South Central Strategic Health Authority Annual Innovation Report 2010/11 Discovery Development Delivery

NHS South Central 2 Annual Innovation Report 2010/11 Foreword Welcome to the second NHS South Central Annual Partnerships have been a key feature of 2010 and we These savings are recurring – millions of pounds saved Innovation Report (AIR). This report shares and celebrates have worked actively with industry, with established and year after year whilst at the same time improving quality. some of the innovative work that has taken place in NHS new players in the field of Innovation such as the National South Central (NHSSC) over the past year. As part of Technology Adoption Centre, the Technology Strategy There is still much more we can do and in 2011/12 the QIPP programme of work innovation has played an Board and the emerging Health Education and Innovation we look forward to working with you to consolidate important part in our drive to support the health economy Clusters (HIECs). These partnerships have resulted in innovations made to date and also to focus relentlessly of NHS South Central in reducing waste, maximising some notable innovations such as a telehealth solution on the highest priorities for the health economy so productivity and enhancing care. New technology and that will cut the cost of home monitoring of people with that innovation remains key to delivering sustained practices have been and will continue to be central to us long term conditions by 75% or more, an innovation improvement in the care delivered to the people of NHS meeting the challenges we face with respect to managing that addresses something as fundamental as whether a South Central. growing demand and growing public expectations within patient in hospital can drink for themselves and the spread the constrained resources available. of winning ideas across NHS South Central such as the inhaler technique improvement project. Andrea Young In 2010/11 new and ambitious developments have been Chief Executive supported that will yield great returns for our residents We have embraced the national Innovation Technology in terms of the availability and quality of care they Adoption Procurement Programme (iTAPP) that has receive. We have supported a wide range of initiatives identified technologies that, when implemented at scale, from the relatively low tech to the leading edge use of can improve clinical outcomes and reduce cost. We are emerging technologies. Low cost innovations such as the the first SHA to achieve 100% adoption of an iTAPP IVR (interactive voice response) for people with chronic identified technology – advanced monitoring techniques obstructive pulmonary disease (COPD) put the patient at for fluid management for patients undergoing major the centre of care and will help people stay well in their surgical procedures is now in place in all hospitals in NHS own home at a cost of £26 per annum. At the other end South Central undertaking these procedures leading to of the scale we now have the first hospital in England higher quality of care at lower cost. using ultrafiltration to save lives and reduce the length of hospital stay for people with the most serious heart We are always conscious of the need to secure good value failure. for the tax payer and financial return on the investment of £2.3m from the RIF over the past two years is important. In addition innovation projects from 2009/10 such as the Careful and cautious analysis of the investment made musculo-skeletal self referral and triage project have been suggests that for every £1 spent more than £17 will be incorporated into mainstream care. saved.

NHS South Central 3 Annual Innovation Report 2010/11 Introduction From 1 April 2009, Strategic Health Authorities (SHAs) ‘Push’ has been supported by the sharing of innovation took on a new legal duty to promote innovation to secure and improvement initiatives and ‘Pull’ by challenging continuous improvement in the commissioning and industry to meet our needs through the innovation provision of health care. challenge.

In 2009/10 South Central SHA focused on stimulating It is important that the SHA has a positive impact on the the culture of innovation at a grass roots level within the delivery of patient services and that a broad strategic health economy and supported over 20 locality based view is taken. With respect to innovation it has become innovative projects with funding that allowed ideas to be clear over the past two years that a key role for the tested. SHA innovation team has been to provide a networking function bringing together service, innovators, industry In 2010/11, the second year of exercising its statutory and the wider innovation landscape. It is impossible to put ‘Necessity is the mother of duty, the SHA has seen those year one projects flourish a monetary value on this interface role but it is clear that it invention. From the very but the main focus for the year has been to support the valued by those who have benefited from it and that this spread and adoption of proven innovations. These proven more facilitative rather than directive approach has yielded start and its initial call for innovations have been selected from a variety of sources: explicit products that are shared later on in this document. tenders the SHA has clearly »» Successful local innovations described unmet needs within »» Innovations developed elsewhere the NHS. Such clarity spurs a »» Innovations sign-posted by the national iTAPP programme commercial company like ours »» Innovations arising from a challenge to industry into action and reassures us In total 17 new projects have been supported in 2010/11. that there is a market for our (See page 11) innovation.’ 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 Director of SME with whom we have worked

NHS South Central 4 Annual Innovation Report 2010/11 The SHA duty and how this is exercised 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” SHA innovation and improvement pipeline 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. The Innovation and Improvement Model The SHA has created a model for innovation and improvement that describes how the Over the year the clinical programmes have reduced to from 8 to 5: SHA frames its innovation activity. This reflects a comprehensive offer to the health »» Maternity and Newborn economy and supports all aspects of innovation from developing awareness and skills to »» Planned Care embedding change in practice. »» Long Term Conditions »» Acute Care »» End of Life Care Evaluation and two are enabling programmes: All innovation projects supported by the SHA are subject to three monthly reporting »» System Reform and an evaluation of delivery from both a productivity and quality point of view and an »» Information Management & Technology. assessment of financial impact. When projects close a final report is produced.

