends & Family Test. It will also begin to incorporate more services. With some Trusts already struggling to meet the original rates its time to question what is the right delivery method and ensure that Trusts are not only able to meet the targets, but easily exceed them.

Friends & Family Test

needs a response rate of

TO MEET TARGETS

Synapta mobile surveys easily exceed targets

MOBILISING FRIENDS & FAMILY

Sally Burley, The 3rd Degree www.synapta.co.uk/health

Mandy Wearne, Inspiration NW

In April this year, Hospitals started surveying Patients within 48 hours of discharge, following new guidelines from the Department of Health.

Achieving 20% response rates for the Friends & Family Test isn’t a problem if we use technologies which are familiar and accessible to patients...”

Known as the Friends and Family Test (FFT), it was announced by Prime Minister David Cameron in May 2012. Following staged implementation, it is expected by October of 2013 that all patients, will be offered an opportunity to answer the survey, along with accompanying questions following treatment. The FFT will enable every patient to give their views and will provide an effective management tool to report patient feedback and prioritise improvement. The challenge will be collecting the FFT on a large scale, starting with the Department of Health’s increased requirement of 20% returns of patients discharged.

In the North of England, a pilot conducted by Inspiration NW, explored the requirements and methodologies to meet this challenge. Working with 11 hospitals and in collaboration with Good4HEALTH and Cinder Lane, we learnt that success requires: Systematic approach - such large-scale operation needs to be automated with minimal reliance on staff. Starting by targeting the majority of patients and then bespoking solutions for any not responding.

A history of innovation

Part Two

Validated feedback - patients are more concerned about confidentiality than providing anonymous feedback. Trusts need to know who, when, where and why so they can understand what is happening in their organisations, make improvements and understand which groups of patients are not responding. Minimal impact on clinical staff - they should not be the ones to elicit or collect feedback but to receive the feedback and implement improvement. 48 hours after discharge – rather than on discharge or before as patients need time to recover and provide considered opinions.

A history of innovation

The role of modifiable lifestyle factors and Souvenaid® in early Alzheimer’s disease

Smart thinking to make Britain healthier and wealthier 42

Terry Young details the work of the Cumberland Initiative, a major driver for innovation in healthcare

Personal touch

A history of innovation

Making the change

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

Talented workforce and a passion for innovation

care for people across England. With many new bodies taking responsibility for the commissioning of services and public health, it is a major, but by no means new challenge. Many of these new bodies including NHS England and the Clinical Commissioning Groups (CCGs) are increasingly considering the use of digital mapping and address data as the basis for sharing information and informing evidence-based decision making. This growth in the use of location and address as a means of linking a variety of information is enabled by data supplied under the Public Sector Mapping Agreement (PSMA). This agreement makes Ordnance Survey geographic data free at the point of use for all local authorities, central government departments and all qualifying health organisations in England and Wales. When budgets must be carefully balanced without compromising services, it is playing a key role in helping the NHS to do more for less – for example, by identifying where new resources could be targeted more effectively or pinpointing areas of low uptake of services. Around 100 hospital trusts, all 12 ambulance trusts and more than two thirds of NHS authorities have signed up to the centrally-funded licensing agreement which also allows data sharing with contractors delivering services on behalf of members. Now the new CCGs, which came into effect on 1 April 2013, are also being encouraged to join.

Ordnance Survey

Central data agreement from Ordnance Survey proves just the tonic in delivering joined-up healthcare

Even if CCGs contract services to Commissioning Support Units (CSUs), they should still sign up to the PSMA as common licensing terms enable them to share mapping data with third parties delivering services on their behalf. As a result they will be able to collaborate and partner on projects more easily, which helps to meet targets, avoid duplication and increase efficiency through joined-up working.’

Part Three

Cultural revolution

Sarah Wrixon, managing director, Salix Consulting, examines the importance of effective communication in the new NHS

A history of innovation

A full body of knowledge

Jan Hull, SWCS Managing Director, delivering support services to CCGs

Central data agreement from Ordnance Survey proves just the tonic in delivering joined-up healthcare

NHS Alliance is the leading voice for primary care, speaking for innovative general practices and providers of healthcare in the community

Improving patient experience and increasing cost effectiveness through personally administered items

NHS reform has sparked fierce debate among healthcare professionals, politicians and patients. Now that the changes are in force, one thing is clear; close cooperation between the newly-created organisations will be crucial in delivering high quality

Breaking boundaries

Part One

Part Four

Hospital doctors are amongst the most important decision-makers in hospital medicine.

Collaborative working is clearly a key aim of the NHS changes. Commenting on the reforms, Lord Howe, Health Minister said: ‘Health and care services will be better joined up by bringing together the NHS, local councils and patients. Through these changes, the health service will improve, work smarter and importantly, build an NHS that delivers high quality, compassionate care for patients’. As the momentum for collaboration and using Geographical Information Systems (GIS) in the NHS continues to grow, it is vital that all the organisations responsible for providing healthcare work together aided by common, consistent mapping and address data. By becoming a member of the PSMA, CCGs will be joining almost 3,000 public sector organisations who benefit from a wide range of Ordnance Survey mapping including highly-detailed OS MasterMap® data, Road Networks, authoritative address and boundary information; and backdrop mapping at various scales.

D10617_0513 Healthcare advertorial.indd 1

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INNOVATION IN HEALTHCARE

24/05/2013 17:26

NHS Clinical Commissioners

Time for change Dr Michael Dixon,, Interim President, NHS Clinical Commissioners, discusses the need for transformational change

There is a story told about a man on an oil platform in the North Sea. One night he is awakened by an explosion and fire on the platform. Striving to escape the impending flames, he is able to find his way through the chaos to the edge of the platform. His only option is to jump more than 100 feet from the fire-ridden platform into the freezing North Atlantic waters or surely be engulfed in a horrible death. If the dangerous jump doesn’t kill him, he will surely die from exposure within minutes if not rescued. With no other rational alternative, he jumped... Fortunately, the man did survive the jump from the platform and was rescued by boat shortly thereafter. His philosophy had been “better probable death than certain death”. The NHS is now facing its own burning platform and we need a transformational change if we are to deliver the care our patients deserve within an ever-increasingly tightening financial environment. There is no doubt that we need to do things differently, try new approaches and deliver services in distinctive and innovative ways. That is where

Clinical Commissioning Groups have the opportunity and the potential to do things differently and make a difference in a way that previous commissioners have not been able to do. Clinical commissioning is particularly important at this time because with the need for financial restraint, we need to have clinicians in the health service who are concerned about resource use as well as good patient care. It is also necessary because the health service under its current system has failed to do what it said that it wanted to do – namely to look after the frail elderly closer to home and outside the hospital and to develop a better model for the treatment of long-term disease outside of hospital. The opportunity to promote innovation is why many have been attracted to the leadership of CCGs. To eliminate unacceptable variations in health inequalities and the outcomes of care, to give the best possible experience for patients and carers, to integrate care and resources around the needs of patients and populations – all require CCGs to promote innovation and the adoption and spread of effective innovative practices. The increasing

INNOVATION IN HEALTHCARE

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NHS Clinical Commissioners

prevalence of long-term conditions, the unrealised opportunities presented by new technologies and social media, the immense financial constraints facing the NHS – all necessitate radical and systemic innovation.

resulting, at least in part, from innovation. All this takes time to appear and so, in the shorter term, CCGs are likely to be judged on the actions they can demonstrate they have taken to promote innovation, including its adoption and spread throughout their local health and care system

For CCGs, innovation is not about new drugs, devices, software or clinical procedures. It is about new forms of care, re-shaped pathways, new models of service delivery, shifts in the control patients have over their care and treatment, new approaches to prevention, new payment mechanisms, new ways of working or leading – all are innovations. And whereas innovations in drugs, devices, software and clinical procedures are often driven by research, these other innovations are often developed by practitioners with evidence of impact accumulated through doing it out in the field.

The NHS has never been bad at innovating, but diffusion remains a major problem with too many innovative practices and models locked in their place of origin. At our recent national event, NHS Clinical Commissioners (NHSCC) brought together CCG leaders from across England to create the opportunity for networks of good practice to develop. We will continue to help CCGs access peer-to-peer support and advice, share learning and gain ideas. NHSCC is committed to providing opportunities for CCGs to share innovation and improve value for money.

CCGs will not be judged by their patients or populations on the number of innovations they have promoted, but on the improvements they see in healthcare, health outcomes and value for money

We are all on that burning platform and our patients and populations require us to make the transformational change that ensures the NHS continues to able to deliver the care they require.

“

The NHS is now facing its own burning platform

For more information, contact: E-mail: info@nhscc.org Tel: 020 7799 8621

INNOVATION IN HEALTHCARE Innovation Vol 6.indb 5

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NHS England

Innovation in the NHS Professor Sir Bruce Keogh Medical Director, NHS England

Innovation takes many forms and I am frequently impressed by the range and scale of innovative thinking that goes on every day within the NHS. Ideas that really make a difference to patients’ health can, for example, range from making a relatively small change to the way in which things are done on a hospital ward or general practice to the development of a new medicine or invention of a new medical device. True innovation is about doing things differently with benefits to our patients. The NHS has a remarkable record of producing pioneering innovators and world class innovation, something of which we should be very proud. Arguably, there has never been a more pressing time for innovation and fresh thinking in our healthcare environment. Today’s NHS faces the challenge of increasing demand for its services from a growing and ageing population - with limited resources and escalating costs. Bluntly, the NHS of the future is going to have to do more with less. Innovation, therefore, is central to the future of the NHS. It will not only transform patient outcomes but will improve overall quality and productivity and is good for the economic growth of the UK. If the experience of this year’s Healthcare Innovation Expo is anything to go by, there is no shortage of innovative people and organisations to support the NHS in the years ahead.

INNOVATION IN HEALTHCARE

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NHS England

Ideas that really make a difference to patients’ health

“

The largest event of its type in Europe, Expo attracted over 11,000 delegates, 250 exhibitors and 300 speakers over two days. It created an environment where exhibitors and delegates were exposed to both networking opportunities and world class innovations. Feedback from the event was overwhelmingly positive. 86% of attendees said that they had been made aware of new innovations at the show and of those, over 90% said they would take what they had seen back to their own organisation – supporting Expo’s ambition to spread innovation throughout the NHS. Commissioners and providers were drawn to the new opportunities on offer through leading international speakers and a comprehensive seminar programme. Of great significance to everyone who attended was the fact that Expo presented a unique opportunity to see and meet with innovative colleagues and new NHS leaders. The ambition is to hold another Expo in 2014 and plans are already underway to shape the next event. If you are interested in being part of Expo 2014 as an exhibitor or a delegate, you can keep in touch with developments by following us on Twitter @NHSExpo or on our website.

www.england.nhs.uk @NHSExpo

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NHS Clinical Commissioners

Strong support Bob Ricketts, Director of Commissioning Support Services Strategy & Market Development, NHS England, looks at what effective collaboration means

The NHS is one of the most valued institutions in the country. There have been significant improvements in the outcomes for patients and the public over the past decade, but it faces unprecedented challenges – from rising demand, increasing public expectations, often poor comparative outcomes, service failures such as Stafford and Winterbourne, and constrained resources. Despite this, is a high-quality NHS free at the point of use sustainable? Yes, but only if we drive out poor quality now and start to transform existing outdated delivery models. Growing strategic challenges will make the current shape of the health and care delivery system increasingly unsustainable. Healthcare delivery needs to be transformed at scale and pace and commissioners will need to lead this. This is a key role for CCGs and direct commissioners – securing better quality today and leading the transformation of services for tomorrow.

But commissioners won’t be successful if they act alone. Success will require effective collaboration to secure the benefits of commissioning at scale – across all local public services and geographically. Commissioners will also need to stay “lean” – focused on what only they can do and where they can add most value – providing strong clinical leadership, engaging effectively with patients, communities and clinicians. This is where effective Commissioning Support Units (CSUs) come in. Good CSUs can help CCGs focus by undertaking on their behalf the “transactional” aspects of commissioning: needs assessment, procurement, contract negotiation and monitoring. This will be crucial to both securing best value and – crucially, given the Francis report into care at Mid-Staffordshire – robustly managing and improving the quality of the services their patients receive.

INNOVATION IN HEALTHCARE

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NHS Clinical Commissioners

Great CSUs, however, can do much more than this. They can support commissioners by: • Diagnosing main strategic drivers (including demand) in local systems and benchmarking current provision • Identifying how to deliver better patient pathways, drawing on UK and international best practice to re-design and transform services to deliver better outcomes and – where needed – effective integration • Stimulating existing and new providers to respond with innovative personalised services for, say, end of life care, or meeting the needs of frail older people with multiple complex problems • Understanding how to make change happen and able to draw on the practical skills to engage patients, communities and partners • Helping to connect the local health system to improve quality and transform services, connecting CCGs with each other to act collaboratively and at scale A great CSU will provide great transformational services, delivering excellent support tailored to the needs of individual commissioners. Every CSU recognises that its future lies in enabling service transformation at scale and at pace, helping commissioners to develop a sustainable NHS – locally and nationally. All CSUs are therefore actively building their transformational skills and capacity – in-house and collaboratively with other CSUs and commercial and voluntary organisations. NHS England is supporting CSUs through the focus we place in assurance on transformational capacity and enabling them to partner with ACEVO (for the voluntary sector) and NHS IQ (to access national best practice and enhance change skills). This will enable every CSU to draw on a much wider network of skills, resources and experience to support transformation, as well as ensuring high standards and the consistent application of a single change methodology. Watch this space!

great transformational services, delivering excellent support to individual commissioners

Innovation Vol 6.indb 9

“

A great CSU will provide

For more information, contact: E-mail: info@nhscc.org Tel: 01777 800647

INNOVATION IN HEALTHCARE

9 24/05/2013 17:26

Hello. Have we met? We’re Central Southern, and our business is in supporting excellence We are NHS Central Southern, one of the largest commissioning support units in the country. And we’re proud to be supporting 14 of the most ambitious and driven clinical commissioning groups in England. As you might expect we provide the support, expertise and insight that’s needed to match the determination of our clients: the people who dene, structure and ultimately provide healthcare for over 3.7 million people. When it comes to commissioning health services we know it’s a balancing act. That’s why we’re here to help health commissioners deliver the ambitions they have for patients, pathways, partnership working, QIPP and wellbeing in their area. It’s an exciting time for us - we’re supporting clients whose vision and quest for innovation requires us to be exible, adaptable and open to adventure. We’re working in new ways which means looking at things in different ways too. Yes we’re technically a young organisation but we’re proud that we have serious NHS mileage on our clock. (After all, it’s that mileage that’s made us who we are). The commitment we have to the enduring values of the NHS is fundamental to our purpose. It is the cornerstone of our values and how we work: •

We listen to our customers so that we can create a solution specic to their needs

•

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

•

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

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

Magazine article_150513.indd Innovation Vol 6.indb 10 2-3

d e t t i m Com

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

Transforming service for patients

24/05/2013 17:26

•

Driving efciency in healthcare providers

•

Promoting quality in all healthcare services

•

Helping run their businesses effectively and efciently

•

Evidencing everything they do.

