View the latest newsletter from the national CUR team to learn about the progress on CUR roll out and see the early data published from the national Early Implementer sites.

1. AUTUMN 2016
35 NHS Trusts sign-up to
CUR during 2016/17
Clinical Utilisation Review (CUR) is a clinical decision
support tool that enables providers and commissioners
to make objective, evidence-based assessments of
whether patients are receiving the right levels of care,
in the right setting, at the right time, according to
clinical need. Use of the tool on a concurrent basis is
key to reducing delayed transfers of care in provider
organisations.
CUR was adopted as national policy in 2007. It is now
being incentivised through a CUR CQUIN available to
providers of specialised services and other NHS acute
providers via the CCG CQUIN, to ensure the benefits of
CUR can be levered.
Following the launch of the CUR CQUN in 2015/16, 30
NHS Trusts have now signed up to implement CUR
during 2016/17. Ten NHS Trusts will be implementing
a CUR Local Learning Pilot during 2016/17, the purpose
of which is to “assess whether implementing a
concurrent CUR solution will provide the Trust and its
local stakeholders (CCGs and Community Providers)
with additional data/ intelligence to inform action to
reduce non-qualified / inappropriate admissions and
reduce non-qualified / inappropriate length of stay”.
NHS Trusts are now at various stages of planning,
procurement and implementation of CUR. The
number of Trusts who have agreed to roll-out CUR
during 2016/17 by Region are:
• London - 8 NHS Trusts
• Midlands and East - 6 NHS Trusts
• North - 11 NHS Trusts
• South – 10 NHS Trusts
During 2016/17 we have continued to
support the five national Early Implementer
Sites (EIS) through procurement,
implementation, roll-out and reporting:-
• Basildon and Thurrock University
Hospitals NHS Trust
• Brighton & Sussex University Hospitals
NHS Trust
• Royal Surrey NHS Foundation Trust
• Salford Royal Hospitals NHS Foundation
Trust
• South Tees Hospitals NHS Foundation
Trust
We are now starting to see the benefits and
learning CUR brings, through the sharing of
lessons learnt and CUR reporting, shared by
the 5 EIS sites, following implementation of
their preferred CUR solution. We have
summarised these early findings below:
• During Quarter 1 2016/17 over 67,528
daily reviews (CUR assessments) were
undertaken on over 1,800 beds across
our 5 Early Implementer Sites (EIS).
• Based on the data provided, 25,703
(38%) of those daily CUR reviews did
not meet the CUR criteria for an
appropriate in-patient stay; with a
range of between 21% – 66% at our 5
EIS Trusts.
• This means, during the quarter, that
across our 5 Trusts, an average of 282
beds had a patient being cared for in
them that did not meet the CUR Criteria
used to assess whether they should
have been at that level of care
• What are the costs involved? If we
assumed that an average sized acute
ward (25 beds), cost £1m to provide this
would equate to c.£11.3m of provision
across our 5 EIS Trusts.
EIS Trusts are yet to complete full roll out of
their CUR solutions – likely to result in
greater opportunities to improve patient
flow.
In order for CUR to be effective, it is important that
assessments are completed for every patient, in
every bed for every day of their stay. Monitoring
compliance across wards is critical to ensure the
benefits of CUR can be realised. A compliance rate
of 80% is optimal and should be the target Trusts aim
to achieve. The EIS sites continue to embed CUR
into daily operational processes in order to achieve
this target.
Most NHS providers, prior to undertaking CUR,
believed that the majority of the reasons for
inappropriate patient stays were due to external
rather than internal reasons, therefore limiting their
ability to improve patient flow. External delays are
caused by issues in community, primary and social
care – these can be process issues, capacity
restrictions or because services do not exist in the
first place, meaning there is no alternative level of
care for these patients.
Early evidence from our 5 EIS sites suggests that this
is not always the case. During Q1 2016/17 the
majority of the reasons (63%) for CUR criteria not
being met (inappropriate patient bed days) were
due to internal delays, within the control of Trusts,
with a range of 22% - 88% at EIS Trusts.
