South Central Strategic Health Authority · » Enable individuals and organisations to learn from each other, avoid ‘reinventing the wheel’ and ‘silo working’, assisting in

South Central Strategic Health AuthorityAnnual Innovation Report 2010/11

NHS South Central Annual Innovation Report 2010/112

Discovery Development Delivery


Welcome to the second NHS South Central Annual Innovation Report (AIR). This report shares and celebrates some of the innovative work that has taken place in NHS South Central (NHSSC) over the past year. As part of the QIPP programme of work innovation has played an important part in our drive to support the health economy of NHS South Central in reducing waste, maximising productivity and enhancing care. New technology and practices have been and will continue to be central to us meeting the challenges we face with respect to managing growing demand and growing public expectations within the constrained resources available.

In 2010/11 new and ambitious developments have been supported that will yield great returns for our residents in terms of the availability and quality of care they receive. We have supported a wide range of initiatives from the relatively low tech to the leading edge use of emerging technologies. Low cost innovations such as the IVR (interactive voice response) for people with chronic obstructive pulmonary disease (COPD) put the patient at the centre of care and will help people stay well in their own home at a cost of £26 per annum. At the other end of the scale we now have the first hospital in England using ultrafiltration to save lives and reduce the length of hospital stay for people with the most serious heart failure.

In addition innovation projects from 2009/10 such as the musculo-skeletal self referral and triage project have been incorporated into mainstream care.

Partnerships have been a key feature of 2010 and we have worked actively with industry, with established and new players in the field of Innovation such as the National Technology Adoption Centre, the Technology Strategy Board and the emerging Health Education and Innovation Clusters (HIECs). These partnerships have resulted in some notable innovations such as a telehealth solution that will cut the cost of home monitoring of people with long term conditions by 75% or more, an innovation that addresses something as fundamental as whether a patient in hospital can drink for themselves and the spread of winning ideas across NHS South Central such as the inhaler technique improvement project.

We have embraced the national Innovation Technology Adoption Procurement Programme (iTAPP) that has identified technologies that, when implemented at scale, can improve clinical outcomes and reduce cost. We are the first SHA to achieve 100% adoption of an iTAPP identified technology – advanced monitoring techniques for fluid management for patients undergoing major surgical procedures is now in place in all hospitals in NHS South Central undertaking these procedures leading to higher quality of care at lower cost.

We are always conscious of the need to secure good value for the tax payer and financial return on the investment of £2.3m from the RIF over the past two years is important. Careful and cautious analysis of the investment made suggests that for every £1 spent more than £17 will be saved.

ForewordThese savings are recurring – millions of pounds saved year after year whilst at the same time improving quality.

There is still much more we can do and in 2011/12 we look forward to working with you to consolidate innovations made to date and also to focus relentlessly on the highest priorities for the health economy so that innovation remains key to delivering sustained improvement in the care delivered to the people of NHS South Central.

Andrea YoungChief Executive


From 1 April 2009, Strategic Health Authorities (SHAs) took on a new legal duty to promote innovation to secure continuous improvement in the commissioning and provision of health care.

In 2009/10 South Central SHA focused on stimulating the culture of innovation at a grass roots level within the health economy and supported over 20 locality based innovative projects with funding that allowed ideas to be tested.

In 2010/11, the second year of exercising its statutory duty, the SHA has seen those year one projects flourish but the main focus for the year has been to support the spread and adoption of proven innovations. These proven innovations have been selected from a variety of sources:

» Successful local innovations » Innovations developed elsewhere » Innovations sign-posted by the national iTAPP

programme » Innovations arising from a challenge to industry

In total 17 new projects have been supported in 2010/11. (See page 11)

Much has been achieved in terms of innovation and improvement and the SHA has supported both ‘Pull’ and ‘Push’ in the innovation and improvement ecosystem

‘Push’ has been supported by the sharing of innovation and improvement initiatives and ‘Pull’ by challenging industry to meet our needs through the innovation challenge.

It is important that the SHA has a positive impact on the delivery of patient services and that a broad strategic view is taken. With respect to innovation it has become clear over the past two years that a key role for the SHA innovation team has been to provide a networking function bringing together service, innovators, industry and the wider innovation landscape. It is impossible to put a monetary value on this interface role but it is clear that it valued by those who have benefited from it and that this more facilitative rather than directive approach has yielded explicit products that are shared later on in this document.

Introduction

‘Necessity is the mother of invention. From the very start and its initial call for tenders the SHA has clearly described unmet needs within the NHS. Such clarity spurs a commercial company like ours into action and reassures us that there is a market for our innovation.’

Director of SME with whom we have worked


NHS South Central (NHSSC) covers four million people with an NHS landscape that includes nine acute trusts, three primary care clusters, three mental health trusts, one learning disability trust, one ambulance service and one specialist trust.

Overseeing these organisations is South Central Strategic Health Authority whose vision for healthcare Towards a Healthier Future sets out the aim of:

“Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

The development of the QIPP agenda across the health economy has remained fundamental to the work of the SHA. This, along with ensuring alignment with Clinical Programme priorities has been the main determinant as to what innovation has been supported by the SHA.

Over the year the clinical programmes have reduced to from 8 to 5: » Maternity and Newborn » Planned Care » Long Term Conditions » Acute Care » End of Life Care

and two are enabling programmes: » System Reform » Information Management & Technology.

The SHA has created a model for innovation and improvement that describes how the SHA frames its innovation activity. This reflects a comprehensive offer to the health economy and supports all aspects of innovation from developing awareness and skills to embedding change in practice.

Evaluation

All innovation projects supported by the SHA are subject to three monthly reporting and an evaluation of delivery from both a productivity and quality point of view and an assessment of financial impact. When projects close a final report is produced.

The Innovation and Improvement Model

SHA innovation and improvement pipeline

The SHA duty and how this is exercised


Supporting our Trusts in Discovery, Development and Delivery will: » Enable individuals and organisations to learn from each other, avoid ‘reinventing the

wheel’ and ‘silo working’, assisting in developing an innovation and improvement culture as part of day to day working

» Grow the capability of staff and organisations to respond positively to the stimuli for change to which they are exposed

» Build local evidence regarding alternative ways of doing things and grow skills and knowledge to deliver change

» Maximise the chances of successful innovation, ensuring new approaches are tested and are likely to deliver anticipated benefits before widespread adoption

» Maximise return on investment and uptake of desirable change, ensuring that SHA priorities are supported by enabling strategies

» Minimise the delay between creation / identification of an improvement and its widespread adoption.

The SHA has been proactive in developing the innovation and improvement culture and in supporting invention, adoption and diffusion by forming partnerships and collaborations with several organisations within and outside of NHS South Central:

» NHS Innovations South East (our ‘HUB’) » South East Health Technology Alliance (SEHTA) » National Technology Adoption Centre (NTAC) with a particular focus on the

innovation Technology Adoption Procurement Programme (iTAPP) » Technology Strategy Board (TSB) with a particular focus on the SHA’s Innovation

Challenge » The Young Foundation has supported application evaluation, project support as well

as education and networking events

As CEO of an established small enterprise, the NHS appeared impenetrable. However, NHS South Central’s innovation challenge process has been fast, straightforward with direct access to key decision makers.

Our innovation has received outstanding technical and business support throughout development. Nearing commercial release our goals are to deliver NHS investment return and continued partnership.

» The SHA has worked with the NHS Institute on the development of the Return on Investment tool and delivered a joint seminar on return on investment at the National Innovation Expo event in March 2011

» The two Health Innovation and Education Clusters » The SHAs nationally where this SHA has taken a lead coordination role on behalf of

all with respect to the National Innovation Expo.

The future will see further partnerships with industry and the third and private sectors.

The SHA duty and how this is exercised


Linkage to Clinical ProgrammesIn all 17 projects were supported over the year. The spread of projects across the clinical programmes is shared in the graph opposite. It can been seen that approximately ¾ of all projects are from 3 clinical programmes – acute, planned care and long term conditions with 35% of all projects impacting on planned care.

