Staffordshire and Lancashire Commissioning Support Unit

Staffordshire and Lancashire Commissioning Support Unit

Category: Setting the Stage – Measuring/Reporting and Acting and Setting the Stage – Staff Engagement / Improving Staff Experience

Staffordshire and Lancashire Commissioning Support Unit

Insight and Involvement – Measuring, Reporting and Acting

Organisation – Staffordshire and Lancashire Commissioning Support Unit (SLCSU) is one of the largest the country delivering a range of transformational and transactional services across Shropshire, Telford and Wrekin, Staffordshire Herefordshire and Lancashire. SLCSU employs over 750 people and covers population of over 3.5 million people.

Aim – Our objectives were to provide one single place for all patient experience, clinical and incident intelligence to provide a holistic view of areas for improvement. Triangulation of the three elements of quality to see the bigger picture
To prevent the likelihood of a recurrence of Mid Staffs by allowing all staff to view relevant data in order to take action on the findings
To gain the greatest amount of intelligence from local data by using the national recognised domains of patient experience to record data and to triangulation local and national data to identify themes and trends

To capture clinical feedback via a real-time system with ease of access and ability to view all data in real time.

To provide opportunities for action based on multi stranded quality data
The work has its genesis in the David-Colin-Thome report into Mid Staffs where the need for a single place for patient feedback, clinical feedback and incidents with real time reporting was highlighted as a requirement to prevent recurrence of the issues. There was a clear need to encourage a culture of openness and transparency the staff engagement element of the project was to ensure that practice managers, GPs and others were comfortable sharing incidents, clinical feedback and patient experience feedback. There was a history of practices being very reluctant to share incidents and feedback from patients and this initiative had a clear objective to encourage the entry and sharing of data. 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 data aggregation was set up in such a way 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.

Outcomes – The Insight model has been transformed into a quality system by entering clinical feedback from GPs and by reporting incidents in primary care settings. All data comes together and is reported in real time to identify themes and trends across the quality spectrum. This holistic approach has been pioneered by Stoke on Trent CCG and has been rolled out to all 54 GP practices. Work is now underway to rollout to the GP practices in Telford and Wrekin and Shropshire with the other 6 CCGs to follow, this will see 260 practices using the system to improve services for patients and the public.

As a result of the system we have been able to respond to patient experience feedback real time with monitoring visits to our provider wards, we have been able to identify key themes and trends from multiple sources and have put actions in place to resolve. It has changed the organisational culture as staff now appreciate they are part of feeding in formation that aces up a big picture that one group or location can create without collaboration. Patients are now at the heart of what we do as they drive the requirements for change supported by the evidence form clinical feedback and incidents. The clinical and patient feedback has highlighted issue with our community nursing team and has directly led to a clinical review of services. Work has also been undertaken to resolve issues with cancer referrals and delays to the confirmation of appointments

The communications and engagement team at SLCSU has worked with our emergent CCGs and we have developed a systematic approach to public and patient involvement that has its roots in systemic review of cause and effect. This approach is achieved by using an Insight database which collates, aggregates, analyses and reports quality data in real time to CCG staff based on their commissioning portfolio.

Over 9000 records entered to the system, 2000 small changes in practices, 3 major service reviews

400 incidents at primary care

50 changes in practice, 150 in progress and review 100 with no changes required and 100 currently in review

Changes to clinical practice for surgery

Procedures put in place to identify fax errors

Procedures reiterated about shredding confidential information

Changes to clinical practice and follow up on surgical procedures

Issues raised at CQRM about 111 service

Sub group established to discuss prescription issues Changes in practice for clinical staff. More open culture for the implementation of learning.

Out of Hours Prescription payment Kiosks for NHS Trusts

pe1The demand for prescriptions in the UK is ever rising, with more than 1 billion items dispensed in 2013 alone; that’s 1,900 every minute according to a report by the Health and Social Care Information Centre (HSCIC). With demand so high, the NHS has the arduous task of fulfilling this huge supply, and one area they have been unable to deliver prescriptions effectively is outside of the hospital pharmacy’s opening hours.

To combat this problem, Cammax Limited has developed a prescription payment kiosk specifically tailored to meet the needs of the NHS, allowing patients to pay for their prescriptions during out of hours. Not only are the kiosks equipped to accept cash, but they also process debit and credit card payments, a service the NHS has found difficult to provide up until now. The change carrying capacity of the kiosks is very large to fulfil even the busiest of periods to prevent a patient being short-changed.

