NHS                                                     NHS ImprovementCANCER   DIAGNOSTICS   HEART   LUNG   STROKENHS Imp...
CANCERDIAGNOSTICSHEARTLUNGSTROKE
03The best of clinical pathway redesign - Practicalexamples delivering benefits to patientsCONTENTS04   Foreword05   About...
04FOREWORDInnovation has always been important in        It is critical that we continue to innovatethe NHS – new ideas, l...
05ABOUT USNHS Improvement’s strength and expertiselies in practical service improvement. It has                           ...
06THE APPROACH: NHSIMPROVEMENT FRAMEWORKFOR SERVICE IMPROVEMENT                           What                   What & Ho...
082010-11ACHIEVEMENTS Working with health sector partners over the past year NHS Improvement has helped to deliver a numbe...
09£1.8m                          £5.9m                             Overcould be saved                 per year could be sa...
10HELPING TO DELIVERQUALITY AND PRODUCTIVITYIMPROVEMENTS AND SHARINGTHE LEARNINGNHS Improvement’s tools and techniques,   ...
11Sharing the learningNHS Improvement has captured the latestlearning and innovative thinking on a rangeof healthcare topi...
12IMPROVINGCANCER CARENHS improvement - Cancer’s work has             • Specific emergency pathways work is            Pri...
13IMPROVINGDIAGNOSTICSIn areas such as cytology, pathology andradiology, NHS Improvement has beenworking with teams nation...
14IMPROVINGDIAGNOSTICS -AUDIOLOGYNHS Improvement has worked inpartnership with the Department of HealthNational Audiology ...
15IMPROVINGHEART CAREHeart disease is still the second biggestcause of death in England despite hugeprogress and reduction...
16IMPROVINGRESPIRATORYCAREAs one of NHS Improvement’s newerprogrammes, 2010 saw completion of NHSImprovement – Lung’s firs...
17IMPROVINGSTROKE CAREThe role of NHS Improvement - Stroke wasset out very clearly in the National StrokeStrategy (2007) a...
18THEEXTERNALASSESSORPERSPECTIVENHS Improvement was formed as a result of      Diagnostics work programmes. It also       ...
19The great advantage of the PerformanceSystem is that it is integrated with the NHSImprovement System and website, provid...
20How NHS Improvement has                         As a result of Tribal’s review, NHS            In response, it has revam...
21THESTAFFPERSPECTIVEIn 2008, an initial staff survey was carriedout to assess their views on life in theworkplace, what s...
22According to a review of staff survey resultsacross the NHS for 2009 produced by theCare Quality Commission (CQC) , 58% ...
24THESTAKEHOLDERPERSPECTIVENHS Improvement’s work can only be               These results were broadly in line with other ...
25Elsewhere, there has been support for NHSImprovement’s work in an Ipsos MORIreview of the Coronary Heart DiseaseNational...
26CANCER                      IMPROVEMENT                                                  Providing long term follow-up f...
27CANCERCASE STUDY                                                                                     DOMAIN 5:          ...
28CANCER                      IMPROVEMENTTransforming Inpatient Care: Driving improvements inquality that values patients’...
29                                                 Enhanced Recovery Partnership                                          ...
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
The best of clinical pathway redesign - practical examples of delivering benefits to patients
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The best of clinical pathway redesign - practical examples of delivering benefits to patients

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The examples here showcase just some of the innovations that have enabled thousands of patients to enjoy better health and well-being thanks to practicalservice improvements implemented on various clinical pathways

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The best of clinical pathway redesign - practical examples of delivering benefits to patients

  1. 1. NHS NHS ImprovementCANCER DIAGNOSTICS HEART LUNG STROKENHS ImprovementThe best of clinical pathway redesignPractical examples delivering benefits to patients
  2. 2. CANCERDIAGNOSTICSHEARTLUNGSTROKE
  3. 3. 03The best of clinical pathway redesign - Practicalexamples delivering benefits to patientsCONTENTS04 Foreword05 About us06 The approach: NHS Improvement Framework for Service Improvement08 2010-11 achievements10 Helping to deliver quality and productivity improvements and sharing the learning18 The external assessor perspective21 The staff perspective24 The stakeholder perspective26 Best practice case studies26 • Cancer34 • Diagnostics39 Audiology44 • Heart52 • Lung58 • Stroke www.improvement.nhs.uk
  4. 4. 04FOREWORDInnovation has always been important in It is critical that we continue to innovatethe NHS – new ideas, listening and for our patients as we design the healthlearning from each other and and care system of the future, ensuringimplementing what works best are at the we improve the quality of care for ourheart of many of the major steps forward patients, while making historic levels ofwe have made for our patients over the financial savings to reinvest in frontlineyears. services. NHS Improvement working with and through clinical networks has beenThe examples here showcase just some of proven as an effective and productivethe innovations that have enabled model and it ensures that positivethousands of patients to enjoy better learning is spread more widely acrosshealth and well-being thanks to practical the system.service improvements implemented onvarious clinical pathways. As we move forward, we will strengthen and widen clinical involvement inI urge each of you to read this report. commissioning decisions. To helpSome of its practical examples of service facilitate this I have asked Sir Bruceimprovement have also been endorsed by Keogh, who leads the NHS MedicalNICE as best practice examples on the Directorate, to work with the national Sir David Nicholson KCB CBE,NHS Evidence website and I would like clinical directors to begin longer term Chief Executive of the NHS in Englandyou to ask yourselves whether you could work to strengthen our multi-disciplinarytake the learning here and replicate some networks and engage with the networksof these achievements within your own to understand how best to improveorganisations. outcomes for patients. There is a central role for networks in the new system asWhether you are based in a local hospital, the place where clinicians from differentGP practice, consortia or PCT cluster, sectors come together to improve thestrategic health authority, clinical network quality of care across integratedor within a community based setting pathways.working with social care partners, thereare initiatives here that could help you While these examples demonstratedeliver your own quality and productivity innovative solutions to major healthchallenges. In addition, there are 200 challenges such as cancer, heart disease,more QIPP case studies on NHS stroke and chronic respiratory conditions,Improvement’s website that provide there is no reason why theseadditional practical examples of improvements could not be applied toimplementation for health organisations other areas. That is why it is essential tothroughout England. continue the good work delivered by NHS Improvement, the NHS and its partners – we must take this opportunity to achieve the best outcomes for our patients.www.improvement.nhs.uk