For 2010/11, NHS South Central received a £2 million Regional Innovation Fund. The fund was segmented three ways with each segment receiving a third of the available funding:

1. Applications from ‘service’2. High impact innovations – local successes and iTAPP technologies3. The SHA Innovation Challenge

End of Life Care

Maternity & Newborn

Mental Health

Staying Healthy

Acute Care

Long Term Conditions

Planned Care

11

1

1

3

4

6SHA

PCT

Industry

Cross organisational / Partnership

Acute Trusts

HIEC

2

2

2

3

4

4

Recipients of fundingThe recipients fall into 6 broad groups:

» SHA - direct to clinical programmes » PCTs » Industry - as a consequence of the innovation challenge » Cross organisational - including community based projects » Acute Trusts » The HIECs

Regional Innovation Fund


Share of funding by valueA breakdown of the fund by value demonstrates that the main beneficiary of funding were acute trusts. This was largely a consequence of the iTAPP programme being secondary care focused. Industry partners also benefited significantly from challenge funding.

Community care organisation

SHA programmes

HIEC

PCTs

Industry partners

Acute Trusts

£56,700£75,981

£195,000

£271,500

£344,717

£348,000

Other (exploratory projects)

Balance of service and technology

Technology

Service change

1

4

5

7

Exploratory

Adoption

Invention

Diffusion

10

1

2

4

Focus of innovationTechnology vs. Practice

The split between a service and a technology focused change has been well balanced, although in reality there is a significant cross over between the two. Many practice based innovations are catalysed by technology and technology change leads to new practice.

Type of innovationInnovation includes:

» Invention - the creation of new ideas, technologies and products

» Adoption - bringing new ideas to the NHS » Diffusion - spreading good practice and proven ideas


Estimated return on investmentEstimating return on investment (ROI) remains an inexact science – the costs are well known, but it is not always possible to confidently predict a return on investment.

RONI the return on investment tool the SHA created in 2009/10 has been further developed and used to predict ROI for SHA supported projects. RONI is also being used in other SHAs and by our local innovation HUB (NHS Innovations South East).

For the 17 projects initiated in 2010/11 the £1m investment will yield a predicted £17m return from the 7 projects where ROI can be confidently predicted (given project success). The impact of other projects will be entirely dependent on the level of adoption of the new technology or practice.

It is noted that our predictions for ROI are conservative. An example of this is that the National Technology Adoption Centre and the National Institute for Health and Clinical Excellence (NICE) [see CardioQ-ODM oesophageal doppler monitor (MTG3)] both predict a £56m (£807m nationally) saving from the widespread adoption of goal directed intraoperative fluid management across NHS South Central (something SCSHA has been the first SHA to achieve) whereas our predictions are a more modest £4.5m saving.

Regional Innovation Fund£ spent

£ saved

Financial return on investment Quality Gain=

Added Value


Innovation projects 2010/11This section of the report summarises the 17 projects supported this year by the regional innovation fund


» Reduced ambulance conveyance » Expected outcomes for patients - right care at the right time, greater confidence in local health services, improved self management

» Expected outcomes for staff- increased productivity/improved use and development of skills and capacity/improved job satisfaction/improved working relationships between providers

Project ProgrammeAcute Care

Grant given£50,000. Anticipated savings - Circa £3M within 1 year of completion of pilot.

What was the problemThe most appropriate model for a local single point of contact had not been established.

What was needed?Initial work to identify the most appropriate model of delivery for 111 ahead of national roll out. This to include testing the impact of 111 on delivery of QIPP targets for reducing reliance on secondary care, unscheduled care services and ambulance conveyance and how any positive impact might be maximised. Testing clinical commissioning by GPCC pathfinder on this major service change.

What was the solutionScoping work in collaboration with a wide range of partners. Pilot testing of impact on key deliverables.

Benefits (delivered or expected) » Reduced A and E attendance and emergency admissions (with an estimated saving of £3m after one year from pilot completion

Project titleDelivering a 111 pilot scheme in South East Hampshire & Portsmouth


Included is a booking webform within NHS Choices that women can populate to request a booking from a specific trust. This will be held securely within NHS Choices until accessed by the chosen Maternity provider. We will publicise this service to inform pregnant women to look for information and book maternity care as early as possible.

Benefits (delivered or expected) » A more positive experience of booking Maternity services with increased Pregnancy information available to them

» As they will not need to go to their GP to be referred for Maternity care it will free GP’s from this initial consultation and form filling

» It will facilitate choice by providing information to compare services

» It will facilitate early access to ensure prompt referral to appropriate services

» Trusts may be better able to meet their target as they will have the booking request earlier than via the GP route

» Efficient for provider allowing them to prioritise women in greatest need to GP.

Project ProgrammeMaternity and Newborn

Grant Given£30,400

What was the problem?Currently 5 PCT’s within the South Central Region are failing to meet the National target to fully book 90% of Pregnant women before 12 weeks, 6 days of pregnancy. There is also a requirement to increase the information available to women looking for maternity care and allow more choice of where they wish to have that care. Liberating the NHS specifically mentions Maternity services “We will extend choice in maternity through new maternity networks“. This means offering pregnant women a range of services and choice around where and whom delivers their care.

What was needed?A simple way for pregnant women and others to gain information about services available and the means for prospective mothers to book with a service of their choice having made an informed decision.

What was the Solution?The majority of the ten Maternity units within the South Central region are developing a web presence on NHS Choices offering enough information to allow women to make an informed choice of place of delivery.

Project titleImproved access to maternity services early in pregnancy


call centre that will promote interdisciplinary working and provide a single point of contact for patients via two telephone numbers, 999 and 111. The hub will support remote monitoring (telemedicine / telecare) that will aid admission avoidance and early discharge from the acute setting and through the use of the Directory of Services will coordinate the most effective use of resources.

BenefitsObjectives of the Urgent Care Hub: » Provide a single point of access for patients/clients for health and social care via 111 / 999 with warm transfer in either direction

» Direct patients to the most appropriate health and / or social care professional and / or Voluntary sector organisation when they make first contact with health services or following a change in condition whilst already in the health or social care system

» Deliver a seamless experience to the patient by enabling professionals to interact and decide on the most appropriate care pathway for a patient

» Provide a ‘command and control’ capability with a single, ‘real time’ view of all health related resources that will enable the efficient and effective management of both business as usual and periods of crisis

» Provide a shared care record and coordinated complex case management for professionals.


Grant Given£32,500

What was the problem?The funding will support the full integration of 111 with NHS Pathways, the Directory of Services and the wider aim of the Urgent Care Hub in providing a seamless integrated service.

What was needed? » The development of generic call takers in the use of NHS Pathways

» Training for use of new technologies » Resourcing the development of the Directory of Services

» Local marketing.

What was the Solution?In partnership with the Local Authority, the PCT is developing an Integrated Urgent Care hub to manage and coordinate Emergency, Urgent and Unscheduled care that can provide care closer to the patient’s home and avoid inappropriate admissions. It will deliver high quality patient and client care and ensure more efficient use of all organisations’ resources. This is a whole system approach that in its end state will link Ambulance, GPs in and out of hours, District Nursing, Community Services, Mental Health, Social Care and the third sector through a

Project titleIsle of Wight Urgent Care Hub


Benefits (delivered or expected)The aim is to promote a ‘continuous improvement approach’ to the delivery of an ER pathway.The outcomes sought from this work include:

» Improved clinical outcomes » Improved patient experience » Less impact on patient health » Patients recover quicker(from surgery) » Patient fitter sooner (normal activities) » Improved staff experience » Length of stay reduced » Ward bed days saved » ITU bed days saved » Reduced waiting times » More patients treated (with less resource) » Money saved.