NHS South Central 5 Annual Innovation Report 2010/11 The SHA duty and how this is exercised »» The SHA has worked with the NHS Institute on the development of the Return Supporting our Trusts in Discovery, Development on Investment tool and delivered a joint seminar on return on investment at the and Delivery will: National Innovation Expo event in March 2011 »» The two Health Innovation and Education Clusters »» Enable individuals and organisations to learn from each other, avoid ‘reinventing the »» The SHAs nationally where this SHA has taken a lead coordination role on behalf of wheel’ and ‘silo working’, assisting in developing an innovation and improvement all with respect to the National Innovation Expo. culture as part of day to day working »» Grow the capability of staff and organisations to respond positively to the stimuli for The future will see further partnerships with industry and the third and private sectors. 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 As CEO of an established small enterprise, the »» Maximise return on investment and uptake of desirable change, ensuring that SHA NHS appeared impenetrable. However, NHS priorities are supported by enabling strategies »» Minimise the delay between creation / identification of an improvement and its South Central’s innovation challenge process has widespread adoption. been fast, straightforward with direct access to The SHA has been proactive in developing the innovation and improvement culture key decision makers. and in supporting invention, adoption and diffusion by forming partnerships and collaborations with several organisations within and outside of NHS South Central: Our innovation has received outstanding »» NHS Innovations South East (our ‘HUB’) »» South East Health Technology Alliance (SEHTA) technical and business support throughout »» National Technology Adoption Centre (NTAC) with a particular focus on the development. Nearing commercial release our innovation Technology Adoption Procurement Programme (iTAPP) »» Technology Strategy Board (TSB) with a particular focus on the SHA’s Innovation goals are to deliver NHS investment return and Challenge continued partnership. »» The Young Foundation has supported application evaluation, project support as well as education and networking events

NHS South Central 6 Annual Innovation Report 2010/11 Regional Innovation Fund 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 technologies 3. The SHA Innovation Challenge Linkage to Clinical Programmes Recipients of funding

In all 17 projects were supported over the year. The spread of projects across the clinical The recipients fall into 6 broad groups: 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 »» SHA - direct to clinical programmes with 35% of all projects impacting on planned care. »» PCTs »» Industry - as a consequence of the innovation challenge »» Cross organisational - including community based projects »» Acute Trusts End of Life Care 1 »» The HIECs 1 Maternity & Newborn 1 SHA 6 Mental Health 1 2 PCT 4 Staying Healthy 2 Industry 3 Acute Care Cross organisational / Partnership Long Term Conditions 2 4 Acute Trusts Planned Care 4 HIEC 3

NHS South Central 7 Annual Innovation Report 2010/11 Share of funding by value Focus of innovation Type of innovation

A breakdown of the fund by value demonstrates that the Technology vs. Practice Innovation includes: main beneficiary of funding were acute trusts. This was largely a consequence of the iTAPP programme being The split between a service and a technology focused »» Invention - the creation of new ideas, technologies secondary care focused. Industry partners also benefited change has been well balanced, although in reality there and products significantly from challenge funding. is a significant cross over between the two. Many practice »» Adoption - bringing new ideas to the NHS based innovations are catalysed by technology and »» Diffusion - spreading good practice and proven ideas £56,700 technology change leads to new practice. £75,981

1 1 £348,000 £195,000 2

4 7

£271,500 4 £344,717 10

5

Community care organisation

SHA programmes Other (exploratory projects) Exploratory HIEC Balance of service and technology Adoption PCTs Technology Invention Industry partners Service change Diffusion Acute Trusts

NHS South Central 8 Annual Innovation Report 2010/11 Regional Innovation Fund Estimated return on investment

Estimating 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. £ spent

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). Financial return on investment Quality Gain 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 Added Value 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 £ saved 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.

NHS South Central 9 Annual Innovation Report 2010/11 Innovation projects 2010/11

This section of the report summarises the 17 projects supported this year by the regional innovation fund

NHS South Central 10 Annual Innovation Report 2010/11 Project title Delivering a 111 pilot scheme in South East Hampshire & Portsmouth Project Programme »» Reduced ambulance conveyance Acute Care »» Expected outcomes for patients - right care at the right time, greater confidence in local health Grant given services, improved self management £50,000. Anticipated savings - Circa £3M within 1 »» Expected outcomes for staff- increased productivity/ year of completion of pilot. improved use and development of skills and capacity/improved job satisfaction/improved working What was the problem relationships between providers The 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 solution Scoping 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

NHS South Central 11 Annual Innovation Report 2010/11 Project title Improved access to maternity services early in pregnancy Project Programme Included is a booking webform within NHS Choices Maternity and Newborn that women can populate to request a booking from a specific trust. This will be held securely within Grant Given NHS Choices until accessed by the chosen Maternity £30,400 provider. We will publicise this service to inform pregnant women to look for information and book What was the problem? maternity care as early as possible. Currently 5 PCT’s within the South Central Region Benefits (delivered or expected) are failing to meet the National target to fully book 90% of Pregnant women before 12 weeks, 6 days »» A more positive experience of booking Maternity of pregnancy. There is also a requirement to increase services with increased Pregnancy information the information available to women looking for available to them maternity care and allow more choice of where they »» As they will not need to go to their GP to be wish to have that care. Liberating the NHS specifically referred for Maternity care it will free GP’s from this mentions Maternity services “We will extend choice initial consultation and form filling in maternity through new maternity networks“. This »» It will facilitate choice by providing information to means offering pregnant women a range of services compare services and choice around where and whom delivers their »» It will facilitate early access to ensure prompt referral care. to appropriate services »» Trusts may be better able to meet their target as What was needed? they will have the booking request earlier than via A simple way for pregnant women and others to gain the GP route information about services available and the means »» Efficient for provider allowing them to prioritise for prospective mothers to book with a service of women in greatest need to GP. 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.