  5. 5. 05ABOUT USNHS Improvement’s strength and expertiselies in practical service improvement. It has • NHS Improvement was formed inover a decade of experience in clinical April 2008, bringing together twopatient pathway redesign in cancer, existing national improvementdiagnostics, heart, lung and stroke services. programmes – the CancerThe organisation demonstrates some of the Services Collaborative (includingmost leading edge improvement work in Diagnostics) and the HeartEngland which supports improved patient Improvement Programme. It alsoexperience and outcomes. extended its work to create a three-year Stroke programmeWorking closely with the Department of within existing resources.Health, trusts, clinical networks, other • Its current work programme ishealth sector partners, professional bodies defined through the Departmentand charities, over the past year it has of Health on behalf of the NHS intested, implemented, sustained and spread the key policy areas of Cancer,quantifiable improvements with over 250 Heart, Stroke, COPD andsites across the country as well as providing Diagnostics and forms part of thean improvement tool to over 800 GP NHS Medical Directorate led bypractices. Sir Bruce Keogh • NHS Improvement employs 74NHS Improvement is: staff, the majority working• Demonstrating the practical • Having skilled expertise in full range peripatetically on a national application of quality improvement of quality improvement tools and basis, and has a small and service redesign with a track techniques including high level Lean administration team based in record of delivering quantifiable and Six Sigma plus experience from Leicester. It is a relatively lean improvement across the healthcare sector as well as organisation which ‘contracts in’• Leading improvement work in commercial knowledge gained at most of its specialist support primary, community, secondary and Toyota, GE, Aviva, Boots and private (e.g. IT) on an as required basis tertiary care healthcare• Providing clinical engagement and • Showing measurable results from leadership by working with over 50 concept to delivery clinical leads • Working in partnership with leading The case studies contained in this report are• Aligning with policy direction, charities, professional bodies, Royal taken from across the clinical pathway and providing a bridge between national Colleges and other associations are helping to deliver the objectives strategy and local engagement and ensuring a strong alignment to contained within each of the domains. It implementation, often through research, patient-facing organisations was only possible to feature a selection of clinical networks and third sector work good examples from around the country, however, there are numerous sites out there NHS Improvement’s priorities across cancer, that could have been featured for the work diagnostics, heart, lung and stroke have they are doing. NHS Improvement would been aligned to domains one, two and like to thank its partners for their ongoing three in the NHS Outcomes Framework work in improving services and bringing 2011-12. However, they could equally align benefits to patients. to domains four and five. Dr Janet Williamson, National Director, NHS Improvement www.improvement.nhs.uk
  6. 6. 06THE APPROACH: NHSIMPROVEMENT FRAMEWORKFOR SERVICE IMPROVEMENT What What & How What, How & How What & How Define the need/ Frame ‘the story Pilot/test Prototype outcome objective to tell’ • Strategic alignment • Definition/proof • Test wider • Align learning for • Scoping of principle applicability spread • Agree approach • Test hypothesis • Proof the ‘how’ • Define what and • Buid interest and • Identify emergent how capability leaders • Recruit leaders for spread 3 months scoping 12 months 12 months 3 months CLINICAL TEAM SPECIALTY SERVICES/SPECIALTIES 1 - 3 YEARS SITE/ORGANISATION LOCATION/REGION/CLINICAL NETWORK WHOLE SERVICE SPREAD NHS Improvement applies a framework for service improvement and clinical pathway redesign to ensure a consistent and systematic approach to its work. The work falls into five key categories: • Long term programmes of work to support delivery of a key national priority (Stroke Improvement Programme) • Bespoke improvement work which is time limited (review of seven day services across England) • Tailored support to assist delivery (working with SHAs to implement primary angioplasty) • Establishment, development and support of clinical networks (cardiac and stroke networks) • Advisory and development work (service improvement training for clinical and managerial staff) It utilises the following approach as part of any service improvement work: • Proof of principle: Piloting and testing new ways of delivering services – redesign and quality improvement (usually 12 month duration), • Testing wider applicability of pilots: Prototyping new service models, innovations and improvements (usually 12 month duration) • Spreading and disseminating learning and innovation more widely (two year plus duration).www.improvement.nhs.uk
  7. 7. 082010-11ACHIEVEMENTS Working with health sector partners over the past year NHS Improvement has helped to deliver a number of patient-centred improvements and identified many future benefits. These are just some: Up to 1 million this has women removed 10m waiting days £10.5m could be saved by halving the length of stay for received cervical cancer and saved those patients having day case/one night stay screening test results breast surgery within two weeks at 16 pilot sites £1.6m Over 290,000 patients 123,000 bed days could be saved each year if the Accelerating Stroke now waiting less time for test results, saving 655,940 waiting days, with up to Improvement aim for 40% of stroke patients leaving hospital to have access to early supported discharge £300,000 saved at some sites is achieved. £45m If every trust applied the Winning Principles we promote, which includes: reducing length of stay; enhanced recovery; and averting admissions, this one initiative has the could be saved nationally potential to reduce bed utilisation by 20%, on home oxygen services based on a minimum reduced saving the NHS spend of £600k across nine project sites. 1m bed dayswww.improvement.nhs.uk
  8. 8. 09£1.8m £5.9m Overcould be saved per year could be savedby increasing access topsychological support forstroke patients by 30%. by giving nearly 66,000 650 health staffApproximately patients direct access to a have been trained to use the tinnitus audiologist or hearing Discovery Interview™ technique£64k per stroke clinical to engage with patients and therapist network carers1.2m £3.25moutpatient appointments could be savedfor cancer survivors could be over the next five years by usingreleased over the next five years safe risk stratified pathways forthanks to testing on four tumour Children and Young People cancerpathways survivors 8,000 strokes every year could be prevented £106m by using the GRASP-AF detection tool. of savings This could save could be released by working with local hospitals to free the NHS £96m up avoidable bed days for non-elective cardiac patients www.improvement.nhs.uk
  9. 9. 10HELPING TO DELIVERQUALITY AND PRODUCTIVITYIMPROVEMENTS AND SHARINGTHE LEARNINGNHS Improvement’s tools and techniques, Most recently its works on developing thecombined with its expertise and experience, one day/one night stay breast surgerycould be applied to other service areas to model and computer modelling on thesupport delivery of the five key domains potential impact of serum natriureticwithin the NHS Outcomes Framework peptide blood tests to GPs practices have2011-2012 and priorities within the joined commissioning for stroke in primaryOperating Framework 2011-2012. care, and the optimal detection of Atrial Fibrillation; Cytology 14-day standard forIt is committed to continue delivering test results and its work as part of thequality improvements that are clinician-led enhanced recovery programme.and patient-focused to enhance patients’outcomes and experiences. In addition to its contributions to the nationally-renowned NHS Evidence site,Practical support for the delivery NHS Improvement continues to encourageof QIPP the identification and scoping,Delivering the Quality, Innovation, development, piloting, prototyping andProductivity and Prevention (QIPP) challenge spread of best practice through thesuccessfully will be key to delivering £20bn Improvement System2 - a comprehensiveof savings across the NHS by 2015. NHS online resource to support shared learning.Improvement’s approach to system It provides service improvement tools andimprovement aligns closely with the QIPP resources, practical guidance, case studies,agenda QIPP and over the past year more useful contacts and signposting for furtherthan 200 good practice examples have been information.identified across the country. These are nowshowcased on the QIPP section of itswebsite www.improvement.nhs.uk/qippExamples can be viewed by specialty (heart,lung, cancer, etc) or across the patientpathway – primary care, referral, diagnosis,treatment, aftercare and end of life care. Inaddition to the case studies there is usefulinformation and tools and since summer2010 the site’s pages have been viewedover 25,000 times.Demonstrating theevidenceNHS Improvement’s NHSleading edge Evidenceimprovement workwith partners across the country has beenrecognised on a number of occasionsduring the past year by NICE and it nowhas six case studies which have beencommended on the NHS Evidence website1.www.library.nhs.uk/qipp/SearchResults.aspx?searchText=ambulatory%20breast%20surgical%20care1http://system.improvement.nhs.uk/ImprovementSystem/Login.aspx?ReturnUrl=%2fImprovementsystem%2fdefault.aspx2www.improvement.nhs.uk
