INTEGRATED CAR E SYS TEMS
report, this is a factor we were acutely aware of. In the interviews, data assessment and patient experiences we looked at, it emerged that changes in performance were not overnight or accountable to a single piece of decision making. A hospital’s performance was driven by a multitude of different reasons, including – but not limited to – the use of medical technology, leadership practices, the utilisation of data to make both better informed workforce and clinical decisions, as well as the integration of primary and secondary care. This finding was reflected in our recommendations. If innovation is to be truly encouraged among the ICSs, then the Department of Health must set targets based on the best performers within the system and, vitally, back up these targets with a meaningful recourse to action for those ICSs which consistently fail. The desire to do this has been alluded to by Thérèse Coffey who, at the start of her post, questioned why all hospitals can’t perform at the rate of ‘top performers’, based on best practice from high performing regions. In order to do this, her department must do serious work in prioritising the adoption and spread of innovation through well-funded national strategies built on best practice already in the system.
Towards a best practice NHS: utilising data, integrated care, medical technology and an informed workforce
Where is the best of the NHS? This was the question the MTG set out to answer in its report into regional inequality. As it turns out, there are consistently high performing regions and pockets of best practice found throughout the country – from the south coast to Manchester. In determining what constituted best practice, we considered not just hospitals that performed consistently well, but also those that managed to dramatically improve during our data period.
The transition to ICSs has come amidst the health service’s worst ever crisis. Yet MTG’s latest report shows that there are regions that are succeeding against the odds, which are providing commissioners and those who sit on Integrated Care Boards (ICBs) with working examples of best practice in the NHS.
Backlog in Bury At the start of our data analysis in July 2021, NHS Bury sat 61st out of the 106 CCGs we looked at over eight months. During the period it was able to improve dramatically and climb into the top twenty in our rankings. But why was this? With a growing orthopaedic backlog, the Bury Care Organisation tested a new way of working within its Fairfield Hospital Theatres by holding a ‘Super Saturday Orthopaedics List’. Using a High Volume, Low Complexity philosophy (HVLC), an orthopaedic ring- fenced unit with standardised kit and consistent staffing was able to double the number of patients it normally treated, with eight out of the ten patients discharged the same day.
The Government has already utilised ‘surgical hubs’ to provide similar high volume specialised surgery. But with NHS staff occasionally complaining that this is merely ‘relocating an already stretched workforce’, Bury’s approach provides a model for future ICSs to build reactive surgery units based around population health data. Indeed, the potential of medical technology through minimally invasive procedures and surgical robotics to expand on this specialised approach is an example of where strategic Government funding can assist in levelling up struggling regions.
Integrated care in Northumbria An understanding of patient data and how to respond to it is built into the ICS model of care. Arguably, one of its earliest adopters and strongest proponents was Northumberland CCG with the benefits of this model of care emerging during pandemic. Communication structures saw different patients prioritised thanks to live dashboards giving data on developing trends and the changing needs of patients. This meant that pressures were foreseen and plans were put in place to tackle them proactively.
This was done in partnership with clinical staff, including key, experienced clinical teams. It was also supported by an effective prevention and control programme, which helped to support the re-opening of services. The executive team also met daily with the surgical and infection prevention team, ensuring that they were supported to deliver safer environments for clinicians and patients.
It is important that all ICSs, when looking at setting structures for success, look to models like Northumbland, where strategies and structures are put in place to allow success on an ongoing basis, that are adaptable to shocks, and allow teams to deliver success for patients on an ongoing basis.
General surgery in South Tyneside South Tyneside has one of the lowest surgery cancellation rates in the country and during our data period consistently stayed in the top five performing CCGs. This is largely in part down to how it organises its services through provider collaboratives like its Path to Excellence programme. This way of working sees an emphasis on organisational autonomy and competition through collaboration and partnership working. The aim is to improve patient experiences, address vulnerable service areas, and deliver the highest possible quality and safety standards to improve patient outcomes and deliver clinical excellence.
By integrating care like this, the best possible surgeons deliver care at South Tyneside District Hospital, with emergency
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