NHS South Central 12 Annual Innovation Report 2010/11 Project title Isle of Wight Urgent Care Hub

Project Programme call centre that will promote interdisciplinary working Acute Care and provide a single point of contact for patients via two telephone numbers, 999 and 111. The Grant Given hub will support remote monitoring (telemedicine / £32,500 telecare) that will aid admission avoidance and early discharge from the acute setting and through the use What was the problem? of the Directory of Services will coordinate the most The funding will support the full integration of 111 effective use of resources. with NHS Pathways, the Directory of Services and Benefits the wider aim of the Urgent Care Hub in providing a seamless integrated service. Objectives of the Urgent Care Hub: »» Provide a single point of access for patients/clients What was needed? for health and social care via 111 / 999 with warm »» The development of generic call takers in the use of transfer in either direction NHS Pathways »» Direct patients to the most appropriate health and / »» Training for use of new technologies or social care professional and / or Voluntary sector »» Resourcing the development of the Directory of organisation when they make first contact with Services health services or following a change in condition »» Local marketing. whilst already in the health or social care system »» Deliver a seamless experience to the patient by What was the Solution? enabling professionals to interact and decide on the In partnership with the Local Authority, the PCT most appropriate care pathway for a patient is developing an Integrated Urgent Care hub to »» Provide a ‘command and control’ capability with manage and coordinate Emergency, Urgent and a single, ‘real time’ view of all health related Unscheduled care that can provide care closer to the resources that will enable the efficient and effective patient’s home and avoid inappropriate admissions. management of both business as usual and periods It will deliver high quality patient and client care of crisis and ensure more efficient use of all organisations’ »» Provide a shared care record and coordinated resources. This is a whole system approach that in complex case management for professionals. 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

NHS South Central 13 Annual Innovation Report 2010/11 Project title Enhanced Recovery Acceleration Project (ERAP) Project Programme Benefits (delivered or expected) Planned care The aim is to promote a ‘continuous improvement approach’ to the delivery of an ER pathway. Grant Given The outcomes sought from this work include: £30,000 (March 2011) Wessex HIEC is delivering this project »» Improved clinical outcomes »» Improved patient experience What was the problem? »» Less impact on patient health The South Central SHA programme on enhanced »» Patients recover quicker(from surgery) recovery is well developed and progressing, however »» Patient fitter sooner (normal activities) the speed of cultural change and the adoption of ER »» Improved staff experience as business as usual is slow. »» Length of stay reduced »» Ward bed days saved What was needed? »» ITU bed days saved To ensure a sustainable future for ER there is a need »» Reduced waiting times to accelerate and reinvigorate the transformation »» More patients treated (with less resource) programme, especially for those early adopters who »» Money saved. 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.

NHS South Central 14 Annual Innovation Report 2010/11 Project title Introduction of human papilloma virus screening for women with low grade Project Programme What was the Solution? Acute Care Introduction of human papilloma virus screening for cytological abnormalities women with low grade cytological abnormalities to Grant Given meet new cancer screening recommendations. Using £32,700 (Saving of £200+ per avoided unnecessary HPV testing for triage it will be possible to identify screening) which specimens require further investigation based on the presence or absence of High Risk HPV type. What was the problem? If the HPV test result is High Risk HPV negative then The relationship between HPV and cervical cancer the woman will be returned to routine recall (3 or has been long established and HPV is found in almost 5 yearly depending on age). If HPV test is High Risk 100% of cervical cancer cases. There are over 130 HPV positive then the woman will be referred to different sub-types of HPV and these are categorised colposcopy for further investigation. into high-risk and low-risk types. The National Health Service cervical smear programme (NHSCSP) Benefits (delivered or expected) conducted an HPV testing pilot scheme which »» Introduction of HPV testing in Winchester & completed in 2006 to investigate how HPV testing Eastleigh NHS Trust cytology department to benefit could be incorporated into the cervical screening 325,000 women eligible for cervical screening programme. Currently if a woman has a low grade test from Hampshire PCT. Approximately 10% of cytology result she would be required to either: women (those with low grade abnormalities) will 1) Attend colposcopy if she has previous abnormal benefit from this test test history »» Provide opportunity of HPV testing facility for other 2) Have regular repeat smears tests over a 2 year hospitals period before being placed back on routine recall »» Reduce the number of inappropriate cervical screening tests What was needed? »» Improve the patient pathway by only referring high The pilot concluded that HPV testing should be risk Women to colposcopy used for the triage of women with low grade »» Reduce expensive regular cytology surveillance for cervical abnormalities resulting in more appropriate women that have been successfully treated for high management and treatment. grade cervical abnormalities (CIN2/3).

NHS South Central 15 Annual Innovation Report 2010/11 Project title Home care integrated pathway

Project Programme »» 24/7 365 day clinical support Planned care »» Utilisation of technology to provide the patients’ clinical records and Advance Care plans to members Grant Given of the multi-disciplinary team £65,000 (Feb 2011) »» Improving the care pathways in: Thames Valley HIEC is leading this project »» End of Life »» Medicines Management What was the problem? »» Admissions Avoidance Care can be fragmented across pathways especially »» Dementia Care where the pathway spans public and private sectors. »» chronic disease management This can lead to inefficient care delivery. »» Developing a clinical governance process within the care home environment What was needed? »» A training programme for clinicians in elderly and A truly integrated pathway and approach to care end of life care, a training programme for care that puts the patient at the centre of care and home staff incorporates their wishes. »» Creating a nationally recognised role for Clinicians specialising in supporting care homes. 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)

NHS South Central 16 Annual Innovation Report 2010/11 Project title Point of care testing at Lymington Hospital Project Programme Benefits (delivered or expected) Planned Care »» Improved care »» Reduced delays in treatment Grant Given »» Short lengths of stay £24,000 »» Improved patient safety. 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.