TRANSFORMING SERVICES FOR PATIENTS AND THE PUBLIC Our clients know that their commissioning landscape and the drive towards integration of health and social care services provides a unique opportunity to diagnose, plan and execute whole system change. They have a strategic focus on health outcomes, understand root causes of system failures, recognise the need to work in partnership with local authorities and other providers of care, and recognise the value of planning service changes with greater public and patient involvement. They also know that programmes of work like this may take many years to complete unless previous ways of commissioning are challenged. We are supporting them to meet this challenge by quickly building upon our core capabilities and investing in new capabilities at the leading edge of commissioning support. Using our world class population proling and risk stratication tool we can support deeper analysis of demand and improved pathways of care for patients. We use evidence based practice and benchmarking to inform on ‘what works’, and advanced healthcare procurement to shape and manage the future provider market. These forward thinking support services build on our strong foundations in robust data management and integration, programme and

Innovation Vol 6.indb 11

project management and contract management. Our progressive commissioning support capability makes us an essential partner for CCGs as they put in place new models of care. DRIVING UP EFFICIENCY We know that embedding efciency in acute care is challenging, particularly as the payment system actively incentivises hospitals to do more work. It’s not surprising, therefore, that many CCGs are investing in strategies to keep people out of hospital, to reduce acute care costs. Primary Care Trusts made headway in delivering savings through better contract management, but in the main they moved the decit from commissioner to provider rather than driving real savings from the health economy. We believe that driving sustainable efciency out of a health economy is a hard task which takes years, not months, and requires precision planning and intelligent implementation. So we suggest that the health economy must develop incentives across the provider landscape to engage with commissioners to reduce cost of services. Therefore we are looking to develop health economy-wide incentives supported by innovative contractual arrangements. But it can’t be delivered in isolation, because a pricing or contractual mechanism alone won’t sustain change. We think it has to be done alongside pathway design, outcome achievement and quality measures to achieve an integrated commissioning strategy that delivers ‘real’ savings through efcient services.

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3.6m

14 ACUTE

456

12 LOCAL

PEOPLE

HOSPITALS

PRACTICES AUTHORITIES

e v i t a Innov

Seeking new ways to deliver better, more responsive healthcare

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

Magazine article_150513.indd Innovation Vol 6.indb 12 4-5

By investing in clinical leadership, and armed with an in depth understanding of our CCG’s priorities, Central Southern ensures that patient safety, clinical effectiveness and patient and carer experiences guide the CCG’s approach to quality. We also respond rapidly to quality issues with local healthcare providers and national initiatives such as the Francis Inquiry. We’re already working with clients to ensure they are “Francis compliant”. HELPING OTHERS RUN THEIR BUSINESS The need to maximise resources for the delivery of services to patients, and the prospect of tight control over public expenditure for many years to come, is a responsibility felt by all health commissioners. So we’re helping our clients to secure the most cost effective way of running their business operations. Some of our customers simply want assurance that these activities are efcient, robust and legally compliant, without having to manage the detailed day to day operations. If you’re looking to drive up the cost of behindthe-scenes services then a multiplicity of systems and ways of working will do the trick. We’d rather commissioners spent every penny that they can on their patients. So we standardise processes as widely as possible to save every penny we can through economies of scale. And while we’re doing that we’re making sure our behind-the-scenes processes are developing through new technologies that make life easier for our customers.

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We cherry-pick the best expertise from across our patch, rather than working in geographical silos. This way we can seamlessly combine internal resources and specialist subcontractors for the benet of our customers. As a result our customers receive competitively priced business support services and have access to leading edge tools and systems. Everyday activities are delivered professionally and without fuss. When something more specialist is required, customers have access to bespoke advice and a deep pool of talent. EVIDENCE EVERYTHING WE DO Just as excellent clinical practice must be evidence-based, we strongly believe that outstanding commissioning will be driven by information and evidence. This means putting data and information in the hands of referrers. It also means benchmarking to enable

commissioners to identify and learn from best practice and remove unwarranted variation. We provide advanced analytics and modelling to help target scarce resources to best effect. We have a strong Health Informatics function and will continue to invest in developing our capabilities, whether in integrated data management or providing more advanced analytical and reporting tools to help commissioners make the right decisions. A FUTURE BEYOND COMPLIANCE When we think about what the NHS needs, what our clients want and what patients deserve we think it is this: performance that goes beyond compliance. We want to be part of a NHS that delivers the best that is possible, rather than just good enough.

Get in touch with our team to nd out how our excellence can support yours. NHS Central Southern Commissioning Support Unit • www.cscsu.nhs.uk • @cscsu #supportingexcellence • F75 at The Commissioning Show 2013

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Integrated care

Practising what we preach John Wilderspin, Managing Director of NHS Central Southern Commissioning Support Unit, on the challenge of integrated care

NHS Central Southern Commissioning Support Unit www.cscsu.nhs.uk @cscsu #supportingexcellence F75 at The Commissioning Show 2013

Integrated care is one of the hottest topics in both the NHS and local government, but it can mean very different things to different audiences. It is often talked about (among managers at least) as a structural issue – if we can integrate organisations such that one body is in total control of the whole process, all will be well. There are instances where this has brought improvement for patients and service users, but all too often it leads to a focus on the needs of the affected organisations, and the patient gets lost in the power-play. This is one reason why there are relatively few examples of care that is systematically and consistently integrated. In a previous role leading the implementation of Health and Wellbeing Boards, I spent a lot of time looking for good examples to share with the emerging Boards. I found a lot of places that wanted to integrate care, but very few that had put it into practice. So why do I think it might be different in future and why do I think that the organisation I now lead (Central Southern Commissioning Support Unit) can help to make a difference? I believe that necessity will drive us to overcome the blocks that have stopped progress in the past. In May, the government more formally acknowledged a requirement to integration by pledging a shared commitment to

officially close the gap between the two systems of health with social care by 2018. The major challenges that face both the NHS and our partners – demographic pressures, financial constraints, changing needs and rising public expectations – can only be resolved by organisations, teams and individual professionals working together in a more integrated way. And that integration needs to start with the patient, not the organisation. Shaping services around the needs of individual patients is not just a “nice to have”; involving people in the planning and delivery of their own care is also the best way to deploy scarce resources to deliver improved outcomes. So how can Commissioning Support Units help with that process? Our CCG customers have ambitious plans to transform care and improve outcomes, underpinned by greater integration of commissioning and provision. We provide a range of services that support that process: information and analysis to identify areas for improvement; service redesign based on best evidence; contracting in a way that facilitates and rewards integrated care, but also holds providers to account if they deliver a poor service. We also have to provide commissioning support services in an integrated way, aligned with the priorities of our customers, not in separate service silos. So we need to “practise what we preach” and I’m keen to learn how others have addressed this important challenge.

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NHS South CSU

From good to great NHS South CSU’s Leadership team explain how CSUs are paving the way to further innovation in healthcare through collaboration and partnership

Commissioning Support Units (CSUs) have emerged to provide support to clinical commissioners and others to commission healthcare services for their populations, while living within a capped running cost allowance. Understandably, in these early days, the focus has broadly been on ensuring that commissioners have the level of transactional support they require in order to carry out their business. This means that the core offer of CSUs focusses on the areas of contracting, finance, business intelligence and so on. This is starting to change. I believe that CSUs have much more to offer than this as we progress through this first year and on into the future. As the CSU market begins to settle and a smaller number of larger CSUs bed in, they are reaching a scale where they can source and share benchmarking from a wide area; seeking out innovative approaches and best practice that

they can share with clinical commissioners. In turn, this can be considered and adapted to fit with local populations needs, thus supporting the promulgation of good work across the country and reducing the burden on individual organisations to reinvent the wheel. CSUs are increasingly developing links and partnerships with a whole range of organisations, using their access to markets and allowing the easy spread of new concepts and ideas to a range of clinical commissioners, thereby reducing or removing the need to have multiple conversations. There are a wide range of companies and industries - large, medium and small - with fantastic ideas, products and processes that can dramatically aid commissioners in creating the radical change in systems of care that are needed to ensure that people can access the high quality NHS healthcare they need and deserve.

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NHS South CSU

Our experience so far is that these organisations want to find ways of bringing their concepts to the attention of commissioners, and CSUs can play a significant role in supporting this. This is not just about market access but also because CSUs, as a result of the relationships that they are building with clinical commissioners, understand the context and the challenges they face and can therefore help to shape offers to match local needs and desires. Collaboration and partnerships are therefore the key ways for CSUs to break into the transformation field. Using their local knowledge and working with a wide range of customers, they can help to focus discussions on the areas in which clinical commissioners want and need support. In this way, the NHS will truly gain the benefits of the new system and people across the country will continue to be able to access the great NHS care that they need. Keith Douglas, Managing Director, gives an overview

NHS South CSU had to fight for its name. But without its broad scope, any other geographical name would have been clumsy at best. How do you incorporate Margate, Milton Keynes, Maiden Newton and the Isle of Wight into a short and pithy title? At the time of writing, NHS South is one of the smaller Commissioning Support Units but it has a strong and stable heritage (emerging from the Cluster of PCTs around Southampton, Portsmouth and Hampshire) and has successfully negotiated all its checkpoints, audits and external assessments. It has signed agreements with twelve CCGs, four area teams, and three councils, and even last year had added three parts of the Surrey system into its portfolio. I believe this success is derived from three key factors: • Starting early and maintaining momentum • Remaining very flexible and responsive to customer requirements • Intensive and on-going organisation development.

The PCT cluster engaged with the reforms very early on. This gave both the CCGs and the CSU the best possible chance to learn and grow together. Each knew that their respective critical success factors were intrinsically linked. Nothing was set in stone. We even have a clause in our agreements which recognises that both parties will have got things wrong and which allows us to change things with minimum disruption. And it has been used! Organisation development was and remains critical. You simply cannot deliver high quality services to CCGs without the willing commitment of all your staff. And you cannot expect that commitment unless those staff have been deeply engaged in the process of building the organisation and its culture, systems and processes. We are still working on this, communicating as hard as we can and training as comprehensively as we can.

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NHS South CSU

I am extremely enthused and excited about the future development of CSUs, I have worked in most parts of the system since I started out in nursing in 1975, but I wanted to join a CSU because I was, and remain, absolutely convinced that clinical commissioning; doctors in the driving seat of system change, is an opportunity of a lifetime to alter the balance of power in health care from the hospital to the home. Given the scale of change required, CCGs will have to work in alliance with each other and across quite large areas. They will also have to implement possibly hundreds of small disruptive changes to get the traction in the system which drives sustainable improvement. They cannot do it alone. They need a trusted supporter. Not one who tells them how to do it, but one who provides intelligence, contributes to the generation of new ideas and drives strong commercial deals with a wide range of providers.

“

Our team’s commercial experience, coupled with many years in the NHS, has helped NHS South CSU set the pace in developing a range of partnerships with independent organisations, which give CCGs access to a suite of services and products which they would otherwise have had to source separately. These include a flexible staffing solution (with Commissioning 4 Health), a senior leadership OD package (with The Worklife Company), a fast, web-based application development capability (with Health2Works), and a Friends and Family Plus product (with Healthcare Commissioning Services and HowRwe). These partnerships are all very well, but what I’d like to see CSUs doing increasingly is bringing together the massive creative talents that exist amongst health professionals with the enormous challenges faced by commissioners. Some call it market development. The task is to link up the thousands of people with great ideas for new and innovative clinical services with those who can commission them. CSUs are uniquely well placed to facilitate this introduction of disruptive innovations into the market place. Their customers desperately need new ideas but the entrepreneurs with the great ideas cannot possibly reach every CCG on their own. CSUs can. Mark Smith, Director of Performance and Development, talks about the power of collaboration

They cannot do it alone. They need a trusted supporter

“

The CSU provides a full range of support services enabling CCGs to choose the range which best suits them. Typically larger CCGs choose to do more in-house, while smaller ones recognise the economies of scale offered by a good CSU. All NHS South’s customers especially value the benefit they gain from an ‘at scale’ solution for total provider management. None could field the range of skills and technical capability that a specialist provider can offer.

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NHS South CSU

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more information is available to more clinicians and care staff

At NHS South we are building on our previous experience of innovation in intelligence and integration through strategic partnerships and in-house expertise. Working with companies such as IBM and Graphnet, we are developing ways to improve a clinician’s ability to access relevant information from the vast repositories of unstructured data in electronic documents. We are developing our Business Intelligence Portal to ensure that commissioners get a holistic view of their health economy. By combining the knowledge of the integrated commissioning teams and quality indicators, we can provide our CCGs with intelligence that will drive their service innovation through QIPP. Learning from Francis, we are working on new and innovative ways to monitor and collate ‘soft intelligence’ about patient experience, which will enhance the current view of quality in the system. We are also looking at similar technology to enable clinicians to view key elements of patients’ notes without the need to laboriously transform written notes into coded data. Integration is core to everyone’s discussion around transformed and cohesive care. Our teams have

been developing and delivering the integrated Hampshire Health Record and are building on their knowledge and experience to enhance and develop the care record to include social care data and provide a key source of information for all providers involved in a patient’s care. This year will focus on enhancing the benefits of the system by ensuring more information is available to more clinicians and care staff, including looking at fully mobile access. NHS South CSU maintains a culture of continuous improvement and innovation in order to offer transformational solutions to the challenges faced by CCGs and the wider health system. Our focus on technology-led innovation, working in partnership with customers, ensures that the technology required to underpin strategic system change is embedded into clinical service transformation from the start. Using best practice methodologies we are working with CCGS to ensure that technology strategies are integrated with transformation strategies through clear leadership and governance. Catherine Dampney, Chief Information Officer, describes NHS South’s focus on technologyled innovation

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NHS South CSU

The world of work is changing and leadership practices that served our businesses in the past are no longer relevant. Leaders must modernise and lead differently if they are to succeed into the 21st Century. Leaders are increasingly seeking new ways of working and deploying strategy in a virtual, fast-moving and fluid market environment. Over the past three years, The Worklife Company, partners of NHS South CSU, has been involved in extensive research and development to define the leadership practices and organisational development (OD) infrastructures that fit today’s world of work. Living Leadership™ is the result, and its findings are compelling, challenging and inspiring. It is a Leadership model that supports the complexities of our workplace, and defines the framework and journey that aligns and allows excellence. Living Leadership™ seeks balance between performance and engagement, risk and conscience, collaboration and individualism and is inclusive of all people – Executive Board to Switchboard! Whilst leadership culture and business success is a focus for most organisations, the true measure of implementation effectiveness is not just being able to “have a plan” or “implement a few strategies”, but the ability to measure and track the impact on people, processes, customers and business results. We have ensured that the implementation of Living Leadership™ not only creates the HR and OD strategies, but is also integrated with business plans.

