Meeting the challenge together... delivering care in the most appropriate setting (October 2008). This document has been designed to support the pilot sites (now starting to test new ideas working with partners in primary care and social care) but will also be of interest to other organisations attempting to reform inpatient care (Published October 2008).

1. NHS
NHS Improvement
CANCER
Transforming Inpatient Care
DIAGNOSTICS Programme for Cancer Patients
Meeting the challenge
HEART
together... delivering care in
the most appropriate setting
STROKE
Supporting delivery...

3. Meeting the challenge together... delivering care in the most appropriate setting 3
Contents
Foreword 4
Introduction: Question: Why focus on cancer inpatients? 5
Delivering care in the most appropriate setting 8
• National programme overview
• New models of care: Transforming Inpatient Cancer Care
• The Winning Principles
Testing, spreading and sustaining 10
Step One: Getting started 10
• Planning and engagement
• Base-lining: Cancer Commissioning Toolkit
• User involvement
Step Two: Measuring quality that is fair,
personalised, safe and effective 14
Step Three: Capturing the learning of testing,
spread and sustainability 17
Useful resources 18
www.improvement.nhs.uk/cancer

4. 4 Meeting the challenge together... delivering care in the most appropriate setting
Foreword
The Cancer Reform Strategy set out the benefits both for patients and for the NHS of
transforming inpatient care for cancer patients. Too many patients are being admitted as
emergencies when, with suitable planning, alternative models of care could have been put in
place. Once admitted, the length of stay is often unnecessarily prolonged because of failure
to define and implement inpatient care pathways and because of delays in decision making.
Better education for patients would lead to self management approaches which could also
reduce unnecessary admissions.
The Transforming Inpatient Care Programme, led by NHS Improvement – Cancer and the
National Cancer Action Team, has been established to support local initiatives to improve
inpatient care for cancer patients. Pilot sites are now starting to test new ideas working with
partners in primary care and social care.
‘Meeting the challenge together... delivering care in the most appropriate setting’ has been
designed to support the pilot sites but will also be of interest to other organisations attempting
to reform inpatient care. It builds on the ‘four winning principles’ that were identified from
previous testing. Key to the success of this phase of the programme will be spread and
sustainability to achieve the maximum impact. It is vital that we capture learning from
individual pilot sites, both about what does and what does not work, in order that the
benefits are optimised as soon as possible.
Mike Richards
National Cancer Director
www.improvement.nhs.uk/cancer

5. Meeting the challenge together... delivering care in the most appropriate setting 5
Question: Why focus on cancer inpatients?
• Answer: To ensure quality that is fair, personalised, safe and effective
• Answer: To promote partnership working, the alignment of systems
and combined leverage for improvement
• Answer: Because it’s an area that’s had little attention
www.improvement.nhs.uk/cancer

6. 6 Meeting the challenge together... delivering care in the most appropriate setting
‘ My time in hospital
was their time,
QUESTION:
’
not mine.
(User feedback)
• Answer: Because it matters Answer: There are some key interfaces
to patients with the social care system
Firstly, the whole system is acknowledged to be
Andy’s reflections currently unsustainable due to the gap between
funding and demographic and demand pressures. The
My name is Andy Millward. I am a 55 year old man, Green Paper, currently in design phase, will be
who was diagnosed in October 2004 with metastatic addressing this. Whatever the answers, it can be
prostate cancer, a form of site specific cancer that was
assumed that funding will remain very tight.
so advanced that I was only given eighteen months to
two years to live. I am very fortunate, in that I have
thus far been able to defeat that timetable and Secondly, improving the inpatient experience does to
prognosis, but the majority of my subsequent some degree depend on social care, especially if there
treatment has been successfully managed whilst at are plans to reduce lengths of stay, move care closer
home, which is very much where I, along with many to home and support early discharge. Taking this
others on similar cancer journeys, wish to be. I have together with funding pressures, it will require whole
had two hospital admissions since then, both via the systems solutions involving social care, including
emergency pathways at my local hospitals and both ensuring that financial incentives work for social as
admissions related primarily to severe pain. The
well as primary/community care.
process of accessing inpatient care was both difficult
and traumatic for both my wife and I and
unnecessarily burdensome, as we had to negotiate very Thirdly, the Government’s Putting People First
different processes and locations to eventually arrive at (December 2007) transformation programme presents
the oncology ward that could attend to my specific the system with the challenge of transforming the
difficulties. way in which services are delivered to put control in
the hands of service users and carers. By 2011 all
I cannot fault the level of care offered as an
service users of social care will have the right to use
inpatient (and in line with many of the audits that I
know have been carried out, some of my time was individual budgets to choose how their care is
spent unnecessarily on general medicine wards). arranged, and those who fund their own care will be
However, whilst recognising that staff who have offered the same level of advice and support as those
responsibility for us have serious considerations of risk receiving state funding. In redesigning pathways,
and clinical governance to consider, I think we as account should be taken of how choice and control
patients could be given more responsibility and will operate for patients.
innovative resources to manage more at home. From
experience, I do also believe that I could very easily Fourthly, each region now has coordinated
have been discharged sooner, thereby shortening my
arrangements for care and support improvement, with
length of stay. This is the real challenge for all of us
and I therefore warmly welcome the launch of the Joint Improvement Partnerships overseeing
national strategy on in-patient care and potential programmes of work, and Regional Improvement and
likely alternatives to managing cancer journeys like Efficiency Partnerships allocating what funding there is
my own away from hospital. in a coordinated way. It is important that any health
We also need to ensure that even if acute admission is systems improvement work is able to link to these
absolutely necessary – and not just a default position new arrangements.
of the system – that treatment and care in hospital is
kept to an absolute minimum. Simon Williams
Director of Community and Housing,
Andy Millward,
National Lead for Urgent Care
Nottingham (September 2008)
www.improvement.nhs.uk/cancer