Previously, A&E departments have issued prescriptions free of charge due to the lack of a payment facility in place, but the new kiosks are enabling thousands of pounds in lost revenue to be captured, providing invaluable incremental income. Not only do the kiosks accept prescription payments, they have been adapted to incorporate payments for a wider range of hospital services such as maternity scans, crutches and walking aids.

The simple to use, self-serve machines operate 24 hours a day providing patients with a quick and convenient way to access their prescriptions. After payment is taken, the machine then issues a receipt that the patient can take to the pharmacy to collect their prescription. The kiosks eliminate the need for staff to take payments therefore freeing up their valuable time to issue medications for example, leading to reduced waiting times. Automated cash handling also provides a safer working environment, due to security risks associated with this.

The Cammax prescription payment kiosks are currently deployed in A&E hospitals throughout the UK. Even low volume kiosks processing 25 transactions per day are generating almost £75,000 in revenue. This capturing of lost revenue enables the kiosks to be purchased by hospitals at very low risk due to the high returns seen almost instantly.

Hywel Dda Shows the Way!

cs_hywelHywel Dda Local Health Board provides healthcare services to a total population of around 372,320 throughout Carmarthenshire, Ceredigion and Pembrokeshire in west Wales. It provides acute, primary, community, mental health and learning disabilities services via general and community hospitals, health centres, GPs, dentists, pharmacists and optometrists and other sites. It employs around 9,000 staff.

Coming into a hospital can be confusing, even more so when you cannot read. On top of this, we knew people were confused with existing signage or were not even bothering to look at signs. Furthermore, there was too much literature and ‘signage clutter’ on the walls that hampered people trying to find their way. We realised how much we take for granted, both when we know our way around somewhere and also our reliance on the written word – how much more difficult was this for people who cannot read?

What did we do?
We held 3 focus groups to start the conversation and develop the concept of using symbols. This generated suggestions including colour zoning the hospital to maximise orientation, positioning signs and use of terminology. We sought specialist advice from the RNIB. We had continued invaluable engagement with users and staff to test, refine, evaluate and agree a final library of symbols. We successfully created a used truly multilingual system (Welsh and English).

Live practical exercises were run with learning disability users and members of the public to test the new symbols followed by a more detailed audit. Symbols were modified as a result and additional ideas have been captured for future improvement.

What impact did it make?
The new way finding and signage system has now been installed at Withybush Hospital and rolled out to Bronglais Hospital. We invited all user groups to return and evaluate the system using an audit tool developed by the learning disability users. We had an external visit to who we gave mock up appointment letters for them to find their way!

cs_hywel1Formal evaluation together with a recent Community Health Council patient environment audit has demonstrated improved accessibility and user satisfaction. Users with poor literacy skills are able to easily use the symbols and successfully way find to departments. We engaged wider public through the local Citizen’s Panels with positive results.

We hope this approach will be replicated across NHS Wales, and indeed further afield. How wonderful would it be if all service users could be certain that wherever they went in the NHS they could find their way by relying on a consistent use of symbols as well as colour zoning? We held a webex to share the learning across NHS Wales and have received requests for information from across Wales, England and as far away as Australia and New Zealand!

This initiative is special because it shows exactly what you can achieve when you work alongside the very people who will benefit from it. If you could see what this means for all the people involved you would be able to feel how important this has been to
them. Watch

A service user noted at the launch “If someone couldn’t understand the picture and writing then the colours would make sure they were in the right area of the hospital”.

cs_hywel2Key Learning Points

  • Always remember you don’t know best! Involve the people who need to use the signs from the very beginning, it is not difficult but be open to challenge. It has not meant things take a lot longer and has provided a much more effective solution to an identified problem for patients.
  • Think about how much symbols are used in the rest of our lives – from park and rides to toilets, why don’t we use them in our hospitals where people are at their most vulnerable?
  • This approach can be effectively adopted across a myriad of problems to find innovative solutions. Accessible communication is essential, it improves the patient experience and does not require many resources to resolve.
  • Above all, enjoy the process and feel a real sense of achievement when you see the new signs up on the wall and the colour zones coming to life.



Cervical cancer prevention in BME communities: raising awareness and overcoming barriers

jo's cervical cancer trustEvent: Cervical cancer prevention in BME communities: raising awareness and overcoming barriers
Location: The Studio Birmingham
Date: Wednesday 16th July 2014

1 in 3 women diagnosed with cervical cancer will die from the disease – but shockingly, in a recent YouGov survey, only 53% of black or minority ethnic women think that cervical screening is a necessary health test.