Project ProgrammePlanned care

Grant Given£30,000 (March 2011)Wessex HIEC is delivering this project

What was the problem?The South Central SHA programme on enhanced recovery is well developed and progressing, however the speed of cultural change and the adoption of ER as business as usual is slow.

What was needed?To ensure a sustainable future for ER there is a need to accelerate and reinvigorate the transformation programme, especially for those early adopters who need to adopt a continuous improvement approach to future delivery.

What was the Solution?Raising awareness through the demonstration of international best practice in orthopaedic surgery for hip and knee replacement that enhanced recovery could be developed beyond the current national and local programmes. To share this best practice via South Central workshop and follow up web based information and establish an orthopaedic network to improve quality in orthopaedic surgery and outcomes.

Project titleEnhanced Recovery Acceleration Project (ERAP)


What was the Solution?Introduction of human papilloma virus screening for women with low grade cytological abnormalities to meet new cancer screening recommendations. Using HPV testing for triage it will be possible to identify which specimens require further investigation based on the presence or absence of High Risk HPV type. If the HPV test result is High Risk HPV negative then the woman will be returned to routine recall (3 or 5 yearly depending on age). If HPV test is High Risk HPV positive then the woman will be referred to colposcopy for further investigation.

Benefits (delivered or expected) » Introduction of HPV testing in Winchester & Eastleigh NHS Trust cytology department to benefit 325,000 women eligible for cervical screening test from Hampshire PCT. Approximately 10% of women (those with low grade abnormalities) will benefit from this test

» Provide opportunity of HPV testing facility for other hospitals

» Reduce the number of inappropriate cervical screening tests

» Improve the patient pathway by only referring high risk Women to colposcopy

» Reduce expensive regular cytology surveillance for women that have been successfully treated for high grade cervical abnormalities (CIN2/3).


Grant Given£32,700 (Saving of £200+ per avoided unnecessary screening)

What was the problem?The relationship between HPV and cervical cancer has been long established and HPV is found in almost 100% of cervical cancer cases. There are over 130 different sub-types of HPV and these are categorised into high-risk and low-risk types. The National Health Service cervical smear programme (NHSCSP) conducted an HPV testing pilot scheme which completed in 2006 to investigate how HPV testing could be incorporated into the cervical screening programme. Currently if a woman has a low grade cytology result she would be required to either:1) Attend colposcopy if she has previous abnormal test history2) Have regular repeat smears tests over a 2 year period before being placed back on routine recall

What was needed?The pilot concluded that HPV testing should be used for the triage of women with low grade cervical abnormalities resulting in more appropriate management and treatment.

Project titleIntroduction of human papilloma virus screening for women with low grade cytological abnormalities


» 24/7 365 day clinical support » Utilisation of technology to provide the patients’ clinical records and Advance Care plans to members of the multi-disciplinary team

» Improving the care pathways in: » End of Life » Medicines Management » Admissions Avoidance » Dementia Care » chronic disease management

» Developing a clinical governance process within the care home environment

» A training programme for clinicians in elderly and end of life care, a training programme for care home staff

» Creating a nationally recognised role for Clinicians specialising in supporting care homes.

Project ProgrammePlanned care

Grant Given£65,000 (Feb 2011)Thames Valley HIEC is leading this project

What was the problem?Care can be fragmented across pathways especially where the pathway spans public and private sectors. This can lead to inefficient care delivery.

What was needed?A truly integrated pathway and approach to care that puts the patient at the centre of care and incorporates their wishes.

What was the Solution?Building of an integrated pathway

Benefits (delivered or expected) » The aims of the project are: » Providing the patients of care homes, in SCSHA, with an innovative integrated care pathway

» To reduce inappropriate admissions and ambulance call out

» Increasing the proportion of patients dying in their home

» To have Advance Care Plans for all care home patients that are central to decision making (caveat to allow for patient and their relatives wishes not to discuss)

Project titleHome care integrated pathway


Benefits (delivered or expected) » Improved care » Reduced delays in treatment » Short lengths of stay » Improved patient safety.

Project ProgrammePlanned Care

Grant Given£24,000

What was the problem?There are no laboratory services on the Lymington Hospital site but there is a requirement for a rapid turnaround time for a limited repertoire of Biochemistry and Haematology tests to serve the minor injuries unit and acute medical admissions ward. This lead to delays in care and longer than necessary stays.

What was needed?A way to speed up access to blood test results to inform best management of the patient.

What was the Solution?Place point of care testing (POCT) devices in situ to allow nursing and medical staff to perform these tests locally. One major problem of using POCT is that the there is no mechanism for the results to be transferred wither to the laboratory computer system (Lab Centre) or the patient‟s electronic health record. This project will allow connectivity to the laboratory system and subsequent transfer of results to the patient record.

Project titlePoint of care testing at Lymington Hospital


and intervene as required in order to stabilise the condition. It has been found in studies that patients who are monitored in this way increase their confidence in coping with and managing their condition.

Benefits (delivered or expected) » Improved self care knowledge for patient and carer leading to a more self sufficient patient and carer

» Reduced anxiety for both patient and carer in knowing that they have the skills and knowledge to self manage the condition plus professional support monitoring and ready to respond if the need arises

» Improved quality of life » Increased independence with the ability to self manage without a carer if one is able to do so

» Reduces the need for face-to-face consultations » Supports early discharge by increasing team capacity - reduced length of stay

» Reduced re-admittance rates » Reduced emergency admissions, shown to be approx 36 admissions from Jan-Jul 2010

» Increased operational effectiveness of primary and community care staff as they will only be attending the patients with most need

» Capacity to increase the number of patients per case manager that can be effectively and proactively case managed

» Reduced travelling time and costs for Heart Failure Nursing Team as they will no longer have to attend patients in a rural setting so frequently

Project ProgrammeLong Term Conditions

Grant Given£65,000 (recurrent saving estimated @ £200,000+ per annum - £70,000 delivered in first 5 months)

What was the problem?This project utilises technology to effectively increase the capacity of the Heart Failure Nursing Team, allowing them to deliver high quality care at home to more patients, increasing productivity in the Team and reducing both inpatient and outpatient activity in the Acute Sector.

What was needed?A way to monitor patients remotely so that team resources could be directed to those patients who most need it.

What was the Solution?The technology interacts with the patient (and or their carer) through audio and visual prompts and can collect a range of both vital signs data and subjective information relating to their condition. The monitors have the ability to deliver self-care information, trend analysis and patient reminders allowing the Heart Failure Team to monitor and manage the patient’s care remotely.

This will be used for patients who require more care at home and will allow nurses to monitor

Project titleHeart Failure Telehealth


particular Primary Care Consortia, to understand what is required to enhance care quality, and reduce healthcare costs for patient populations who experience co-morbid anxiety and depression combined with a physical Long Term Condition (LTC).

Benefits (delivered or expected) » To provide a robust evidence base for commissioners for investing in access to psychological therapies for patients with a LTC and co-morbid anxiety and depression

» To provide credible information on productivity, cost-avoidance, return on investment and implementation costs

» To describe a number of innovative approaches and demonstrate their benefits

» To test a number of economic impact tools including the SHA modelling tool for “Psychologically Impacted Illnesses”

» To describe and evaluate the application of new workforce roles to changing service models

» To evaluate critically a range of appropriate patient outcome measures

» To deliver a toolkit of approaches which work and disseminate their benefits across South Central region

» To inform the developing national evidence base for the benefits of psychological therapies for patients with a LTC and co-morbid anxiety and depression.

Project ProgrammeLong Term Conditions / Mental Health

Grant Given£50,000Thames Valley HIEC is delivering this project

What was the problem?It is widely accepted that including psychological interventions in the care for those experiencing a long term physical health condition will add value to the patient’s experience. It is also widely believed that added value will improve patient outcomes for those with co morbid depression and/or anxiety, and that improved outcomes will lead to an ‘upstream’ reduction of costs across the health care system. Whilst these beliefs are widely held there is much concern that the economic case for such inclusion has yet to be sufficiently demonstrated. Some evidence has been produced out with NHSSC but this has yet to be fully understood and replicated within the region.