NHS South Central 17 Annual Innovation Report 2010/11 Project title Heart Failure Telehealth

Project Programme and intervene as required in order to stabilise the condition. It has been found in studies that Long Term Conditions patients who are monitored in this way increase Grant Given their confidence in coping with and managing their condition. £65,000 (recurrent saving estimated @ £200,000+ per annum - £70,000 delivered in first 5 months) Benefits (delivered or expected) What was the problem? »» Improved self care knowledge for patient and carer This project utilises technology to effectively increase leading to a more self sufficient patient and carer the capacity of the Heart Failure Nursing Team, »» Reduced anxiety for both patient and carer in allowing them to deliver high quality care at home knowing that they have the skills and knowledge to to more patients, increasing productivity in the Team self manage the condition plus professional support and reducing both inpatient and outpatient activity in monitoring and ready to respond if the need arises the Acute Sector. »» Improved quality of life »» Increased independence with the ability to self What was needed? manage without a carer if one is able to do so A way to monitor patients remotely so that team »» Reduces the need for face-to-face consultations resources could be directed to those patients who »» Supports early discharge by increasing team capacity most need it. - reduced length of stay »» Reduced re-admittance rates What was the Solution? »» Reduced emergency admissions, shown to be The technology interacts with the patient (and or approx 36 admissions from Jan-Jul 2010 their carer) through audio and visual prompts and can »» Increased operational effectiveness of primary and collect a range of both vital signs data and subjective community care staff as they will only be attending information relating to their condition. The monitors the patients with most need have the ability to deliver self-care information, trend »» Capacity to increase the number of patients per case analysis and patient reminders allowing the Heart manager that can be effectively and proactively case Failure Team to monitor and manage the patient’s managed care remotely. »» Reduced travelling time and costs for Heart Failure Nursing Team as they will no longer have to attend This will be used for patients who require more patients in a rural setting so frequently care at home and will allow nurses to monitor

NHS South Central 18 Annual Innovation Report 2010/11 Project title Evaluating the application of psychological interventions on patients with long term Project Programme particular Primary Care Consortia, to understand Long Term Conditions / Mental Health what is required to enhance care quality, and conditions and co-morbid reduce healthcare costs for patient populations anxiety and depression Grant Given who experience co-morbid anxiety and depression £50,000 combined with a physical Long Term Condition (LTC). Thames Valley HIEC is delivering this project Benefits (delivered or expected) What was the problem? »» To provide a robust evidence base for commissioners It is widely accepted that including psychological for investing in access to psychological therapies interventions in the care for those experiencing a for patients with a LTC and co-morbid anxiety and long term physical health condition will add value depression to the patient’s experience. It is also widely believed »» To provide credible information on productivity, that added value will improve patient outcomes for cost-avoidance, return on investment and those with co morbid depression and/or anxiety, and implementation costs that improved outcomes will lead to an ‘upstream’ »» To describe a number of innovative approaches and reduction of costs across the health care system. demonstrate their benefits Whilst these beliefs are widely held there is much »» To test a number of economic impact tools including concern that the economic case for such inclusion has the SHA modelling tool for “Psychologically yet to be sufficiently demonstrated. Some evidence Impacted Illnesses” has been produced out with NHSSC but this has »» To describe and evaluate the application of new yet to be fully understood and replicated within the workforce roles to changing service models region. »» To evaluate critically a range of appropriate patient outcome measures What was needed? »» To deliver a toolkit of approaches which work and An evaluation of the potential impact of psychological disseminate their benefits across South Central support for this group of patients region »» To inform the developing national evidence base for What was the Solution? the benefits of psychological therapies for patients This project will identify critical factors associated with a LTC and co-morbid anxiety and depression. 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

NHS South Central 19 Annual Innovation Report 2010/11 Project title Alcohol misuse screening Research Collaborative supports this approach. Project Programme Alcohol misuse reduction is a key aim, for example, of Acute Care the Southampton City PCT QIPP programme. Grant Given What was the Solution? £50,000 The use of screening and brief interventions in Wessex HIEC is delivering this project approaches to alcohol misuse has been proven to be effective. What was the problem? NICE has recently published an integrated set The key aim of this proposal is to develop and deliver of guidance related to the treatment of alcohol a simple alcohol misuse screening, identification and misuse. Key to this is the recognition that misusing response programme to reduce levels of dangerous alcohol is widespread in UK society and is, at the alcohol consumption and related co-morbidity. very least leading to exacerbations of other physical Reducing the level of dangerous alcohol consumption and mental health conditions. In many cases it is will have direct effects on health as well as reducing the direct cause of specific conditions such as liver the effect of other clinical conditions. This will, in disease, hypertension, depression and other mental turn, reduce medical needs and costs to the health illness, traumatic brain injury as well as the impact on service where alcohol misuse is a key contributor to affected families and child health. ill-health. What was needed? Benefits (delivered or expected) Recent work has shown that ‘brief intervention’ therapies managed by any clinical practitioner can »» Reduce the impact of alcohol misuse on use of NHS be instrumental in enabling people to address an services underlying alcohol problem. There is a growing »» Improve the overall health of the individuals interest in this approach. This can take place across concerned the range of health settings, for example work in »» Demonstrate financial case for investing in acute hospital settings in Basingstoke, Southampton integrated systems to reduce alcohol misuse across and Portsmouth is making a demonstrable impact. NHS agencies A recent local workshop for GP’s was oversubscribed »» Build on existing pilots and develop comprehensive and there is evidence that those who attended approach for screening and brief intervention changed their practice to address underlying alcohol therapies through NHS staff problems in their patients. The Wessex Alcohol »» Evaluate initial roll out phase, identify the case for further extension if appropriate.

NHS South Central 20 Annual Innovation Report 2010/11 Project title Medicines Patient Helpline

Project Programme Acute Care 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.

