Summary slide from the Cheshire and Wirral Best Practice Event, 8 November

1. Cheshire & Wirral Best Practice Event
A Summary of Key Learnings captured from
Round Tables.
Quick wins and early adoption

2. Introduction
• Very successful event held at Cheshire
View Conference Centre
• 109 Registered with 92 attending on
the day
• Excellent contributions from
everyone especially Local Authorities
• A Wide range of different types of
topics discussed.
• Relevant and interesting speakers
– Innovation Agency
– Care Home Support
– Over Diagnosis
– Integrated Care Teams
– Model Hospital
– Health and Social care Integration
– Lesson learnt (AQUA)
– Nursing associate roles

3. Quick Wins (Available Now)
1. Web-based applications for the self management of chronic obstructive
pulmonary disease. Based on an average CCG with 5000 patient with COPD
and 25% reduction in exacerbations and hospital admissions: In year savings
of >£200k Cost £20 per patient. For each period of activity, providers must
report back on a minimal data set
2. Prostatic hyperplasia as a day case. Alternative to transurethral resection
of prostate (80 min op under GA, 2-3 day LOS). No cutting, heating or
removing of prostate tissue. (<30 min day case under local anaesthetic or light
sedation)
3. AHSN Network, Working to reduce AF related strokes. Supporting spread
of NICE approved technology to improve pathways
For further information contact DR Liz Mear or Dr Phil Jennings 01772 520263

4. Table 1 (Over diagnosis)
Key Themes
• Conflicting agendas of needing to comply with guidance/rules/regulations vs sitting
down with patients and families and taking a much more holistic patients centred
approach
• Applies equally across all sectors
• Doing more for patients is not always better
• Doing less more accurately produces better outcomes
• Trust with a different doctor patient relationship
Key Messages / Actions
• Time for more informed consultations
• Training needed in `patient centred care` and shared care decision making
• Clinical approach should add value to the conversation not dictate the outcome
• Informed patients, knowing all elements of risk make better outcomes
• Key element in tackling unwarranted variation

5. Table 2 (Integrated Teams)
Key Themes
• Catalyst for change was the prospectus that went beyond a single organisation
• Governance is critical especially in breaking down the silos between
Acute/Community and Primary care
• Specification is very different and focus on outcomes as per QOFF and a series of ‘I’
statements
• Work with the collation of the willing
• Signal GP Alliance approach has been a significant enabler
Key Messages / Actions
• Don’t underestimate the amount of engagement needed
• Delegation / Trust and allow teams to develop solutions
• Shared financial risk within the context of the capped expenditure programme
• Positive impact on staff / patients with reduced incidents and complaints
• Collaboration not competition

6. Table 3 (Social Care Integration)
Key Themes
• Had to have buy in from senior leaders of all parties
• Hearts and minds with a change of culture of us and them to colleagues and shared
working even if the ways are different
• Colocation of teams reaped bigger rewards than expected
• Give people permission to work together
• Joined up strategic intent
Key Messages / Actions
• Concerns about social care staff transferring to NHS acknowledged but have been
alleviated by open and transparent welcome and approach
• Agreed governance with clear accountability of staff and budgets
• Due diligence and risk assessments took long time especially with regulators
• There are differences but there is more in common so focus on these first
• We would do it again

7. Table 4 (Nurse Associate – New role)
Key Themes
• Innovation is linked with the Carter ‘Stable’ but this is not the only reason for
developing this role
• This role may be seen as being similar to the ‘state enrolled nurse’ of the past but it
would be mistake to not see the opportunities that this role brings
• Added benefit for this role is to be the voice of patients/clients
• This role is not about cost reduction or shifting work rather building capacity
• The right culture is essential in having conditions to make this role work.
Key Messages / Actions
• Trust between Staff and Nursing Associates is very important
• First hand experience of two colleagues was inspirational
• Colleagues asked if this could be written up and shared so as to be more visible across
the system, this being with the intent of adopting as best practice
• Links will be made with Skills for Health and Care
• Links with signs of safety work of local authorities