Next, the finalists for transformation programme of the year!
NHS England
Overview: NHS England established the South East Annual Check and Health Action Plan Working Group to increase uptake and improve quality of annual health checks for people with a learning disability.
Why? In previous years, with pandemic complications, annual health checks for people with a learning disability didn’t reach the expected levels; the end-of-year position for 2021/22 saw the number reach 68.5 percent of the locally set ambition for the South East.
What happened? The South East Regional Annual Health Check and Health Action Plan Working Group was established in early May 2022, working in close collaboration with the overarching regional Health Inequalities Steering Group. The group has representation from all ICBs who are fully engaged in the programme of work required to drive change; the first piece of work undertaken followed a national funding bid centred around people who didn’t have an annual health check in 20/21 with the aim of raising awareness, educating, empowering and signposting towards checks. Within the first three months, 1,632 people had their check or booked an appointment and the South East is not on track to achieve the 75 percent NHS England national target.
Looking ahead. The implementation of the group supports ICBs in scoping their current positions, acting as an enabler to identifying more effective ways of working that capture data as well as improving communications with PCNs, clinical champions, GPs and community services. A number of ICBs are now in a position to stretch beyond the 75 percent target.
Nottingham and Nottinghamshire ICB
Overview. Nottingham and Nottinghamshire ICB has established the Community Care Transformation Programme (CCTP) to plan for and deliver a future sustainable model of community care provision, to optimise people’s independence by addressing physical, mental and social needs.
Why? At the time of the CCTP’s launch, many community health services were delivered as standalone services; standardised delivery models across the ICB footprint didn’t reflect demographic needs; there was limited integration; commissioned services tended to give limited consideration of the wider determinants of health; the current workforce were at their limits; and the workforce identified more with their employing organisation than with their geographical area.
What happened? The CCTP aimed to address these issues, developing an approach focused on alignment of health and social care resources and workforce in order to implement place-based community teams. The programme is driven by population health data, with personal and community assets fully utilised and developed to support outcomes. An organisational development approach for all community care staff has been developed irrespective of employing organisation and role, and a transparent approach adopted across commissioners and providers to ensure that best value for money is delivered. The programme has engaged with nearly 200 stakeholders to date, identifying ‘what good looks like’ themes. The subsequent service redesign takes place using 100-day transformation cycles, with multiple cycles completed by early 2023 across five early adopter sites.
Looking ahead. The aim is to continue to spread this methodology across the entire ICS to have a far-reaching impact through better planning, integration and communication.
Gloucestershire Hospitals NHS Trust
Overview. Organisations across Gloucestershire ICS have created a patient flow dashboard which allows all partners to see to the current number of patients awaiting discharge from each organisation, enabling faster discharges, improved flow and significantly improved partnership working.
Why? With a build-up of pressures leading to ambulance handover delays and longstanding delays to discharge, organisations across the ICS needed to find quick and simple solutions to help staff work together and do their best for patients. Managing system flow was becoming increasingly difficult as pressures grew, with providers working in siloes and no joined-up approach in place.
What happened? The trust looked at in-house expertise to develop a digital solution to assist in handling these challenges. As all organisations held row-level patient data, it was deemed feasible to join datasets from all partners into one central, secure repository. Data is represented in an interactive tableau dashboard with controlled access, bringing in data from a number sources into one simple view, from any secure device. The information is live, allowing partners to monitor and track patient movement across the sector. The solution provides oversight of patients, leads to improved data quality, supports clinical and operational communication across the ICS and identifies patients who are not designated to a pathway and reduces the risk of them becoming ‘stranded’. It reduces time spent procuring information for clinical teams, supports collaborative working and assists in monitoring demand and capacity across discharge pathways.
Looking ahead. Monitoring demand and capacity will help to inform commissioning of services to meet population needs, and over time the data will provide trend analysis to support predictive modelling of system flow requirements.
South West London Local Pharmaceutical Committees and South West London ICB
Overview. South West London ICB worked with local pharmaceutical committees to develop a model for successful healthcare collaboration and social prescribing through WinterFit MECC (Making Every Contact Count), highlighting the impact that community pharmacy can have on public health.
Why? WinterFit MECC sought to engage and support patients over 65 in South West London during the winter months, addressing key topics such as winter warmth, prevention of falls, care in the home, cost of living, connectedness and social prescribing.
What happened? The approach focused on empowering community pharmacy teams, enabling them to initiate 15-minute conversations with older individuals without the delays caused by external referrals. Pharmacy teams were provided with the necessary training, resources and support in order to facilitate a quick and efficient deployment across the region. WinterFit MECC has seen over 10,000 interventions delivered by 70 pharmacies in just over four weeks. They attribute this largely to the strong collaboration between the ICB, Dr. Heffernan, Amit Patel, the Local Pharmaceutical Committees, and the participating pharmacy teams; they worked together to identify local population needs, developed the intervention framework, and provided ongoing support with regular communication and feedback.
Looking ahead. The intervention is scalable and adaptable, easily replicable in other regions and settings. The team believes that the model can be extended to address other public health issues. Future plans include expanding the intervention to additional locations and exploring new areas in which community pharmacy teams can make an impact on public health.