What was needed?An evaluation of the potential impact of psychological support for this group of patients

What was the Solution?This project will identify critical factors associated with improved patient outcomes and test their ability to reduce the costs associated with long term health care. It will engage, and enable commissioners, in

Project titleEvaluating the application of psychological interventions on patients with long term conditions and co-morbid anxiety and depression


Research Collaborative supports this approach. Alcohol misuse reduction is a key aim, for example, of the Southampton City PCT QIPP programme.

What was the Solution?The use of screening and brief interventions in approaches to alcohol misuse has been proven to be effective.

The key aim of this proposal is to develop and deliver a simple alcohol misuse screening, identification and response programme to reduce levels of dangerous alcohol consumption and related co-morbidity.

Reducing the level of dangerous alcohol consumption will have direct effects on health as well as reducing the effect of other clinical conditions. This will, in turn, reduce medical needs and costs to the health service where alcohol misuse is a key contributor to ill-health.

Benefits (delivered or expected) » Reduce the impact of alcohol misuse on use of NHS services

» Improve the overall health of the individuals concerned

» Demonstrate financial case for investing in integrated systems to reduce alcohol misuse across NHS agencies

» Build on existing pilots and develop comprehensive approach for screening and brief intervention therapies through NHS staff

» Evaluate initial roll out phase, identify the case for further extension if appropriate.


Grant Given£50,000Wessex HIEC is delivering this project

What was the problem?NICE has recently published an integrated set of guidance related to the treatment of alcohol misuse. Key to this is the recognition that misusing alcohol is widespread in UK society and is, at the very least leading to exacerbations of other physical and mental health conditions. In many cases it is the direct cause of specific conditions such as liver disease, hypertension, depression and other mental illness, traumatic brain injury as well as the impact on affected families and child health.

What was needed?Recent work has shown that ‘brief intervention’ therapies managed by any clinical practitioner can be instrumental in enabling people to address an underlying alcohol problem. There is a growing interest in this approach. This can take place across the range of health settings, for example work in acute hospital settings in Basingstoke, Southampton and Portsmouth is making a demonstrable impact. A recent local workshop for GP’s was oversubscribed and there is evidence that those who attended changed their practice to address underlying alcohol problems in their patients. The Wessex Alcohol

Project titleAlcohol misuse screening



Grant Given£13,000 (Estimated recurrent savings up to £2.3m - if implemented Trust wide at Southampton University Hospitals Trust)

What was the problem?When patients are discharged from hospital they very often are not fully conversant with the medication they have been prescribed which may be new or changed from those they had before admission. The result of this is that sometimes patients do not take their medication correctly or have to visit their GP to gain clarity.

What was needed?A simple way for patients to clarify what the medication is for and how and when to take it.

What was the Solution?Setting up a helpline so patients have a one stop expert source of advice on their tablets and other medication. Staffed from the acute hospital’s pharmacy department it is low cost.

Benefits (delivered or expected) » Improved care » Improved medication compliance - with a reduction in admissions due to poor usage of medication

» Reduced calls to wards and to GPs.

Project titleMedicines Patient Helpline


What was the Solution?Dementia care crosses primary care, acute trusts, mental health trusts and social care boundaries. Consequently the leadership to deliver such a complex and cross-organisational area is critical to its success. To this end, a whole systems partnership is being set up with the intention to offer new possibilities for the investment of dementia monies and to ensure best value for money. We are also supporting training for GPs which will enhance their abilities to deliver services for people with dementia across the full spectrum of health and social care systems.

Benefits (delivered or expected) » agreed end to end, whole-system, patient centred integrated south central dementia pathway

» reduce diagnosis gap » reduce unnecessary hospital admissions » improved care in acute hospitals » reduced length of stay in acute hospitals » cost savings as a result of the above - 0.8 day saving per admission equates to £50m per annum.

Project ProgrammeMental Health

Grant Given£50,000

What was the problem?Dementia presents a huge challenge to society, both now and increasingly in the future. There are currently 700,000 people in the UK with dementia and the illness costs the UK economy £17 billion each year which will increase to over £50 billion in the next 30 years. This level of cost is unsustainable. The Dementia strategy and other local dementia initiatives are seeking whole systems solutions to address this spending gap.

What was needed?Improving the quality of dementia care in South Central, is a key plank in the Mental Health clinical improvement programme. This level of transformational change requires a mind shift in the clinical leadership community and the empowerment of hundreds of change agents out in the region. South Central SHA has trialled the Mass Mobilisation method, based on the principles of Social movements which is an innovative approach that combines leadership development, clinical engagement and change management delivery. A specific commitment has been developed for each group of stakeholders to enable everyone to play their part to achieve the overall goal.

Project titleClinical Leadership for Dementia


What was the Solution? » A common DNACPR (Do Not Attempt Cardio

Pulmonary Resuscitation) Policy across NHS South Central was negotiated with wide stakeholder engagement

» Common documentation for capturing decisions has been created

» Shared education regarding end of life care decision making and the policy and documentation to be used.

Benefits (delivered or expected) » More patients having their wished respected and

dying in their place of choice » Fewer unnecessary and unwanted interventions

at end of life » Fewer patients being moved between care

settings at the end of their life » This supports Domain 4 of the NHS Outcomes

Framework: Ensuring that people have a positive experience of care’.

Project ProgrammeEnd of Life Care

Grant Given£57,400 (Estimated recurrent savings - up to £635k per annum being delivered)

What was the problem?Senior staff in the End of Life Care Clinical Programme recognised that policies with respect to managing end of life care decisions were not uniform across organisations within NHS South Central, were not always applied and that decisions made did not alway follow the patient as they moved between care provisions. This was resulting in patients’ wishes not always being properly understood and not always being reflected in care given. As a consequence care quality was compromised and unnecessary costs were being incurred.

What was needed?What was needed was a common policy across all care settings within NHS South Central. Decisions should be captured in the same way by staff working with patients and families using a consistent approach and decisions should be transferable across care settings so they need be captured only once. There needed to be agreement that these decisions would be respected and acted upon.

Unified Do Not Attempt

Cardiopulmonary Resuscitation (DNACPR)

Adult Policy

www.southcentral.nhs.uk

© NHS South Central. March 2010. CS18784. Designed by NHS Creative - www.nhscreative.org

Project titleRoll out of the DNACPR strategy


The cost per patient contact is low (50p per week), the system can manage large numbers of patients and is very flexible - for example ‘flu jab’ reminders can easily be added in for a period of time.

The IVR service will help staff identify ‘at risk’ patients and enable them to focus their efforts on those with the greatest need thereby allowing early intervention and avoiding exacerbations.

Benefits (delivered or expected) » Improved patient experience » Better quality of life » Reduce secondary care admissions and visits » Reduce primary care visits » Total savings made will be dependent upon

uptake and admissions saved.


Grant Given£48,000 (Savings £1,850 per avoided admission)

Challenge project summaryIVR uses the most ubiquitous of technologies, the telephone to monitor the wellbeing of people over time. It is both convenient and acceptable for patients and easy to implement. Upon discharge patients are asked to consent to receiving IVR calls. These calls are made by a computer at a time and frequency that the patient finds acceptable – usually a couple of times a week.

Patients can specify any days (for example weekends) when they do not want to be disturbed. The automated calls give the patient three choices about a range of symptoms.

For example:

Is your breathing:1. the same as or better than usual? > Press 12. worse than usual? > Press 23. much worse than usual > Press 3

The series of questions have been established with clinical input and a response dependent escalation plan ensures clinicians are alerted automatically when they need to be by email or text.

