Midlands & Lancashire Commissioning Support Unit
Midland and Lancashire Commissioning Support Unit employs over 900 people and provides commissioning support services to 24 CCGs, NHS England, some acute providers and other related organisations. There are regional offices in Staffordshire, Lancashire and in West Bromwich.
Rationale & Summary
- Create a single repository for patient experience feedback from so that themes and trends could be established to ensure that a future Mid Staffs scandal was avoided by using real time feedback via dashboards confirmed based on a personal portfolio of service provision.
- The project was extended to include clinical feedback and safety information this creating a safety system this was to ensure that all data could aggregated and themes via standardised data set. The project allowed, multiple organisations to feed information on quality into one system to provider themes and trends the users of the system are outlined in figure 2
- The data aggregation was set up to allow data to be aggregated at a provider level across multiple locations and organisations/CCGs to ensure that a true picture of provider performance could be seen.
This innovation is 5 years old, and has grown from a small patient experience project to a holistic quality approach to collecting, theming and trending date from patient-experience, clinical-effectiveness and safety data across organisations to provide real time feedback on provider services. It was developed by the MLCSU working in partnership with CCGs to develop insight from real data and has the potential to be used by providers too. Some of the CCGs are considering this part of the contracting arrangement with their providers to report data using standardised data-sets.
In 2009 standardised data-sets were developed and a single database to record commissioning patient-experience data from complaints, focus groups, social media/media, and online source (Figure 1). It developed into a quality system that currently covers 12 CCGs, over 440 GP practices, NHS England local area team in Staffordshire/Shropshire, condition support groups and out of hour’s providers.
All data is fed into the system and themed as below(Figure 2)
All data covers of the three pillars of quality to provide information in real time across multiple organisations and locations. This has been achieved through system wide leadership and a health economy approach to sharing data and managing contracts/performance of providers.
The project has been supported by senior leadership and via clinical engagement with GPs has been extended to cover multiple sites and sources of data. It has been led and implemented by people who truly want to see patients at the heart decision making within the commissioning process learning has been gained through the delivery of the project.
The system has been developed to incorporate multi-site reporting with bespoke data entry and reporting options that encompasses the three pillars of quality, by collating, aggregating and triangulating data to pinpoint areas of improvement.
What Was Done
The system was developed to use the five domains of patient-experience to theme and trend data, CCGs to develop new ways of providing, theming and trading data. Stoke-on-Trent and Fylde and Wyre CCGs have been instrumental in the development of the system to record safety and clinical effectiveness data through events (incidents) reporting at GP Level
The project is now 5 years old and has grown organically as outlined
4 2009 – 1 PCT
5 2010 – 2 PCTs
6 2011 – 6 CCGs
7 2012 – 9 CCGs
8 2013 – 10 CCGs and 54 practices
9 2014 – 12 CCGs, 228 GP practices and an out of hours provider
10 2015 in progress 1 CCG, 66 practices and NHS England Midlands
The project continues to grow with the advent of co commissioning, federation and integration of health/social care and the fact that the approach is now embedded into the culture of the organisations will ensure its sustainability. We have interest from other strategic partners in creating network of sub regional data and are exploring the possibilities of working with other CSUs across the country.
Impacts / Outcomes
A total of 21,715 individual records have been entered into the system and are available via real time dashboards
1. Complaints 1738
2. Compliments 213
3. Voluntary Sector 275
4. Media 1590
5. Social-media 231
6. MP Letters 620
7. PALS 5530
8. Patient Story 58
9. Clinical Feedback 680
10. Soft Intelligence 7659
Events – Safety and Clinical Effectiveness -3121
Death (Caused by the event)
Low (Minimal harm)
Moderate (Short term harm)
None (No harm)
Severe (Permanent or long term harm)
1. 98% of events rated as severe and above have had follow up action taken on them.
2. All events and feedback are reviewed within 30 days
3. All data is shared across health economies figure 3
4. 1200 active users of the system
5. Over 600 hours per year reviewing the data and setting actions across the CCGs
6. Data is review at quality subcommittee and formally reported to the CCG board for primary and secondary care
7. 68% of cases that require action have an action formally recorded against them
8. 181 GP practices trained
9. Over 350 GP practice staff trained
10. Over 600 members of staff at CCGs trained
11. Over 150 CSU staff trained
12. Over 50 NHS England staff trained
13. Regular quarterly reporting for 12 CCGS by theme and trends
14. Over 300 individual real-time dashboards and reports
15. Top ten themes and trend identified
Changes initiated as result of the system
1. New system to inform practices in Blackpool when a patient dies in hospital
2. Changes to referral system for CAHMS
3. Contract review for WMAS to deal with suspected fractures
4. Use of locum radiographers to clear backlogs on imaging
5. Improved discharge reports and communications
6. Full clinical review of district nursing services
7. Review of the falls service
8. Themes and trends feeding into communications and engagement strategy
9. Review of coding in radiology and pathway
10. Improvements to the paediatric discharge pathway
11. Improvements to confidentiality and training on information governance
12. Plain film reporting has been improved
13. Standardised format for discharge summaries
14. Improvements to scripts for 111 service
15. Contract reviews of 111 and radiography service
16. Assurance measures for ophthalmology service
17. Adult protection and safeguarding referrals
1. Clinical leadership both initiating and sustaining sponsorship
2. Engagement with GPs and practice managers – linking into what important to them and what they are passionate about
3. Long project length and its organic growth based on what people can feel as the tangible benefits
4. Linking insight to involvement and giving the information about what patients experience to patients to ensure improvement, accountability and scrutiny.
5. Health system approach, data sharing and looking at themes and trends across primary scoriae and tertiary providers
6. Use of standardised data sets and pre designed forms to ensure data consistency and calibration
7. Use of real time data and the ability to set flags within the system – reposnvine4ss to patient and clinical feedback
8. The ability to have all data in one place so that smaller anecdotal feedback is turned into evidence
9. The use of clinical champions to encourage engagement with clinical staff and practices.
10. The CSUs ability to understand what CCGs need from the reporting in terms of quality and working in partnership to develop it
11. The cross health economy approach as outlined in figure 3 sharing data, comparing data at contract monitoring meetings and setting actions that have an audit trail.
12. Passion and commitment to the small team of people who have developed the system and have worked from a patient perspective to implement.
1. Taking a whole system approach
2. Developing standardised data sets
3. Calibrated data with clear entry instructions
4. Champions at local level
5. Clinical engagement about the things that practice value and find important
6. Tenacity in development
7. Vision about what the system could achieve rather than just a focus on what it does
This project has been the subject of national interest through the below accolades and through speaking at national conferences