  10. 10. 11Sharing the learningNHS Improvement has captured the latestlearning and innovative thinking on a rangeof healthcare topics and disseminated thisknowledge during the past year through anumber of channels. These have included:• Review workshops with clinicians, cancer survivors and representatives from a range of NHS organisations and third sector• Social marketing training session for those working in cardiac rehabilitation• Sponsorship and facilitation of FiLM (Frontiers in Laboratory Medicine) 2011 - a forum where global influential leaders address the key challenges facing laboratory medicine• A collaborative event jointly-led and designed by GPs looking at the challenges facing those working in the new commissioning landscape• Website which was accessed by 75,000 unique visitors last year from 140 countries• an e-seminar on heart failure end of life useful information including personal Following successful testing the care which attracted 100 participants and accounts from patients of their conditions trademarked ‘Discovery Interview™3’ is being explored further to help support and explanations of how work involving innovative approach is now used by a stakeholders facing resource and financial NHS Improvement has helped improve their number of specialties in the UK health challenges in the current climate lives. system to improve care by understanding• Working with local, national and patient and carer experiences and by specialist media Working with clinical networks, NHS gaining insight into their needs. They are organisations across England and in based upon a philosophy that puts patientsInvolving public and patients partnership with charities we support and carers at the centre, and valuesEngaging the public and patients in its clinical teams and managers, providing listening to their experiences as a way ofactivities is one of NHS Improvement’s core practical tools and techniques that gaining insight which is unavailableprinciples in the way it works. It is transform, deliver and build lasting elsewhere to stimulate qualitycommitted to designing and delivering improvements across care pathways making improvement.health and care services around the needs a difference to patients, services and staff inof patients and carers and now has a new meeting the quality goals as part of thesection on its website showcasing this QIPP agenda. Most recently we havepartnership approach. The patient worked in partnership with the Strokeexperience website supports people Association to co produce Community Voiceworking with patients and carers, offering events around the country designed to heareasy to access engagement resources, the experiences of stroke survivors andexamples of good practice and links to carers.The Discovery Interview™ technique was originally developed by the Coronary Heart Disease Collaborative in 20003 www.improvement.nhs.uk
  11. 11. 12IMPROVINGCANCER CARENHS improvement - Cancer’s work has • Specific emergency pathways work is Priorities for 2011-2012 now include:gained national recognition and continues focused on aligning with other continuing to support the 10 initial sitesto work closely work with its key emergency initiatives such as NHS 111 with ongoing testing and a package ofstakeholders including the Department of pathways, emergency care practitioners, evidence by October 2011; supporting theHealth and other members of the Cancer spread of tried and tested innovations four prototype sites to present evidence ofprogramme team, cancer networks, such as communication alerts, promoting four proposed models of care being testedcharities, local organisations and clinical acute oncology models and preventing and defining the quality key indicators thatteams. It is also liaising more closely with unnecessary readmissions need to be in place within services tosocial care organisations and professional provide effective care of patients within allcolleges to further enhance outcomes for Adult Survivorship aims to improve the levels of after care. NHS Improvement is alsopatients. outcomes for adults living with and beyond working towards providing evidence of a cancer. Over the past year it has completed 20% reduction in CYP cancer survivorshipIntegral to the Improving Cancer Outcomes the pilot phase of testing elements of the hospital-based outpatient appointmentsStrategy (2011), NHS Improvement’s work care pathway, which are summarised in the (those patients already routinely followedincludes Transforming Inpatient Care, across case study section. Over the next year it will up) and achieving the goal that 100% CYPelective and emergency care, Living with work with 13 tumour projects in breast, survivors have a treatment summary andand Beyond Cancer (Survivorship) for Adults prostate, lung and colorectal cancer across care plan.and Children and Young People, seven communities in England to test risk “ stratified pathways of care based on theTransforming Inpatient Care promotes the individual needs to:spread and adoption of the four winningprinciples (one: unscheduled (emergency) • Improve the patient experience and Our aspiration is that Englandpatients should be assessed prior to the reported outcomes of caredecision to admit. Emergency admission • Reduce outpatient attendances by 50% should achieve cancer outcomesshould be the exception not the norm; two: • Reduce avoidable admissions by 10% which are comparable with theall patients should be on a defined inpatient best in the world. However, thepathways based on their tumour type and All patients will be offered an assessmentreasons for admission; three: clinical and care plan at key stages of their changes required to deliver ondecisions should be made on a daily basis to pathways. this aspiration are complex andpromote proactive case management and will take time. However, I amfour: patient and carers need to know The enabling projects which are testingabout their condition and symptoms to remote monitoring and care coordination confident that we are moving inencourage self-management and to know will support the effective delivery of the right direction and will seewho to contact when needed. Tried and supported self managed care. more of the positive results thattested models of care include: In the Children and Young People (CYP) have already been achieved by• Day case/one night stay for major Survivorship workstream there has been NHS Improvement. Working with breast surgery tangible progress since September 2010. a range of NHS partners,• Approaches to reduce avoidable The initial 10 CYP tests sites have continued emergency admissions and reducing evaluating and testing models of care, national charities and patients, lengths of stay for those who do need identifying proposed models of follow up they have delivered improved to be admitted as emergencies care, and other non clinical initiatives to outcomes in some key areas. But• Supporting the spread and adoption of support CYP cancer survivors. Achievements enhanced recovery approaches across have included four existing sites moving we can and we must go much colorectal, gynaecology urology and into prototyping phase; defining further if we are to achieve the musculoskeletal. The DH Enhanced measurable outcomes; developing after care levels of ambition for cancer Recovery Partnership Programme ended pathways with clinicians, commissioners, ” March 2011 but this partnership work patients and local teams and a patient patients. continues to support implementation experience workshop held with test sites Professor Sir Mike Richards (CBE), National within Transforming Inpatient Care and Teenage Cancer Trust. Clinical Director for Cancer and End of Life Carewww.improvement.nhs.uk/cancer
  12. 12. 