7. Meeting the challenge together... delivering care in the most appropriate setting 7
Why focus on cancer inpatients?
Answer: A move from a care delivery
chain to a whole care system
Why focus on cancer
Delivering the next stage of the Cancer Reform inpatients? This is
Strategy will require increased levels of integrated
working alongside substantial redesign of services to
ensure that services are relevant and responsive to
no longer a question
service users. Commissioners have a vital role in
leading thinking on new services whilst supporting
but an opportunity
providers to work together, innovate and think
differently about the scale, scope and style of services for action...
which will be required outside of traditional settings.
Commissioners will need to set out clear service
strategies which focus on supporting an increase in
for example self-management. This will undoubtedly
create opportunities for new ideas and new providers
in the area of cancer care.
Andrew Donald
Chief Operating Officer, Birmingham East & North PCT
(September 2008)
Answer: Care being delivered in the
most appropriate setting and
improving outcomes is a key
commissioning role
Doing this in a methodical and explicit way to develop
new models of care brings acceptability and
sustainability into consideration. Extending this work
beyond secondary care and involving more
stakeholders increases the complexity but the
importance and potential benefits of this work make
it worthwhile. A challenge faced by a PCT is working
with the systems in place and developing new ways of
commissioning new models.
Philippa Muir
Head of Specialist Commissioning
and Clinical Networks, Oxfordshire PCT
www.improvement.nhs.uk/cancer

8. 8 Meeting the challenge together... delivering care in the most appropriate setting
Delivering care in the most
appropriate setting
A programme of work has been established, supported by NHS Improvement and the Cancer Action
Team, working with key organisations, users, charities and professional bodies. The overall programme
covers six priority workstreams.
Lead - (TBC)
HES
Lead - Cancer Lead -
Action Team National
Cancer
Services
Lead - Cancer Analysis
Action Team Team
Lead - Cancer
Action Team
Lead - NHS
Improvement
This document focuses on
supporting the delivery of the
New Models of Care: Transforming
Inpatient Care.
www.improvement.nhs.uk/cancer

9. Meeting the challenge together... delivering care in the most appropriate setting 9
Winning Principles
Previous testing identified four winning principles that can improve length of stay management,
avert unnecessary admission, deliver care in the appropriate care settings, improve efficiency,
quality, promote value for money and importantly value the patients’ time.
1. Unscheduled (emergency)
patients should be assessed The task now is to:
prior to the decision to admit.
• Ensure that these winning
Emergency admission should be
the exception not the norm. principles are spread and
embedded across the NHS
2. All patients should be on • Test new ideas with new
defined inpatient pathways partners such as primary
based on their tumour type and social care
and reasons for admission.
• Sustain proven improvements
to achieve maximum impact
3. Clinical decisions should be
made on a daily basis to
promote proactive case
management.
www.improvement.nhs.uk/
winning_principles
4. Patient and carers need to
know about their condition
and symptoms to encourage
self-management and to know
who to contact when needed.
www.improvement.nhs.uk/cancer

