Planned Care Improvement Programme News
The Daily Planner
The Daily Planner is the Planned Care Improvement Programme newsletter. Below are articles from the current and previous editions. If you would like a copy of The Planned Care Improvement Programme newsletter, please contact max.brown@scotland.gsi.gov.uk
Edition 6 - December 2007
As we head into the last 3 months of the Programme our focus is on sustainability of the many changes made through the local Board project teams. Improvements have been made across the five simple changes and will build the foundations for transition to the 18 Week Referral to Treatment Time Programme, which will launch in the new year.
In October, we ran three regional events with representatives from NHS Elect, a members' network that works with organisations' to deliver improved elective care. The bulk of NHS Elects work is on the 18 Week Referral to Treatment Time Programme in England.
The events focused on redesigning whole patient pathways and offered a valuable insight into the English experience of implementing the 18 week patient pathway. The main learning points from the events were around leadership, clinical and staff engagement, data management and analysis of capacity and demand.
Key Learning Points:
1. Seek Accurate Measurement of the Whole Patient Pathway
The following steps should be considered in relation to measurement: agree local principles and definitions, improve the quality and completeness of data to understand local pressures , ensure your IT systems can support measurement across the whole patient pathway, identify areas where manual data collection may be required, work out ways to measure 'clock starts and stops'. We have an article from Pat Pirie, Information Manager from the National Team, giving more detail on improving data on page 3 of this edition.
2. Matching Capacity with Demand
Data systems need to be robust in order to get a true picture of the demand on current services. Understanding your baseline demand and capacity at an early stage is essential to inform pathway redesign and service planning. Having data to inform change can help to obtain buy-in to your change programme.
3. Engagement
It is essential to have influential clinical leaders and buy-in from the Executive management team in your Board to support service redesign. All stakeholders need to be engaged at an early stage and communication links should be maintained through out the duration of your change Programme. Involvement of Primary Care colleagues in improving the referral process and shifting the balance of care into the community is a key element of any 18 Week Programme. Dedicated programme teams, including project and information management are required to drive change.
Edition 5 - September 2007
BACKGROUND TO NHS ELECT
Caroline Dove joined NHS Elect in 2003 and, with the NHS Elect Chair, Derek Smith, created the organisation in its current form. She joined the NHS as a graduate trainee on the national management training scheme in 1989. Below Caroline tells us about the organisation.
What exactly is the function of NHS Elect?
NHS Elect is a members' network that helps healthcare organisations to deliver improved elective care, through supporting innovation and sharing experiences across the network. We are currently a network with around 20 members and provide support to our members in a wide range of areas including marketing and customer care; delivering improved care pathways with shorter waits; financial planning; management development and building relationships with independent sector (IS) providers.
What is your background in healthcare?
I joined the NHS as a graduate trainee on the national management training scheme in the 1980s. Since then I have enjoyed a varied career, working largely in secondary care in both operational and strategic management. Working as a general manager in teaching and district general hospitals, I led the operational development of the UK's first treatment centre at Central Middlesex Hospital in 1999 and then moved to the London Regional Office as Head of Health Services Development for the capital. I have worked at Director-level in several organisations, most recently working as Director of Services at Chelsea and Westminster Hospital. I joined NHS Elect in 2003.
Why is elective care important? What are the issues currently facing your members?
Elective care is important because many, many patients each year access NHS services on an elective pathway and expect and deserve to receive excellent care that enables them to return to a full life with minimal waits, pain and delays. In our experience, patients report that they want not only excellent clinical care, but also a good experience. NHS Elect therefore works with its members to develop and deliver better (and more cost-efficient) pathways of care and improved models of customer care. We also help members to create strategic alliances with other providers to support their improvement efforts and help them to market their services to patients and commissioners.
How do you support your members? What expertise do you offer them?
NHS Elect is led by its NHS Trusts members and we deliver a programme designed by our members to meet their needs. We deliver their bespoke programme by working alongside their managers and clinicians on site. This year, NHS Elect members have asked us to support them in marketing services, reducing costs, improving customer care, creating relationships with IS providers, supporting management development and linking as far as possible the relevant Department of Health (DH) policy areas of Independent Sector, 18 weeks and Choice & Plurality. I am very proud of the excellent team at Elect, with each team member bringing expertise in their lead areas. For example, Sue Kong is a Chartered Marketer, with extensive experience of marketing and branding within the NHS. Colin Reeves was recently the Finance Director of the NHS and Sir Graham Morgan, our Nurse Director leading our clinical pathways work, received a knighthood for his work on elective care redesign.
How have you been engaged with the 18 weeks programme? How have your members been involved?
We have been asked by the Department of Health to provide support to the 18 week programme as part of our sponsorship from the DH on the elective care programme and we are delighted to be part of this important work. Our work with 18 weeks will evolve as the programme develops, but at present we are working with the eight Pioneer sites (and plan to expand our work here as the Pioneers begin work on service redesign), with the orthopaedic project, including finalising the musculo-skeletal service framework and with planning a service transformation strategy. Of the eight Pioneers, two are our members (Huntingdon and Sherwood Forest) and we are involved in supporting them across the full range of our services. For our other sites, we will be helping them to take the learning from the Pioneer sites and implement improved pathways locally at the earliest stage possible.
How important is service redesign to the achievement of 18 weeks?
I believe firmly that we cannot deliver 18 weeks by simply doing 'more of the same' and that changing the models of care we provide is fundamental to reducing waits and delays for patients. One good example of this is in orthopaedics, where the musculo-skeletal service framework recommends the development of 'interface' clinics that offer patients immediate diagnosis and access to therapy services and pain relief ahead of being referred to secondary care. Where these clinics have been successfully set up, they have reduced the number of patients referred to hospital, providing services closer to home for these patients and reducing waits for the smaller number of people needing secondary care.
