Ann Wagner

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Seminar D Connecting technology, workforce and
improvement in a patient led NHS

• Maggie Morgan-Cooke West Midlands South SHA

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Connecting Technology, Workforce Improvement to
achieve a Patient Led NHS
ISIP
6 Sept 2005
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Connecting Technology, Workforce Improvement to
achieve a Patient Led NHS
ISIP
6 Sept 2005
Maggie Morgan Cooke Head of Improvement West
Midlands South Strategic Health Authority Email
maggie.morgan-cooke_at_wmsha.nhs.uk
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The ISIP Value Proposition

• The primary benefit of service improvement is to
  bring about real benefits to patients, largely
  delivered through clinicians.
• ISIP will facilitate a richer conversation, both
  within LHCs and between the local NHS and the
  centre, about how local NHS will practically
  deliver service improvement, and how the
  portfolio of national people, process and
  technology solutions could be better designed and
  co-ordinated in support of local delivery, within
  the context of the system reform agenda.

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• To the local NHS, ISIP will offer
• A single language and currency for benefits
  realisation and change, focused on patients
  rather than organisations
• A definitive, and increasingly evidence-based,
  source of guidance on how national solutions can
  be exploited to deliver benefits to patients and
  clinicians and achieve service improvement goals
• A transparent and inclusive means of aligning
  and, as necessary, integrating existing and
  planned change projects (people, process,
  technology) in order to achieve LHC goals
• A forum for planning and implementation of
  redesigned care delivery systems and pathways
  within an LHC, leveraging both modernisation,
  workforce and IMT solutions AND system reform
• An evidence-based means of planning qualitatively
  and proactively how to meet commitments contained
  in Local Delivery Plans for 2005-2008 and
  providing early warning of inability to deliver
• A managed network through which good practice and
  lessons learnt from successes and failures can be
  shared.

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Care Delivery System
INDICATORS OF IMPROVE- MENT
ENABLING INFRA-STRUCTURECHANGES
SYSTEM CHARACT-ERISTICS
CARE DELIVERY SYSTEM
STRATEGICGOALS
CATALYTIC REFORMS
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The Front Line Perspective

• A snowstorm of initiatives
• Links between projects not explained nor
  understood
• Difficulty to plan and prioritise resources
• Added bureaucracy to track and performance manage
  benefits realisation
• Silo working by local implementation teams

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Background

• Gershon Efficiency Review
• 20bn per annum across Public Sector by 07/08
• 6.5bn per annum in healthcare
• Approx 2.7 annual saving

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Productive Time

• Is about making better use of staff time
• Not about working harder
• Is about working smarter
• More time on where is matters
• Maximising service improvement by aligning key
  enablers of Process, People and Technology value
  2.9bn

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Integrated Service Improvement Delivery
Architecture
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One Local Health Community Example
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Integrated Service Improvement Programme

• South West Peninsula
• 6 September 2005

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South West Peninsula

• Plymouth LHC
• 1 Acute Trust, 2 PCTs, 1 Ambulance Trust, 2
  Mental Health Trusts
• Well established LHC infrastructure, with an
  existing series of service improvement plans

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South West Peninsula

• South Devon LHC
• 1 Acute Trust, 2 PCTs, 1 Ambulance Trust, 1
  Mental Health Trust
• History of working together, with good
  relationships between members

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ISIP SWP perspective

• Planning tool to secure service improvement
  benefits
• Moves away from silo mentality
• Brings together major initiatives (C4H, AfC,
  Consultant/GP contracts) and links to LHC
  objectives

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ISIP - Benefits

• Device to link desired outcomes with plans to
  achieve them
• Good Communication tool if given sufficient local
  flavour
• Clear link between effort and outcome

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Process

• Create team ISIP champion plus representatives
  from members
• Engage senior people done one-to-one. Buy-in
  secured.
• Systematic process for developing plans -
  wide-narrow
• Best endeavours not perfection

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ISIP Bear traps

• NOW
• Definition of community
• Too strategic vs. too local
• LATER
• Making it useful
• How is it followed through?
• Link to LDP