SUMMER 2016
Early Implementer Sites – Key Findings

2. Page 2
is one of our five national CUR Early Implementer
Sites. The CUR national team recently visited the
Trust to see at first hand the progress the Trust is
making in implementing CUR.
Nigel Kee, Chief Operating Officer, described the
complex issues challenging the Trust which resulted in
them applying to be one of the Early Implementer
Sites.
The challenges facing the Trust include: a 25%
increase in A&E attendances since 2011/1; lack of
primary care provision across the region; social care
capacity with significant impact on Delayed Transfers
of Care (DTOC); and a commissioner sponsored review
of ambulance conveyancing. The Trust had embarked
on a review of ‘front end’ processes to review
bottlenecks and a review of ‘back door’ processes to
identify opportunities for improvement.
The Trust has established a project team to oversee
the implementation of CUR with a Project Lead who is
the Head of Operations for the Trust, and a Clinical
Lead who is the Head of the Discharge Team for the
Trust.
Since commencing implementation in November
2015, the Trust has rolled out CUR across 300 beds
and aims to roll-out to an additional 250 beds during
2016/17. Discharge facilitators are undertaking the
reviews on behalf of ward staff, a process which is
currently being embedded across the Trust.
As a result of implementing CUR, the Trust identified
approximately 447 out of 1738 individual bed days
(25%) that were avoidable relating to 84 patients
who could have been treated in a less intensive care
setting.
The reasons for delay relating to these patients
equated to 72% of internal delays – physician and
hospital related delays and 27% external delays –
community and social services.
Reasons for internal delay include awaiting
consultation with the medical team; and waiting
for therapies. External delays included awaiting
rehabilitation and social service review.
Nigel Kee believes that the CUR data has
provided momentum to alter the dialogue with
clinicians, and has acted as a catalyst to review
how organisations operate together as a system.
“CUR has enabled us to identify those
patients that shouldn’t be in a Trust setting
to enable wider discussion at our local SRG
meeting”.
For further information on CUR at Basildon and
Thurrock, please contact a member of the CUR
national
Watch out for more…
Salford Trust are currently developing a Case
Study on unmet criteria, due to be published
September 16.
Royal Surrey County Hospital NHS
Foundation Trust
Before implementation of the CUR system the Trust
would solely rely on MDT meetings and handovers
to plan patient discharges. However, the role of
discharge co-ordinators was non-existent and
discharge facilitation relied mainly on nurses, Social
Services and therapy staff. This could occasionally be
time-consuming for staff having to deal with tasks
outside their job specification including daily
contacts with the community services.
“As a team leader I strive to be aware of the teams’
caseload and support my staff with complex
rehab and discharges. This often involves a
round through the medical wards to discuss the
caseload but also for me to have a general
overview of all ward patients to check if therapy
can help facilitate discharges of more complex
patients”.
“Since the introduction of CUR to the medical
wards, I am able to access first thing in the
morning the report highlighting the RFD status
of patients and therefore tailor my support to the
appropriate ward physiotherapy staff to facilitate
the relevant patient’s care, rehab and discharge”.
The use of CUR has positively changed the outlook of
therapists on the “return to baseline” concept as
physiotherapists are now more aware of community
services and how those can take responsibility for
the patient’s rehabilitation, whether it be home or
community hospital.
“We are now, more than ever before, consistently
and actively aiming for our patients to work
towards rehabilitation goals from day 1 of
admission in order to effectively advise the team
on discharge destination as soon as possible to
ensure organised, prompt and safe discharges as
soon as the patients are MFFD”.
“I have found the introduction of both the CUR
system and discharge coordinators very positive
as it has helped in the discharge and rehab skills
development of my more junior members of staff
as direct results of the conversations happening
in the daily MDT handovers/ meetings”.