Project titleMessage dynamics - interactive voice response for people with COPD


» Bespoke (individual patient tailored solution) telehealth remote monitoring and knowledge bases system for less than £5 per patient per week including equipment

» Full integration with telecare.


Grant Given£198,000 (recurrent savings estimated at £2,500 per patient per annum)

Challenge project summaryThis project utilising leading edge internet cloud based computing and drawing on techniques used in industry for remote monitoring of industrial plant is still in development but promises to offer flexible and low cost telehealth and telecare solutions tailored to the individual person’s condition and needs.The product will support self care and facilitate remote monitoring and early intervention. The solution is particularly suited to supporting people with a long term conditions but will also lend itself to virtual wards and intermittent / short term monitoring situations.

The approach user Android based devices (phones and tablet PCs) as the hub and low cost peripherals – B/P, Weight, blood sugar, spirometry etc. for monitoring.

Benefits (delivered or expected) » New way to create cheaply an integrated telehealth hub that offers full interoperability between technology providers - reduced admissions better care

Project titleSolcom - Cloud based remote integration of patient home diagnostics



Grant Given£80,000 across NHS South Central to support Adoption. (Estimated recurrent savings - up to £2.1m based on iTAPP estimates)

What was the problem?Catheter acquired urinary tract infections (CAUTI) are common. These infections are unpleasant for the patient and in a few cases serious or even life threatening. They prolong lengths of stay, and increase costs. Reducing the numbers of catheters inserted is the most direct way of reducing CAUTI.

What was needed?A way of assessing who would and who would not benefit from having a catheter inserted. Bladders scanners do this by assessing the extent to which the patient retains urine after voiding. A Catheter will not help where the patient voids fully and there is no urinary retention.

What was the Solution?Funding to support adoption of scanners

Benefits (delivered or expected » Reduced infection rates » Reduced prescribing costs » Reduced length of stay » Increased efficiency in saved staff time and avoided unnecessary catheterisations.

Project titleBladder Scanners - part of the national Innovation Technology Adoption Procurement Programme (iTAPP)



Grant Given£200,000 across NHS South Central to support adoption (Estimated recurrent savings - £4.5m to be delivered in 2011/12)

What was the problem?Up take of goal directed intraoperative fluid management was patchy across NHS South Central despite some good evidence of positive impact on speed of recovery for patients undergoing major surgery.

What was needed?Local evidence of efficacy

What was the Solution?Support for uptake – a programme of funding uptake for a year and of gathering evidence of impact locally so that future funding decisions could be made on the basis of robust local evidence. NHS South Central now has goal directed fluid management available in all Trusts undertaking surgical procedures where patients might benefit.

Benefits (delivered or expected) » enhanced recovery post op through ensuring optimal intraoperative fluid load

» reduced ITU stays reduced LOS » faster recovery.

Project titleIntraoperative goal directed fluid management - part of the national Innovation Technology Adoption Procurement Programme (iTAPP)

In patients undergoing some forms of orthopaedic and abdominal surgery, intra-operative treatment with intravenous fluid to achieve an optimal value of stroke volume should be used where possible as this may reduce postoperative complication rates and duration of hospital stay

‘Although currently logistically difficult in many centres, preoperative or operative hypovolaemia should be diagnosed by flow-based measurements wherever possible.

- British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients


» Staff to be supported with training and on line resources for them and their patients

» Free supply of twotone or aerochamber devices to patients so they can maintain a good technique.

Benefits (delivered or expected) » Improved quality of life for patients whose condition is better managed

» Reduced admissions » Reduction in prescribing of reliever inhalers » Estimated £12 saved for every £1 invested in the programme

» This supports Domain 2 of the NHS Outcomes framework - Enhancing quality of life for people with long-term condition.

Project ProgrammeLong term conditions

Grant Given£124,000 across NHS South Central (Estimated recurrent savings - £9m to be delivered in 2011/12)Wessex HIEC is supporting this project

What was the problem?Poor inhaler technique is very common amongst patients who use inhalers to manage their chest condition. This greatly reduces the effectiveness of inhalers. Many patients are taught a poor technique when they first start to use inhalers. The main reason for a sub-optimal technique is inhaling too fast.

What was needed?This project which started on the Isle of Wight and is now being rolled out across NHS South Central determined that what was needed was:

» A way of demonstrating to patients the effectiveness of their inhaler technique

» Updating of staff in teaching an optimal technique. » A way to reinforce good patient technique in their

own home

What was the Solution? » Community pharmacists agreed to conduct Medicines Use Reviews with patients using inhalers.

» Use of the InCheck dial measures and demonstrates the effectiveness of patient’s technique

Project titleInhaler technique improvement programme


Other Innovation Activity


The Regional Enabling Group (REG) is led by a sub-set of Chief Executives from Trusts across the South Central region with the aim of driving specific opportunities where the regional benefit of working together is significant across the whole of the QIPP agenda.

There are four projects underway to help achieve this:

1. Integrated Supply Chain (ISC): Health organisations joining together in a consortium and pooling their non-pay spend (equipment and supplies) so they save money through bulk buying and standardising contracts. (excludes Pharmacy drugs) (£400m benefit over 4 years if 20 trusts join)

2. Pathology: Providing pathology services in a more efficient manner by rationalising buildings, facilities and equipment. (£16m p.a. benefit in 2013-14)

3. Medicines Use & Procurement: Making sure the prescribing of medicines is being done as efficiently as possible and that medication errors and waste are reduced. Benefit of £23m in 2011/12

4. Estates: Better management of health service buildings and land to ensure care is provided in the most appropriate and cost effective locations. This work stream is now closed.

Regional Enabling Group


The Innovation and Development Team is responsible for the development of innovative training roles and CPD for medical and healthcare practitioners. Workforce innovation remains a strong focus for the SHA and partners. Some examples of activity in this field are given below.

Hospital at Night Project – Portsmouth Hospitals

One of our Acute Medicine trainees took a year Out of Programme to work full time on the Portsmouth Hospitals ‘Hospital at Night’ project. The project, jointly funded by Wessex Deanery, South Central SHA and Portsmouth Hospitals, reviewed the current arrangements for out of hours staffing, redesigned and then implemented a Hospital at Night programme.

This involved revising junior grade rotas, establishing new senior nurse and medical technician posts, and setting up a management structure for Hospital at Night. Formalisation of handover arrangements was also involved, as was a general raising of the profile of handover issues and establishment of a monitoring system.

Extranets

Trainees have been instrumental in developing the Wessex Deanery’s extranet sites, starting with a single site for Trauma & Orthopaedics in 2009. It was established as a project by one of the T&O trainees and has now grown to 36 extranets each with its own trainee lead.

The main function of the extranets is to act as an educational communication tool between trainees, consultants and the deanery. The most visited pages on the T&O Extranet are those giving details about the regional training days in the events diary but other pages include a forum and interactive document library. There is educational material in the form of presentations, abstracts & reading lists, exam advice & example questions (including links to questions housed at Southampton University’s EASiHE -

EAssessment in Higher Education - project), interesting cases, useful books & links, a news page, details on the journal clubs in the region, a directory of consultants and trainees, and a short history of Orthopaedics in Wessex. Trainees can also upload short sound bites and video clips of relevant material.

General Practice Fellowships

In the Wessex GP School, six GP Fellowship pilot posts have been set up of which 4 culminated in October 2010. The Fellows have undertaken a wide range of projects looking at unscheduled care and the benefits of spending additional time in general practice early in GP training. There have been significant and varied achievements from those working within the scheme including presentations at the Ottawa Medical Education Conference May 2010, Miami and AMEE Medical Education Conference September 2010, Glasgow, publications submitted to Education for Primary Care, two posters presented at RCGP Conference, November 2010 and a publication accepted by the Primary Care Foundation.

To quote one recent graduate from the scheme:

The Fellowship has been a unique and eye-opening experience. I have been exposed to the other side of the NHS – found out how the NHS is run; the health economy, the politics around health care, commissioning services, budgets, contracts etc.