NHS South Central 21 Annual Innovation Report 2010/11 Project title Clinical Leadership for Dementia

Project Programme What was the Solution? Mental Health Dementia care crosses primary care, acute trusts, mental health trusts and social care boundaries. Grant Given Consequently the leadership to deliver such a £50,000 complex and cross-organisational area is critical to its success. To this end, a whole systems partnership What was the problem? is being set up with the intention to offer new Dementia presents a huge challenge to society, possibilities for the investment of dementia monies both now and increasingly in the future. There are and to ensure best value for money. We are also currently 700,000 people in the UK with dementia supporting training for GPs which will enhance their and the illness costs the UK economy £17 billion each abilities to deliver services for people with dementia year which will increase to over £50 billion in the across the full spectrum of health and social care next 30 years. This level of cost is unsustainable. The systems. Dementia strategy and other local dementia initiatives are seeking whole systems solutions to address this Benefits (delivered or expected) spending gap. »» agreed end to end, whole-system, patient centred integrated south central dementia pathway What was needed? »» reduce diagnosis gap Improving the quality of dementia care in South »» reduce unnecessary hospital admissions Central, is a key plank in the Mental Health »» improved care in acute hospitals clinical improvement programme. This level of »» reduced length of stay in acute hospitals transformational change requires a mind shift in the »» cost savings as a result of the above - 0.8 day saving clinical leadership community and the empowerment per admission equates to £50m per annum. 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.

NHS South Central 22 Annual Innovation Report 2010/11 Project title Roll out of the DNACPR strategy

Project Programme End of Life Care What was the Solution? »» A common DNACPR (Do Not Attempt Cardio Grant Given Pulmonary Resuscitation) Policy across NHS South £57,400 (Estimated recurrent savings - up to £635k Central was negotiated with wide stakeholder per annum being delivered) engagement »» Common documentation for capturing decisions What was the problem? has been created Senior staff in the End of Life Care Clinical »» Shared education regarding end of life Programme recognised that policies with respect to care decision making and the policy and managing end of life care decisions were not uniform documentation to be used. across organisations within NHS South Central, were not always applied and that decisions made did not Benefits (delivered or expected) Unified alway follow the patient as they moved between care »» More patients having their wished respected and Do Not Attempt provisions. This was resulting in patients’ wishes not dying in their place of choice Cardiopulmonary Resuscitation always being properly understood and not always »» Fewer unnecessary and unwanted interventions (DNACPR) being reflected in care given. As a consequence care at end of life quality was compromised and unnecessary costs were »» Fewer patients being moved between care Adult Policy being incurred. settings at the end of their life »» This supports Domain 4 of the NHS Outcomes What was needed? Framework: Ensuring that people have a positive What was needed was a common policy across all experience of care’. 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. www.southcentral.nhs.uk

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NHS South Central 23 Annual Innovation Report 2010/11 Project title Message dynamics - interactive voice response for people with COPD Project Programme The cost per patient contact is low (50p per week), Long Term Conditions the system can manage large numbers of patients and is very flexible - for example ‘flu jab’ reminders Grant Given can easily be added in for a period of time. £48,000 (Savings £1,850 per avoided admission) The IVR service will help staff identify ‘at risk’ patients Challenge project summary and enable them to focus their efforts on those with IVR uses the most ubiquitous of technologies, the the greatest need thereby allowing early intervention telephone to monitor the wellbeing of people over and avoiding exacerbations. time. It is both convenient and acceptable for patients Benefits (delivered or expected) and easy to implement. Upon discharge patients are asked to consent to receiving IVR calls. These calls are »» Improved patient experience made by a computer at a time and frequency that the »» Better quality of life patient finds acceptable – usually a couple of times a »» Reduce secondary care admissions and visits week. »» Reduce primary care visits »» Total savings made will be dependent upon Patients can specify any days (for example weekends) uptake and admissions saved. 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 1 2. worse than usual? > Press 2 3. 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.

NHS South Central 24 Annual Innovation Report 2010/11 Project title Solcom - Cloud based remote integration of patient home diagnostics Project Programme »» Bespoke (individual patient tailored solution) Long Term Conditions telehealth remote monitoring and knowledge bases system for less than £5 per patient per week Grant Given including equipment £198,000 (recurrent savings estimated at £2,500 per »» Full integration with telecare. patient per annum) Challenge project summary This 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

NHS South Central 25 Annual Innovation Report 2010/11 Project title Bladder Scanners - part of the national Innovation Technology Project Programme Adoption Procurement Planned Care Programme (iTAPP) 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.

NHS South Central 26 Annual Innovation Report 2010/11 Project title Intraoperative goal directed fluid management - part of the national Innovation Technology Project Programme In patients undergoing some Adoption Procurement Planned Care forms of orthopaedic and Grant Given abdominal surgery, intra-operative Programme (iTAPP) treatment with intravenous fluid £200,000 across NHS South Central to support adoption (Estimated recurrent savings - £4.5m to be to achieve an optimal value of delivered in 2011/12) stroke volume should be used where possible as this may reduce What was the problem? postoperative complication rates Up take of goal directed intraoperative fluid and duration of hospital stay management was patchy across NHS South Central despite some good evidence of positive impact on speed of recovery for patients undergoing major ‘Although currently logistically surgery. difficult in many centres, What was needed? preoperative or operative hypovolaemia should be Local evidence of efficacy diagnosed by flow-based What was the Solution? measurements wherever possible. 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 - British Consensus Guidelines on Intravenous the basis of robust local evidence. NHS South Central Fluid Therapy for Adult Surgical Patients 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.