The Living Leadership™ framework allows NHS South CSU to accelerate the change from a role to a matrix organisation and we have built a planning, performance management and employee communication system that is aligned. For example, key objectives on the business plan are translated into people’s objectives and measures in our new performance management system. This new system measures objectives, and also behaviours. These are then linked back to the balanced scorecard to track implementation and progress towards our vision. Our staff survey has been designed to measure all aspects of the framework and highlight areas that we can focus on in the coming year. Our customer alignment and CRM system allows us to identify key customer priorities and then align the right team to the task; making our organisation nimble and flexible. Management practices, education and the forthcoming launch of our CSU Development Academy mean that we can train and develop staff in up-to-date methods. Living Leadership™ touches every aspect of our business and provides us with the path to great – a great company to do business with, and a great company to work for. Lynne Copp, Lay Member and Founder of The Worklife Company, outlines a leadership framework designed to align all areas of the business

Call Mark Smith on 023 8062 5795 / 07733 326016 or email mark.smith@southcsu.nhs.uk www.southcsu.nhs.uk

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NIHR Clinical Research Network

A risk to research? As the Health and Social Care Act takes effect, Dr Jonathan Sheffield, chief executive of the NIHR Clinical Research Network, looks at the possible effects on clinical research and the development of new treatments for NHS patients, and argues that CCGs could help to protect a research-active culture for the future. On 1 April this year, the NHS changed. The Health and Social Care Act, which had been the subject of much debate as it went through Parliament, came into force, and Clinical Commissioning Groups – groups of GPs responsible for commissioning acute care - took up their new responsibilities. There has been a great deal of comment about the introduction of Clinical Commissioning Groups, and many column inches devoted to the possible effects of GP commissioning on the health service as a whole. But there is one aspect of the change that has not yet hit the headlines: the effect of the changes on clinical research in the NHS, and our ability to gather the robust evidence we need on “what works”, so we can keep improving treatments and the care we give to patients. Clinical research is - and always has been - part of the core business of the NHS, and this is no more than common sense. How else could we respond to innovations in the development of medicines or devices, or understand how to administer treatments to best effect? The fact that clinical research is a fundamental activity is reflected in the fact that it features in the NHS Constitution – and even more strongly in the newly-revised version that was published earlier this year. Now, not only do the principles of the NHS include a commitment to promote, conduct and use research, but there is also 20

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

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

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

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

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

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

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

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North of England Commissioning Support Unit (NECS)

Support and solutions North of England Commissioning Support Unit (NECS) is a unique NHS start-up business providing a range of services to commissioning organisations across the North of England

Employing around 750 specialist staff (many from the former Primary Care Trusts), the purpose of North of England Commissioning Support Unit (NECS) is, quite simply, to enable our customers to achieve their commissioning goals. Our inspirational people will combine their unique knowledge with our market-leading solutions to provide customers with high quality services and innovative solutions to their complex issues. Recognising the individual needs of its customers, all NECS teams are dedicated to delivering tailored solutions to meet specific customer objectives. NECS upholds NHS values and has a proven track record in developing solutions designed to improve patient choice, patient safety and health outcomes. NECS is led by managing director Stephen Childs, who has over 18 years’ experience in the NHS. Previous roles include Interim Chief Executive for NHS Tees and Managing Director of Middlesbrough, Redcar and Cleveland Community Services. He has also worked in the pharmaceutical industry, general practice and GP fund-holding.

Stephen Childs says: “As a practice and fund-holding manager in South East London, I experienced first hand the challenges and the opportunities facing a commissioning GP. I find myself drawing on that knowledge and experience each and every day as we endeavour to find transformational solutions and provide business support for our CCG customers. “Our approach is to liberate CCGs from the burden and the distraction of managing a significant commissioning support function, freeing clinicians to focus their precious time the quality of healthcare outcomes and the experience of patients receiving that care. “We are absolutely convinced that commissioning support at scale, utilising the skills and experience of the best local commissioning talent in the NHS, embedded and integrated with customer teams, is the way forward.

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North of England Commissioning Support Unit (NECS)

“

Our approach is to liberate CCGs from the burden of managing a significant commissioning support function

“

“Our customers have at their fingertips the skills, the experience, the capacity, the innovation and the tools within the CSU, which when combined with their own clinical commissioning ingenuity, particularly when in collaboration with other CCGs (a strong feature of the North of England), became an enormously powerful force for transformational change. “Unique strengths include our technical ability to develop clinician-bespoke business intelligence tools, our expertise in the field of healthcare procurement advice and delivery and our skills in the area of service transformation applying the learning we have accrued from the Virginia Mason Medical Centre production system –known as lean methodology. “Establishing a start-up business within the NHS is an extraordinary opportunity and is allowing us to unlock the potential of some fantastic people in the NHS. We are already expanding our scope of delivery into new markets bringing benefits to new and existing customers alike. “One of the products leading the way for NECS is our market leading business intelligence tool RAIDR (Reporting Analysis and Intelligence, Delivering Results). Developed by the NHS for the NHS, RAIDR continues to evolve and improve thanks to our dedicated product development team and GP user groups. By analysing and understanding clinical activity and financial performance, we are able to inform and underpin critical decisions with hard, indisputable evidence.

“Internally, our enterprise programme management office (EPMO) oversees the application of standardised processes and project management discipline whilst also ensuring our resources are deployed most effectively. Underpinned by an IT solution, the EPMO knows exactly how much time is being spent on each project and service. It’s a very different way of working for our people, requiring each of us to account for what we do on a weekly basis using our Time Recording System (TRS) and to forecast demands upon our time. “When this is harnessed with our competency library, we are able to guarantee the right skills, in the right measure for the right project and service. The really exciting prospect is the potential extension of this capability to embrace CCG personnel, thereby optimising the totality of resource within the commissioning system. “We have plans to create a management information tool covering sickness absence, expenses, mandatory training, incident reporting and appraisal. RAIDR is already being used to provide the EPMO dashboards as the focus currently is on benefits for CCGs, but it has huge potential for other CSUs as well. “We have ambitions for both RAIDR and our enterprise programme management office approach in the wider commissioning marketplace.“

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North of England Commissioning Support Unit (NECS)

RAIDR - Reporting Analysis and Intelligence, Delivering Results RAIDR is a dashboard analysis and reporting tool developed out of the need for GP practices to utilise the wealth of available NHS data. It allows users to navigate, select, and drill down to gain intelligence in a wide variety of ways, from high level trends to detailed patient level data. RAIDR provides healthcare professionals in commissioning and primary care with a single portal for all their information needs, integrating previously isolated data sources. Four years ago, the North of Tyne PCT cluster identified the need for a commissioning reporting and analysis tool that is flexible, wide-ranging and easy to use, but could find nothing suitable on the market. As a result, RAIDR was developed by NHS information experts at NHS North of Tyne, who worked collaboratively with local GPs considering and incorporating their needs and requirements in their new role as both commissioners and primary care providers. Launched in 2011, the system was rolled out across all 111 GP practices and five CCGs in the North of Tyne cluster. Due to its success, it is now the information reporting tool of choice across over 550 GP practices and 15 CCGs serving a patient population of over 3.5 million across the North of England. RAIDR includes data from various sources allowing integration and comparison across multiple data sets. By demonstrating variation in behaviour across

practices in a CCG, it can profoundly influence clinical care and referral patterns. For individual GP practices, it improves data quality, supporting campaigns such as flu and health checks, driving up the quality of care provided through enhanced services. It has a very simple operating platform that’s easy to learn and very easy to use and helps GPs make commissioning decisions. RAIDR facilitates both commissioning and GP practice management by providing users with powerful, fast and intuitive access to a wide range of health information, including secondary care datasets covering inpatient, outpatient and A&E activity, QOF, prescribing, disease area indicators, risk stratification tools, finance and contracting, weekly urgent care and primary care data direct from diverse GP practice systems. Further functionality and enhancements are continually being added to the system. There is already clear evidence that demonstrates how RAIDR can improve the quality of patient outcomes and experiences. RAIDR provides a number of risk stratification tools that can enable GPs to identify patients most at risk of multiple non-elective admissions – this ultimately improves patient care and experience and moderates cost. Importantly, data is timely, allowing patient-centred decisions to be confidently based upon the latest information, allowing appropriate action to be taken. Users have highlighted many instances where there has been a direct impact on patient care. Just one

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North of England Commissioning Support Unit (NECS)

example of improved patient experience is a practice that identified a patient with 35 A&E attendances in a 12-month period at a cost of almost £2000. It was found that the patient was attending A&E to receive injections to relieve migraine attacks. This patient now receives these injections at home – much more convenient for the patient while greatly reducing cost. There is also evidence that RAIDR drives cost savings and efficiencies. The benefit of RAIDR is that it delivers a webbased solution to help measure, understand and improve the quality and cost-effectiveness of services. RAIDR empowers GP practices to manage their finance and contracting and prescribing budgets. Unique access to secondary care data and the ability to link this to local datasets from primary care can support and underpin all areas of performance, measurement and improvement. Ultimately, patient care and service delivery will be enhanced, improving patient experience and moderating cost. Many examples of savings have already been seen by CCGs using RAIDR – payment challenges, risk stratification and alternative patient care pathways have all been implemented and have made a direct impact on practice finances. One in-patient spell, for example, was recorded by secondary care as 366 days costing £90,000. RAIDR highlighted this and, when challenged, the Trust found the wrong year had been recorded for discharge (spell length of stay was one night), making almost £90,000 difference to the practice’s financial outturn. Ian Davison, NECS Business Information Services Director, joined the NHS 10 years ago and, most recently, held the post of Director of Informatics and Project Management for NHS North of Tyne. He has a range of commercial experience including manufacturing, retail and consultancy, and leads the development of the RAIDR tool.

Ian Davison says: “This is by the NHS for the NHS –RAIDR could offer an affordable system to CCGs looking afresh for the right solutions at the right price. RAIDR is currently the business intelligence tool of choice for 15 CCGs with 550 member GP practices. Interest in the system has been expressed by other CCGs across the country.” “The data held within RAIDR is protected to the highest information governance standards, with tight security and strictly controlled access based on the role of each user within a highly resilient and reliable technical infrastructure. RAIDR is built on industry standard architecture which is repeatable and scalable. “Over the past year, the Information Services Team has worked to implement the system in practices and train users of RAIDR and will continue to provide long-term support to present and future clients.” For more information: E-mail: raidr@northoftyne.nhs.uk Visit: www.raidr.co.uk

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North of England Commissioning Support Unit (NECS)

NECS Enterprise Programme Management Office (EPMO) - ‘Do the right work and do the work right’. Jonathan Maloney, NECS Head of Enterprise Programme Management, joined the NHS from British Steel plc over 19 years ago and most recently held the post of Deputy Director of Contracting, Information, Planning & Performance. He has held a broad range of corporate roles including performance management, corporate governance and quality improvement, and is now leading the development and implementation of enterprise programme management across NECS.

Jonathan explains: The EPMO gives a strategic and tactical view across the entire NECS business and ensures control and grip over work programmes for both NECS and its customers. Its focus is principally on optimising our finite capacity to ensure that we deploy the right capacity and capability onto packages of work to ensure we are best placed to meet all of our customers’ expectations. EPMO also has enterprise level oversight of the entire portfolio of projects and services and ensures we target our energies where it is most needed.

Optimising resources to meet the strategic needs of NECS and its customers is the core function of EPMO as is continuously looking at opportunities for improving ways of working with our identified process owners. EPMO isn’t about controlling resources allocated to services or projects or performance managing them but it is about supporting process owners to find the optimum way of delivering a particular service as well as helping project managers to resolve resource issues, acting as a ‘critical friend’. The project managers still remain accountable for the delivery of their projects and services.

Optimum utilisation of people means NECS can deliver strong customer satisfaction through the quality delivery of promises and commitments made to our broad customer base.

EPMO’s role also extends to sense checking new business opportunities for their ‘fit’ with the business strategy and particularly regarding resource availability.

Described as having the ‘helicopter view’ of the business – that is, the strategic oversight of total business delivery and performance against strategic plans – the EPMO brings together people, processes, the operating model and technology to generate the change needed to keep NECS current and competitive.

Underpinning the EPMO are two business critical systems: our Time Recording System (TRS) and our Competency Library (CL). Both systems have been developed using expert in-house web developers. The web based TRS allows every member of staff to easily forecast their planned work and subsequently report what work they have actually done for individual customers. This enables NECS to accurately cost the delivery of its services and projects and ensure that what we provide for our customers is excellent value for money.

Board level business strategy is aligned across a portfolio of programmes underpinned by a robust set of processes and standardised workflows which keep the NECS leadership team assured of overall delivery of the strategy.

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Our web-based Competency Library complements the TRS by capturing the broad experiences of our individual employees and their corresponding levels of competence, in a single enterprise wide electronic repository. This invaluable tool provides EPMO with the ability to identify who might be able to support delivery of the broad range of projects and services that NECS offers which helps NECS to meet short term demands as well as plan for the future and drive continuous improvement. Just as crucial though, is that the Competency Library also provides a mechanism to support our employees in acquiring experiences outside of their normal day job as part of their agreed career development plan which ultimately contributes to improving our ability to retain the key employees. An intelligent, highly configurable web-based IT solution is the ‘engine’ which matches resources to the demands and commitments facing the business – NECS is now developing this so it can link a range of business critical information and make recommendations about which staff can be best matched to a particular project or service, then monitor actual versus forecasted delivery. A key success factor is bringing NECS staff on board. We have worked with our people at visioning events and corporate welcome events to create a set of organisational values and operating model where the majority of our people absolutely understand the need to complete time recording to support the way the new organisation will operate. This is a significant cultural shift for many people as they have previously worked for PCTs. We had to explain to our staff the importance of capturing where their time is spent and who it’s spent working for in order to be able to identify opportunities for improving our systems and processes and assess the cost effectiveness of the services and projects we provide. We also had to raise awareness with our customers that what we were aiming to do required a significant in our ability to plan and schedule our finite resources to ensure we delivered their expectations. In some cases however, our customers don’t yet know what they want us to deliver on their behalf. This is justification enough to be able to schedule resources as accurately as possible so that when new work is clarified by a customer, we are able to swiftly respond to move resources around and negotiate realistic delivery dates. This is a paradigm shift in terms of the traditional PCT way of working.