Are there any other considerations for reducing waiting times?
We need to ensure that we have the right capacity available (particularly in diagnostics) and that we are using our work-force creatively. We need to be prepared to learn from each other to understand quickly what works well and have systems to replicate this across the NHS. As well as developing new models of care, we also need to ensure that our internal systems are efficient and that we are removing unnecessary steps from the patient journey. All of this is easy to describe but, as we know from our careers in the NHS, can be difficult to implement. Where possible, NHS Elect works to support our members in addressing these issues, providing support to sites in addressing these issues.
For more details please visit http://www.nhselect2.org.uk
Edition 4 - July 2007
Message from Dr Ian Jackson, President of BADS (British Association of Day Surgery)
I started my Presidency by stating that we are the British Association of Day Surgery and so we must ensure we represent short stay surgery across the whole of the UK. I am therefore pleased to be able to report some success. Scotland is using co-operation across large health communities to plan services fit for the future that also take into account medical and nursing manpower. This follows the publication of the Kerr Report which was accepted in full by the Scottish Parliament. BADS is supporting this process through the Planned Care Improvement Programme being run by the Scottish Executive. Day and short stay surgery form one of the 5 keystones of this initiative, their relative importance is increased due to some of the sparsely populated and remote geographical areas involved. Our thanks to the members of the Planned Care Improvement Programme who provided feedback on the first addition of our Directory of Procedures.
The updated edition of the Directory of Procedures will be distributed to Boards shortly.
Edition 3 - May 2007
Katie Dutton, Planned Care Flow Lead for Day Surgery and Pre-Admission Assessment in NHS Tayside informs us about the 'one stop hernia service' in Angus.
Change 2 : Improve Referral and Diagnostic Pathways
As Katie explained, the general surgeon in Angus worked in collaboration with local GPs and staff in the Stracathro Surgical Unit to reduce the time from referral to surgery for low risk inguinal hernia patients.
The surgeon recognised that depending on symptoms and co-morbidities, not all patients over 70 needed to have surgery for inguinal hernias. However it was recognised that some younger patients were being booked unnecessarily onto outpatient clinics. The advantage of the 'one stop hernia service' is that patients do not have to attend hospital for appointments that are clinically unnecessary.
Making it happen
The General Surgeon discussed the concept of eliminating the outpatient consultation for a specified group of inguinal hernia patients with staff in the surgical unit.
An information booklet was developed for patients detailing; What a hernia is; the procedure; how to prepare for the procedure; arrival time on day of surgery; to phone to arrange pre-admission assessment.
This booklet is handed to the patient by the GP if they are thought suitable for the one stop service.
Edition 2- March 2007
Day Surgery Masterclass on 16 February 2007
Change 1
Treat day surgery as the norm;
Thank you to those of you who attended our day surgery and pre assessment event on 16 February. The day was a great success with representatives from 13 boards and over 100 delegates. Feedback suggests that you found the day useful and particularly enjoyed the presentations from our guest speakers on the "how to" elements of increasing day surgery rates and implementing pre assessment. We will be sure to act on the comments about the layout of the afternoon round robin sessions, when planning future events.
All speakers agreed that in order to make significant improvements to the patient experience it is essential to have good leadership, buy in from Chief Executives, clinicians, and staff of all levels. They also stressed the importance of having a plan, to ensure that all staff are consulted about what they need to increase day surgery rates. A culture change is also needed to help management accept that increasing day surgery rates does not necessarily mean saving money, but that it enables resources to be freed up so that more patients can be seen. Good quality data is the key to getting executive buy-in and demonstrating changes. Standardising pre assessment and admittance procedures and reducing wasteful processes all work to improve the patient experience. Whilst collaboration between primary care and acute care is essential to shifting the balance of care.
Launch of the Planned Care Programme
The Minister for Health and Commuinty Care officially launched the Planned Care Improvement Programme on 29th September 2006 at the Beardmore Hotel and Conference Centre in Clydebank. The programme for the day also included presentations from:-
- John Connaghan, Director of Delivery on the scope of Planned Care Improvement Programme
- Dr Ian Jackson, Preseident of the British Association of Day Surgery on Treating Day Surgery as the norm for planned procedures;
- Professor Tim Cooke, St Mungo Professor of Surgery on Shifting the Balance of Care through lessons learned from the outpatient programme on referral and admissions management;
- Mr Roddy Nash, Consultant Surgeon, Derbyshire Royal Infirmary on Actively Managing Discharge and Length of Stay;
- Alan Cumming Associate Director, Elective Care, National Leadership and Innovation Agency for Healthcare, Wales on the Welsh experience - an update on the guide to good practice programme.
Regional break out sessions took place to enable Boards to discuss their plans for implementing the five simple changes.
Edition 1 - February 2007
The Launch of the Planned Care Improvement Programme
The Planned Care Improvement Programme was introduced to the NHS in Scotland in August of 2006 and officially launched on 29th of September by Andy Kerr, the Minister for Health and Community Care.
In order to implement the 5 simple changes NHS Boards were asked to submit Project Plans. Initial funding and programme guidance was released in August 2006 in order to initiate local projects, begin to recruit key project members and to collect baseline capacity, demand and benchmarking data. The plans were then evaluated using a simple scoring system and the remainder of funds were released just before Christmas.
In order for us to be able to monitor each boards' progress, we have asked project managers to submit monthly highlight reports. These will enable us to keep the Health Department Board informed of your achievements and allow us to give you targeted support to help you deliver against your objectives.
The successful delivery of the plans will be dependent upon the development of locally integrated services, where patients can experience a smooth and quick "journey of care" wherever and however they access services.