Bullying and Harassment video training tools in Obstetrics and Gynaecology

In 2009 the annual trainee survey revealed that a significant number of trainees in obstetrics and gynaecology have felt undermined at some point in their training. This prompted the production of a series of educational videos in conjunction with the RCOG underpinned by research from the northern deanery and feedback on experience via the college website from both trainees and trainers.

Workforce Innovation 2010/11


These novel videos give trainees and trainers valuable insight into what bullying, harassment and undermining behaviour actually are and how these issues can be constructively dealt with. They are a useful educational tool for all specialties and should allow people to reflect on their own experience, attitude and behaviour.

Within Wessex we plan to use these videos when organising a series of workshops to help reduce the incidence of undermining behaviour reported by trainees.

Foundation Anaesthetics Module at Portsmouth Hospitals NHS Trust

Training foundation doctors efficiently is a challenge whilst they are providing service commitment. Ensuring patient safety and high quality care is always the aspiration. Anaesthesia is an ideal specialty for teaching generic skills and competencies because of the close senior medical supervision and the culture of safety and attention to detail that exists within the specialty. At Portsmouth Hospitals NHS Trust the Anaesthetic Department in conjunction with the Foundation Programme Directors has developed a 4 week programme for foundation year 1 doctors. Fifty percent of the year cohort of trainees rotates through the placement (approximately 26 doctors per year).

During their attachment they are entirely supernumerary and receive direct senior supervision at all times. Prior to their attachment, they receive a logbook detailing aims and objectives for the placement and also a handbook of peri-operative care. The latter is a valuable reference throughout the whole period of their foundation training.

Foundation doctors spend their time in theatre, recovery, pre-assessment clinics, as well as with the acute pain team and critical care outreach. They are required to keep a logbook of attendance, practical procedures performed, critical incidents and interesting case reports. They are also strongly encouraged to take the opportunity to complete workplace-based assessments. They gain skills in pre-operative assessment, optimisation of patients for theatre, general resuscitation and post-operative care including pain management.



Their knowledge is objectively assessed by an exit multiple-choice questionnaire and each doctor is appraised at the end of their attachment with the opportunity for dialogue and feedback. This programme is highly regarded for its educational value by foundation doctors. Confidence scoring for individual doctors in terms of skills and application of knowledge shows significant improvement. These attributes help to equip the junior doctor for the challenges of managing acutely-ill patients elsewhere during their training. It is one of the reasons that doctors cite for choosing Portsmouth for their foundation training. The programme has also been highly commended by the Society for Education in Anaesthesia (UK) (2008/9) and has also gained several “green triangles” as evidence of good practice in the most recent GMC trainees survey.

Health Innovation Education Clusters (HIECs)

Thames Valley HIEC Knowledge Team and Wessex HIEC aim to promote innovation in practice, bring forward developments to improve service quality, reduce costs and also to improve knowledge and skills of SHA staff by providing best practice in education and training for health and social care workers in all healthcare settings. HIECs also aim to facilitate speedier adoption of innovations in care and treatment, including new service models, use of technology and medicine and devices to NHS patients.

Examples of specific achievements this first year are:

» The agreement and signing of a Memorandum of Understanding or Memorandum of Agreement between the SHA and the host for each HIEC (the University of Southampton for Wessex, and the Oxford and Buckinghamshire Mental Health Foundation Trust, now Oxford Health NHS FT, for Thames Valley)

» Establishment and recruitment of a small core Management team for each » Establishment of Governance system between each Partnership Board and the SHA

» The agreement and support of strategic priorities and broad work programmes, in line with local QIPP plans, for each:

» Thames Valley: » Integrated Services; Patient Safety; Care Closer to Home; Capacity and

Capability Development in Practice » Wessex:

» Knowledge Programme (supporting the dissemination of local initiatives and innovations); Community Solutions (with a focus on Community based Stroke Care and End of Life Care); Telemedicine Programme (supporting the use of internet-based solutions)

» Stakeholder engagement » Support of and to the Regional Innovation Fund

Preceptorship

The aim of the Preceptorship framework is to consolidate knowledge and skills gained by newly qualified practitioners, allowing them to develop competence and confidence in the workplace. The framework has agreed outcomes which highlight high quality practice, establishing best practice for continuing professional development. NHS South Central is supporting trusts to implement and develop their own Preceptorship programmes.

Public Health Practitioner Development

We provide a focus for education, training and development for those who want to develop their knowledge and skills in public health and wellbeing and reduce health inequalities. In particular, we work together to co-ordinate and develop training for the Wider Workforce, Practitioners and Specialists.



Improving Global Health though leadership development

This is a ground breaking project in rural and urban settings in Cambodia and Tanzania, concentrating on achieving the millennium development goals for health. During placements of normally, three to six months participants from a variety of health care backgrounds have the opportunity to develop leadership skills through the application of quality improvement methods under the mentorship of UK experts, developing a transferable skill set applicable to working within the NHS.

Outcomes for 201-11 » 28 Fellows completed 91 months of placements in total across three sites – Samlout,

Cambodia; Tabora, Tanzania and Kisumu & Nairobi, Kenya » Awarded a grant of £14,100 from THET; in order to support a specific project for

improving maternal mortality in Tabora, Tanzania » A partnership has been agreed with the Royal Society of Medicine and the Royal

College of Obstetricians and Gynaecologists – which will enable us to increase our input to the THET funded project

» A paper written by the team “Global health partnerships: leadership development for a purpose”, published in Leadership in Health Services (22,4, 2009) was awarded the 2010 Outstanding paper award by the Emerald Literati Network, Emerald Group Publishing Ltd

» Active discussions are taking place with the University of Cape Town, Faculty of Public Health to explore possible future partnership for this work



Evaluation of Fellowship experience from Fellow’s perspective, using the Medical leadership Competency Framework as a tool – the following are 2 illustrative quotes

Working with others:

I am much more aware of how people’s strengths and weaknesses influence their methods of doing things, and how this may influence the team as a whole. I am now conscious that there are areas in which certain individuals may be more effective, and that I should utilise different team members’ skills at different times. I am much more conscious of situations where my methods of working are less effective, and in those situations to get the support and ideas of a colleague. This is going to be important in my career, so that I can form teams with the right mix of people and skills – not just those people I like, but those whose skills will be useful.

Setting Direction:

I found the way we stood back and looked at the service before taking any action has helped me to be more patient in the way I approach decisions rather than just rushing in after a very brief appraisal of the situation.



Simulation StrategyNHS South Central has been identified as one of the leading SHA’s in developing and implementing a simulation strategy across the health economy. We are now in year three of our plans and the focus is on embedding simulation training in NHS organisations while improving patient safety.

To achieve these objectives we identified the top serious untoward incidents in the region and recruited seven highly qualified clinicians to focus on developing clinical simulation education packages to address these safety concerns. In addition, we shall be doing a cost benefit analysis to properly measure the financial implications of using simulation based training. The seven Clinical Simulation and Patient Safety Fellows are from Trusts across South Central and the education packages they develop will be used across the region and indeed the wider NHS.

The Packages:

1. A cost benefit analysis: How to improve patient safety and quality of care while reducing costs This project will explore the costs and benefits of using simulation training and help us to focus our efforts to achieve high quality; cost effective and safe care.

2. To reduce the incident of hospital acquired complications from VTE This project is to raise the profile and ownership of venous thromboembolism (VTE) risk assessment to improve patient outcome. There will be reduced risk to patients with optimal treatment being provided. The result will be a proactive multidisciplinary approach to VTE for patients.

Other Innovation Activity3. Medication Errors

To create a robust culture of safe sedation practise and ensure staff are trained to proficiently assess and provide pain relief and safe sedation to children in pain.

4. A multidisciplinary approach to improving Handover Use simulation to improve clinical handover in healthcare professionals that will enable an efficient and patient-focused service to be delivered.