Put simply, our enterprise programme management approach is to ensure we do the right work and do the work right. Furthermore, standardising on how we do things will significantly reduce inefficiency and make the task of scaling up our operation to other customers much easier. This is fundamental to ensuring the success of the EPMO operating model and therefore EPMO maintains the single source of truth of standardised NECS work processes. Initially some staff were apprehensive in making the transition to having to account for the work they were doing every day – having never had to do this before working for PCTs. Now that EPMO is providing feedback reports concerning utilisation and finance (profit and loss) this has really helped raise awareness among staff of how their time now directly impacts on the financial viability of their particular service line and the wider NECS business. We are continuing to raise awareness among all employees of how crucial it is to operate as a single entity, rather than ensure one particular area of the business is a success to the detriment of other service lines. Managing our resources in this holistic way is key to the success of NECS. Above all, our EPMO operating model gives us a competitive edge. We can use intelligence and experience to make changes as quickly as we need to, minimising waste and putting us in the best position to respond swiftly to any new business opportunities.

For more information about the EPMO approach, contact Jonathan Maloney at jonathan.maloney@tees.nhs.uk

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First Databank

Tackling Prescribing Errors Phil Verplancke, Product Manager at First Databank, explores the recent study of the prevalence and causes of prescribing errors and how to address them

The 2012 GMC PRACtICe 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. The findings were attributed to factors such as polypharmacy for the elderly with four in ten patients suffering an error and a 16% increased risk of error for each additional medicine, and the complexities of dosing in children. Over one third of the prescribing errors reported were related to dosing, including errors with dose/ strength, timing and frequency, and incomplete information accounting for almost another third of errors. The findings were not a particular surprise; similar messages have been delivered over the previous 10-15 years in various reports. What is surprising is that the recommendations should suggest that there is a need to develop more point of care clinical decision support to assist the prescribing process. This technology and functionality already exists and is readily available in the market right now! First Databank (FDB) already supports clinicians throughout the prescribing process through the provision of advanced active clinical decision support (CDS), dosing instructions and monitoring prompts. FDB has invested heavily to update its

Multilex drug knowledge base and deliver advanced active CDS to healthcare system vendors. However, the current GPSoC accreditation process has not kept up with market advancements. Clinical systems are still only required to provide the most basic CDS ePrescribing functionality with the result that GPs have not had access to the available enhancements. It has been left up to clinicians to demand these innovations. FDB’s Multilex Dose module provides dose suggestions which are filtered according to the drug and route of administration, the condition being treated and the patient’s age and weight/body surface area. When necessary, dose suggestions can be modified by the prescriber, whereupon they are safety checked against documented upper and lower dose range bounds and frequencies, and deviances reported. This functionality catches many of the errors within the prescribing process referenced by the GMC report. FDB’s Multilex drug knowledge base also provides useful key prompts for baseline measures and on-going monitoring requirements, with additional supportive advice on discontinuation. And in Medicines Optimisation, the latest solution from FDB, evidence based prescribing best practice is used to support safer, more efficient patient centric prescribing.

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First Databank

“

Over one third of the prescribing errors reported were related to dosing

For more information, visit fdbhealth.co.uk or phone 01392 440100

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West and South Yorkshire and Bassetlaw CSU

Innovation is part of our DNA Alison Hughes,, Managing Director An opportunity to help our CCGs to innovate

These are exciting times for clinical commissioners and commissioning support providers. I am experiencing a different problem-solving approach being taken by commissioners; conversations with clinicians about some of the NHS’s thorniest issues are amazing me with their creativity. This is fantastic news for the NHS and for patients; and for us in commissioning support an opportunity to help our CCGs to innovate and to genuinely transform services. We have 15 CCGs across our patch, covering a diverse population with huge health inequalities: from the rural Yorkshire Dales, to former mining towns, from some of Yorkshire’s richest cities, to some of the poorest. There is no ‘one size fits all’; there are no easy solutions.

Find out more: www.wsybcsu.nhs.uk Tel: 0845 1115000

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

West and South Yorkshire and Bassetlaw Commissioning Support Unit

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West and South Yorkshire and Bassetlaw CSU

GP revalidation: freeing up time to care NHS West and South Yorkshire and Bassetlaw CSU (WSYB CSU) is justifiably proud of its innovation heritage. Employing some of the top software developers in the North of England, with a particularly high level of .NET and SharePoint expertise, the CSU is constantly developing exciting applications that make an immediate and measurable difference to GPs, CCGs and, crucially, quality of care for patients. Revalidation readiness at a glance A major success is the GP appraisal and revalidation application used throughout Yorkshire and the Humber, currently covering 3,500 GPs. In this postFrancis era, the need to assure ourselves of the quality of care throughout the health service is paramount and this application gives us a powerful tool that achieves this goal in primary care. The application, which sits on the WSYB CSU secure servers, manages the appraisal process from end to end and provides a traffic light dashboard of each GP’s trajectory towards revalidation. For GP appraisers, the application has been a boon. They are better informed, as they are able to view the revalidation summary of the key Medical Appraisal Guide statements and outputs which leads to better engagement in the appraisal process. The system also shows positive improvement against any concerns or development needs, and the appraiser can see at a glance each GP’s journey to revalidation – as can the GPs themselves. Fundamentally, it makes the appraisal system much simpler which, in turn, frees up both the GP’s and appraiser’s time to care. For the revalidation Responsible Officer, not only does it enable them to easily assess each GP’s readiness

for revalidation, they can also quality assure the appraisers and appraisal process and have easy access to documentary evidence and GP records. Beyond Yorkshire This is a proven and tested application which is already delivering measurable benefits to clinicians – and we are working with NHS England in other parts of the UK to roll out the system more widely. We are also developing a direct link between the application and GMC Connect, which will provide that final link for Responsible Officers. This application isn’t just for primary care: wherever revalidation is required there are obvious synergies, for example, secondary care consultants and doctors working in private healthcare. The application is a web-based system, with no software installation required and is compatible with mobile devices. The CSU provides a dedicated support and Service Desk team. Other IT innovations Freeing up time for GPs and pharmacists and helping both CCGs and the CSU itself towards a paperless environment has been a driving force behind recent WSYB CSU software developments. Applications which manage local enhanced services, risk stratification and premises valuations and running costs have been developed for CCGs/ GPs, while the CSU’s Needle Exchange application is used by pharmacists throughout the Bradford district. If you’re interested in the revalidation application, or any of the systems mentioned, please contact Pete Thomas, Commercial Director, on 07983 971850 or peter.thomas@wsybcsu.nhs.uk See over for more information INNOVATION IN HEALTHCARE

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West and South Yorkshire and Bassetlaw CSU

Our GP revalidation system Administration •

Appraiser selection rules: • Check maximum number of appraisals by the Appraiser • Same Appraiser not used in previous year • Appraiser doesn’t work in same practice

•

Appraiser feedback form is sent upon completion of appraisal to the Appraisee

•

Searching: • Able to search by GP or appraisal

•

Appraisee and Appraiser invoice generation • View/print invoices • Search for invoices

•

Reports: • Appraisal management reports • Finance reports • Revalidation reports/extracts

System settings •

Control panel to configure the application • Manage appraisal years • Manage workshop sessions • Manage user accounts and security roles • Configure concern types • Appraisal Exemption or Not Require reasons • GP roles • GP types • GPwSI • Performers lists

“

Employing some of the top software developers in the North of England

“

How does it work?

Stop press! We’re delighted to be part of the winning team that scooped the BMJ Renal Team of the Year award. This was an exciting and innovative project, led by Bradford City, Bradford Districts and Airedale, Wharfedale and Craven CCGs and supported by our Transformation team, which specialises in enabling evidence-based, transformational change for the benefit of patients. The project was praised for helping hundreds of previously undiagnosed people to manage the early stages of chronic kidney disease.

West and South Yorkshire and Bassetlaw Commissioning Support Unit

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Greater Manchester CSU

I believe As managing director of Greater Manchester CSU, I believe that we will support commissioners by identifying, implementing and driving forward innovation

That belief is embedded in every solution we provide for our clients, thanks to more than 500 talented CSU colleagues, with experience and expertise gained across the NHS, government and private sector organisations, motivated by the desire to help clients systematically drive improvement across their local health services. This background gives us an in-depth understanding and ability to navigate the constraints and challenges facing our clients and the wider health economy, in achieving transformational change. Our portfolio of tailored services are geared to achieving transformational commissioning, where we put challenges into the system to think and act differently, supporting CCGs in creating effective services, which in turn deliver change for the benefit of local communities and contribute towards tackling existing health inequalities.

I like to think strategically and system-wide, and see the future of commissioning support achieving robust and wide-ranging transformational change, but we must never forget that services are for individual people and their localities. This is why we focus on designing services around our clients, collecting and combining insight, establishing their needs, priorities and objectives. This enables us to co-design transformational change with real added value, and deliver a tailored solution. I will be presenting at The Commissioning Show, talking about how we’ve worked in Greater Manchester to achieve transformational change, and will have experts with first-hand experience ready to field questions and discuss how this was achieved – both at the presentation and at our stand (D61). I look forward to seeing you there for what will be a stimulating and thought-provoking session.

Leigh Griffin bio Leigh has led GMCSU since October 2012, having previously worked as a PCT Chief Executive in the North West and the West Midlands. A passionate advocate of system-wide improvement and transformation, he is committed to the need to co-design and deliver services with real added value, tailored to the unique needs of our clients.

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Greater Manchester CSU

High quality patient experience Greater Manchester Commissioning Support Unit (GMCSU) is at the forefront of innovation and best practice and is committed to identifying, implementing and driving innovation in health. This is embedded within all the services we deliver

Our portfolio already contains award winning and nationally recognised services, including the Greater Manchester Medicines Management Group (GMMMG), a nationally recognised example of best practice, which has delivered tangible results. The Greater Manchester Joint Formulary was developed under direction from GMMMG with the aim being to maximise safe, effective and economic prescribing. The Formulary provides consistent, high quality, respected guidance, with links to NICE guidance, new therapies recommendations, local pathways and safety alerts. The Greater Manchester Joint Formulary covers 12 CCGs, 13 providers and a population of 2.8 million. This is the largest population covered by a joint formulary in England. The group has medical and pharmaceutical representation from primary and secondary care across the whole of Greater Manchester and works closely with the pharmaceutical industry. The wealth of expertise drawn on by working across a wide footprint ensured that the generation of the Formulary was truly innovative.

The consultation period was novel for a formulary and was hugely valuable to increase awareness and buy in from both the NHS and pharmaceutical industry. The result was much richer for this input. Consistent prescribing across Greater Manchester is crucial for ensuring a good patient experience. The Formulary reduces variations in prescribing practice and reduces the risk of prescribing errors. It also ensures that patients receive seamless care across primary and secondary care and reduces the need for switching programmes. As well as contributing towards a high quality patient experience, GMMMG’s Formulary allows CCGs to make real progress on QIPP goals. Productivity increases thanks to a reduction in incorrect or inefficient prescribing, while more effective management of long term conditions prevents emergency admissions. The Formulary Subgroup is also responsible for the production of a ‘Do Not Prescribe’ list. The aim of this list is to reduce prescribing rates of drugs deemed to be less suitable for prescribing

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Greater Manchester CSU

due to safety, efficacy or cost effectiveness. The list has provided the support to stop prescribing ineffective yet costly medicines. This has contributed to significant cost savings of up to £250,000 per CCG for commissioners and providers. The Greater Manchester Joint Formulary has encouraged manufacturers to make their products more cost effective. One way of doing this is by offering a rebate scheme. GMCSU’s Medicines Management Team triages and manages the consideration of any rebate schemes on behalf of CCGs. GMCSU developed an ethical framework that is applied to all schemes. The rebate scheme is particularly intended for drugs included within the Formulary and provides consistency of savings realised across the health economy. Drugs which are not on the Formulary will be recommended to have any rebate rejected, as quality, safety and efficacy are prime considerations in optimising prescribing. GMCSU is now reviewing all chapters on an ongoing basis, and monitoring usage in primary and specialist care. This is improving relationships at the interface and reducing conflict through better understanding and reducing inappropriate prescribing. In the near future we see our best practice being the model of care for the whole UK, which we are happy to assist other areas in developing. GMCSU’s Head of Medicines Management, Andrew White, said: “The Formulary has generated a great deal of interest from both the NHS and pharmaceutical industry, due to the scale and impact of a formulary covering six per cent of UK drug spend. “I am very proud that the consultation, which generated over 420 responses, was unique to formularies across England. It has been a catalyst to improve working relationships between trusts and CCGs, facilitated by GMCSU. “The industry is now very keen to be placed on the Formulary and has now provided a benchmark from which to assess new and existing products, so the power base has shifted, for the first time, in the favour of the NHS decision makers.”

For further information on the Joint Formulary or any aspect of medicines management, contact Andrew White, GMCSU’s head of medicines management, on 0161 212 5680, or via email at andrew.white6@nhs.net.

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PA PA ATIENT TIENT ENGAGEMENT VIA MOBILE

MOBILISING FRIENDS & FAMILY “Achieving 20% response rates for the Friends & Family Test isn’t a problem if we use technologies which are familiar and accessible to patients...”

Jim Ward, Good4HEALTH www.good4health.co.uk Sally Burley, The 3rd Degree www.synapta.co.uk/health

Mandy Wearne, Inspiration NW

In April this year, Hospitals started surveying Patients within 48 hours of discharge, following new guidelines from the Department of Health. Known as the Friends and Family Test (FFT), it was announced by Prime Minister David Cameron in May 2012. Following staged implementation, it is expected by October of 2013 that all patients, will be offered an opportunity to answer the survey, along with accompanying questions following treatment. The FFT will enable every patient to give their views and will provide an effective management tool to report patient feedback and prioritise improvement. The challenge will be collecting the FFT on a large scale, starting with the Department of Health’s increased requirement of 20% returns of patients discharged.

needs a response rate of

TO MEET TARGETS

Systematic approach - such large-scale operation needs to be automated with minimal reliance on staff. Starting by targeting the majority of patients and then bespoking solutions for any not responding.

Friends & Family Test

Synapta mobile surveys easily exceed targets

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PATIENT ENGAGEMENT VIA MOBILE With these overriding requirements, Mandy Wearne and Janet Butterworth, Directors of Inspiration NW, chose to use personal mobile devices to collect feedback... "We realised that we now live in a fast- moving, changing age, where the mobile device is a central communications tool. Almost everyone in the UK have mobile phones, although, less than half of those are smartphones. Even in the over 70’s age group, it's the fastest-growing area of ownership. We knew from previous work with SMS, that every phone could use it and it could be used to trigger other feedback methods. That's why we decided to work with Good4HEALTH and their mobile engagement platform – Synapta. They had previous experience with the NHS and had successfully garnered feedback from Community Trusts." "In the pilot, we have had outstanding results. Hospitals have achieved an average response of over 50% of people taking part in the FFT. Of those, over 60% also leave comments to follow-up questions. Some of those comments have been over 300 words long and almost all are plain English. The potential for change is massive and already, Hospitals are being made aware of ways of improving services."

