LORD CARTER AWARD 2018
Claire Hennessy, head of Operational Estates and Facilities Services at Oxford University Hospitals NHS Foundation Trust, and (right), her colleague, lead project manager for the Hospital Energy Project, Mark Bristow, pick up their Highly Commended certificate. Top right: The CHP unit arrives at the John Radcliffe Hospital’s new Energy Centre. Below: The Energy Link trench, with the district heating pipes, HV, and ‘comms’ cables, in a continuous loop around the John Radcliffe to the Churchill Hospital.
savings are not met, Vital will pay the difference. The company projects a 10,000 tonne/annum reduction in CO2
emissions
(equivalent to 4,000 homes’ emissions), while the first quarter ‘post-implementation’ saw £600,000 in financial savings made. The £14.8 million project took just over two years to complete. The Trust expects to save £11 million on backlog maintenance over three years.
Integrated musculoskeletal service The second Highly Commended certificate went to The iMSK (Surrey Integrated Musculoskeletal Service) service at Ashford and St Peter’s Hospitals NHS Foundation Trust, which the Trust says is ‘unique in that, combining the roles of commissioner and provider, it has allowed us to achieve radical improvements in quality, efficiency and productivity’. The Trust’s innovations in MSK care pathways have seen Lord Carter visit the service, and on also visiting it, Professor Tim Briggs, national director for Clinical Quality and Efficiency at the NHS, announced the Surrey Trust as an ‘Exemplar site’ for the GIRFT and the Carter Model Hospital ethos.
The impetus for this ‘large-scale cultural and behavioural change’ came from the Right Care commissioning data and the Trust’s Orthopaedic Getting it Right First Time (GIRFT) report and recommendations. The Surrey iMSK service incorporated all of the patient outcome data and procedural activity information to build a new service around changing culture and behaviour to improve quality, value, and efficiency, with commitment to providing a biopsychosocial approach to patient care as the basis on which to implement change.
Multidisciplinary MSK approach Patient pathways start with a MSK-specific MDT Virtual Clinic (MDTVC), where 600 referrals per week are discussed. The
20 Health Estate Journal August 2018
multidisciplinary team comprises a GP, MSK consultant, Extended Scope Practitioner, (physiotherapist), and a dedicated administrator. Being hospital- based allows the triage team access to any previous imaging and medical history, which helps with assessment; triage allows for ‘straight to test’ and post-test assessment, resulting in direction of the patients to the correct clinical pathways. The MDTVC ‘delivers key success metrics necessary to ensure the MSK Service has effective clinical pathways’. There is ongoing internal audit, and processes are modified to allow for continuous improvements.
Benchmarking clinical activity Using the Comparative Health Knowledge System (CHKS) the Trust developed methodology for change based on benchmarking its clinical activity against
its national and GIRFT peers. It said: “We changed practice by using this benchmark activity data to promote the clinical engagement needed to achieve changes in practice. We audited practice, communicated findings, and led improvements in patient care, by eliminating variation and standardising practice. Eliminating variation in clinical practice has resulted in high quality standardised care with increased efficiency and productivity, and a sustainable reduction in surgical intervention, despite a 25 per cent increase in new patients seen.” As part of its innovation work the Trust also developed detailed evidence-based clinical pathways incorporating any published national guidelines, specifically tailored to meet the needs of the local healthcare environment. These pathways are integral to the iMSK service, and promote consideration of non-surgical methods of treatment consistent with the biopsychosocial model of care.
Numerous benefits
This quality in care has led to increased efficiency and productivity, reduced surgical activity, and reduced associated costs, as follows: n Total recurring annual savings of £3.9 million.
n A 40% reduction in elective orthopaedic surgery performed.
n A 73% reduction in knee arthroscopy surgery.
n A reduction in variation enabled a recurring procurement saving of £700,000 per year.
n A £140,000 saving through the reduction of 1.6 wte consultant surgeons due to reduced surgical activity.
n A £200,000 cost reduction by giving up theatre sessions no longer needed due to reduced surgical activity.
hej
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72