13IMPROVINGDIAGNOSTICSIn areas such as cytology, pathology andradiology, NHS Improvement has beenworking with teams nationwide tore-design services, focusing on efficiencyand quality. “ NHS Improvement provides a wealth of information and support to imaging services across England. ServiceIn cytology, it has used Lean methodology improvement changes promotedto support the new Vital Sign that all and delivered by NHSwomen have their screening test results Improvement working withwithin two weeks. At 16 pilot sites, this hasbenefitted one million women, removed 10 imaging departments havemillion waiting days and saved £1.6 million played a large part in the(around £100,000 per site). reduction in waiting times forIn histopathology, NHS Improvement has imaging services seen in recentbeen working with nine pilot sites, aiming years. The implementation offor 95% turnaround results in seven days, Lean methodology to radiologywith half of those sites processing testswithin three days. 290,000 patients are now services has delivered massivewaiting less time for test results saving improvements for patients and655,940 waiting days with up to £300,000 also for the staff working insaved at some sites (extrapolating thisacross England could deliver £3.375 million these departments. NHSsavings). Improvement is seen as a beacon of excellence in service deliveryIn radiology, NHS Improvement has beenworking to reduce waiting times and both nationally and internationally. ”working towards creating a ‘no wait’imaging service. The radiology team iscontinuing to support the National Stroke Dr Erika Denton,Strategy and contributing to the National Clinical Director for ImagingAccelerated Stroke Improvementinitiative.A programme of clinically-led SHA imagingevents and local site visits is helping to takethis work forward. The new radiology workfocusses on interventional radiology andearly diagnosis to support the ImprovingOutcomes: A Strategy for Cancer (2011). “ I have been extremely impressed with the work of NHS Improvement and the contribution they have made to the diagnostics agenda, particularly their work on pathology. Improving turnaround times for histopathology and cytology is a vital step in the wider cancer agenda and the evidence shows that this will have enormously positive effects on patients and trusts alike. Phlebotomy is one of the main ways in which patients experience pathology testing first hand and so dramatically improving that experience - through reduced waiting times and a more streamlined service - will have a profound ” effect upon a huge number of people. Dr Ian Barnes, National Clinical Director for Pathology www.improvement.nhs.uk/diagnostics
  13. 13. 14IMPROVINGDIAGNOSTICS -AUDIOLOGYNHS Improvement has worked inpartnership with the Department of HealthNational Audiology Programme since July2008 supporting service improvementsacross England. Assisting 12 challengedsites to reduce waiting times for patientsand later 18 sites to improve the quality ofpatient experience, four key winningprinciples were identified and tested:• Direct access• One-stop clinics• Care closer to home – community services• Developing protocols for patients with complex hearing problemsAmidst economic adversity and thechallenges posed by times of change in theNHS, these teams rose to the challenge ofdeveloping their services and deliveringsuccessful projects that will influence thefuture practice of audiology services acrossEngland. Emerging learning from the pilot and Society (NDCS), the Royal National InstituteCentral to their philosophy was a prototype sites was shared via strategic for the Deaf (now Action on Hearing Loss)multidisciplinary approach where health authority clinical lead networks, as and the British Tinnitus Society Associationconsultants, clinicians, scientists, managerial well as through presentations and (BTA) to gain support and input for theand administrative staff worked together to workshops such as the British Academy of improvement work.deliver truly patient focussed services – Audiologists (BAA) and via an audiologyacross primary and secondary care. e-bulletin subscribed to by nearly 300 Essentially these are proactive teams. interested stakeholders. Strong partnerships Clearly, these are leading departments.Fostering the right project approach was were forged with third sector partners More importantly, patients are benefiting.key to planning, implementation and including the National Deaf Children’sdeveloping the new services. The audiologypilot and prototype sites have proved they “are the epitome of today’s forward thinkingNHS staff.Crucially, these teams are keen to share These pilot sites, working with NHS Improvement have applied Leantheir learning. Their onward aim is to principles to demonstrate how improvements can be made acrossembed the approach that has beenachieved locally and the national goal is the pathway that will change the way audiology services should be delivered in the future. ”adoption and replication across the country. Professor Sue Hill, Chief Scientific Officer, Department of Healthwww.improvement.nhs.uk/audiology
  14. 14. 15IMPROVINGHEART CAREHeart disease is still the second biggestcause of death in England despite hugeprogress and reductions in mortality andmorbidity since the publication of theNational Service Framework for CoronaryHeart Disease in 2000.NHS Improvement – Heart, continues tobuild on its excellent record of improvementwork across the cardiac agenda over thepast 10 years.The current work programme is tackling avariety of contemporary issues which spanthe cardiac patient pathway including:preventing strokes caused by atrialfibrillation; improving efficiency in usinghospital beds in acute cardiology andcardiac surgery; pioneering a new way ofcommissioning cardiac rehabilitation andimproving efficiency and quality across theheart failure pathway from early diagnosisto end of life.NHS Improvement has worked alongside The work is promoted through a range ofDepartment of Health colleagues to support publications, presentations on national anddelivery of national priorities such as the international platforms, e-seminars andimplementation of primary angioplasty for more recently as a publishing partner fortreatment of heart attack and jointly on the the NICE Quality Standards on chronicdevelopment of a Commissioning Pack for heart failure.Cardiac Rehabilitation.The programme provides ongoing supportto cardiac networks across England, as theycontinue to be a key resource in the deliveryof local improvements to services throughwork with commissioners and providers ofcardiac care. “ Service improvement does not happen spontaneously. It requires organisation, leadership and a great deal of hard work. This is what NHS Improvement has provided in spades over the years. Their industry and commitment have been consistent levers for changeCollaborating with charities and over the years working with the local delivery mechanisms and theprofessional bodies has always been animportant part of NHS Improvement’s work 28 cardiac networks.and recent examples include an awarenesscampaign with the Stroke Association and I would like to thank every one of them for their outstanding effortsthe Arrhythmia Alliance and also developed and their determination to extend healthy life and reduce suffering ina cardiac rehabilitation resource and ”partnership working on end of life care in our population.heart failure with the British Heart Professor Sir Roger Boyle,Foundation. National Director for Heart Disease and Stroke, Department of Health www.improvement.nhs.uk/heart
  15. 15. 16IMPROVINGRESPIRATORYCAREAs one of NHS Improvement’s newerprogrammes, 2010 saw completion of NHSImprovement – Lung’s first full 12 months.During this time the team worked withstakeholders across the country incontributing to the Department of Health’sconsultation on the national Chronic publication of emerging learning, examples and key measurable improvement principles and approaches. Through developing new and sustainable models of care, using capacity differently, reducing variations, and focussing on the “ People who are training Olympic teams at the moment will be focusing on even very small components of their team and howObstructive Pulmonary Disease (COPD) implementation of good practice, the team they can improve to ensure thatstrategy. is aiming to: they will win a medal rather than going out in the heats. That’s whatIn addition, the team linked up with the • Reduce overall spend on home oxygenBritish Thoracic Society, Primary Care services and prescriptions every single clinical team needs toRespiratory Society (PCRS) UK, Asthma UK • Reduce avoidable unscheduled be doing, making the outcomes forand the British Lung Foundation, admissions by 20% patients amongst the best in theestablished a web presence and launched • Reduce the length of stay by 25%the Lung Improvement News e-bulletin, • Reduce readmissions within 30 days by world. On the NHS Improvement -which now has over 1,200 subscribers. 20% Lung web pages there is a whole • Increase patient satisfaction, experience host of resources, the result of 10The programme has continued to support and outcomes years experience - which can bethe SHA Respiratory Clinical Leads and helpguide clinical network and community of Priorities for 2011-2012 include further used to help clinicians at a local ”practice development across the country. In development of respiratory networks as level understand and improve.addition, the website contains over 70 vehicles to spread good practice andexamples of good practice alongside other improve the access of data, and establish Professor Sue Hill, Joint National Clinicalresources, case studies, tools and practical high quality and cost effective commissioning Director for the Respiratory Programmesuggestions to guide improvement activities pathways with the new GP consortia.in clinical teams and organisations. Its work going forward will continue toIt has also provided direct support to over concentrate on six core areas of care, which40 COPD and asthma national improvement are aligned to the NHS Outcomesprojects and trained a number of staff in Framework 2011-2012, domains and QIPPproject management and improvement workstreams. The six areas are: earlymethodologies and approaches. As the accurate diagnosis, improving oxygenCOPD projects come to the end of the services, transforming acute care, chronictesting phase of work, the results have seen care and self-management-models, end ofdemonstrable improvements as well as the life care and asthma.“ NHS Improvement is a collection of clinicians and experts in improvement science that help to translate a clinical vision into a sustainable service improvement. They have been invaluable in lung work in actually helping clinicians realise their ambitions and vision in terms of quality ” improvement and improving clinical effectiveness, patient experience and patient safety. Dr Robert Winter, Joint National Clinical Director for the Respiratory Programmewww.improvement.nhs.uk/lung