I believe the patients to be benefitting greatly
from this new discharge planning structure as
their current care, rehab and appropriate place of
care are reviewed daily and discharges are more
prompt from the day they are MFFD therefore
reducing their stay in an acute setting and
reducing exposure to the risks associated with
acute stay”
Clinical Utilisation Review is enabling all key MDT
members to work together resulting in all staff
aware of our patients’ discharge plans and therefore
presenting to the patients and their relatives an
informative, supportive and knowledgeable team.
Sam Towers
Inpatient Head of Physiotherapy
Royal Surrey County Hospital NHS Foundation Trust
“Clinical Utilisation Review, and
its use on a daily basis, changes the
way professionals talk to each
other”. It enables resource allocation
on a daily basis, rather than a
reactive weekly or monthly
schedule”
Karen Scott, Head of Discharge
Team, Basildon and Thurrock NHS
Foundation Trust
“CUR adds real value to the role
of the Trust Case Managers, it's
their discharge compass. The tool
is patient focused and
financially self-supporting by
reducing bed days”.
John Coleman, Director of
Operations, Royal Surrey
Hospital
SUMMER 2016

3. As part of the event, we were joined by 2
ward managers and a staff nurse from the
wards to provide an account of how they
use the system on a daily basis, and the
benefits this has provided to them as part of
their working day.
Rebecca Thompson, CUR Analyst provided
an overview of the work undertaken to
create a CUR dashboard, now being used on
the wards. The purpose of the dashboard is
to provide at the press of one button, an
overview of the number of patients meeting
criteria for their continued stay, those who
do not meet the criteria, the top internal
reasons for delay, and compliance rate in
entering the data.
Feedback from the event was very positive
with the following comments received:
“Excellent event. Well organised.
Covered lots of issues and honesty
around the challenges faced”.
“A good session with plenty of thoughts
and ideas to take away to consider
around my Trust’s implementation”.
“Helped increase my awareness of CUR,
and why it’s needed; good presentations”.
Further events are planned in September
and November. If you would like further
information about attending an event,
please contact
Rebecca.Thompson@srft.nhs.uk
Salford held its second open day on 8th August
2016. The event was well attended by 8 different
Trusts from the North and London regions. The
purpose of the event was to provide an overview
of CUR, and to learn from the Salford experience,
one of the 5 national CUR Early Implementer
Sites.
The event was hosted by Sarah Bridgford, CUR
Project Lead, and Dr Richard Warner, Consultant
in A&E Medicine and CUR Clinical Lead. Sarah
described the journey that Salford have
undertaken in implementing CUR, and the
successes and challenges along the way. This
included a number of lessons learnt from the
implementation period; Salford Royal have now
rolled out CUR across 660 beds, their total bed
base.
Dr Richard Warner, Clinical Lead at Salford Royal
Hospitals for CUR described how CUR provides an
opportunity for clinicians to fully understand and
engage in the quantifiable blockers to flow, and
prompts thought for where resource and
investment needs to be targeted for change with
key decision makers. Richard emphasised that
clinical ownership and accountability for the data
arising from CUR is the key driver for change at
Salford.
One of the challenges being addressed by Salford is
improving compliance of CUR across the Trust. In
order to address this, the Trust has produced a weekly
compliance report shared with all wards. This report
identifies the actual compliance rate for each ward for
that given week and the change in compliance against
the previous week. This allows the Trust to identify
where additional support, for example training, is
required and therefore support can be directed
appropriately at those wards.
As part of addressing Length of Stay across the Trust
they are now in the process of establishing KPIs for
each ward to actively reduce LOS as an outcome of the
CUR data produced to date.
In addition, they are currently running a test of change
to ensure CUR is fully embedded and standardised
across all wards. This will result in a standard
operating procedure (SOP) being produced for all
wards – due to complete by end of December 2016.