10. 10 Meeting the challenge together... delivering care in the most appropriate setting
Testing, spreading and sustaining
Step One: Getting Started
Tip 1:
Create a shared vision – time and effort spent in
agreeing high quality and performance
indicators at the start will enable the team to
stay focussed.
Tip 2:
Keep the service users and carers central.
Tip 3:
Create co-production energy – work with
an approach that encompasses professional,
organisational and functional boundaries
to create partnership environments.
Tip 4:
Define the workstream scope
– there are many project
initiation documents
available but it is worth
agreeing which one you are
going to adopt to ensure
appropriate links are correctly made at the start.
Tip 5:
Test small step changes - one service user at a
time makes the experience safe and controlled.
Tip 6:
Engage partners early in discussions. Make
sure you are not just shifting existing services
without the infrastructure to support and
adding more unnecessary steps into the process.
Tip 7:
Use clinicians and leaders as a catalyst to
improve care at all stages.
Tip 8:
Use and involve the local network service
improvement team as a resource.
Tip 9:
Focus on really understanding the problem
not jumping to the solution.
www.improvement.nhs.uk/cancer

11. Meeting the challenge together... delivering care in the most appropriate setting 11
Good planning can inspire change
that leads to improvements
Planning
Leadership and • Identify the key people to be involved early on in the workstream.
engagement • Who are the key stakeholders?
• Clinical and managerial leadership is critical to success.
• Have you included data and informatics and finance, primary care and
social care?
Knowledge and • Establish the steering/working group.
skills – the basics • Has the group got the people with the knowledge and skills? Can they make the decisions?
• Do they have service improvements skills?
• Knowledge of heath and social care processes?
• Is there service user Involvement?
• Is their agreed local accountability and responsibility for delivery?
• Knowledge of commissioning?
• Information gathered from all perspectives (service users, staff,
commissioners, partnerships etc).
Planning the • Identify, understand and define the ‘real’ problem not the solution.
improvement • Review data to understand demand, activity and variation in performance.
workstream • How are your improvements going to be measured and monitored?
Have you included qualitative and quantitative performance indicators?
• Match the collection of baseline data with the scope of the problem identified.
• Remember that no data will be perfect and beware of analysis paralysis
(collecting everything that tells you nothing).
• Break the data down into sections of information to help you identify
what needs to be collected and analysed.
• Look for the 80/20 rule (Pareto principle) this happens to 80% of our users;
focus on the 80% first, look for trends in retrospective data.
• Keep clinicians, leaders and key people involved.
• Identify (visioning) and design the ideas to tested.
Engagement with • Seek and build continuous and meaningful engagement with the public
public and service and service users, involve them in shaping services.
users • Have an understanding of different user engagement options, including
the opportunities, strengths, weaknesses and risks.
• Routinely invite service users and the public to respond to and comment on issues.
• Ensure that users and the public understand how their views will be used, which decisions
they will be involved in, when decisions will be made, and how they can influence improvement.
Test out your ideas • Communicate widely about ideas being tested.
• Test the idea (maybe more than one testing cycle).
• Capture results, benefits and measure the impact. Match across to your performance indicators.
• Capture the learning (the things that work and those that didn’t documenting reasons why).
• Communicate regularly with the whole team and partnerships - keep the message short and snappy.
• Ensure identified ownership of action points.
Evaluation • Analyse the results and quantify the impact of actual and potential.
• Identify benefits- e.g. quality, cost, outcomes.
• Identify risks.
• Evaluate the alternatives.
• Make recommendations.
• Build your business case on evidence.
Implementation – • Recommendations for implementation (provide the evidence that supports your testing).
spread and sustain • Commissioners want to see the evidence.
• Celebrate your achievements.
• Share the learning - publicise your work.
• Prepare your spread/adoption strategy.
• Include how you will measure sustainability.
www.improvement.nhs.uk/cancer