NHS South Central 27 Annual Innovation Report 2010/11 Project title Inhaler technique improvement programme Project Programme »» Staff to be supported with training and on line Long term conditions resources for them and their patients »» Free supply of twotone or aerochamber devices to Grant Given patients so they can maintain a good technique. £124,000 across NHS South Central (Estimated Benefits (delivered or expected) recurrent savings - £9m to be delivered in 2011/12) Wessex HIEC is supporting this project »» Improved quality of life for patients whose condition is better managed What was the problem? »» Reduced admissions Poor inhaler technique is very common amongst »» Reduction in prescribing of reliever inhalers patients who use inhalers to manage their chest »» Estimated £12 saved for every £1 invested in the condition. This greatly reduces the effectiveness of programme inhalers. Many patients are taught a poor technique »» This supports Domain 2 of the NHS Outcomes when they first start to use inhalers. The main reason framework - Enhancing quality of life for people for a sub-optimal technique is inhaling too fast. with long-term condition. 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

NHS South Central 28 Annual Innovation Report 2010/11 Other Innovation Activity

NHS South Central 29 Annual Innovation Report 2010/11 Regional Enabling Group The Regional Enabling Group (REG) is led by a sub-set of Chief Executives from Trusts There are four projects underway to help achieve this: 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. 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.

NHS South Central 30 Annual Innovation Report 2010/11 Workforce Innovation 2010/11 The Innovation and Development Team is responsible for the development of innovative EAssessment in Higher Education - project), interesting cases, useful books & links, a training roles and CPD for medical and healthcare practitioners. Workforce innovation news page, details on the journal clubs in the region, a directory of consultants and remains a strong focus for the SHA and partners. Some examples of activity in this field trainees, and a short history of Orthopaedics in Wessex. Trainees can also upload short are given below. sound bites and video clips of relevant material.

Hospital at Night Project – Portsmouth Hospitals General Practice Fellowships

One of our Acute Medicine trainees took a year Out of Programme to work full time In the Wessex GP School, six GP Fellowship pilot posts have been set up of which 4 on the Portsmouth Hospitals ‘Hospital at Night’ project. The project, jointly funded by culminated in October 2010. The Fellows have undertaken a wide range of projects Wessex Deanery, South Central SHA and Portsmouth Hospitals, reviewed the current looking at unscheduled care and the benefits of spending additional time in general arrangements for out of hours staffing, redesigned and then implemented a Hospital at practice early in GP training. There have been significant and varied achievements Night programme. from those working within the scheme including presentations at the Ottawa Medical Education Conference May 2010, Miami and AMEE Medical Education Conference This involved revising junior grade rotas, establishing new senior nurse and medical September 2010, Glasgow, publications submitted to Education for Primary Care, two technician posts, and setting up a management structure for Hospital at Night. posters presented at RCGP Conference, November 2010 and a publication accepted by Formalisation of handover arrangements was also involved, as was a general raising of the Primary Care Foundation. the profile of handover issues and establishment of a monitoring system. To quote one recent graduate from the scheme: Extranets The Fellowship has been a unique and eye-opening experience. I have been Trainees have been instrumental in developing the Wessex Deanery’s extranet sites, exposed to the other side of the NHS – found out how the NHS is run; the health starting with a single site for Trauma & Orthopaedics in 2009. It was established as a economy, the politics around health care, commissioning services, budgets, project by one of the T&O trainees and has now grown to 36 extranets each with its contracts etc. own trainee lead. Bullying and Harassment video training tools in Obstetrics and Gynaecology 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 In 2009 the annual trainee survey revealed that a significant number of trainees in Extranet are those giving details about the regional training days in the events diary obstetrics and gynaecology have felt undermined at some point in their training. This but other pages include a forum and interactive document library. There is educational prompted the production of a series of educational videos in conjunction with the RCOG material in the form of presentations, abstracts & reading lists, exam advice & example underpinned by research from the northern deanery and feedback on experience via the questions (including links to questions housed at Southampton University’s EASiHE - college website from both trainees and trainers.

NHS South Central 31 Annual Innovation Report 2010/11 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.

NHS South Central 32 Annual Innovation Report 2010/11 Workforce Innovation 2010/11 Their knowledge is objectively assessed by an exit multiple-choice questionnaire and each »» The agreement and support of strategic priorities and broad work programmes, in doctor is appraised at the end of their attachment with the opportunity for dialogue and line with local QIPP plans, for each: feedback. This programme is highly regarded for its educational value by foundation »» Thames Valley: doctors. Confidence scoring for individual doctors in terms of skills and application of »» Integrated Services; Patient Safety; Care Closer to Home; Capacity and knowledge shows significant improvement. These attributes help to equip the junior Capability Development in Practice doctor for the challenges of managing acutely-ill patients elsewhere during their training. »» Wessex: It is one of the reasons that doctors cite for choosing Portsmouth for their foundation »» Knowledge Programme (supporting the dissemination of local initiatives training. The programme has also been highly commended by the Society for Education and innovations); Community Solutions (with a focus on Community based in Anaesthesia (UK) (2008/9) and has also gained several “green triangles” as evidence Stroke Care and End of Life Care); Telemedicine Programme (supporting of good practice in the most recent GMC trainees survey. the use of internet-based solutions) »» Stakeholder engagement Health Innovation Education Clusters (HIECs) »» Support of and to the Regional Innovation Fund

Thames Valley HIEC Knowledge Team and Wessex HIEC aim to promote innovation in Preceptorship 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 The aim of the Preceptorship framework is to consolidate knowledge and skills gained training for health and social care workers in all healthcare settings. HIECs also aim to by newly qualified practitioners, allowing them to develop competence and confidence facilitate speedier adoption of innovations in care and treatment, including new service in the workplace. The framework has agreed outcomes which highlight high quality models, use of technology and medicine and devices to NHS patients. practice, establishing best practice for continuing professional development. NHS South Central is supporting trusts to implement and develop their own Preceptorship Examples of specific achievements this first year are: programmes.