5. Recognition and Intervention into the rapidly deteriorating patient A culture of timely recognition and treatment of the deteriorating hospital patient in our hospital, which will keep our patients safe on our wards.

6. CTG interpretation and the management of safer childbirthMaking childbirth safer. Using clinical simulation to enhance prompt, consistent and reliable response to foetal distress in labour.

Research and developmentResearch and evaluation are integral elements in the delivery of quality and productivity.

NHSSC maintains a very active research portfolio with over 30,000 patients involved in studies at any one time. The most prevalent research fields are: » Cancer » Children / paediatrics » Genetics » Infectious diseases » Mental health » Diabetes » Reproductive health.


The National Innovation Expo 2011The Innovation Expo took place in March 2011 with thousands of people in attendance. South Central SHA took on a coordinating role for all SHAs nationally as well as making an individual contribution in the form of a seminar planned and delivered jointly with the NHS Institute for Improvement and Innovation, posters and partner presentations in the Regional Innovation Fund (RIF) zone and the SHA’s own stand in the SHA Zone.

Joint Seminar

The SHA Seminar delivered jointly with the NHS institute for Innovation and Improvement took the form of a workshop focusing on ‘Return on investment’. It was well received with attendees enjoying an intensive 45 minute experience.

SHA Stands

Each SHA took the opportunity to showcase their approach to developing innovation in the SHA Zone. The zone attracted many visitors who toured the stands, including Sir David Nicholson (Chief Executive of the NHS) and Lord Howe (Parliamentary Under Secretary of State at the Department of Health). Secretary of State Andrew Lansley was interviewed by Sky News in the SHA Zone. South Central SHA’s stand was particularly busy with many delegates wanting to discuss the work of the SHA. Feedback received during and after the Expo has been very positive and many useful contacts were made which are being followed up.

It is also noted that Hydrant an innovation developed locally supported by the SHA innovation fund was represented on its own company stand and was an innovation highlighted in Jim Easton’s (NHS Director General for Improvement and Efficiency) key note speech as an innovation with potentially the highest return on investment of any he had seen.

RIF Zone

The development and delivery of the RIF Zone was lead by South Central SHA on behalf of all SHAs. The RIF (Regional Innovation Fund) Zone gave the 10 SHAs the opportunity to show case 40 Projects which had been supported by the regional innovation funds received in 2009/10 and 2010/11. Four of these projects were from NHS South Central.


The National Innovation Expo 2011The zone was noteworthy for its striking layout with the showcased projects being displayed on 5 Columns each representing part of a generic patient pathway:

Prevention » Diagnosis » Treatment » Long Term Care » End of Life Care. Mental Health projects were also featured.

Each showcased project sign-posted the audience to the very real and far reaching benefits being delivered to service users across the NHS in England and highlighted the extent to which innovation is crucial to meeting the challenges the NHS faces today and tomorrow.

The centre piece of the zone was a ‘Tube Map’ displaying all 214 RIF funded projects as stations on the 6 tube lines representing the generic patient pathway. This proved to be a high impact way of demonstrating the wealth of innovation that has blossomed from the relatively small innovation funds the SHAs have managed. The tube map is now on display in David Nicholson’s office as he requested that he have it post event.

The back of the zone provided a small presentation area where, over the two days of the expo, 18 innovation partners who had worked on projects with SHAs demonstrated the products of that work. Several partners commented on what a receptive audience they had had. Two of these presentations were from South Central SHA partners the companies working on our phase 2 challenge projects – Message Dynamics Ltd and Solcom Ltd.

The zone attracted favourable comment from many visitors who toured the zone, including Sir David Nicholson (Chief Executive of the NHS) and Lord Howe (Parliamentary Under Secretary of State at the Department of Health). Many requests for further information were received and have been responded to since the Expo.


HALO for Dysplastic Barrett’s Oesophagus (SW)

Diabetic ‘Pen Station’ (SW)

Get

ting

Sort

ed D

iabe

tes

(Y&

H)

Unified DNACPR Strategy (SC)

A Good Death (NE)

Patient Decision Aid – Advanced Kidney Disease (EoE)

Improving Choice for Terminally Ill Patients (SEC)

Palliative Care in Prisons (NE)

Spiritual Needs of the Dying (NE)

Dignity Workers (NE)

Do Not Attempt CPR (Y&H)

Choices for Individuals at End of Life (NW)

Achieving a Good Death in Warrington (NW)

Quality Care for EOL Dementia Patients (NW)

End of Life Care - Advanced Kidney Disease (NW)

Dementia & EOL: Spreading Best Practice(NW)

Dignity Bidet Commode (Y&H) Rehab for Stroke Survivors (Y&H)Physiotherapy for Physical Difficulties (Y&H)

Unique Care for people with multiple health needs (Y&H)

Altogether Better Diabetes (Y&H)

HIEC Long Term Conditions (Y&H)

Inhaler Training (SC)

Buddy Recovery in Mental Health (LONDON)

Drink Down (EM)

Psychological TreatmentModification for Bulimia Nervosa (EM)

Clinical Pathway for Alcohol Dependent Offenders (EM)

Nurse Led Dementia Service (SC)

Insomnia and Pain CBT (SC)

Targeted Mental Health in Schools (NW)

Mental Health Anti-Stigma Campaign (SC)

Bridge Project – Adolescent Mental Health (WM)

Telehealth in Lancashire (NW)

Assessment Framework for Disability & LTCs (NW)

Paediatric Care in Primary Care (NW)

Improving Lifestye in Maternity Services (NW)

Young People Integrated Healthcare Models (WM)

Redesign of Mental Health Community Services (SEC)

Identification of Patients at Risk of Acute Kidney Injury (SEC)

Improving Hydration for People with Dementia (SEC)

Improving Independence in Dementia (SEC)

Reducing Burden of Dementia (SEC)

Empowering Patients via Self-Care Plans (EM)

ThinkGlucose Initiative (EM)

Monitoring Diabetes with TeleHealth Solution (NW)

fMRI for Patients with Brain Tumour (NW)

On-Line QA Diagnostic Radiology Services (NW)

Patientrack (NW)

Teenager Digital Intervention and Therapy (WM)

PROMS 2.0 (NW)

Dev

ice

Eval

uatio

n N

etw

ork

(WM

)

IGNITE Telehealth Hub (EM)

Silver Coated Catheters (SC)

Disease Containment Zones (SC)

Project Health (NW)

Domiciliary Eyecare (NW)

Razorfish (SC)

Walk

ing A

way fr

om D

iabet

es (E

M)

Medicines Patient Helpline (SC)

Tele-Health Programme (Y&H)

Teledermatology (SC)

Getting Sorted Asthma (Y&H)

Supporting People with Cancer (SW)

Personal Rectocele Management (SW)

Opportunistic Wellbeing Training (SW)

NeuroResponse (LONDON)

GPs Implementing Guidelines (SW)

Home Newborn Hearing Assessment (SC)

Heart Diagnostic Information for Patients (SW)

Dark Field Imaging of Intestinal Mucosal (SW)

Cut Carbon – Cut Costs (EM)

Think Home First (EM)

Community diagnostics of arrhythmias (NE)

Molecular Diagnostics – Thyroid Cancer (NE)

ISABEL – Clinical Diagnostics Web Programme (NE)

Dia

gnos

tics

in P

olys

yste

ms

(LO

ND

ON

)

Telehealth in Long Term Conditions (COPD & HF) (SW)

3 Dimensions of Care for Diabetes (LONDON)

Patie

nt R

elat

ions

hip

Man

agem

ent

for

LTC

(LO

ND

ON

)

Diabetes Care Planning and Self-Care (LONDON)

Telehealth Solutions for Nursing Homes (LONDON)

Innovating Rehabilitation using Wii Technology (LONDON)

Stroke Buddies (WM)

Healthy Eating in Pregnancy (EM)