“In the pilot, we have had outstanding results. Hospitals have achieved an average response of over 50% of people taking part in the FFT. Of those, over 60% also leave comments to follow-up questions”

Compared to other methods, SMS ticks all the boxes. Paper, the simplest form of feedback, is actually costly in resources and almost impossible to transcribe comments. Reporting is slow and not comprehensive. Achieving 15% is a massive challenge for feedback cards and with initiatives in place to significantly reduce paper use across the NHS it is a dying methodology for us. Web, while attractive and 'free' is another option. Unless we ask personal questions, we cannot validate the patient. Almost double the population has access to SMS over Web, on a daily basis. To meet the requirement of 48-hours after discharge, we need to be pro-active, web is too re-active as a methodology. There are lots of other methods, including tablets, but in our opinion, these suit the minority, hard-to-reach groups, rather than the majority. For us SMS should be the lead method.

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“Without doubt what we achieved in the North, has given valuable insight into not only how to run the FFT successfully, but also what needs to happen within the establishment, to ensure minimal impact and successful implementation”

"Without doubt what we achieved in the North, has given valuable insight into not only how to run the FFT successfully, but also what needs to happen within the establishment, to ensure minimal impact and successful implementation. We not only looked to the technology, but how to create proper project teams, representative of the cross-service nature of the survey. We also looked at the service improvement impact. That’s how to achieve long-lasting success.”

Why Mobile? We are mobile. Mobile is our primary communications tool. Two-thirds of the human race rely on SMS text messaging to connect with a growing network of family, friends, businesses, organisations - even governments. Text messaging is the most widely-used data application on the planet. It is critical then, to make sure that the mobile channel leads the way in our conversation with patients to understand and monitor their experiences as well as engaging them throughout their NHS journey. There are many benefits to using life the Synapta s happen platform to on mobile garner patient feedback through automated SMS surveys. It is familiar, fast, convenient, private and secure, delivers incredible completion rates and high quality, instant data. Taking a mobile first approach to delivering the Friends and Family Test has a number of key benefits for Trust and patient.

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FFT MOBILE IMPLEMENTATION REPORT

NORTH OF ENGLAND TRIAL The Synapta patient engagement platform has been successfully implemented across 11 Hospitals in the North of England, as part of a pilot, to enable evaluation of the delivery of the FFT though the use of personal mobile phones. The trial has highlighted a number of key findings that Trusts must take on board to successfully implement FFT. In successfully implementing the Friends and Family Test for our Trusts, we found the most successful approach to rapid adoption and highest response rates, was where full consultation took place within the Trust at every level. A project team needs to be established, with a project champion leading with representative delegates from every part of the trust and participation and delegation of all. All clinical staff need to discuss the FFT with patients, as a positive project, designed to elicit feedback to improve services for the benefit of stakeholders. Where the enthusiasm of staff is passed to patients, high response rates ensue and the toolset can be used to drive improvement in both patient satisfaction and service delivery. The FFT should also be seen as just a part of an overall patient experience project. SMS has the major advantage of allowing validation of the participants, as well as enough distinct information to allow segregation of data into appropriate areas, such as Ward, Specialty, Date of Discharge and so on. Comparison of results across similar services, allows Hospitals to identify differences.

KEY FINDINGS All sites who implemented SMS text surveys easily exceeded the initial 15% national target The average response rate was 52% at the end of the pilot . Response rates were seen to increase once process was full embedded in each Trust Participating sites responses ranged between a 30% (minimum) and 62% (maximum) for the initial FFT question throughout the period of the pilot. Again, once established, this range increased from 45% to 69% Based on total number (all participating sites) of surveys returned, 63% of patients also left a text comment to a second question. This represents a very high response rate, when compared with other methodologies. It is also noteworthy that free-text responses regularly contained specific detail, which could then be fed back to staff and used to directly improve services

Patients discharged from an in-patient episode were approximately 10% more responsive to the surveys (in terms of answering the FFT question and leaving a comment) than A&E attendees There was a direct correlation between the speed and extent of success and the efforts made to brief, train and involve staff and communicate with patients Trusts valued retaining their own information, meaning that they could drill down to ward and speciality level as well as interrogate demographics

The average number of patients who would be extremely likely to recommend their experience, to Friends & Family, is 75%, the number likely is 14%, with 4% unlikely and 3% extremely unlikely. The variance on being extremely likely to recommend, was from 49% to 91% and on extremely unlikely to recommend, from 0% to 7%

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PA PA ATIENT TIENT ENGAGEMENT VIA MOBILE

MEET THE EXPERTS Good4HEALTH together with Inspiration NW and Cinder Lane have been implementing highly successful FFT solutions for Trusts via mobile using the feature rich Synapta mobile engagement platform. We believe there is no better or more viable primary solution to FFT delivery than mobile, both for the convenience of patients and for the needs of Trusts. Jim Ward, Good4HEALTH www.good4health.co.uk

Good

HEALTH

Good4HEALTH Ltd is a specialist mobile & wireless company, with specific expertise in public sector and in particular, healthcare. They have provided mobile services to councils and healthcare for a number of years, excelling in hands-on and close project management. Jim Ward, Managing Director, has worked in ICT and Sales and Marketing for over 20 years. He has worked closely with Inspiration NW for over 4 years and has been involved with Department of Health pilots in using Mobile and SMS for patient feedback and reminders. These pilots have been published nationally and audited by PWC. Jim has worked closely with pilots in Friends & Family as a consultant with hospital trusts, ensuring smooth transition and providing expertise with implementation. Good4HEALTH has partnered with the 3rd Degree’s Synapta platform solution for almost 5 years, having chosen this as the most professional and complete solution in the market.

Mandy Wearne, Inspiration NW www.inspirationnw.co.uk Mandy is a highly motivated and enterprising health expert with over 10 years executive experience in key roles in the National Health Service in England, working in complex and political environments both regionally and national. An innovator with an extensive background in leadership, management, clinical practice and public health, Mandy has a track record of designing, planning and implementing change in health and social care settings. As the first Executive Director of Service Experience in England, she has been acclaimed as a passionate and practical force for change engaging the confidence and commitment at all levels, to improving the experience of care. Mandy has now set up her own independent company with her business partner Janet Butterworth with the ambition of continuing to inspire excellence in the experience of care.

The Synapta platform has a proven track record for delivering patient feedback over mobile for the National Health Service. Not all research platforms are equal. Synapta was the first commercially available mobile research tool in the UK and continues to lead the field with 10 years experience delivering successful, scalable and reliable data via mobile. Synapta comes with a feature-rich research module. This lets you design and launch surveys ultra-quickly and effectively with real-time reporting and analysis. There’s also optional verbatim coding that can identify sentiment and automatically code responses. Synapta also delivers alerts and reminders, information and content delivery channels and mobile web to engage patients at all levels from staying healthy, to appointment reminders, treatment diaries and feedback - all from a single platform. For More Information on delivering the Friends & Family Test through the power of mobile visit our dedicated mini site at www.FFTHealth.com

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or contact Jim Ward at Good4Health jim@good4health.co.uk +44 (0)1555 666344

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460 BC

910

1628

1670

Birth of Hippocrates, Greek physician and founder of the ﬁrst university, considered the father of medicine. He bases medicine on objective observation and deductive reasoning, although he does accept the commonly held belief that disease results from an imbalance of the four bodily humors – an idea that persisted for centuries.

Persian physician Rhazes is the ﬁrst to identify smallpox – as distinguished from measles – and suggest blood as the cause of infectious disease.

William Harvey publishes An Anatomical Study of the Motion of the Heart and of the Blood in Animals, describing how blood is pumped throughout the body by the heart and then returns to the heart and recirculates. The book is very controversial but becomes the basis for modern research on the heart and blood vessels.

Anton van Leeuwenhoek reﬁnes the microscope and fashions nearly 500 models. Discovers blood cells and observes animal and plant tissues and microorganisms.

130 AD

1590

1656

Birth of Galen, considered the most important contributor to medicine following Hippocrates. Born of Greek parents, Galen resides mostly in Rome where he is physician to the gladiators and personal physician to several emperors. He publishes some 500 treatises and is still respected for his contributions to anatomy, physiology, and pharmacology.

Dutch lens grinder Zacharius Jannssen invents the microscope

Experimenting on dogs, English architect Sir Christopher Wren is the ﬁrst to administer medicine intravenously by means of an animal bladder attached to a sharpened quill. Wren also experiments with canine blood transfusions (safe human blood transfusions became feasible after Karl Landsteiner develops the ABO blood-typing system in 1900).

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1747

1800

1816

1842

1844

James Lind, a Scottish naval surgeon, discovers that citrus fruits prevent scurvy. He publishes his Treatise of the Scurvy in 1754, identifying the cure for this common and dangerous disease of sailors, although it takes another 40 years before an ofﬁcial Admiralty order dictates the supply of lemon juice to ships.

1796

Sir Humphry Davy announces the anesthetic properties of nitrous oxide. Dentists do not begin using the gas as an anaesthetic for almost 45 years.

René Laënnec invents the stethoscope.

American surgeon Crawford W Long uses ether as an anaesthetic during surgery but does not publish his results. Credit goes to dentist William Morton.

1818

1846

Edward Jenner develops a method to protect people from smallpox by exposing them to the cowpox virus. He rubs pus from a dairymaid’s cowpox postule into scratches on the arm of his gardener’s eight-yearold son and then exposes him to smallpox six weeks later (which he does not develop). The process becomes known as vaccination from the Latin vacca for cow. Vaccination with cowpox is made compulsory in Britain in 1853. Jenner is often called the founding father of immunology.

British obstetrician James Blundell performs the ﬁrst successful transfusion of human blood.

Boston dentist Dr William Morton demonstrates ether’s anaesthetic properties during a tooth extraction.

Dr Horace Wells, a US dentist, uses nitrous oxide as an anaesthetic.

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The role of modifiable lifestyle factors and Souvenaid® in early Alzheimer’s disease Dr Junaid Bajwa; Conway Medical Centre, Plumstead, London, UK; Dr Jon Tuppen; Derby Road Surgery, Ipswich, UK

Modifying nutritional factors and adopting a healthier lifestyle may reduce the risk of developing Alzheimer’s disease and could slow the rate of progression in patients with existing disease. Alzheimer’s disease (AD) is one of the leading causes of dementia and, in light of the predicted increase in the prevalence of dementia as the population continues to age [Ferri et al 2005], is a major public health concern and research priority. There is an urgent need to prevent AD and to find new approaches to manage existing AD. The NHS Commissioning Board has proposed an enhanced primary care service to facilitate the timely diagnosis of dementia and provision of support for people with dementia. GPs are usually the first healthcare professionals to be approached by patients experiencing cognitive problems. It is important that GPs are able to identify patients at risk of developing AD so that they can be monitored and patients with suspected AD so that they can be referred for further assessment and diagnosis. In addition, GPs need to be aware of the benefits that lifestyle interventions and nutritional supplementation may provide. The characteristic pathological hallmarks of AD are amyloid plaques, neurofibrillary tangles and loss of neurones, but research evidence suggests that synaptic failure may play a key role in the progressive cognitive and functional decline [Selkoe 2002]. The precise aetiology of AD remains unclear, but

several risk factors have been identified, including advancing age [von Strauss et al 1999], female sex [Carter et al 2012], low level of education [Bicalho et al 2012], family history [Fratiglioni et al 1993], excessive alcohol intake [Fratiglioni et al 1993], presence of the apolipoprotein E-Ð4 allele [Seshadri et al 1995], inflammation and infection [Johnston et al 2011], traumatic brain injury [Sivanandam & Thakur 2012], and cardiovascular risk factors (such as obesity, smoking, raised serum cholesterol, high intake of saturated or trans fats, high blood pressure, diabetes, physical inactivity) [Kivipelto et al 2005; Whitmer et al 2008; Rusanen et al 2011; Solomon et al 2009; Morris et al 2003a; Feldstein 2012; Ott et al 1999; Rovio et al 2005]. Acetylcholinesterase inhibitors and memantine are used in the early-to-late stages of AD to mitigate neurotransmitter deficits, but the symptomatic benefits are short-lived and these drugs are unable to prevent the degenerative process. There are currently limited pharmacological interventions for early AD. For these reasons, there is growing interest in the modifiable risk factors for AD and the potential impact of lifestyle modification and nonpharmacological approaches on the development and progression of AD. Modifiable risk factors associated with AD include smoking, excessive alcohol intake, physical inactivity and nutritional factors. Evidence for association between smoking and alcohol consumption and

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risk of AD is inconsistent, with epidemiological studies showing positive or negative associations or no effect. Establishing an association between smoking or alcohol use and AD in epidemiological studies is complicated by the high prevalence of concurrent smoking and alcohol use among subjects [Tyas et al 2000]. In the absence of definitive data, and in line with general lifestyle advice, GPs should encourage patients to stop smoking and reduce their alcohol intake. The risk of AD has been found to be inversely associated with levels of daily physical activity [Hamer & Chida 2009; Buchman et al 2012]. The level of exercise does not need to be excessive in the elderly, and activities such as walking a mile daily [Erickson et al 2010], or pursuing a leisuretime physical activity twice a week [Rovio et al 2005], may be sufficient to reduce the risk of developing AD. However, no randomised controlled trials (RCTs) have demonstrated that regular physical activity prevents the development of AD. Regular exercise may also benefit patients with existing AD. Epidemiological studies in patients with AD have suggested that moderate physical exercise may reduce the risk of falls [Rolland et al 2000], reduce neuropsychiatric and behavioural problems [Rolland et al 2000; Christofoletti et al 2011], and attenuate cognitive decline [Palleschi et al 1996; Winchester et al 2013]. Small RCTs in patients with AD have shown that moderate exercise may reduce depression [Williams & Tappen 2008], and enhance memory and performance on neuropsychological tests [Stevens & Killeen 2006; Yágüez et al 2011]. Some large RCTs are being initiated and include the EXERcise and Cognition In Sedentary adults with Early-ONset dementia (EXERCISE-ON) study, which will assess whether exercise slows progression of the symptoms of AD in sedentary adults with earlyonset disease (onset <66 years of age; n=150) [Hooghiemstra et al 2012]. This study will compare

“

Modifiable risk factors associated with AD include smoking, excessive alcohol intake, physical inactivity and nutritional factors

an aerobic exercise programme with a flexibility and relaxation programme. The relationship between nutrition and AD appears to be similar to that between nutrition and cardiovascular disease [Scarmeas et al 2006; Gardener et al 2012]. High dietary intake of saturated and trans fats has been associated with an increased risk of developing AD [Morris et al 2003a], whereas regular fish consumption [Morris et al 2003b; Barberger-Gateau et al 2007], and a diet rich in fruit, vegetables, fish and unsaturated fatty acids [Scarmeas et al 2006; Gu et al 2010; Gardener et al 2012], are associated with a reduced risk of AD. Individual dietary components, including folate and vitamins C and E, have been associated with a reduced risk of AD [Luchsinger et al 2007; Li et al 2012; Harrison 2012]. Small studies have suggested that patients with dementia, including those with AD, may gain some benefit from dietary supplementation with B vitamins [Nilsson et al 2001], eicosapentaenoic acid (EPA) [Boston et al 2004], and omega-3 polyunsaturated fatty acids [Freund-Levi et al 2006]. The widely held belief that commercially available computerised brain-training programs improve general cognitive function in the wider population lacks empirical support [Owen et al 2010]. A six week online study was conducted in which 11,430 healthy adult participants trained several times each week on cognitive tasks. Observed improvements in all tasks were found to be the result of practice effects, and no evidence was found for transfer effects to untrained tasks or any generalised improvements in cognitive function following brain training [Owen et al 2010]. Furthermore, the effects of cognitive interventions were measured in samples of healthy elderly, which found no evidence that structured cognitive intervention programs delay or slow progression to AD in this group [Papp, Walsh and Snyder 2009].