»» The agreement and signing of a Memorandum of Understanding or Memorandum Public Health Practitioner Development of Agreement between the SHA and the host for each HIEC (the University of Southampton for Wessex, and the Oxford and Buckinghamshire Mental Health We provide a focus for education, training and development for those who want to Foundation Trust, now Oxford Health NHS FT, for Thames Valley) develop their knowledge and skills in public health and wellbeing and reduce health »» Establishment and recruitment of a small core Management team for each inequalities. In particular, we work together to co-ordinate and develop training for the »» Establishment of Governance system between each Partnership Board and the SHA Wider Workforce, Practitioners and Specialists.

NHS South Central 33 Annual Innovation Report 2010/11 Workforce Innovation 2010/11 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

NHS South Central 34 Annual Innovation Report 2010/11 Workforce Innovation 2010/11 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.

NHS South Central 35 Annual Innovation Report 2010/11 Other Innovation Activity 3. Medication Errors Simulation Strategy 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. NHS 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 4. A multidisciplinary approach to improving Handover of our plans and the focus is on embedding simulation training in NHS organisations Use simulation to improve clinical handover in healthcare professionals that will while improving patient safety. enable an efficient and patient-focused service to be delivered. To achieve these objectives we identified the top serious untoward incidents in the 5. Recognition and Intervention into the rapidly deteriorating patient region and recruited seven highly qualified clinicians to focus on developing clinical A culture of timely recognition and treatment of the deteriorating hospital patient in simulation education packages to address these safety concerns. In addition, we shall our hospital, which will keep our patients safe on our wards. 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 6. CTG interpretation and the management of safer childbirth from Trusts across South Central and the education packages they develop will be used Making childbirth safer. Using clinical simulation to enhance prompt, consistent and across the region and indeed the wider NHS. reliable response to foetal distress in labour. The Packages: Research and development 1. A cost benefit analysis: How to improve patient safety and quality of care while reducing costs Research and evaluation are integral elements in the delivery of quality and productivity. 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. 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: 2. To reduce the incident of hospital acquired complications from VTE »» Cancer This project is to raise the profile and ownership of venous thromboembolism »» Children / paediatrics (VTE) risk assessment to improve patient outcome. There will be reduced risk to »» Genetics patients with optimal treatment being provided. The result will be a proactive »» Infectious diseases multidisciplinary approach to VTE for patients. »» Mental health »» Diabetes »» Reproductive health.

NHS South Central 36 Annual Innovation Report 2010/11 The National Innovation Expo 2011 The Innovation Expo took place in March 2011 with thousands of people in attendance. Joint Seminar 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 The SHA Seminar delivered jointly with the NHS institute for Innovation and Improvement NHS Institute for Improvement and Innovation, posters and partner presentations in the took the form of a workshop focusing on ‘Return on investment’. It was well received Regional Innovation Fund (RIF) zone and the SHA’s own stand in the SHA Zone. 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.

NHS South Central 37 Annual Innovation Report 2010/11 The National Innovation Expo 2011 The 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.

NHS South Central 38 Annual Innovation Report 2010/11 Peer Support in Mental Health (EM) Light Assessment Traffic / Paient Passport (EM) Time to Take Make Time (EM) Neighbourhood (SW) Health Watch Allergy Referral (SW) Process Patient Minder (SW) Sores for Pressure

Fun with Food for Families of Children with Learning Disability (NW)

Pre-referral Clinics for Children’s Drink Down (EM) Speech & Language (NW) Raising Awareness of Sexual Assault Referral Centres (NW) Clinical Pathway for End of Life Care - Alcohol Dependent Hospital-Based Lifestyle Service Advanced Kidney Disease (NW) Improving Choice for Offenders (EM) for Smoking, Alcohol and Obesity (NW) Terminally Ill Patients (SEC) Psychological Treatment GR8 Wellbeing (NW) Quality Care for EOL Modification for Dementia Patients (NW) Addressing Dementia in Acute Settings (WM) Addressing ASSIGnw Ankylosing Spondylitis (NW) Programme Exercise Community Networks for Health, (NW) Quality & Productivity Online Learning: Dual Diagnosis (NW) Nurse Practitioner Led Abdominal Paracentesis Service (NW) Home Intravenous Therapy (EM) Antimicrobial Flourishing People, Connected Communities (NW) Experience the Care ICEPT – Improving (NW) Post-Transplantation across Enhanced Recovery Programme the Surgical Division (NW) IInteractive Health Services using TV & Mobile Phone (NW) for Patients with Quality of Care Cancer (NW) Breast (NW) Meeting the Needs of Neck Breathers (NW) HMP Risley Adult ADHD Project Wirral Drug Service Adult ADHD Pilot (NW) Human Rights in Learning Disabilities Service (NW) (NW) Urgent Care Children’s Pulmonary Embolism Clinic (EM) Ambulatory Care Integrated Community Rehabilitation Service (EM) Bulimia Nervosa (EM) Nurse-led Community Hep-C Service (EM) SIMPLE Approach to Asthma Management (EM) SIMPLE Approach Campaign (EM) Awareness Leicester Stroke Primary / Secondary Falls (EM) Management Proforma Getting Sorted Diabetes (Y&H) Achieving a Good Death Improving Inpatient Oral Hydration (SC) in Warrington (NW) Physiotherapy for Monitoring Diabetes with HALO for Dysplastic Barrett’s Oesophagus (SW) Dignity Bidet Commode (Y&H) Rehab for Stroke Survivors (Y&H) Mental Health Anti-Stigma Campaign (SC) Strength & Balance Classes for Unified DNACPR Strategy (SC) Physical Difficulties (Y&H) Falls Prevention (NW) TeleHealth Solution (NW)