12. 12 Meeting the challenge together... delivering care in the most appropriate setting
Use a simple approach: Apply a practical framework for
testing, spreading and sustaining
YES
Analysis Is it the
Identify the Visioning
Baseline from Testing Cycles right solution to
real root of the What are you trying address the real
different perspectives problem Test out the idea’s
to achieve? problem?
NO
YES
Case for change
Evaluate and Implementation Agree the redesign Evaluation
Plan the implementation
check sustainability Implement the idea & implementation of Evaluate the benefits
of the tested idea. Build the improvements What is the difference
the case for change
Spread/Adoption
Strategy
Use available resources for gathering The Cancer Commissioning Toolkit will
baseline information help you to define who needs to be
engaged and define who will drive the
The Cancer Commissioning Toolkit (CCT) workstream – commissioning, primary
The Cancer Reform Strategy (2007) identified better care, secondary care or social care
information and stronger commissioning as two of the
key drivers to achieve the goal that cancer services in You will still need to capture
England should be amongst the best in the world. The a local baseline
CCT is a one stop online library of key cancer To find out locally and to understand what
information and data which can be easily accessed for lies beneath the numbers of the CCT.
use. The Cancer Commissioning Tool provides the
To help you with local baselines a series
starting point by providing useful baseline and
of questions have been developed into
benchmarking information.
an inpatient checklist which is available
at the back of this document. Most of
this information should be available in
The Cancer Commissioning Toolkit (CCT) inpatient your local organisations.
chapter is divided into three key sections
www.improvement.nhs.uk/cancer

13. Meeting the challenge together... delivering care in the most appropriate setting 13
Capturing your baseline The involvement of users can result in a
number of benefits for the organisation.
• Find out why your length of stay is X and
bed days Y User involvement
• Tip 1: Don’t look at the numbers of the CCT in • Raises your awareness of the issues
isolation from the whole improvement picture that impact on service users
for the patient • Helps to clarify how health services can
• Tip 2: Don’t jump to solutions be improved and redesigned
based on the numbers without • Helps to identify issues and support
identifying the real their improvements to make the
problem biggest impact for service user needs
• Tip 3: Think about: • Challenges the professional views and
‘How can you really manage existing approaches to services.
length of stay if you do not know
what the right length of stay is?’
•Tip 4: Do not get complacent, if User involvement - methods
you identify from the CCT data • Questionnaire surveys
that you are in the higher or • Satisfaction surveys
middle quartile - there is • Interviewing
always room for improvement. • Discovery interviews
• User diaries
• Focus groups
• Workshops
• Reader panels
Getting the user involved
• User panels
User involvement is increasingly becoming accepted • Citizens’ juries
by planners, service providers and users. The need to • Local 18 week patient experience
listen and act on the views of users and the public is surveys.
an integral part of improving quality and delivery of
healthcare.
There are many different approaches to user The inpatient test sites used a variety of
involvement; start by identifying what already exists these methods, for example, patient
across the health community. satisfaction surveys were developed to
ensure that there were no adverse
effects on patient experience due to
User involvement changes in their pathways.
• Patient Advice and Liaison Services (PALS)
‘
• Studying the complaints and compliments
• Suggestion boxes and comments slips
• Local organisational audit and national audit
I much preferred coming to
e.g. Health Care Commission Annual Health day care for my antibiotics
Check, National Cancer Audit
• Study the organisations website for as I was able to have my
suggestions/comments. It is also worthwhile
exploring what is currently happening in local
treatment early enough to
areas to gain feedback from patients for allow me to go home and
example:
’
• Patient and public involvement forums care for my disabled wife.
• Local Involvement Networks (LINKs) (Patient interview)
• Patient groups: User groups, carer groups
and disease support groups
• Expert Patient Programmes www.improvement.nhs.uk/
• Patient participation groups in primary care.
winning_principles
www.improvement.nhs.uk/cancer

14. 14 Meeting the challenge together... delivering care in the most appropriate setting
Step Two: Measuring that quality is fair,
personalised, safe and effective
Tip 1:
To be able to realise benefits - it is important to
agree the measures (metrics or indicators) right
at the start of the workstream with all partners.
Tip 2:
Measures (metrics/indicators) should reflect
the whole performance spectrum:
• Quality and patient experience
• Efficiency and value for money
• Effectiveness and impact of improvements
• Alignment with national indicators across
partnerships.
Tip 3:
Set up a data capture system
for continuous monitoring
of improvement at the start.
Tip 4:
Feedback regularly on the
improvements made.
A true measure captures
all the benefits that
everyone can gain.
www.improvement.nhs.uk/cancer