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Supporting Care Pathways Project - Plymouth

• Improve PHT administration systems to
• Provide a better service for patients
• Be easier for others to deal with
• More efficient processes
• Reduced error rate
• Engaging with
• PHT staff
• Patients
• PCT PECs
• Technology

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Stroke Care South Devon

• Improve response to stroke
• Provide a better patient journey
• Treatment closer to home
• Work with community services
• Engaging with
• PHT staff
• Patients
• PCT staff
• Community
• Ambulance staff

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Plymouth HC as a pilot

• Request for projects to test Benefits Realisation
  Planning
• Supporting Care Pathways project
• Plymouth Area Redesign Board
• Vanguard Project

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Project team

• Chris Hoult - ED lead
• Nick Cheshire - PARB support manager
• Richard Towers - Field Test co-ordinator
• Louise Sturgess - Vanguard planner
• John Harrison - Plymouth PCT
• Paula Bland - NEC PCT
• Carolyn Price - SHWDPCT
• Sam Sheridan - SCP Project manager

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Engaging the community

• Annual Leave period!
• Early August - CH/SS/RT what is it??
• Mid August - CH/RT Brief C. Executives
• 17 August - Project team meets
• 24 August - 1st Draft circulated
• 27 August Project team meets
• 31 August Pilot Draft finalised

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LHC Care Delivery System
Priority Objectives
Patient seen at right time/place by right person
Principle 1 Reducing health inequalities across
populations
Principle 2 Interventions to support individual
wellbeing
Principle 3 Care provision in the right setting
Reduce/avoid hospital admission and reduce LOS
Principle 5 Timely, convenient and responsive
care
Principle 4 Appropriate access and choice for all
Principle 6 High quality clinical outcomes,
safety and governance
Deliver healing therapeutic environment
Financial Balance
Principle 8 Services structured and delivered
efficiently
Principle 7 Individual staff supported, engaged
and rewarded
Principle 9 Financial balance across local
health economy
Unscheduled Care
Integrated Change Programmes
Long Term Conditions
Diagnostics
Elective Care Management
Patient led Services
Standards for better Health
Reduced Waiting Times
Financial Balance
HIC System Reform
Connecting for Health Programme
Capital Investment PFIs
Workforce reform
Drivers / Challenges
Enablers
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Organisational (LHC) Outcomes   Shift of
activity from an acute to a community setting
with services provided by both primary and
secondary care (including mobile
solutions)   Community support packages for
long term conditions        Expansion of RITA
re-ablement teams        Patient centred care
pathways        GP direct booking electronic
access to diagnostics        Patient
environment differs dependant on their
needs        More patients will be treated as
day cases and all patients will be admitted on
the day of surgery   Dedicated acute childrens
facilities        Integrated GP and social
services assessment and treatment based in
AE        Increased access to rehabilitation
programmes delivered by multidisciplinary
teams   Improved internal environment of
healthcare premises through colour, art and good
design (including ensuite single rooms, more
space per bed/patient)   Attractive external
environment with patient/public/staff
amenities        Lower hospital acquired
infection rates        Increased private sector
contracts        Clinicians provided with
contemporary information when it is required and
in an appropriate format
LHC PARB Workstreams   Principle C1 Unscheduled
Care C2 Long Term Conditions   C3 Diagnostics  
C4 Elective Care Management   Supporting C5 Clin
ical effectiveness and medicines
management   C6 Cancer   C7 Workforce   C8 Integra
ted Service Improvement Planning
(ISIP)   C9 Choose and Book
Priority Objective P1 Patient seen in the
right place at the right time by the right person
(localism)   P2 Reduce /avoid hospital
admissions and reduce lengths of stay
  P3 Deliver a healing and therapeutic
environment within the resources available to the
LHC   P4 All organisations to achieve financial
balance
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Timetable - September

• LHC Strategy
• 6 September - SHA workshop
• 8 September - Project team meeting
• 16 September - PARB sign-off
• 30 September - Submit plan to SHA
• Pilot Project
• 30 September - Benefits realisation plan

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