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Souvenaid® is a Food for Special Medical Purposes that has been designed to address the specific nutritional needs of patients with early AD

A less well-recognised, but scientifically wellsupported, observation is that patients with AD have a relative deficiency in the nutrients needed to build new neuronal membranes that are essential for synapse formation. Levels of many of the precursors and cofactors required to support the Kennedy pathway, the metabolic pathway responsible for the formation of synaptic membrane phospholipids, have been shown to be relatively low in patients with AD [Igarashi et al 2011; Pettegrew et al 2001; Mulder et al 2003; Glasø et al 2004]. The high requirement for new synapse formation in AD suggests that individuals with AD would benefit from dietary supplementation with the precursors and cofactors involved in the Kennedy pathway.

Kennedy pathway. RCTs have shown that Souvenaid improves episodic memory in patients with early AD [Scheltens et al 2010; Scheltens et al 2012]. Souvenaid is well tolerated and well accepted by patients and has not been associated with any adverse effects or interactions with standard drugs for Alzheimer’s disease.

Souvenaid® (is a Food for Special Medical Purposes that has been designed to address the specific nutritional needs of patients with early AD. It is a once-daily, low-volume drink that contains a combination of nutrients (docosahexaenoic acid, EPA, phospholipids, choline, uridine monophosphate, folic acid, vitamins B6, B12, C and E, and selenium) designed to support the

What is known is that lifestyle modification can be challenging for patients, carers and clinicians. It requires determination on the part of the patient and carer, and a change to a more motivational, and potentially time-consuming, consultation approach by clinicians. Other non-pharmacological interventions have their place in the holistic care of early AD alongside lifestyle interventions.

Mednet is a healthcare consultancy and solutions provider of patient-focused and cost effective solutions to any healthcare requirement.

For more information, contact: Mednet Consult Ltd., 40 Otley Road, Headingley, Leeds, LS6 2AL Tel: +44 (0) 113 827 2039 E-mail: info@mednet.co.uk Website: www.mednet.co.uk

Mednet is working with Nutricia to provide medical education for healthcare professionals in the management of early Alzheimer’s disease. References for this article are available on request from Stephen Bahooshy, e-mail: sbahooshy@mednet.co.uk)

What has not been studied yet is the combined effect of pharmacological intervention, nonpharmacological interventions and lifestyle interventions on the development and progression of AD. Common sense would argue that a holistic approach to care of those diagnosed with AD or Mild Cognitive Impairment (MCI) would be beneficial, but more studies are needed.

“Providing Excellence in Healthcare”

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PSUK

Personal touch Improving patient experience and increasing cost effectiveness through personally administered items

Richard Gleave, previous Director of Patient Experience at the Department of Health said “three key elements – patient experience, clinical effectiveness and patient safety – should be given equal status in improving services”. The King’s Fund report Improving GP Services in England (Nov 2012) found that both clinical effectiveness and patient experience are key domains of healthcare quality and that, generally speaking, practices that deliver a good experience for their patients have a higher QOF outcomes score. Every GMS practice in England and Wales can takes steps to ensure that their patients receive the best possible service they are able to offer. In line with QIPP and the emphasis on value-added services that drive quality and efficiency in general practice, a simple review of their processes on personally administered items can have a beneficial outcome for both profit and patient experience. If a practice is sending its prescriptions to a local pharmacy, it could be losing valuable profit. Certain manufacturers, including AstraZeneca and Pfizer, offer discounts to prescribing-only practices when their products are purchased through selected suppliers. As the PPD will reimburse the full NHS cost of the product, the practice would make a profit when it buys them in and administers them on site. Even if there isn’t a discount available on the drug, the practice receives a fee for dispensing it in the consultation and this can generate profit. Not only does this generate income for the practice, but it frees up valuable practice time. One of the main concerns for a patient is ease of access to their clinician. A change in the process of procuring personally administered items could ensure more available appointment times, less time spent on administration and a single trip to the surgery, as opposed to both pharmacy and surgery by the patient. This not only enhances the patient experience, but removes the danger of pharmaceuticals intended for administration by the doctor being left in the hands of patients. Further information on Personally Administered (PA) items You can find a list of PA items on our website at www.psuk.co.uk and marked within our catalogue. We also have a PA calculator online for a practice to use to identify the profit available to them. While every effort is made to keep this information as up to date as possible, if you have any specific queries, please contact the PPD’s prescription pricing helpdesk on 0845 610 1171.

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PSUK

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Not only does this generate income for the practice, but it frees up valuable practice time

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

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PSUK

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:

• • • • • •

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 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

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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South West Commissioning Support (SWCS)

Talented workforce and a passion for innovation Jan Hull, SWCS Managing Director, delivering support services to CCGs

At South West Commissioning Support (SWCS) we understand the step change in commissioning practice that clinical commissioners require. We have a talented workforce and a passion for innovation, with a clear focus on delivering a real difference for our customers and their patients. We believe in putting our customers at the heart of our business, and have structured our services to best deliver to their needs. Each customer has a relationship manager, who is responsible for the overall business relationship and its success. SWCS provides end to end commissioning support services including business intelligence, IT, major reconfiguration and service redesign, commissioning strategy, provider management, contract

management, clinical procurement, HR, finance and communications services, as well as a range of specialist services. To deliver our services SWCS has a Matrix operating model, and has put considerable effort into developing this, working with staff and our customers. We have functional teams, consisting of experts in their particular service area, and cutting across these we have delivery teams, that consist of experts from different specialist areas working together to deliver services to the customer. We know that we will be judged on the quality of our services, and believe that this approach truly enables us to be flexible and responsive. At SWCS, we pride ourselves on making ideas happen. We provide organisational change through a wide range of services, built on many years’ experience.

For further information please contact: Nik Attryde Business Development Nik.attryde@swcsu.nhs.uk

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Central data agreement from Ordnance Survey proves just the tonic in delivering joined-up healthcare NHS reform has sparked fierce debate among healthcare professionals, politicians and patients. Now that the changes are in force, one thing is clear; close cooperation between the newly-created organisations will be crucial in delivering high quality care for people across England. With many new bodies taking responsibility for the commissioning of services and public health, it is a major, but by no means new challenge. Many of these new bodies including NHS England and the Clinical Commissioning Groups (CCGs) are increasingly considering the use of digital mapping and address data as the basis for sharing information and informing evidence-based decision making. This growth in the use of location and address as a means of linking a variety of information is enabled by data supplied under the Public Sector Mapping Agreement (PSMA). This agreement makes Ordnance Survey geographic data free at the point of use for all local authorities, central government departments and all qualifying health organisations in England and Wales. When budgets must be carefully balanced without compromising services, it is playing a key role in helping the NHS to do more for less – for example, by identifying where new resources could be targeted more effectively or pinpointing areas of low uptake of services. Around 100 hospital trusts, all 12 ambulance trusts and more than two thirds of NHS authorities have signed up to the centrally-funded licensing agreement which also allows data sharing with contractors delivering services on behalf of members. Now the new CCGs, which came into effect on 1 April 2013, are also being encouraged to join.

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‘Mapping really helps people to visualise and understand complex data by providing a geographic context for a wide variety of information’, says Iain Goodwin, PSMA Relationship Manager for Health, Ordnance Survey. ‘We are seeing some innovative uses of mapping in the health sector as a result of the PSMA. From carrying out public health analysis and service planning to emergency response and estate management, the availability of open and shared geographical data is having a significant effect on the way in which the NHS works. Even if CCGs contract services to Commissioning Support Units (CSUs), they should still sign up to the PSMA as common licensing terms enable them to share mapping data with third parties delivering services on their behalf. As a result they will be able to collaborate and partner on projects more easily, which helps to meet targets, avoid duplication and increase efficiency through joined-up working.’ Collaborative working is clearly a key aim of the NHS changes. Commenting on the reforms, Lord Howe, Health Minister said: ‘Health and care services will be better joined up by bringing together the NHS, local councils and patients. Through these changes, the health service will improve, work smarter and importantly, build an NHS that delivers high quality, compassionate care for patients’. As the momentum for collaboration and using Geographical Information Systems (GIS) in the NHS continues to grow, it is vital that all the organisations responsible for providing healthcare work together aided by common, consistent mapping and address data. By becoming a member of the PSMA, CCGs will be joining almost 3,000 public sector organisations who benefit from a wide range of Ordnance Survey mapping including highly-detailed OS MasterMap® data, Road Networks, authoritative address and boundary information; and backdrop mapping at various scales.

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

Health

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

GIS and mapping services for CCGs in Bristol, North Somerset, Somerset and South Gloucestershire are provided by South West Commissioning Support (SWCS). Assessed by the NHS Business Development Unit as one of the top three CSUs in the country, SWCS is also one of only nine accredited Data Management and Integration Centres (DMICs). Clients include GP practices, community and primary care health teams and the South of England Specialised Commissioning Group – South West, as well as some organisations outside the South West region including Anglia Support Partnership (Serco) and NHS Shropshire. Informatics support is provided by the award-winning Avon Information Management and Technology Consortium (AIMTC). Now part of SWCS, the team – which has pioneered the use of GIS and digital mapping within the NHS – offer a wide range of services, including GIS support to underpin the Somerset GP Out of Hours service review for the Bristol, North Somerset, Somerset and South Gloucestershire area team. ‘Without mapping, it was hard for people to visualise the extent of the service’s coverage or exact locations’, says Trevor Foster, GIS Manager, SWCS. ‘Once data is given a geographic context it becomes much easier to spot patterns and make appropriate recommendations’.

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The reputation of SWCS means that many public sector clients also ask it to manage GIS and associated services on their behalf. ‘This enables them to improve efficiency by concentrating on providing care for their patients whilst benefiting from our expertise in business intelligence and GIS’, explains Trevor Foster. ‘There is no extra cost for geographic data as we have the appropriate licence to host mapping from Ordnance Survey and the mapping is provided free under the terms of the PSMA. For other clients, such as charities, we use OS OpenData™ which makes GIS an attractive and cost-effective option for those operating on tight or diminishing budgets.’ As the creator of HealthGIS, an interactive online portal for visualising and analysing data, and provision of hard copy mapping for reports and presentations, South West Commissioning Support (SWCS) uses digital map data to deliver a wide range of services. Benefits include improved access of information to support clinicians delivering patient care; better interorganisational working; and greater efficiency through effective use of time and resources.

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GP Practice Maps show practice boundaries, location and population

Pinpointing patients and practice areas Understanding the distribution of patients within a practice area is vital for planning the effective delivery of services to improve healthcare whilst making efficiency savings. GP Practice Maps show practice boundaries, location and population, spread against a range of Ordnance Survey backdrop data including electoral and administrative boundary information and street-level mapping. This helps GPs and other Clinical Commissioning Groups (CCGs) to understand where their patients are located in relation to their practice

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

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Walking times to needle exchange locations in Bristol

Targeting specific services to areas most at need By identifying gaps in drug and alcohol service provision, data supplied under the PSMA has helped with the future planning of treatment centres in Bristol to provide better value for money and use of resources. Information presented in HealthGIS was used with other maps showing public health indicators, such as areas of deprivation and hospital admissions, to show where people using drug and alcohol services live, and pinpoint the treatment centres they attend. Used as part of a joint-working initiative between NHS Bristol

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

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

A self-service to seek and find GP practices quickly and easily Available from any computer with access to the NHS network, the easy-to-use self-service HealthGIS GP Finder has streamlined response times to queries about patient registration. GPs are contractually required to provide primary care services to patients living within their catchment boundaries so support services and administrators often need up-to-date information on the areas each practice serves. By entering a patient’s postcode, the GP Finder tool uses the latest GP contractor data and GP practice areas to identify all practices where they are eligible to register. Search results are displayed with other information, such as hospitals or pharmacies, on Ordnance Survey mapping at a range of scales. Addresses are pinpointed using AddressBase® Plus and travel access analysis is

carried out using OS MasterMap® Integrated Transport Network™ (ITN) Layer. The GP Finder enables users to quickly and confidently identify practices in relation to other services using the map interface, allowing them to provide added value when dealing with the public and other healthcare professionals. To find out more about South West CSU’s GIS service please visit http://www.healthgis.nhs.uk/ or call Trevor Foster on 01179 002490. To find out more about Ordnance Survey data and the PSMA, please visit www.ordnancesurvey.co.uk/health

To find out more please visit us on stand J50

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Mednet Advert 17May13.pdf 1 5/17/2013 11:25:53 AM

“Providing Excellence in Healthcare”

Mednet Consult, a Healthcare Consultancy dedicated to providing advanced solutions serving diﬀerent aspects of the healthcare sector and has extensive experience and consulting competence dealing with service delivery, clinical processes and digital technology. Mednet currently works in line with National Healthcare Strategy in collaboration with the NHSprovider and commissioning organisations, Department of Health, CCG’s and private/commercial healthcare organisations.

Pathway Optimisation We have been working with healthcare organisations to review service delivery models across pathways of care, with a speciﬁc focus on long term conditions. Assessments of the existing model of care have been undertaken on web based systems, designed by Mednet. The appropriate healthcare professionals in the organisation will complete these assessments. A full report will be generated; this will be agreed at project initiation and will give all the information required by the organisation. Speciﬁcally the report can show the existing resource and therefore lead to capacity optimisation and savings realisation.

Healthcare Training Following a training needs assessment, Mednet can work with a primary care organisation to provide a bespoke training solution to match their needs. This will be developed with an organisation and modules will match the needs of each highlighted healthcare professional. This could be a two way communication web-based platform to disseminate up to date information to staff users effectively and efficiently using the media they prefer i.e. through a web-based portal also including e-learning modules, mobile phones (using apps), portable media such as CD’s, DVD’s, and print media. Add-on features for the users such as discussion forum, file sharing, blog-writing, live chat etc. can also be enabled as an extension with an aim to support knowledge sharing.