LTC Dragon's Den (WM)

Farming on Prescription (EoE)

Automated Pill Dispenser (WM)

PACE: Supply Chain-Led Service Innovations (LONDON)

Pulpit – Patient Transfer Wheelchair to Toilet (SW)

Nurse Led Telephone Monoclonal Gammopathy Clinic (SW)

Redesigning the Ambulance (London)

e-vent: Supporting Complex Hospital Discharge (London)

Enhanced Recovcery after Major Surgery (London)

Student Advocates – Transforming Patient Experience (London)

Improving Emergency Abdominal Surgery for Elderly (SW)

Urgent Care Pain Management in Children (SW)

Reducing LOS for Transurethral Surgery (SW)

Bed Magnetic Cable Management Strap (SW)

Cutting Block for Knee Replacements (SW)

Pliable Drinking Straw (SW)

Superbed (WM)

Tele-Wound management (Y&H)

Out

com

e - O

rient

ated

CA

MH

S (E

M)

Just Checking Tele-care (Y&H)

Transoesophageal Echocardiography Simulator (SC)

Teledermatolgy Triage (SC)

Therapy Improvement Programme (EM)

District Nursing, Mobile Working (EM)

Paperless Electronic Requesting System (EM)

Identification of Patient's Specimens in GP Surgery (NW)

Value 4 Vision (EM)

Telehealth Monitoring in Heart Failure Patients (NW)

Testing and Integrated Diagnostic System (London)

Migrant Worker Health Access (LONDON)

Streatham Young Person's Centre (LONDON)

Homeless Health Peer Advocates (LONDON)

HIEC Patient Safety (Y&H)

HIEC Maternal and Infant Health (Y&H)

Smoking Related Age Progression Techniques (WM)

Ethnic minority’ Cystic Fibrosis DNA Screening Panel (NW)

Global Mental Health Assessment Tool (NW)

Improving Atrial Fibrillation Diagnosis for Stroke Prevention (Y&H)

Maternity Support Workers (NE)

Community IVT Services (NE)

Surv

ivin

g Se

psis

(NE)

Aire

dale

Te

lem

edic

ine

Cen

tre

(Y&

H)

VERSAJET – Wound Debridement (NE)

RF-ID Kanban (WM)

Improvements to Colonoscopy (NE)

15-25 – Mentally Disordered Youth (NE)

Fractured Neck of Femur (SW)

One-Stop Day Surgery (SW)

Nutrition in Cancer Care (SW)

Modified Air Mattress (SW)

Gui

danc

e D

evic

e fo

r Ep

isio

tom

iess

(SW

)

Perinatal Mental Health Care (SW)

Urin

ary

Trac

t In

fect

ion

(UTI

) (SW

)

Per

son

Cen

tred

Le

arni

ng D

isab

ilitie

s (E

oE)

Alc

ohol

Car

e Te

am (E

oE)

Web

-Bas

ed In

flam

mat

ory

Bow

el D

isea

se S

elf-

Hel

p P

rogr

amm

e (E

oE)

Dem

entia

in C

are

Hom

es (E

oE)

Chr

onic

Pel

vic

Pain

Syn

drom

e (E

oE)

Bon

e H

ealth

& O

steo

poro

sis

Pre

vent

ion

(NW

)

Pre

vent

ing

Repe

at A

lcoh

ol A

dmis

sion

s (N

W)

Met

Off

ice:

Ear

ly W

arni

ng S

yste

m (N

W)

Tar

gett

ed a

nd E

ffec

tive

Serv

ice

Del

iver

y (E

M)

Val

ue 4

Vis

ion

(EM

)

Pro

batio

n H

ealth

Tra

iner

Ser

vice

(N

W)

Tele

-Med

icin

e in

Pris

ons

(Y&

H)

Loca

l Vis

ion

Impa

irmen

t S

uppo

rt (N

W)

Com

mun

ity H

ealth

Cha

mpi

ons

Prog

ram

me

(NW

)

Interactive CD-ROM for Smoking Cessation (EM)

Walking Away from Diabetes (EM)

Better Health Outcomes for Young Offenders (EM)

Improving Safeguarding for Young People (EM)

Doppler Guided Intra-operative Fluid Management NW)

Fal

ls R

espo

nse

Vehi

cle

(EoE

)

Prim

ary

Car

e H

ealth

C

oach

ing

(EoE

)

Stim

ulat

e th

e M

arke

t f

or L

TC C

are

(NE)

SIN

AP

+ L

ive

Stro

ke D

ata

(NE)

Impr

ovem

ents

to

Car

e Pl

anni

ng (N

E)

Lim

bs A

live

– In

depe

nden

ceA

fter

Str

oke

(NE)

E-di

abet

es f

or

Youn

g Pe

ople

(Y&

H)

Eye

Clin

ic L

iais

on O

ffic

ers

(EoE

)

Uns

ched

uled

Adm

issi

on V

irtua

l War

d (W

M)

Intr

aope

rativ

e Fl

uid

Man

agem

ent

(SC

)

Hea

rt F

ailu

re U

ltraf

iltra

tion

(SC

)

Enha

nced

Rec

over

y N

urse

(SC

)

Psyc

holo

gica

l Int

erve

ntio

ns in

Eat

ing

Dis

orde

rs (N

W)

Para

med

ic P

athf

inde

r Tr

iage

Sup

port

Str

ateg

y (N

W)

Enha

nced

Tec

hnol

ogy

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GR8 Wellbeing (NW)

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Strength & Balance Classes for Falls Prevention (NW)

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Children and Young People’s Disability Partnership (NW)

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Chrysallis II Online Weight Management (EM)

‘Tube Map’ displaying all 214 RIF funded projects as stations on the 6 tube lines representing the generic patient pathway


2011/12 will see the SHA building new partnerships that support innovation and improvement whilst managing transition to new HNS structures. It will be important to ensure that the knowledge and experienced gained over the last 3 years is not lost and that innovation remains at the heart of forging new and improved services.

RIF 2011/12

Given that 2011/12 is the last year of operating as an SHA there is a shift in focus from stimulating locally driven innovation in the form of longer term projects to an approach that supports the delivery of the SHA and wider health economy “must do’s” for 2011/12.

It is proposed that the following are triangulated to determine how best to utilise the time of the innovation team and, where appropriate, target spend of the RIF: » Priorities for QIPP » Clinical programme priorities » Red flagged items in the PIAG report

This will ensure that innovation activity has a very strong strategic fit with the overall work of the SHA, ensure that nothing is started that cannot be finished and will facilitate handover of innovation activity and outcomes to new structures as they emerge.

The Skills Network

On Monday 20th December 2010 the Department of Health published a consultation document entitled ‘Liberating the NHS: Developing the Healthcare Workforce’. Building on the work of ‘Equity and Excellence: Liberating the NHS’, it sets out a vision to empower healthcare providers, with clinical and professional leadership, to plan and develop their own workforce.

Looking forwardThe proposals set out in ‘Liberating the NHS: Developing the Healthcare Workforce’ include some significant changes from the existing system of planning and commissioning the education and training of the clinical workforce in particular the establishment of local Provider Skills Networks (consisting of all providers of NHS-funded care) with responsibility for planning and developing the workforce and taking on many of the workforce functions currently discharged by Strategic Health Authorities and Deaneries.

The workforce and leadership portfolio commissioned an options appraisal in February 2011 with a view to exploring options for the future development of local skills networks. It is anticipated that when the new structure comes in to being at its heart will be the capability to support innovation and improvement and the desire to promote a culture in which innovation flourishes.


For further information please contact Duncan Goodes [[email protected]]

South Central Strategic Health Authority First Floor, Rivergate HouseNewbury Business ParkLondon RoadNewbury BerkshireRG14 2PZ

Tel: 01635 275500www.southcentral.nhs.uk

mailto:duncan.goodes%40nesc.nhs.uk?subject=

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