  16. 16. 17IMPROVINGSTROKE CAREThe role of NHS Improvement - Stroke wasset out very clearly in the National StrokeStrategy (2007) as supporting itsimplementation and establishing clinicalnetworks in stroke care.A system of Stroke Care Networks, covering “ There has been a revolution in the improvement of quality stroke care in recent years, and the work of the stroke networks and NHS Improvement has been at its centre. In particular, great progress has been made in raising public and professional awareness and inall services in England, was completed in delivering comprehensive specialist acute stroke care. NHS2009 when they were audited againststrategy specifications. Since then, NHS Improvement will continue to guide and inform the work prioritiesImprovement has continued to guide and in the stroke networks to address these areas in a timely, effective ”develop networks, providing coordination and productive fashion.and support for local improvement activitiesand links to national initiatives. Damian Jenkinson, National Clinical Lead, NHS Improvement - Stroke and Consultant Stroke Physician, Royal Bournemouth and Christchurch Hospitals NHS Foundation TrustFour years on from the strategy its roleremains as crucial, leading on theAccelerating Stroke Improvement initiative -launched by the Department of Health in In addition, the NHS Improvement websiteresponse to the National Audit Office’s contains over 200 examples of stroke good(NAO) report on stroke services. The NAO practice alongside other resources, casenoted the importance of NHS Improvement studies, tools and practical suggestions toand Stroke Care Networks in improving guide improvement activities in clinicalservices for people affected by stroke and teams and organisations. The most recentcalled for further work to build on the addition - the Community Stroke Resourceprogress in service development. page - is a comprehensive collection of material including evidence from literatureNHS Improvement is also working closely and research, business cases, presentationswith the Care Quality Commission to drive and documentation to show how toservice improvements identified in its 2011 develop community stroke services.report ‘Supporting life after stroke’. Thisincludes leading the drive to ensure that New developments include joint venturesfocus on improving outcomes extends to with two major stroke charities - The Strokethe whole stroke care pathway, including Association and Connect - to improvecommunity services, nursing homes and stroke survivors’ experience in post-hospitalsocial care. care and develop practical tools to ensure patients with aphasia can fully participate inOn the ground, it has also provided direct the planning, delivery and evaluation ofsupport to over 40 stroke projects, resulting their care.in demonstrable improvements in clinicaloutcomes and patient experience as well as Priorities for 2011-2012 include guiding Accelerating Stroke Improvement initiative,the publication of learning, examples and stroke care networks through the transition aiming to ensure effective servicekey development principles which have to new commissioning arrangements and development along the whole strokebeen subsequently used nationally to guide supporting their role in developing pathway pathway throughout England.service improvement. commissioning for stroke patients within the new GP consortia. NHS Improvement - Stroke will continue to lead the www.improvement.nhs.uk/stroke
  17. 17. 18THEEXTERNALASSESSORPERSPECTIVENHS Improvement was formed as a result of Diagnostics work programmes. It also Tribal did identify some areas where NHSthe Hosted Services Review (November reviewed existing literature and empirical Improvement could strengthen its offer to2007). The review endorsed the evidence, conducting interviews with 26 the NHS. These included: ensuring systemscontinuation of work delivered by the people and facilitating discussion workshops and processes demonstrate return onCancer Services Collaborative ‘Improvement between April and July 2010. investment; supporting and developing staffPartnership’ and the Heart Improvement so they can maximise their contributionsProgramme and requested that they be In summarising their findings, Tribal said and promoting its profile and identity withintegrated and extended to include other NHS Improvement had a “catalytic” role in stakeholders.clinical specialties such as stroke. The bringing about improvements to outcomes.objectives were to: share learning across It recognised the organisation’s importance Work to address some of these areas hadclinical specialties, increase impact and in disseminating best practice through already begun before Tribal’s final reportshow value for money. clinical networks and other stakeholders - however, the external assessment has acted using a range of channels such as its as a catalyst to accelerate this.NHS Improvement was asked to deliver this publications, events and online support.agenda by having: Tribal further argued that NHS Improvement In terms of ensuring our systems and• A clear programme of work aligned to was “well positioned” to provide a processes can demonstrate return on national priorities with measurable coordinated whole NHS system approach to investment, NHS Improvement has outcomes healthcare improvement. developed three key systems that make best• A focus on the delivery of high quality use of its knowledge and information and improvements based on latest evidence According to Tribal: “Good value for demonstrate the impact its making across based practices money can be demonstrated by the the full range of specialties – they are the• Clinically led and patient focussed relationship between costs and website, NHS Improvement System workstreams benefits. Our evaluation uncovered (available through the website), and new• A close working relationship with other substantial benefits from the work of Performance System. national organisations, stakeholders and NHS Improvement, even if not all of professional organisations these can be measured. There are some The Performance System is central in• Robust monitoring and performance projects which do have very evidencing the outcomes of its work, measurable results, for example, the gathering information in a number of vitalTo determine just how effective NHS faster access to diagnostics (cytology), areas such as patient experience,Improvement has been since its creation, saving bed days (23 hour breast cancer productivity and efficiency gains and thean external evaluation was commissioned. model), and primary angioplasty unit resources allocated. Using real-time dataTribal Consulting carried out a robust, admission (PPCI roll out programme).” dashboards, it allows information to beindependent assessment and produced its qualified, quantified and aggregated infindings in September 2010. The report concludes by saying: “...It is our order to demonstrate value for money, considered view that NHS Improvement impact and return on investment againstTribal based its work on a series of does represent value for money, QIPP. These data dashboards mean that NHSquestions: “Has the work of NHS playing a critical role in the Improvement staff can even drill down toImprovement led to an improved quality of development, testing and roll-out of individual project sites - who are contractedservices? Does it continue to do so? Does it clinical improvements. Due to the to provide baseline information, monthlyrepresent good value for money?” ‘behind the scenes’ role that it often monitoring data and case studies - and takes, especially when clinical evaluate performance against the projectReviewing both ‘what we do’ and ‘how we improvements may have many milestones and identify any risks.do it’, the consultants looked at NHS stakeholders and participants, it is easyImprovement’s identity, value creation and to underestimate the relative impactoperational factors. They evaluated case and importance of NHS Improvement.”studies from the Heart, Stroke, Cancer andwww.improvement.nhs.uk