Mednet Adherence Support Service (MASS) We have developed a proven working model for our clients to increase patient outcomes and reduce the cost of partial or non-adherence. Through combining ever improving information technology and telecommunications, we are able to offer a customised state-of-the-art treatment reminder service which is an effective way to increase patient involvement, loyalty and attendance to medication appointments which significantly improves efficiency of treatment whilst simultaneously reducing cost. Reminders can be delivered in the form of text messages, phone calls or mobile alerts using a mobile app.

Digital Solutions Mednet firmly believe in its capability to develop and manage customised digital solutions for various areas within the healthcare sector. We build a two-way communication platform allowing dissemination of up-to-date information to users effectively and efficiently using the media they prefer. Using state-ofthe-art technologies, we develop - web-based working model designed for Healthcare Professional’s (HCP’s) that aims to enhance their knowledge and expertise, advanced and accessible web applications for any healthcare setting, e-learning packages to meet specific individual training needs, mobile technologies that educate HCP’s, graphic design solutions for 3D, Digital Graphics and Interactive Media, films and video tutorials that support education materials using experts in the therapy area. For more information, please contact us at T: +44 (0) 113 827 2039 E: info@mednet.co.uk W: www.mednet.co.uk http://twitter.com/mednetconsult

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Business Development Manager: Kirti Tandel T: +44 (0) 113 827 2039 Ext:- 554 E: ktandel@mednet.co.uk

Mednet Consult Ltd., 40 Otley Road, Headingley, Leeds, LS6 2AL Company Registration Number: 06494718 VAT Number: 922862516

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Patient Access

Clarendon Practice, Salford, turns around This 8,700 list practice in Salford was struggling with stressed doctors unable to meet the demands of frustrated patients. Receptionists were stuck in the middle, taking abuse from patients and unable to help them. Then they changed.....

Clarendon practice is located in an area which is the 14th most deprived in the country. Alcohol admissions are the highest in UK, 49% of the population live in poverty with pensioner poverty being 55.8% and unemployment is 7% (higher than the England rate of 5.1%). Life expectancy is 63.9 years for women and 67.8 years for men (lower than the national average). Before the change, the practice was experiencing a high demand for their services where patients had to wait over three days to get an appointment with their doctor. There was often a mad rush on the practice telephones at 8.00am as soon as the phone lines were switched over from the out- of- hours service, as well as patients waiting outside the surgery hoping to get one of the spare appointments available that day. Patients were having to phone back day after day to secure an appointment. Generally within the first hour of the surgery opening all the pre-bookable appointments were taken leaving the patients frustrated. This had a knock on effect on the reception staff who were at the receiving end of abuse from unhappy patients, leading to increased stress for the doctors and the tarnishing of the practice’s reputation. In the autumn of 2012 Dr Jeremy Tankel, GP principal at Clarendon, together with his two partners and three salaried GPs decided to do something about the increasingly worsening situation. They and the rest of the practice team embarked on a transformational journey with the help of Patient Access to improve their working lives and their patients’ experience.

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Patient Access

All data from Clarendon, charts by PA Navigator

What was the change? The practice changed the way they handled the request for appointments by patients. The new system was simple: • The patient wants the doctor • The doctor phones the patient • Together they resolve the problem Through this change the practice has been able to achieve remarkable results. Patients can now speak to their doctor on the same day they contact the practice. The graph shows the average number of days wait has fallen off a cliff.

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

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

As the GPs phone all the patients, 56% of the problems are resolved on the telephone leaving 44% to be seen as a face-to-face appointment. The doctors are able to respond quickly telephoning patients back within a median of 30 minutes and which has recently reduced further to 20 minutes median. There is now flexibility in the face-to-face appointments to allow the GPs to spend the right amount of time with each patient, in some cases up to 20 minutes or more if needed. Patients are more likely to see the same doctor, with 85% continuity – up by 15% from before the change. This has had a dramatic effect on DNA rates which have dropped by 60% right from day one of the changeover.

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

All data from Clarendon, charts by PA Navigator

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Patient Access

“

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

Excellent

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I like it. Keep it

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Patient quotes:

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

90%) whilst the remaining 10% chose to wait for their own convenience.

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

The system has worked so well for the practice that it has now been able to save one clinical session. So what do the patients think? The patients themselves have responded well to the new system.

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

In a survey of patients post transformation, 61% have said that the change is better and 75% are satisfied or very satisfied with the service.

The practice staff feel less stressed and the level of abuse from patients has gone. All the patients who need a face-to-face appointment are able to have this on the same day (around

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

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Patient Access

What is Patient Access? Patient Access is a social enterprise that is transforming primary care across the UK. Invented by GPs who wanted to develop and make known their discovery of a better way to provide access for patients to their doctors, it now serves over 500 000 people. We are now working with over 80 practices across the UK and have an ongoing research programme. The structured change programmes are tailored to each practice and includes products and services such as: • Pathfinder – which through informed consensus on changing the system allows partners to discuss the options with the benefit of precise knowledge on current practice performance • Launch – which involves a whole system change, completed, working and evaluated over 12 weeks • Navigator – an analysis suite which supports the above programmes

For further information go to www.patient-access. org.uk and see the other case studies.

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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. 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.

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

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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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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

Bradford District Care Trust 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.

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1867

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

1879

First vaccine for cholera

1881

First vaccine for anthrax

1882

First vaccine for rabies

1895

1849

1870s

1890

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

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

German physicist Wilhelm Conrad Roentgen discovers X rays.

1896

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

First vaccine for typhoid fever.

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1897

1906

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

1899

1901

First vaccine for plague.

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

1907

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

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

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

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NHS Alliance

Breaking boundaries NHS Alliance is the leading voice for primary care, speaking for innovative general practices and providers of healthcare in the community, who care about a sustainable NHS.It is committed to making clinical commissioning work and is a founding partner of NHS Clinical Commissioners, as its chief executive Rick Stern explains

The NHS Alliance sees a bright future for primary care, one that makes the most of the traditional values of locally-based healthcare provision that delivers continuity of care. General practice, community service providers and community pharmacy are vital assets in managing health – central resources at the heart of their communities. Our recent manifesto, Breaking Boundaries, sets out a vision for a primary care system in which new models can create a new culture of co-operation. Key among the boundaries to break are those between professional silos, whether specialist consultant and GP, or that between GP and community pharmacist. In one of the manifesto’s 25 thought-pieces, Mark Robinson, a community pharmacist, explores why medicines optimisation is an essential focus for primary care within the new system1. Medicines optimisation is not medicines management in disguise. It is about achieving better outcomes for patients. The success of medicines optimisation can be measured in terms

of improved patient experience, reduced referrals and unplanned admissions, reduced medicine waste, increasing quality of care and improved outcomes. Unlike medicines management, where the currency is prescribing budget, the currency of medicines optimisation is outcome, measured by referrals and admissions. It recognises that the benefits from investment in medicines often have an impact outside the health arena and, as well as improving clinical symptoms, medicines can also contribute to wellbeing and support people to re-engage with their families and wider society, return to work, reduce dependency on social care and make progress towards achievement of personal life goals. Medicines are the most common health intervention and are included in the majority of treatment pathways. Treatment with a medicine is not always the answer and, in particular, may not always be what the patient wants. One flaw in the system is that a medicine always follows a diagnosis. Everyone may talk about shared decision making, but is it really happening in practice?

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NHS Alliance

There is room for much improvement in how we embed medicines optimisation as an integral part of care. Currently, we know that 30-50% of medicines are not taken as intended. Ten days after starting a new medicine, 30% of patients are not taking them as prescribed. There is extensive waste of medicines, estimated at £300m a year, with about half of that waste being preventable. There are errors too, with safety and cost implications. Medication errors may occur in up to 11% of prescriptions, mainly due to errors in dosage.

•

Approximately 6.5% of all hospital admissions have been attributed to, or associated with, adverse drug reactions; with up to two-thirds estimated to be preventable. The waste of medicines is an important cost pressure, but these are dwarfed by the cost of failing to achieve best outcomes. Research into peoples’ experiences of medicines2 can help us understand the patient’s medication experience. The key stages are: • A meaningful encounter: where clinicians should be equipped to introduce the medicine to the patient in a meaningful way and involve the patient in their decision to continue. Poor early encounters can leave patients feeling confused and anxious. • Experience of taking a medicine: as the person starts to take a new medicine they begin to feel and evaluate the benefits for themselves, based their experience and perceptions. The

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Approximately 6.5% of all hospital admissions have been attributed to, or associated with, adverse drug reactions; with up to two-thirds estimated to be preventable

patient weighs up the benefits and the tradeoffs in taking the medicine. The medicine burden: medicines for long-term conditions are by their nature long term and the patient will reconsider the position of the medicine within their life and the dependence upon it. Exerting control: based on their experience, people take control of their medicines. Patients encounter the meaning of the medicine, question it, realise the effects and the continuous nature and will experiment becoming the managers of their condition. In some cases, we may consider this poor noncompliance or perhaps non-compliance.

Knowing this, we can understand the touch-points where we might intervene to support the patient to achieve a better health outcome. But the NHS requires three important changes: •

•

The embedding of medicines optimisation within general practice through the employment or attachment of medicines optimisation pharmacists. A new community pharmacy contract that supports the wider introduction of medicines optimisation and clinical services in community pharmacy. A change in CCGs where the focus is medicines optimisation rather than cost reduction, clinician engagement and joined-up services.

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NHS Alliance Creating an integrated approach simply requires joining the dots. Here are a few simple examples: • Integrate the medicines reconciliation services in secondary care with general practice (see CQC report) and primary care, and link to the New Medicines Service provided within community pharmacy. • Drive improved quality of medication review in general practice (see the CQC report), focus on the elderly and linking to Medicines Use Reviews in community pharmacy. • Deliver improved disease management services promoting self care by linking charities and voluntary sector providers through the community pharmacy network • Support patient responsibility with medicines through the use of patient-own-drugs (PODs) and selfadministration in the hospital setting. • Support medicines changing pathways, through the education of prescribers in all care settings, utilising the expertise of the pharmaceutical industry. • Improve the patient experience of medicines, through the medicines optimisation lead in general practice, with clear provision of information and decision support tools and an opportunity for patients to discuss their experiences and decide a way forward. And when the patient has issues with compliance, to provide appropriate support through commissioned community pharmacy.

Many of the existing functions within CCGs must be adjusted to ensure that medicines optimisation is discussed and delivered. • Formulary and formulary processes must become more transparent, supporting the rapid introduction and local promotion of medicines that have the potential to reduce admissions, prevent admissions or change pathways. Greater consideration should be given to the patient benefits through active engagement of stakeholders patients/carers and members of the public in the decision making process in line with the NICE best practice guidance. • Prescribing data should support the analysis of referral and admission data and practice performance determined through analysis of QoF. This should be less focused on cost and more on outcomes. • Education must become positive, educating prescribers in what to do rather than telling them what not to do. Prescribers must also have better links with specialists to share experiences and gain confidence in supporting more patients within primary care. • Better mechanisms should be developed to share local experiences with medicines to support and drive changes in clinical practice. Commissioners up and down the country are already commissioning services that are based on medicines optimisation. They are already showing how quality improves and costs go down as a result. The issues in this article will be explored further at this year’s NHS Alliance conference, Breaking Boundaries, which will take place on 27 and 28 November, in London.

1 Read the Breaking Boundaries manifesto and accompanying articles on the NHS Alliance website, www.nhsalliance.org/manifesto/ 2 Shoemaker SJ, de Oliveira DR. Understanding the meaning of medications for patients: The medication experience. Pharm World Sci. 008; 30(1): 86-91

The NHS Alliance cordially invites you to come and break some boundaries. Building on its long heritage of positive disruption, the Alliance, its members and friends – innovative leaders and providers in primary care – like nothing more than a bit of divergent thinking. Together, we have set agendas, shaped policy, moved the patient centre stage, and put clinicians at the heart of commissioning. But the journey continues. We want to see a true primary care led NHS, one where providers can survive and thrive, working collaboratively and productively alongside their patients.

Together, we can break boundaries, and build bridges. Together, we really can make a difference. Breaking Boundaries, our 2013 conference, is the only health conference that brings together Britain’s brightest health care minds, innovative providers and passionate commissioners, with the sole purpose of working together to deliver the care people have said they want – care as close to their homes as possible. Find out more at www.nhsalliance.org/conference2013www.nhsalliance.org

But we’re not there yet and we can’t do it without you.

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Brunel University

Terry Young, Professor of Healthcare Systems at Brunel University, is one of the co-founders of the Cumberland Initiative

www.cumberland-initiative.org

SMART THINKING TO MAKE BRITAIN HEALTHIER AND WEALTHIER Terry Young details the work of the Cumberland Initiative, a major driver for innovation in healthcare that promises to improve patient care and cost effectiveness while spawning a new wealth-creating UK industry Can we build a healthier, wealthier UK by exploring new models of care that efﬁciently deliver better health outcomes? Can we then use the expertise and knowledge springing from this investment to stimulate a new health industry that feeds exports and other sectors of the economy?

foot. Economically, our ambition is to transform healthcare from sitting predominantly on the cost side of the national purse into a place of innovation, employment opportunity and wealth creation. In short, we are looking for a revolution in the way people think on a day-today basis about healthcare delivery.

