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Managing Change: Transformation for Productive Public Services 6/12/2016

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Jen Parsons presentation

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Managing Change: Transformation for Productive Public Services 6/12/2016

  1. 1. Jen Parsons - Leading on transformation in the NHS what it really takes to deliver meaningful change
  2. 2. Who are we? ~35 strong team of skilled professionals ~35 strong team of skilled professionals We are NHS but not as you know it… We are NHS but not as you know it… A not-for-profit internal consultancy A not-for-profit internal consultancy Passionate about improving care for patients Passionate about improving care for patients Specialists in service transformation Specialists in service transformation
  3. 3. Why transformation? Why not incremental change?
  4. 4. Incremental change doesn’t always get you to where you need to be… Today - share with you some of our learning and experience of what it really takes to deliver change
  5. 5. The NHS is facing some huge challenges The NHS belongs to us all Reconfiguring services can challenging, rewarding and controversial… The NHS belongs to us all Reconfiguring services can challenging, rewarding and controversial…
  6. 6. Two examples OG Cancer OG Cancer Healthier Together Healthier Together
  7. 7. OG Cancer Service, Oct 2016 “Greater Manchester hasn’t been compliant on this service since new guidelines came out in the early 2000s, so efforts to consolidate the surgical sites have been going on for more than 10 years. This is a really powerful sign that Greater Manchester is now able to sort its own stuff out.”
  8. 8. How did we get there? • Picked something difficult, but small 150-170 patients a year • Developed a repeatable process with 5 deliverables: • Clinical leadership to design a ‘best in class service’ • Co-design with patients • Clear governance for commissioner decision System co-design Commissioner decision making
  9. 9. Sue was diagnosed with breast cancer 14 years ago, and while in remission became chair of a patient group in Chester, and a member of a patient group for Upper Gastro Intestinal Cancer. She was then diagnosed with cancer again. “It is ironic that whilst sitting on this group, I was diagnosed with a rare UGI cancer. After a big operation and part of my stomach removed, I felt I had earned my badge to sit on the group. It is amazingly powerful to speak at these meetings and start a sentence with ‘as a patient’. The professionals listen to you and respect our input. We have had many successes of tweaking the system for the good of patients. There have been challenges, yet throughout, we didn’t lose sight of the need to make meaningful change for Greater Manchester residents. We’ve started from scratch from diagnosis to recovery. I feel proud that there are a set of standards developed by patients and professionals.” Co-design with patients – Sue Kernaghan
  10. 10. Healthier Together A&E, Acute Medicine, General Surgery • Larger scale ~160 patients a day experiencing a life- threatening condition • High variation in patient outcomes from hospital to hospital • Patients who may need emergency abdominal surgery are high risk, need to be assessed by a consultant surgeon, will require critical care • Critical shortage of A&E consultants, and general surgeons • Geography of Greater Manchester provides an opportunity to work together
  11. 11. Patient with a bowel obstruction, Lynda 69 Lynda was unlucky. By the time she was operated on some bowel had died and had to be removed. She suffered a chest infection after surgery but slowly recovered on the surgical ward for 12 days before being discharged with a wound infection. Average mortality nationally following emergency general surgery is ~15% and ranges from 3 – 40+%. These patients have been called ‘the forgotten group’ At the ED, Lynda is assessed by an A&E junior doctor who is on shift. It’s 8pm She examines Lynda and notes she is vomiting, with abdominal pain and distension. She refers her to the general surgical F2 15 hours after Lynda arrived at A&E a critical care bed is confirmed and the consultant performs an emergency laparotomy The general surgical F2 examines Lynda and arranges blood tests and x- rays. She is not sure what is wrong and is not senior enough to order a CT scan The general surgical registrar sees Lynda 6 hours after she arrives. He suspects adhesion- obstruction and orders a CT scan The radiology registrar isn’t sure whether the CT scan shows strangulation but decides it can be reviewed by his consultant in the morning Lynda is reviewed by the consultant general surgeon at 9am. She suspects bowel strangulation and the radiology consultant agrees The general surgical registrar is busy in theatre for several hours. The consultant is on call at home and is scheduled to do an elective operating list in the morning. Lynda has been in hospital more than 4 hours so she’s been moved to a ward. A&E CT scans take priority so her scan is delayed The surgical registrar is busy so it’s 6am before he reviews Lynda. Her abdomen is rigid but he wonders if it will settle. There are no dedicated surgical critical care beds which delays Lynda’s surgery further.
  12. 12. Future model of care – example standards EGS013 EGS022 In hospitals specialising in general surgery, a specialist general surgical doctor is available at all times within 30 minutes In all high risk cases, a consultant surgeon and consultant anaesthetist is present for the operation EGS103 In hospitals specialising in general surgery, emergency patients will be assessed within 30 minutes of referral in the case of a life-or limb-threatening emergency, and within 60 minutes for a routine emergency referral A new model of care is needed, with new standards and a different staffing model… But none of our hospitals can achieve this on their own A new model of care is needed, with new standards and a different staffing model… But none of our hospitals can achieve this on their own
  13. 13. Decision making challenge How do you design a decision making process that will stand up to scrutiny in court? How do you design a decision making process that will stand up to scrutiny in court? ~29,000 consultation responses ~29,000 consultation responses 8 options consulted upon 8 options consulted upon 42 permutations of hospitals working together 42 permutations of hospitals working together Travel analysis Cost £ Workforce Travel analysis Cost £ Workforce
  14. 14. Healthier Together 17th July 2015: Unanimous decision on the configuration of services 17th July 2015: Unanimous decision on the configuration of services
  15. 15. January 2016 Judicial Review We planned for it… governance takes on a new level of importance sat opposite a high court judge… We planned for it… governance takes on a new level of importance sat opposite a high court judge…
  16. 16. Our services
  17. 17. What’s next? • Standardising acute hospital care across Greater Manchester • Large programme ~£1.6bn provider cost base • Clinically sustainable services • Big financial challenge
  18. 18. Our work is rapidly expanding Our ambition is to keep skills in the NHS and reduce NHS reliance on external consultancy Our ambition is to keep skills in the NHS and reduce NHS reliance on external consultancy (Pan Staffordshire)
  19. 19. Thank you jen.parsons@nhs.net www.transformationunitgm.nhs.uk

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