  18. 18. 19The great advantage of the PerformanceSystem is that it is integrated with the NHSImprovement System and website, providinga seamless flow of information.Stakeholders working with NHSImprovement will be able to access theImprovement System. This provides acomprehensive online resource developedto support every stage of an improvementinitiative, including initial scoping; projectmanagement; reporting; case studydevelopment and ultimately sharing theoutputs and outcomes with the wider NHS.“IDENTITYVisible leadership and a mentoringapproach were demonstrated byNHS Improvement in various VALUE CREATION Its ability to engage with key stakeholders, the strength and value of NHS Improvement’s NHS Improvement’s knowledge and understanding of the NHS context was seen as a major asset. Respondents noted that thisimplementation programmes. connections, an ability to bring included both practical and people together around a common theoretical knowledge – of keyNHS Improvement, to our agenda of improvement, and clinical areas, of the health serviceknowledge, is unique in employing working in partnership with system and of the challenges faced(on a part-time basis) a variety of charities and voluntary by NHS staff.clinicians (consultants, GPs, nurses, organisations, as well as the NHS.physiotherapists, ambulance staff NHS Improvement is a learning andetc) who are chosen because of BUSINESS APPROACH teaching organisation with strongtheir expertise and standing in the NHS Improvement has a strong commitment to improvement. It isareas which the programmes are focus on aligning its planning to successful in terms of helping theconcentrating... as a consequence the strategic priorities of the NHS to focus on meeting theof this background, all of them have Department of Health... at the national priorities, sharingmajor national ‘street credibility’. organisational level, measures to knowledge and developing evaluate the performance of the networks and relationships.NHS Improvement staff appeared to organisation and individualhave a common set of beliefs andvalues and work towards acommon objective of sharinglearning, increasing impact andbringing tangible improvements inthe delivery of NHS services. projects have been introduced and aligned to QIPP. ” www.improvement.nhs.uk
  19. 19. 20How NHS Improvement has As a result of Tribal’s review, NHS In response, it has revamped itsresponded to the Tribal report Improvement intends to re-affirm its communications strategy in order to better commitment to supporting staff in a manage its brand and raise its positiveSupporting and developing its staff so number of areas including: profile so key stakeholders are better placedthey can maximise their contributions to know who NHS Improvement is, what itNHS Improvement has run its ‘Valuing Staff’ • Sharing and learning between stands for and how it can help them. It willinitiative for three years and conducted two workstreams encourage feedback from its wide range ofstaff surveys during that period to assess • Increasing use of IT solutions to support stakeholders to ensure what it offers andhow well it is doing. ‘Valuing Staff’ aims to virtual working how it is communicated is well-timed andmake sure that it provides personal • Ensuring a healthy work/life balance well-targeted.development opportunities, improves • Introducing an anonymous questionsworking between programmes, develops and answers facility to pose questions In the last year around 75,000 uniquemore effective team working, and creates a to the national director as well as an visitors from 140 countries visited NHSmore supportive/ listening environment. As online forum Improvement’s website and there werepart of the initiative, 10 working principles • Maintaining the programme of monthly more than 350,000 page visits. Ourhave been agreed to ensure that staff are National Team meetings to allow website was refreshed to include a newvalued and developed and a training contributions to future planning, QIPP section featuring more than 200 caseprogramme supporting business priorities knowledge sharing and networking studies from across both our specialtyfunded. This has included: programmes and all parts of the patient A member of NHS Improvement’s executive pathway. The site also links to our highly• Statutory/mandatory training from the team is leading this work. Planning includes commended case study examples on the NHS Core Learning Unit a funded training and development NHS Evidence website.• A programme of service improvement programme which will encompass specific training days/events for all staff skills, training opportunities and a broader Nearly 9,000 people have subscribed to• Development days focused on team focus on career development in the NHS Improvement’s range of e-bulletins to development changing health landscape. A two day receive news about best practice in their• Attendance at courses and conferences workshop will be held in September 2011 particular field of interest as well as national and ad hoc events with a focus on preparing for the future. guidance, latest news and information about learning events and workshops. TheOther means of supporting staff to fulfil Promoting its profile and identity with organisation also showcased its services andtheir demanding national roles have stakeholders achievements over the past year, reachingincluded a practical focus on using new and thousands of people from across the healthemerging technologies to enhance The Tribal report stated that NHS sector and beyond through appearing atcommunication and reduce avoidable Improvement: “In common with similar over 100 events and producing over 25travelling. Notable examples include the bodies has been formed from the publications which help to further share andincreased use of teleconferencing and web amalgamation of previous programmes, embed best practice.conferencing. The results of the latest staff following a review. As such, the exactsurvey are shown in the following section nature of NHS Improvement is not‘How our staff see us’. always immediately apparent to the outside, and an improved market profile is one of the recommended outcomes of this evaluation.”www.improvement.nhs.uk
  20. 20. 21THESTAFFPERSPECTIVEIn 2008, an initial staff survey was carriedout to assess their views on life in theworkplace, what support they required toperform more effectively, where progresswas being made and to identify potentialfuture improvements. This was repeated in2010, with some identical questions forcomparison but also additional questions,reflecting the new world and its challenges,to establish what it was like.The 2010 survey was completed by 51 staff(a response rate of 74%). In summary, thefeedback was very encouraging, despite theclimate of uncertainty within the NHS andwider public sector.More than 80% of staff agreed or stronglyagreed that they understood the scope anddirection of work covered by theirworkstream and NHS Improvement as awhole. A total of 84% of staff said they feltsupported in forging strong workingrelationships with their team and linemanager – a 22% increase on the previoussurvey findings. More staff were receiving More than 72% of staff wished to take The survey revealed positive themesinductions than in 2008 and these were advantage of additional training and around opportunities, relationships,helping to provide reassurance of expected development in order to fulfil their roles communication, organisation andperformance. while 86% of staff said their line manager leadership, induction, training and was genuinely concerned about their well- development, and work/life balance. ThisStaff indicated they have freedom to act being – a similar result to 2008. will be used to further develop the role ofwith 80% saying ‘I have an opportunity to line managers, explore trainingdo what I do best as part of my job’ – a A total of 72% of staff also felt there were opportunities and build staff views intosimilar result to 2008. While staff generally opportunities to discuss work issues with future corporate plans.acknowledged that the pace and volume of colleagues in other workstreams. Staff saidwork has increased, 84% also recognised in general they felt empowered to Direct comparisons between NHSthat support was provided to maintain an contribute to discussions regarding the Improvement’s survey and the annualappropriate work/life balance. future of their workstream (90% agreed or national NHS survey are slightly difficult due strongly agreed) and NHS Improvement as a to different methodologies, however the whole (64%). general comparison is favourable. www.improvement.nhs.uk