These are key challenges being tackled by the Cumberland Initiative. It’s a network of communities – healthcare, business and academic experts. We’ve come together to engineer a predictive NHS – one that anticipates, plans and acts effectively – rather than one that ﬁnds itself, too often, on the back

We all know that current models of care are unsustainable. We are applying systems thinking, engineering design, operational research, management science, and statistics to prove what can be done towards developing a more agile and efﬁcient service in health and social care. This would be a world

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Brunel University where unwarranted variation is reduced, the needs and experience of the patients are centre stage, and where the most effective and efficient processes are ubiquitous. It would also be a world in which information comes more directly from knowledge systems, based on evidence and including simulation and risk management. Information would be used more proactively – to predict demand, to drive process and to make ready the resources. This is not a fanciful vision. In other sectors, the knowledge economy, including process management, data and process modelling, data warehouses and the application of advanced analytics has played a major role for decades. It employs millions of people in high-value jobs. The forces driving this change have included the profit motive, the need for increased agility, pressures from regulators and an increasing focus on environmental impact. We seek to add better and more efficient patient care to this list of motives. Part of the challenge is that health and social care in most developed countries are delivered in the context of even larger systems than exist in other economic sectors. Even the healthcare system needs to be considered as a “system of systems”, where the goal is reached by the complex orchestration of many parts in the interest of better patient care. That orchestration has proved difficult, not surprisingly given not only the many NHS players, but also the many other players that are completely beyond the influence of the NHS. The Cumberland Initiative aims to contribute through: • Capacity building: working with trusts to embed these skills through the NHS. • Establishing evidence: building an evidence framework around delivery and helping all communities – from patients to clinicians – to contribute to the evidence base. • A systems understanding: developing a culture where the systemic impact of decisions is readily understood, where expertise and tools are accessible (see above). • Risk-management: developing a culture that addresses risk prospectively at all levels and in all decision. • Information: embedding all of these in smart infrastructure that informs and drives process in line with clinical need. • Service, systems and product

development: commercial innovations to create wealth within healthcare and spin out into other sectors and stimulate the economy To make this viable, the Cumberland Initiative has received an offer from UK developer SEGRO of a property to establish a national centre, close to London, along the M4, with access to Heathrow and excellent rail links in all directions. The centre, a huge warehouse with a sandpit environment for testing out healthcare processes at scale, will address the critical issues of care delivery. We envisage it as being the forum for a series of “grand challenges”. Key players – clinical staff, managers, policy makers, academics and industry experts - would be brought together for extended periods to work together and test, with the appropriate data, analytical tools and models, how to resolve major issues such as, for example, problems around unscheduled care. We hope that the national centre will take its place alongside similar centres around the world – Kaiser Permanente’s Garﬁeld Center, for example – providing space for healthcare to work closely with industry and with academics. We see it as a place where best practice can be captured to share and have real impact. The creation by the government of more than a dozen Academic Health Science Networks (AHSNs), devoted to innovation in planning and delivery of healthcare, provides us with the perfect partners to root our work in the real life and dilemmas of the NHS. We are already heavily involved with two AHSN’s, Oxford and Kent, which have provided some support and funding. We hope that engagement will spread throughout the network as all the AHSN’s establish themselves during 2013 and seek a forum, technology and data sets within which to test new ideas and tackle new challenges. We are encouraged by Sir David Nicholson, the NHS Chief Executive, who has urged us to make ourselves indispensable to the AHSNs. The centre will also provide a national point of referral, reference, fellowships and education. As an example, those wanting to know the best complete solution for A&E, will have access to models, data to populate and validate them, process speciﬁcations, infrastructure and equipment requirements, and so on. The centre will gather best practice and make it available throughout the UK.

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Brunel University Finally, no change embeds fully without education and the centre will provide training and core education elements to complement the AHSNs’ staff colleges. We already have major input from companies such as BT and IBM and many smaller firms. Our analysis of the sector shows a gap in the UK profile between the smallest of the global giants and the largest of the SMEs. We are working with Intellect UK, the trade association for the technology industry, to stimulate growth through innovation and to fill out the UK’s health profile. Meanwhile, existing companies recognise the role that their industries might play in the information capture, knowledge management, modelling and simulation that is required to make our ambition a reality. With its wider network, especially of academic groups, the Cumberland Initiative has the reach across the UK to put people on the ground with trusts for implementation, research

and codifying best practice. It also ensures that there is always support close to industrial partners. Once operational, it is envisaged that the centre will benefit from a productive flow of experts and those seeking to learn from around the world. As industry spins out products, systems and services, a new health sector will be formed that turns the special needs of healthcare into solutions that will sell in other markets and countries. Senior academics from some 15 universities, chiefly with expertise in modelling, simulation and healthcare management, have for three years been meeting regularly around the country to develop the Cumberland Initiative. It will serve as a shop window for the best that the UK has to offer in healthcare services, systems and products. Our stand at this show has been sponsored by nearly 20 organisations and represents a mix of health, industry and academia.

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1913

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

1922

Insulin ﬁrst used to treat diabetes.

1923

First vaccine for diphtheria.

1928

1921

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

1926

First vaccine for pertussis (whooping cough).

1927

First vaccine for tuberculosis. First vaccine for tetanus.

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

1935

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

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1937

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

1943

1945

First vaccine for inﬂuenza.

1952 1953

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

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

1954

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

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

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Cultural revolution Sarah Wrixon,, managing director, Salix Consulting, examines the importance of effective communication in the new NHS

GPs fought long and hard to have the right to develop and commission services on behalf of their patients and, after nearly three years of prolonged and savage debate, clinical commissioning groups (CCGs) took full responsibility for public health services in England in April. The NHS has spun on its axis. Our health service will now be shaped by those at the frontline, working closely with their communities, to improve the health and wellbeing of people within their locality, encouraging and enabling them to look after and manage their health and helping them get better when they are ill. The vision is simple, but as the recent report by Robert Francis QC into the appalling care failings at mid-Staffordshire shows, a service as

all-encompassing as the NHS can’t afford to be complacent. Post Francis, we should demand – and expect – great care that comes from motivated, frontline staff with good training and humane working conditions, who listen to patients and aren’t afraid to speak up when they spot a problem. And it is precisely this cultural, bottom-up revolution that CCGs could achieve through a new model, which is clinically-led and patient-centred, and should encourage peer-to-peer accountability in an open and non-threatening environment – an environment where pro-active and effectively implemented communications have never been more important. If patients are to be at the heart of healthcare and motivated staff at the heart of delivering that care, everything comes back to their views and opinions.

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It is this common thread that runs through our work with both commissioners and providers. Engagement with health professionals, patients, carers, the general public, communities of interest and geography, health and wellbeing boards, and local authorities are starting points whether for a large CCG or for a provider of infomatics, telehealth or pathology services. Once we have gathered a broad range of views, we use them to inform our communications strategy. So, from a commissioning perspective, it should be evident how the views of the individual patients translate into commissioning decisions and how the voice of each practice population will be sought and acted on. From a provider perspective, it should be evident that the commissioners’ requirements are fully understood and embraced. Our work with NHS Alliance, an influential, thought-leading organisation representing general practice and providers of services in primary care, gives valuable insight into the requirements and mindsets of the GPs, practice nurses and practice managers that make up, and influence, CCGs. Walking into a general practice with a product and three key messages isn’t going to work anymore. Hard-pressed GPs and their teams, who are increasingly being asked to do more with less, are much more interested in pragmatic solutions that will improve their professional lives and the lives of their patients. In our experience, a strategic partnership approach, supported by appropriate media work, is the most effective form of engagement with commissioners and purchasers. It works best when linked to CCG performance expectations, for example around the management of long-term conditions. The most significant political and financial driver for CCGs is to move services away from the expensive hospital setting to the community. This is where partnership opportunities arise. The new NHS is all about localism and one size won’t fit all. Providers, whether of medicines or services,

independent or third sector, who work with CCGs to truly understand their communities are creating a valuable starting point for co-production. Communications are likely to get very granular: schools, religious centres, knit and natter groups, even the local hairdresser provide invaluable insight and interactive messaging platforms that will help CCGs and their partners support an NHS that is sustainable for patients and providers alike. How NHS reforms influence communications Broad-brush PR strategies are now less effective than strategies that are far more granular in their media approach and include direct engagement with key stakeholders. An approach that includes personal advocacy and peer power and harnesses community assets is more relevant in the new, locally-led commissioning world than national, multi-million pound “do” and “don’t do” campaigns. It’s important to work with a communications provider that is well placed to understand the nuances of the NHS and its points of vulnerability, and how to support those by appropriate and careful partnership work. A new communications approach in action Telehealth is a key technology of the future with the power to transform the lives of people living with long-term conditions by helping them understand and manage their conditions at home. When Appello, a new-wave provider of end-to-end, nurse-led telehealth services, wanted to establish a market presence, we worked with it to launch a national Telehealth Forum to understand the needs of both patients and commissioners. This brings together health professionals, commissioners, a number of leading patient groups like the British Lung Foundation, British Heart Foundation, Diabetes UK, and the National Association for Patient Participation with policy makers to develop an educational programme that is helping more people understand the benefits of telehealth as a help to patients and clinicians alike.

Salix Consulting provides strategic communications for public and independent sector organisations in the health, education and social sectors. Visit: www.salixconsulting.com

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1955

Jonas Salk develops the ﬁrst polio vaccination.

1957 1962

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

1964 1967

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

First vaccine for measles.

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

1970 1974

First vaccine for chicken pox.

1977 1978

First vaccine for rubella.

First vaccine for pneumonia.

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

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1980

World Health Organization announces smallpox is eradicated.

1981

1982

1983

1996

2007

First vaccine for hepatitis B.

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

HIV, the virus that causes AIDS, is identiﬁed.

1992

First vaccine for hepatitis A.

1998

First vaccine for lyme disease.

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

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

Advances in Innovation in Healthcare. The future is in development

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CloserStill

A full body of knowledge Hospital doctors are amongst the most important decision-makers in hospital medicine. But they are also, notoriously, amongst the hardest to reach, particularly those involved in acute and general medicine. And now, with hospital doctors faced with unprecedented demands on their time, it is even harder to get face-to-face with the decision makers at the sharp end of secondary care

Introducing That’s where AGM comes in: a new approach to medical training that’s emphatically cost and time efficient for doctors. AGM: Not the traditional conference Acute and General Medicine (AGM) 27-28th November 2013, London Excel Brought to you by a team that has had dramatic success in bringing clinical decision-makers and suppliers together in cutting edge medical events, Acute and General Medicine 2013 is a comprehensive event specifically constructed around the new realities of hospital medicine and secondary care. You don’t need us to tell you that the inexorable rise in patient expectations coupled with the downward pressure on budgets and an aging population all combine to create unprecedented demands on hospitals. And just when medics need support to help them meet the new challenges, training budgets and study leave are being severely squeezed.

AGM is not a typical, over-priced, didactic conference, in which weary delegates get locked into endless lectures. Our programme allows doctors to follow their learning needs across the medical specialties with pacey, interactive seminars, uniquely offering knowledge AND skills training in acute AND general medicine. An “all you can eat” modular format, allows delegates to customise their own programme ensuring they have time for networking as well as learning. Neither is AGM a typical exhibition with endless rows of “me too” products and second rate content. AGM IS a new type of event, part compelling conference, part essential CPD training, part intimate networking event with a strictly limited number of sponsors and exhibitors to ensure high quality interactions between delegates and commercial participants.

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CloserStill

Capturing the moment Hospitals are under budgetary pressure. Doctors are under time pressure. The entire secondary care sector is under pressure to deliver better outcomes at lower cost. All of this means that both the budget to fund training, and the time available to clinicians to do it, are at a premium.

The AGM 2013 programme has been designed to appeal to all senior grades of physician — from core medical trainees to consultants — making it one of the few events they can jointly attend to learn and be inspired together. Medics can gain 12 CPD points accredited by the Royal college of Physicians.

That’s why AGM offers two days of the highest quality training, with 11 points of CPD accredited by the Royal College of Physicians, delivered by leading experts across the medical specialties for practically nothing. With delegates who book early paying less than £100 — dramatically less than every other serious clinical training conference where prices for delegates can often be as much as £500.

The programme will offer 80 insightful seminars on both acute and general medicine — covering the major medical specialties including:

It’s a ground-breaking model that guarantees an unusually large physician audience offering both cost and time efficiency to hardpressed doctors. Help! Please An in-depth survey with close to 200 consultants revealed a community of senior physicians keen for acute and general internal medicine training. Key facts •

• •

88% of physicians said gaining CPD accreditation in general internal medicine is “important”. 43% of those physicians said it’s “difficult” to keep up-to-date in acute and general medicine. 94% told us they would attend a low cost, two-day event in acute and general medicine offering 10+ CPD points.

We’ve joined together with a number of leading organisations and companies including The Royal Society of Medicine, Royal College of Medicine and Bayer to create a compelling event for medics and those that support them.

• • • • • • • • •

cardiology; diabetes and endocrinology; gastroenterology; nephrology; neurology; rheumatology; respiratory medicine; Medical essentials; Hot topics

The acute medicine talks will provide delegates with up-to-the-minute guidance and protocols. The general medicine seminars will cover the latest advances, evidence and practice in general medicine. Delegates can book online at www.agmconference.co.uk An event for all the team AGM will be located alongside Hospital Directions, a practical, hands-on learning event, responding to changes in the way the NHS commissions and delivers services. The event will offer senior secondary care managers best practice advice and real world solutions through seminars and workshop sessions, plus a tightly focussed exhibition space featuring some of the most innovative suppliers to the sector. For more information visit www.hospitaldirections.co.uk

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“

AGM breaks the mould — no event combines acute and general medicine training, no event offers knowledge and skills training under one roof, no one has designed a comprehensive package of post-event learning for its delegates and no event is offering all this for practically nothing

Hospital Directions 2013 Hospital Directions is a practical, hands-on learning event, responding to changes in the way the NHS commissions and delivers services. The NHS is operating under a massive challenge to deliver savings of £20bn by 2015, at the same time as implementing 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 real-terms cut to funding. The event will offer senior secondary care managers best practice advice and real world solutions through seminars and workshop sessions, plus a tightly focussed exhibition space featuring some of the most innovative suppliers to the sector. Hospital Directions will be held at London Excel on the 27-28th November. It will run alongside Acute and General Medicine, giving exhibitors the opportunity to engage all the major decision makers in secondary care at a single event.

“

Mike Broad, editor, hospital Dr and AGM programme director

penny counts. Every trust in the UK will be able to send up to ten 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 high quality training, who can turn down the opportunity for a master class in NHS management at affordable prices? For more information visit: www.hospitaldirections.co.uk

This event rejects traditional conference models with irrelevant blue sky thinking and embraces the current climate, where every minute and every

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Making Britain healthier and wealthier The Cumberland Initiative is building a healthier, wealthier UK by exploring new models of care which efficiently deliver better health outcomes. We are a not-for-profit organisation, seeking to update the NHS and stimulate a new UK industry delivering smarter process management in healthcare. We aiM to:

We are:

• SAVE the NHS 20% in costs

• SuppORtInG a new knowledge economy in health care

• DELIVER 20% more • GROW GDP by £20Bn in a strong health sector

SPoNSorS:

• DEVELOpInG a predictive, instead of a reactive, NHS • BuILDInG a national centre as a laboratory for models of care • CREAtInG a network of thought leaders in healthcare, industry, and academia • BACkED by NHS organisations, more than 15 universities, industry and clinicians.

For FUrtHer iNForMatioN PLeaSe CoNtaCt: professor terry Young | terry.Young@brunel.ac.uk or Elizabeth Deadman | Elizabeth.Deadman@brunel.ac.uk

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A PROVEN CURE FOR YOUR COMMISSIONING SUPPORT HEADACHE TAILORED SERVICES, PROFESSIONAL SOLUTIONS NHS South Commissioning Support Unit oﬀers a full range of commissioning support services to Clinical Commissioning Groups and NHS England across Southern England in support of around 10 million people. Our collaborative approach ensures close working relationships, tailored support and a focus on innovation.

Call Mark Smith on 023 8062 5795 / 07733 326016 or email mark.smith@southcsu.nhs.uk www.southcsu.nhs.uk

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