You can help to change this mindset in your community. Jo’s Cervical Cancer Trust and the NHS Cancer Screening Programme will be running a FREE workshop on Wednesday 16th July 2014 (during Ethnic Minority Cancer Awareness Month) at The Studio Birmingham. The day will provide information on how to develop a successful awareness programme for cervical screening in your community. You will hear from a range of experts, including other community leaders, who have already set up successful programmes – saving the lives of countless women in their immediate circle and beyond.

The key takeaways you will receive in this one-day seminar include:

  • How to encourage women to go for screening
  • How to provide key information to increase understanding
  • How to approach the barriers created by ethnicity
  • Meet other community leaders who have done it before

To register for the event, for more information or to apply for one of five travel bursaries to attend, visit:

Follow us on Twitter: @JoTrust
Follow the event on Twitter: #CommunitiesBeatingCC

Patient Experience Professional of the Year

Patient Experience Professional of the Year

Patient Experience Professional of the Year

This year PEN introduced a new judging category – Patient Experience Professional of the Year. The entrants are nominated by colleagues or patients and are judged on the submissions and testimonials made on their behalf by those around them, from within and without the organisation. The inaugural winner was Sally Ryan of Ipswich Hospital Trust – here are some excerpts from the entry submission explaining why Sally was deserving of such an Award.

Name: Sally RyanPosition: Learning Disabilities Liaison Nurse

Sally started her lifelong quest for improving the experience of people with learning disabilities over 20 years ago. She started with volunteer roles which inspired and galvanised her to become a champion in her field. She describes as ‘the best job ever’ her role as a teaching assistant taking clients through their paces within a specially designed life skills flat. Early on she began honing her particular skill of tuning in to an individual’s specific way of communicating and learning and over the years she has developed her empathic abilities to an exceptionally high degree showing time and again an uncanny ability to get under people’s skin to enable them to communicate more clearly their needs and wishes. She also began to formulate her understanding of the wider social impact of this empathic approach – her clients were able to develop practical skills enhanced by the extra effort made by Sally to help them to develop their social and emotional skills. Sally describes this early part of her career as transformative – realising that people with learning disabilities do not see life as the challenge others perceive and by aligning herself with this view she has been able to create relationships of greater depth than ‘worker:client’ thus enhancing the quality of the care provided.

An epiphany of equal importance in formulating Sally’s approach was carved out of an altogether less pleasant work experience at a day centre where she witnessed and was encouraged to adopt an approach with little or no personalisation of care, no freedom for the clients, a high level of boredom (clients and staff) and an attitude of ‘maintaining’ or ‘containing’ people. A great of example of everything sally found to be an anathema.

Sally ploughed this experience into earning a first in her Specialist Practice Degree in LD ten years ago and established herself within the community services before deciding to make the leap to be a champion of LD patients’ experience within Ipswich Hospital – a busy acute district general hospital.

Sally came to the Trust in 2011 with a solid reputation for her work within the community and immediately her passion and dedication and approach stood out as exemplary. Sally had clarity of vision for improving the experience of patients with a learning disability. She understood that we faced challenges – she knew of these from her contacts within the community of some patients whose experience had not been good enough and she came with clear ambitions for us as an organisation.

Coming into a busy, acute environment and being the lone dedicated voice for a marginalised and perceived as ‘difficult’ group required Sally to stand out and stand up – potentially daunting for anyone!

Sally’s skills and experience in communicating and giving voice to a challenging and difficult topic enabled her quickly to build a network of supportive colleagues and gain the support of key Board and other senior staff – all necessary for taking forward such a big agenda.

Sally has a ‘big’ personality to go with the ‘big’ agenda and this has stood her in good stead to keep focussed and galvanise a whole organisation and its culture.
Sally arrived at Ipswich Hospital at a time when they had recently completed a short piece of work with a patient with a Learning Disability (LD) and her family carer following their raising of a complaint about the patient’s care and the lack of engagement with the family. This had resulted in the organisation focussing on some key issues eg; lack of basic care, fear/lack of understanding of LD, poor liaison with the family carer. The Trust had been privileged that the patient and carer concerned had wanted to make a difference and had talked to the Board of Directors, taken part in educating staff and the development of a DVD to share their experience and our response.