CUR Engagement Events – London
Region
On 5th July 2016 a CUR engagement workshop was
held for provider Trusts and commissioners across
London. The purpose of this half day event was to:
• provide an overview of CUR for NHS provider Trusts
implementing CUR during 2016/17;
• to present data from the Early Implementer Sites to
substantiate the benefits to both providers and
commissioners in implementing CUR; and
• to explore the key milestones for Q2 2016/17
The CUR national team were on hand to provide
information and guidance on getting started with
implementation and to answer specific Trust
questions.
Feedback from those attending found the event useful
and on that basis a further session is planned during
October 2016 to review success criteria at individual
Trust level. This event is open to both commissioners
and providers who are implementing CUR in 16/17
from the London region.
Page 3
EVENTS AROUND THE REGIONS - SITES GO LIVE
The Salford
Story
SUMMER 2016
Page 3

4. Page 4
The network also presents an opportunity for
Early Implementer Sites to feedback on
progress, share learning and ideas, and to
shape the future direction of the CUR
programme with the national team.
During 2016/2017, we will be extending an
invitation to NHS providers to join the network
as they begin to implement CUR.
What our EIS sites wish they’d
known that they know now…
“CUR is a system wide
transformation tool and not just
about data entry”.
A great deal of emphasis has been placed on
understanding who will be entering the data on
a daily basis. What we haven’t truly
appreciated is the work truly starts when you
begin to analyse the data, and fully appreciate
what it is telling you. Compliance in use of the
system is important, we mustn’t under-
estimate this, but of more importance is
understanding how the data will be used to
effect change and enhance patient quality.
Start to engage with your Transformation/QI
team at your earliest opportunity to
understand the additional patient flow working
taking place within the Trust, and how CUR can
add to this.
The top internal based reasons for
delay reported by our EIS sites include:
• Awaiting ‘Physiotherapy’ and ‘Other
diagnostics tests/ treatments’
• ‘MDT intervention’, ‘Awaiting Senior
Clinical Decision to Discharge/ At
Consultant Request’
• ‘Medication Related’ and ‘Processing of
Transfer/ Discharge by Trust’.
CUR LEARNING NETWORK UPDATE
“Senior Sponsorship of the CUR
Programme – both clinical and
operational”
It’s really important that leadership is
evident at the start of the programme;
both clinically and operationally. CUR is
a critical enabler for Trusts to
understand their blockages, and delays
at ward level, divisional level and the
impact of this for the whole
organisation.
This requires strong leadership - is the
Trust ready to accept what the data is
showing – what are the key behaviours
and attributes required by the
organisation to drive forward the
changes on this basis.
Using the Data
Each of the CUR systems will generate
automated reports identifying the
number of patients who meet the
criteria on a daily basis, and those
patients who do not. Working with the
wards and departments to draw off and
use this data consistently, as part of
daily routine is a key requirement to
ensure ownership of the delays and
blockages, and to ensure change can
occur quickly.
Take time to invest in analysing,
interpreting and educating others in
what your data is showing - this is key
for buy-in from the wider health system.
Using the data as soon as possible with
clinical staff will ensure buy-in, and help
to support increased compliance once
they understand the benefits being
derived from what they are inputting.
A Learning Network has
been developed to
support the CUR Early
Implementer Sites,
additional Trusts are set
to join!
“CUR is helping us deliver improved
outcomes, including accelerated
discharge and reduced bed usage
where it is not clinically indicated,
thus improving the experience for
those using our services”
Jennifer Slater, Clinical Lead – Case
Management, Operational Services
South Tees Hospitals NHS Foundation
Trust
Implement over 7 days
To get the most benefit out of the CUR data
being produced it’s important to enter the
data daily over 7 days. By ensuring real-time
data is input, data capture on every patient
can be realised thus avoiding a retrospective
view, or missing cohorts of patients who may
have been admitted and discharged over a
weekend.