15. Meeting the challenge together... delivering care in the most appropriate setting 15
Identifying the potential alignment of national and local
indicators with Transforming Inpatient Care
‘Vital Signs’ ‘National Indicators’ Cancer Reform
Indicators for progress against Local Authority and Local Authority Strategy (CRS)
national/local priorities for PCTs Partnerships for adult health and wellbeing New Models
Transforming
Inpatient Care
Rates of hospital admissions for Number of social care clients receiving self directed Winning Principle 4
ambulatory care support per 100,000 population – designing the
care and support package that best suits their
specific needs
Proportion of people with long term The percentage of people with a long-term Winning Principle 4
conditions supported to be independent condition supported to be independent and in
and in control of their condition control of their condition
Patient experience of access to Timeliness of social care assessments and social Winning Principle 1
primary care care packages following assessment
Number of delayed transfers of care per The average weekly rate of delayed transfers of Winning Principle 1
100,000 population (aged 18 and over) care from all NHS hospitals, acute and non-acute, Winning Principle 2
per 100,000 population aged 18 and over Winning Principle 3
Timeliness of social care assessment The ability of the whole system to ensure Winning Principle 3
and package appropriate discharge from hospital
Self reported experience of patients Self reported experience of social care users Winning Principle 4
and users perceptions of services
Patients and user reported measures of User reported measures of respect and dignity in Winning Principle 3
respect and dignity in treatment their treatment
Number of emergency bed days per Number of emergency bed days per head of Winning Principle 1
head of weighted population weighted population
Ambulance conveyance rate to A&E
Proportion of all deaths that occur Percentage of all deaths that occur at home - end Winning Principle 4
at home of life care, access to appropriate care enabling
people to be able to choose to die at home
Percentage of patients receiving their Waiting times targets Winning Principle 2
first definitive treatment for cancer
within two months of urgent referral
for suspected cancer
Percentage of patients seen within 18 Winning Principle 3
weeks for admitted pathways
www.improvement.nhs.uk/cancer

16. 16 Meeting the challenge together... delivering care in the most appropriate setting
Remember, measures provide evidence Transforming Inpatient Care
and motivate stakeholders: has the potential of:
• Reducing cancer bed days by 25%
Providers are motivated to reduce
per SHA
length of stay and to release capacity. • Ensuring inpatient care for cancer does
not exceed 12% of all inpatient bed
PCTs are motivated to reduce days (baseline CRS 2007)
inappropriate admissions and bed • Ensuring costs do not exceed the
2008 baseline
days over trim points.
• Reducing emergency admissions
by 5%.
Patients do not want
to be in a hospital Capturing and measuring the quality,
unnecessarily - efficiency and impact through the
NHS Improvement microsite
adding no value
to their well being The microsite will be one of a cluster of
or treatment. specialised websites linked to the Cancer
Commissioning Toolkit and the NHS
Improvement website.
The microsite is being developed to
support the new models workstream. It
will present specific information and data
relating to the impact of testing, spread
Early intervention and the sustainability of the work being
undertaken by the provider sites actively
by social care. Early
involved the workstream.
supportive discharge
benefit - cost saving in The microsite will be a ‘working web
the community - right space’ that will allow organisations to
support at the review their historic activity, scenario
plan, quantify their assumptions and
right time.
measure the actual and potential impact
of their improvement ideas.
The microsite will go live in January 2009
and will continue to evolve and develop
during 2009.
www.improvement.nhs.uk/cancer

17. Meeting the challenge together... delivering care in the most appropriate setting 17
Step Three: Capturing the learning for testing,
spread and sustainability
To enable the learning to be collated and shared, 3. Sustainability Checklist
three approaches have been developed, that together
can enhance the delivery of improvement across the It is important to develop a plan for
new models workstream and build the momentum for sustainability which ensures that we
spread. (The learning diary/spread planner and create lasting improvements.
sustainability check list can be found in the back
pocket of this document). The sustainability check list focuses on
some key questions to assist you in
1. The Testing Learning Diary developing your strategy.
Capturing the elements of the ‘Testing process’ (Aim,
Measures, Process and Impact) will help to support a
learning framework that will enable the key outcomes
of the ‘testing phase’ to be shared with the wider
NHS.
The Inpatient Learning Diary is a tool which collates
the learning from the testing, and helps to guide
the sites through the testing approach by a series
of questions. This is available on:
www.improvement.nhs.uk/improvementsystem.
To learn objectively from the whole process, the
project needs to be reviewed in order to establish
what has been accomplished, and to also learn from
what did not go so well. This will enable all
organisations involved to learn from the experience
and to share that learning with others.
2. Spread Planner
Success is often gauged by how quickly an idea is
rapidly adopted and spread. Having a spread strategy
can eliminate the gap between what is and what can
be. It promotes equity of service delivery in order that
all can gain from the benefits. The spread planner is a
guide to spreading the winning principles and other
outcomes and benefits from testing. It derives from
the experience of the early test sites, Institute for
Health Improvement (IHI) and the work of Everett
Rodgers (Diffusion of Innovation 2003).
www.improvement.nhs.uk/cancer