Sally joined us and took this catalyst to learning and ran with it. She identified key areas to target for improvement and has led the way across the organisation:

  • Access to services
  • Correct diagnosis
  • Support with treatment
  • People feeling safe and heard
  • Ensuring individualised care – getting needs recognised, understood and met

Taking a systematic and pragmatic approach Sally developed a strategy for working towards a greater standard of care for patients with a learning disability. Sally identified that we had to deal with both the simple and the complex and she has tackled each with the same optimism and enthusiasm.

A key to improving LD patient experience has been training staff – something which is a challenge for all organisations struggling to keep the frontline covered and costs down. Sally has provided formal training for over 1,000 staff since joining us but Sally’s approach is to educate, challenge and promote great care at every opportunity.

Typically for Sally she has been creative in her approach to training – building an army of 40 ‘link professionals’ enables on the job, informal training opportunities provided by people with a passion for LD issues on their own wards reducing the need for staff to leave the ward to attend training sessions. Sally also walks the wards – chatting and explaining as she goes – this personal approach enables staff to learn in a straightforward, practical way enabling staff to ‘just do it’. This approach has enabled staff to ‘join the dots’ and realise the fat handled cutlery can be really useful for patients with a LD as well as enabling staff to recognise the clues from patients when they need the toilet or are in pain.

Sally’s army of link professionals are often people touched by LD through their own lives as family members or carers/friends. Encouraging champions with this personal understanding can require some challenge and support but reaps rewards through their dedication and inherent understanding and empathy. Sally has developed their skills to enable them to support others in understanding mental capacity and facilitating consent; best ways to support people and make reasonable adjustments; enabling communication and understanding of people as individuals; ensuring family carers are involved.

Sally’s approach is to enable and encourage patients with a LD to have a say over what happens – however small or limited that ability might be – and encouraging/enabling staff to likewise.

This belief in personal empowerment and opportunity extends to Sally having created a learning disabilities (LD) expert patient support network who have undertaken the Expert Patient Support Programme training. This group is now fully involved in the development and progress of hospital services and proposed changes which also positively impact on services for all patients and carers. The group provide feedback on their own and others’ experiences of accessing the hospital and have advocated for patients and carers at training and development events. In particular they advised on the redesign of Central Outpatients providing insight into the signage and way-finding project whereby a mixture of coloured corridors, improved maps and signage using symbols as well as words was introduced.

In August they undertook an access audit of this completed work in Central Outpatients and gave a thumbs up to most of the signage whilst identifying further work needed on the maps and also the disabled access toilets. Without Sally’s support and championing this group would not have the gravitas it does nor would the voice of those with an LD be heard so loudly.

Sally has also led the way in creating a more seamless service – she facilitated Ipswich being the first hospital regionally to establish information sharing protocols with GPs and the Local Authority to ensure the early identification of people with LD via an alert across all patient administration systems. This has recently been recognised nationally as best practice and ensures potential barriers to accessing services are removed.

People with an LD are thus identified early, pre appointment assessments can be made, adjustments identified and patients/their carers are enabled to be actively involved in their care and treatment, with the hospital making the necessary reasonable adjustments to support individualised care.

This specific care is supported by the introduction of the LD patient passport and use of a purple dot symbol to be a visual reminder for staff on the Patient Needs at a Glance board above the bed.

Sally has supported 328 elective attendees on various pathways ensuring the highest quality of person centred care is provided.

Sally has ensured we have introduced access to easy read literature and is always finding creative tools for engaging and communicating with LD patients.

Ensuring the LD voice is heard is central to Sally’s tenet and as well as the expert patient group she has developed an ‘easy read’ feedback form although much of the feedback comes back via personal anecdote collected in conversation with patients and their carers. The grapevine is a very strong conduit for information and feedback within the local LD community. Before Sally started working with us the grapevine talked about how frightening hospital was and the few poor experiences coloured all. To ensure we learn from mistakes Sally instigated an alert system whereby all incidents, complaints and compliments involving a person with LD are reviewed by Sally who ensures that if there is a risk or area of concern, the necessary changes are made.

The grapevine now talks about the changes made and the ‘good stuff’ instigated by Sally and there has been a gradual shift in the ‘collective memory’ of the LD community. There can be no better illustration of the esteem Sally is held in and the impact of her work than the very recent LD community event held in September – Sally attended to talk about the changes at the hospital and she was treated to a standing ovation as she walked into the hall.