Reporting Lessons…
Acknowledge Its Importance! The CUR
CQUIN Report is essentially a high level
summary of the data produced by your CUR
Solution. It is not complicated. Trusts need to
ensure that the data included in this report is
not only good enough to comply with the
reporting requirements of the CQUIN but also
for the organisation itself, as you should be
using the CUR data to plan and implement
actions that will improve the quality,
efficiency and effectiveness of the services
provided. It is critical that Trusts ensure that
sufficient analytical capacity and skills are
included within their CUR Project
Management Teams. The CUR programme is a
transformation programme and needs to be
resourced as such.
Data Quality is key to making the right
decisions, not validating and testing
understanding of the data before submitting
can result in wasted time and confusion.
Work with your CUR supplier, who is
committed to supporting you with the
production of the report, to ensure that
inappropriate conclusions are not drawn and
to ensure the CUR National Team understand
what sits below the headlines we will follow-
up every submission with every Trust, working
with both the Trusts and suppliers to ensure
the data is ‘clean’.
Please ask the CUR National team if unsure,
we are happy to help.
SUMMER 2016

5. CUR TEAM MEMBERS
UPCOMING EVENTS
Don’t forget to visit the
CUR Extranet site for all the latest
documents, briefings, case studies and
supporting information. Please contact
denise.edwards13@nhs.net for access.
For further information on any of the
articles published in this edition of CUR
news, please contact a member of the
CUR team.
The delivery of the CUR
programme is supported by a
national team who are:
HILARY HEYWOOD
National Programme Director
T: 07717 467483
E: Hilary.Heywood@nhs.net
MICK DOLAN
Relationship Lead – South and Midlands &
East
T: 07875 363263
E:
Mick.Dolan@integralhealthsolutions.co.uk
ALISON JOHNSON
Relationship Lead – North and London
T: 07810 752876
E: Alison.Johnson27@nhs.net
ELISA TAYLOR
PMO Lead
T: 07798 888999
E: Elisa.Taylor@nhs.net
DENISE EDWARDS
Relationship Lead – South and Midlands &
East
T: 07806 780409
E: Denise.Edwards13@nhs.net
NATIONAL CUR EVENT
The National CUR Team are planning an event
in the New Year to share the Learning on CUR.
Further details will be issued in December
2016.
SALFORD ROYAL HOSPITALS
OPEN DAYS
Further events are:
• Monday 26th September 2016
• Monday 12th December 2016
If you would like further information about
attending an event, please contact
Rebecca.Thompson@srft.nhs.uk
CUR CQUIN REPORTING
All NHS Trusts who have signed up to the
2016/17 CUR CQUIN (including CUR Local
Learning Pilots) are required to complete
CUR CQUIN Reports once they have gone
live with their CUR solution. The
information provided in the CUR CQUIN
Reports will be used to understand the
scope and potential for improving patient
flow. Depending on local agreements they
may also be used to highlight
improvements in a reduction in CUR
Criteria Not Met (Non Qualifying) beds
days, from the baseline.
By combining the data from individual
Trusts the national CUR Programme Team
is using the data in the reports to
understand/ illustrate:
• The size, scope, scale and pace of
implementation at a national level
• The potential for improving patient
flow across the national programme
and the main reasons for CUR Criteria
Not Being Met
• Reductions in CUR Criteria Not Met
(Non Qualifying) bed days (and where
appropriate non-elective admissions).
Due to the differences in local
implementation, local modifications to CUR
software and the differing characteristics of
local systems the information gathered in
these reports will not be used for
performance management purposes. As
part of signing up to the CQUIN Providers
can be assured that the publication of
identifiable Trust specific data will only be
made available with permission from their
Trust Board e.g. to support cases studies or
good practice guides.
Page 5
SUMMER 2016
We would particularly like to thank our
colleagues at Basildon & Thurrock
University Hospitals, Salford Royal NHS
Foundation Trust and Royal Surrey
County Hospital for their valuable
contributions to the CUR Learning
Network and production of CUR case
studies as detailed in this newsletter.