  21. 21. 22According to a review of staff survey resultsacross the NHS for 2009 produced by theCare Quality Commission (CQC) , 58% ofstaff felt that they had adequate materials,supplies and equipment to do their work, “ The passion, energy and motivation of NHS Improvement’s staff were commented on. Employees arewhereas the figure was 90% for NHSImprovement. drawn from a range of backgrounds and professions;In the national NHS survey (which covered however they appear united inall 388 NHS trusts in England), just overtwo-thirds of respondents said they had their passion for improving theclear objectives, but in answer to a similar health service. This was seen asthemed question, 84% of NHS an important asset, both toImprovement staff said ‘I know exactly whatis expected of me in my work in NHS inspire and energise the NHSImprovement’. organisations they work with and to sustain NHS ImprovementThe national picture is that more than halfof all staff (57%) said they knew how their staff in what can often be challenging work. ”role contributes to what their trust wastrying to achieve. The NHS Improvementposition is that 64% agreed or strongly Tribal Report, September 2010agreed that ‘I feel empowered to contributeto discussions regarding the future directionof NHS Improvement’.The national NHS survey found 63% of stafffelt they had frequent opportunities toshow initiative in their role, whereas 92% ofcolleagues in NHS Improvement said ‘I havesome say over the way that I work’.www.improvement.nhs.uk
  22. 22. 24THESTAKEHOLDERPERSPECTIVENHS Improvement’s work can only be These results were broadly in line with other In a census of cancer networks carried outsuccessfully progressed in partnership with pieces of research carried out on a national by the National Audit Office in 2010, 89%varied interest groups (clinicians, front line scale which involved consideration of NHS of respondents were ‘aware of’ and ‘hadstaff, managers, policy-makers, charities, Improvement. A primary care trust census used’ NHS Improvement as an informationprofessional associations, carers and carried out by the National Audit Office in source whereas 11% were ‘aware’ but hadpatients). 2010 showed 69% of respondents were ‘not used’ it. These figures compare ‘aware of’ and ‘had used’ NHS favourably with other national programmesIn order to better understand how NHS Improvement as an information source. and centres within the NHS. The censusImprovement is viewed by its stakeholders, revealed that 15% had found NHSto improve its working relationships and Nearly a quarter of those polled were aware Improvement ‘very useful’ as an informationenhance its communication channels, of but had ‘not used’ the organisation while source, in this case we were behind the topresearch was conducted at a number of 8% were ‘not aware’ of NHS Improvement. three of NICE guidance, Improvingevents between November 2010 and June Their census found 52% of respondents Outcomes guidance and the National2011 which involved nearly 500 had found NHS Improvement ‘very useful’ Cancer Intelligence Network. A further 69%participants. as an information source (only topped by in their census stated they had found us Hospital Episode Statistics and Improving ‘fairly useful’.The overwhelming majority of survey Outcomes guidance results) and 42% said itrespondents viewed NHS Improvement’s was a ‘useful’ source.contribution as positive – with 56% sayingits work was ‘good’ and a further 29%saying it was ‘very good’. A similar responsewas received in judging how effectivepeople saw NHS Improvement as anorganisation with 51% saying good and26% saying very good.The stakeholder research did indicate thatits reputation was seen as overwhelminglypositive – 24% said it was ‘very good’, 48%said was ‘good’, 26% were ‘not sure’ and2% said ‘poor’.www.improvement.nhs.uk
  23. 23. 25Elsewhere, there has been support for NHSImprovement’s work in an Ipsos MORIreview of the Coronary Heart DiseaseNational Service Framework. Their reportsaid national improvement teams/improvement agencies “played afundamental role in supporting servicedesign and developing networks but weremuch less at the forefront of most people’sminds.”NHS Improvement - Stroke worked with theNational Audit Office during production ofthe 2010 report ‘Progress in ImprovingStroke Care’ and also cooperated with theNAO to create an addendum to ‘Progress InImproving Stroke Care: A Good PracticeGuide’. Similarly, the Care QualityCommission 2010 report ‘Stroke services:National report’ highlights the work of NHSImprovement and directs those seekingadvice and information on improvingservices to our resources.The National Audit Office also in its recentreport ‘Managing high value capitalequipment in the NHS in England’ drew ongood practice identified by NHSImprovement including case study evidenceand recommended that Trusts make use ofits work to improve their management ofhigh value equipment (MRIs, CT scannersand linac machines for cancer treatment). www.improvement.nhs.uk
  24. 24. 26CANCER IMPROVEMENT Providing long term follow-up for all childhood cancer survivors in a hospital setting is not viable or appropriate in the future given the exponential increase in the number of cancer survivors. The Children and Young People (CYP) workstream, working with clinicians, commissioners, patients and local teams, has developed national safe risk stratified pathways that identify how follow up for children and young people can be delivered in line with current pressures and aspirations.Helping youngsters The pathways form the basis of thecope with cancer models of care now being tested by the four prototype sites. The principles emerging from the testing emphasise theStrategic overview importance of:Today more than 1.6 million people living in • Patient choice and being responsive to • Managing transition between paediatric,England have had a diagnosis of cancer4 individual, clinical, psychosocial and young adult and adult servicesand with an ageing population this is likely practical needs • All after care services need to be costto increase significantly in future years. The • Providing patients with treatment effective and delivered by the appropriateImproving Outcomes - A Strategy for summary and care plan health care professional to ensure theCancer publication5 (January 2011) sets out • Stratify risk and signposting patients to best use of skill mix and resourcesplans to drive up Englands cancer survival these appropriate and tailored pathwaysrates so that they match the best in Europe, • Providing differing levels of care and Patients have been involved in shaping andsaving an extra 5,000 lives every year by support based on risk assessment developing these pathways of care with an2014-15. But as Professor Sir Mike Richards, • Effective coordinated supported care emphasis on actual / practical improvementsEngland’s clinical director for cancer, says: • Effective automated surveillance / remote for all cancer patients."... improving outcomes for people with monitoring systems to remind patients /cancer isn’t just about improving survival healthcare professionals when specific The following case study is one aspect ofrates. It is also about improving patients’ screening/investigations are required the important issues identified for CYPexperience of care and the quality of life for • Fully supporting primary care within any cancer survivors.cancer survivors and our strategy also sets shared care arrangementsout how that will be tackled."An important population within these “figures are children and young peopleaffected with cancer.There are approximately 40,000 survivors of All children and young people who are cancer survivors shouldchild or young person cancer in England expect to receive the same, high quality standard of individualisedwho will need some level of care and long ”term follow up as they live into adulthood, care irrespective of where and when they are treated.perhaps 50+ years after their cancerdiagnosis. Alex Brownsdon, Patient Representative NCSI CYP Steering Groupwww.improvement.nhs.uk/cancer/documents/NCSI_Vision.pdf4www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_1233715www.improvement.nhs.uk/cancer