18. 18 Meeting the challenge together... delivering care in the most appropriate setting
Useful resources
Service Improvement Information
• NHS Improvement, Transforming Inpatient Care, Winning Principles
www.improvement.nhs.uk
• Gold Standards Framework (GSF)
www.goldstandardsframework.nhs.uk
• Liverpool Care Pathway for the Dying Patient (LCP)
www.lcp@mariecurie.org.uk
• Palliative Care
www.endoflife.nhs.uk
Social Care Information
• Adult Social Care: The Government’s Green Paper and the LGA’s Campaign
www.lga.gov.uk/lga/aio/275402
• Putting Patients First
www.nationalhealthcouncil.org/initiatives/putting_patients.htm
• High Impact Changes for Health & Social Care
www.csip.org.uk/silo/files/hics-doc-11th-march.pdf
• Care Support Independence: Meeting the needs of a changing society
www.orderline.dh.gov.uk
Health Information
• Our NHS Our Future: High Quality Care for All (Lord Darzi)
www.ournhs.nhs.uk
• Cancer Reform Strategy
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/dh_08100
• Cancer Commissioning Tool
www.canceruk.net
• Department of Health
www.dh.gov.uk
• World Class Commissioning
www.dh.gov.uk/en/managingyourorganisation/commissioning/worldclasscommissioning/index.htm
• Our Health, Our Care, Our Say
www.dh.gov.uk/en/Healthcare/Ourhealthourcareoursay/index.htm
• National Planning Guidance ‘Vital Signs’
www.dh.gov.uk/publications
User and Public Involvement
• Department of Health (2004). Choose and Book
www.chooseandbook.nhs.uk
• Department of Health (2005). Creating a Patient Led NHS -
Delivering the NHS Improvement Plan
www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/Publications
PolicyAndGuidanceArticle/fs/en?CONTENT_ID=4127453&chk=NXIecj
• Department of Health (2006). Developing a Stronger Local Voice
www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/
PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4137040&chk=U6PSmq
• Department of Health (2006). Reward & Recognition
www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/
PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4138523&chk=vDLLsV
www.improvement.nhs.uk/cancer

19. Acknowledgements
With our thanks to:
• All the Test Sites for their continuing
commitment to
this national workstream
• Professor Mike Richards
• Simon Williams
• Andy Millward (User Representative)
• Philippa Muir
• Dr. Brian Cottier
• Andrew Donald
• Celia Ingham Clark, National Clinical Lead
• Cancer Action Team
• NHS Improvement Team: Dr Ann Driver,
Angie Robinson, Marie Tarplee, Catherine
Strong, Jim Farrell, Wendy Gray
For further information please contact:
Dr Ann Driver
Director, NHS Improvement
Email: ann.driver@improvement.nhs.uk
Tel: 07900 223142
Angie Robinson
National Improvement Lead, NHS Improvement
Email: angie.robinson@improvement.nhs.uk
Tel: 07900 223346
Marie Tarplee
National Improvement Lead, NHS Improvement
Email: marie.tarplee@improvement.nhs.uk
Tel: 0791 7233248

20. NHS
NHS Improvement
CANCER
DIAGNOSTICS
HEART
STROKE
NHS Improvement
Formed in April 2008, NHS Improvement brings
together the Cancer Services Collaborative
‘Improvement Partnership’, Diagnostics Service
Improvement, NHS Heart Improvement Programme
and Stroke Improvement into one improvement
programme.
With over eight years practical service improvement
experience in cancer, diagnostics and heart, NHS
Improvement aims to achieve sustainable effective
pathways and systems, share improvement resources
and learning, increase impact and ensure value for
money to improve the efficiency and quality of
NHS services.
Working with clinical networks and NHS
organisations across England, NHS Improvement
helps to transform, deliver and build sustainable
improvements across the entire pathway of care in
cancer, diagnostics, heart and stroke services.
NHS Improvement
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