  25. 25. 27CANCERCASE STUDY DOMAIN 5: DOMAIN 3: DOMAIN 4: DOMAIN 1: DOMAIN 2: Helping people to Ensuring that Treating and caring Enhancing quality for people in a safe Preventing people recover from people have a of life for people environment and from dying episodes of ill positive with long-term protecting them prematurely health or experience conditions from avoidable following injury of care harmThe Christie Survivorship ProgrammeThe Survivorship Programme aims to Questionnaire feedback was completedprovide relevant, sufficient and timely as part of the programme with furtherinformation that informs, supports and follow-up evaluation to come. This workempowers survivors in relation to many helped measure the value of theaspects of their lives that have been intervention, ensuring continuousaffected by treatment for cancer. assessment and on-going refinement. Participants were asked whether theThrough three education courses course met expectations and 12 sessionscompleted in 2010, the programme out of 24 received 100% feedback ofseeks to improve the quality of patient either ‘agree’ or ‘strongly agree’. Theycare and self-management. Sessions also gave 100% backing to eight out offocused on a range of topics including 24 sessions that had motivated them torelationships and body image, anxiety, learn more.coping strategies and risky behaviours, “ “late effects of treatment, fertility,finances, education, employment andlife skills. The programme is part of theNational Cancer Survivorship Initiative The survivorship programme A cancer diagnosis in children(NCSI6) and The Christie is one of the helped me in many ways. and young people is rare.test sites for the children and young Primarily it gave me a better However, when this occurs aspeople workstream. understanding of what help a child or young person this isThe pilot courses were held in was available after having at a time in their lives whenManchester with patients from the cancer, as well as being able they need to meet manyTrust’s Young Oncology Unit. A total of56 patients enrolled on the courses with to use the folder as a challenges. Physical and socialattendances varying between sessions. handbook to refer to in the development, education,Attendees were aged between 16 and short and long term. It also and the learning to take32, with the average age being 22. Themajority of people on the courses were gave me vital contacts to get responsibility to move on intofrom the Greater Manchester area. in touch with which really the adult arena for example helped a lot and on the The diagnosis, treatment whole I think it’s a brilliant and later consequences of idea! treatment puts this normal ” Patient who took part on the programme development into jeopardy. Longer term support is vital to assist survivors to achieve maximal quality of life. ” Dr Gill Levitt, Great Ormond Street Hospital for Children NHS Trust, National Clinical Lead for Children and Young People Survivorshipwww.ncsi.org.uk6
  26. 26. 28CANCER IMPROVEMENTTransforming Inpatient Care: Driving improvements inquality that values patients’ time and increases efficiencyStrategic overview The improvement programme promotes The lessons learned from testing prototypesThe Cancer Reform Strategy (2007) innovation and new models of care delivery: and new models is disseminated across thehighlighted the need to focus attention on • Day case/one night stay for breast NHS in order to improve the quality of careinpatient care for cancer patients. The surgery and other procedures and experience for patients and to maximiseTransforming Inpatient Care Programme • Enhanced recovery approaches for the potential scope of savings.was established to take this forward led by elective care (colorectal, gynaecological,NHS Improvement. urological and musculoskeletal) The Transforming Inpatient Programme is • Approaches to reduce avoidable underpinned by four ‘Quality WinningThe National Audit Office (2010) reported emergency admissions and readmissions Principles’.good progress has been made in reducing • Reducing unnecessary lengths of stay forthe number of inpatient days per year for those who need to be admitted ascancer patient’s, however, there is scope to emergencies and electivego much further and to make a significantcontribution to the efficiency savings thatthe NHS needs to make.The Transforming Inpatient CareProgramme continues to be a cancerpriority and this is reflected within the The Quality Winning PrinciplesImproving Cancer Outcomes Strategy(2011) supporting the QIPP agenda and Winning Principle 1 Winning Principle 3Outcomes Framework. Unscheduled (emergency) patients Clinical decisions should be made on a should be assessed prior to the decision daily basis to promote proactive case to admit. Emergency admission should management. be the exception not the norm. Winning Principle 4 Winning Principle 2 Patient and carers need to know about All patients should be on defined their condition and symptoms to inpatient pathways based on their encourage self-management and to know tumour type and reasons for admission. who to contact when needed.
  27. 27. 29 Enhanced Recovery Partnership The principles of enhanced recovery in elective surgery are currently being implemented across the NHS nationwide and, as a result, transforming the approach to care before, during and after surgery. This innovative, evidenced-based practice has already resulted in dramatically improving the recovery times for patients across colorectal, gynaecology, urology and musculo skeletal care pathways. It has so far been recognised that implementing enhanced recovery pathways instead of using traditional models actual improves efficiency as it is helps patients to get better sooner after surgery - it also has improved their experienced due to shorter stays in hospital and a more rapid return to normal living as they are encouraged to contribute to their own recovery. The hospital itself benefits in stable or reducedGetting breast surgery patients readmissions rates, with lower complications and better bed utilisation as reductionsbetter sooner have also been witnessed in the amount of high dependency and intensive bedsThe ‘Quality Winning Principles’ were which are normally required.applied to the redesign and streamlining ofthe breast surgery pathway for all patients Enhanced recovery entails a multidisciplinary team and healthcare communityundergoing major breast surgery (without approach as they are actively involved in the patients care before, during and afterreconstruction). surgery. This means the patient is well informed and prepared pre-operatively, which helps to reduce anxiety or stress levels prior to surgery and results in the patientThe working hypothesis was that the making the correct decisions about their treatment and recovery pathway.streamlining of the breast surgical pathwaycould reduce length of stay by 50% and The Enhanced Recovery Partnership led by NHS Improvement working in partnershippotentially release 25% of bed days and with National Cancer Action Team, SHA Enhanced Recovery Leads, Cancer Networksmanaging patient expectations the patients and National Clinical Leads supports the NHS to implement and realise the benefitsexperience could be improved. of enhanced recovery.Why breast surgery?Baseline data drawn from local and nationalsources indicated:• Variation in clinical practice and • All admissions for mastectomy are Patient feedback tells us that being conflicting clinical evidence surrounding elective but only a quarter of patients diagnosed with cancer can be a difficult the use and effectiveness of wound (27%) were treated as day cases transition to make. Patients undergoing drains, drainage of seromas, anaesthetics • In 2007-2008, there was 54,115 elective surgery for both cancer and non cancer and pain control admissions form breast surgery that expressed they wanted to be in hospitals• Breast cancer is one of the most occupied 305,061 bed days (HES) for as short a time as possible. Through commonly diagnosed cancers in the UK. • The mean range of length of stay patient forums, diaries and interviews, In England, female breast cancer equates between acute providers ranged from people have talked about how unnecessary to approximately 34,000 new cancer 0-7 days for mastectomy procedures. waits and procedures increased anxiety. cases registered per annum and Prompting the question. Why should Patients have stressed the importance of approximately an additional 20,000 mastectomy be an inpatient procedure? getting back to normal as soon as possible patients undergo breast surgery for It is a: and valuing their time. benign conditions. (Cancer Registration • Relatively short operation in England 2000) • Low post operative pain• Breast cancer is one of the areas which • Patient can mobilisation early appears to perform worst – survival rates • No high risks as with other major• Significant geographical variation in surgery such as retention/ileus length of stay • Rare significant post op events www.improvement.nhs.uk/cancer

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