Pulpit – Patient Transfer Wheelchair to Toilet (SW) Pharmacy Innovation to fMRI for Patients with Brain Tumour (NW) Unique Care for people Bridge Project – Adolescent Mental Health (WM) Improve Health & Well-being (NW) with multiple health needs (Y&H) e-vent: Supporting Patient Decision Aid Children and Young People’s On-Line QA Diagnostic Radiology Services (NW) Complex Hospital Discharge (London) – Advanced Kidney Disease (EoE) Disability Partnership (NW) Buddy Recovery in Mental Health (LONDON) Dementia & EOL: Home Newborn Hearing Assessment (SC) Nurse Led Telephone Monoclonal Spreading Best Practice Anticipatory Care Learning Patientrack (NW) (NW) Disabilities & Dementia Patients (NW) Gammopathy Clinic (SW) Altogether Better Diabetes (Y&H)

Choices for Individuals The Green Dreams Project (NW) PROMS 2.0 (NW) Redesigning the Ambulance (London) Alcohol Screening Pathway (NW) Preventative Nanopool Liquid Glass (NW) Leaflets (NW) Talking Our School is WOW! (NW) VitalPAC (SC) VitalPAC Improvements to Care to Care Improvements Planning (NE) Limbs Alive – Independence (NE) After Stroke E-diabetes for People (Y&H) Young Patient Relationship Management (LONDON) for LTC at End of Life (NW) E-consultation in Chronic Kidney Disease (Y&H) GPs Implementing Guidelines (SW) Diabetic Getting Sorted Enhanced Recovcery ‘Pen Station’ (SW) Asthma (Y&H) after Major Surgery (London) Migrant Worker Nurse Led Dementia Service (SC) Testing and Integrated Do Not Attempt Health Access (LONDON) Diagnostic System (London) Teenager Digital Intervention and Therapy (WM) Heart Diagnostic Information for Patients (SW) Supporting People CPR (Y&H) Streatham Young Student Advocates Data (NE) Clinical Leadership for Dementia (SC) – Transforming with Cancer (SW) Person's Centre (LONDON) Dignity Workers (NE) Coaching (EoE) HIEC Long Homeless Health Peer Patient Experience (London) (EoE) Syndrome Insomnia and Pain CBT (SC) for LTC Care (NE) Care for LTC

Chronic Pelvic Pain Chronic Term Conditions (Y&H) Advocates (LONDON) SINAP + Live Stroke Telehealth Monitoring in

Primary Care Health Primary Care ThinkGlucose Initiative (EM)

Dark Field Imaging of Intestinal Mucosal (SW) Stimulate the Market Personal Rectocele 15-25 – Mentally Heart Failure Patients (NW) Management (SW) HIEC Patient Safety (Y&H) Tele-Health Disordered Youth (NE)

Falls Response Vehicle (EoE) Falls Response Vehicle Ethnic minority’ Cystic Fibrosis DNA Programme (Y&H) HIEC Maternal and Empowering Patients via Self-Care Plans (EM) A Good Screening Panel (NW) Opportunistic Targeted Mental Infant Health (Y&H) Death (NE) Health in Schools (NW) Wellbeing Training (SW) Smoking Related Age Device Evaluation Network (WM) Spiritual Needs of Global Mental Health Teledermatology (SC) Progression Techniques (WM) Reducing Burden of Dementia (SEC) Cut Carbon – the Dying (NE) Perinatal Mental Health Care (SW) (WM) WithoutCare Walls (NE) Bridge – New Model of Primary Care Slater’s Assessment Tool (NW)

Improving Emergency Abdominal Surgery for Elderly (SW) Multidisciplinary Revascularisation Training (EM) Programme Surviving Sepsis (NE) Airedale Telemedicine (Y&H) Centre Cut Costs (EM) Post Discharge Medication follow-up (NW) NeuroResponse Maternity Support Workers (NE) (LONDON) Improving Independence in Dementia (SEC) (LONDON) Urgent Care Pain Management in Children (SW) Palliative Care in Prisons (NE) Think Home First (EM) Chrysallis II Online Inhaler Training (SC) Weight Management (EM) Silver Coated Improving Hydration for People with Dementia (SEC) Reducing LOS for Transurethral Surgery (SW) Community IVT Services (NE) Medicines Patient Helpline (SC) Catheters (SC) Community diagnostics of arrhythmias (NE) Rapid Access Telehealth in Long Term Disease Physiotherapy

Diagnostics in Polysystems Identification of Patients at Risk of Acute Kidney Injury (SEC) Conditions (COPD & HF) (SW) Razorfish (SC) Self Referral (SC) Bed Magnetic Cable Management Strap (SW) Containment

Molecular Diagnostics Patient Medicine & Zones (SC) Referral Pathway for

3 Dimensions of Care VERSAJET – Wound Debridement (NE) (NW) of Heart Failure Pathway Planner (NW) Patients with TB (NW) – Thyroid Cancer (NE) Pathway Management for Diabetes (LONDON) Project Redesign of Mental Health Community Services (SEC) 'SPACE' for COPD (EM) 'SPACE' Smoking in Pregnancy (NE) Smoking in Pregnancy Cutting Block for Knee Replacements (SW) Health (NW) Communications Bag (EM)

ISABEL – Clinical Diagnostics Clinic (NW) Blackouts Triage Interactive Doppler Guided Walking Away Web Programme (NE)

Rheumatology Route Map (NW) Therapy Improvement CD-ROM for Intra-operative Domiciliary Commission for Rural Health (NE) from Diabetes Programme (EM) Improving Lifestye in Maternity Services (NW)

Smoking Cessation Fluid Management in Prisons (Y&H) Tele-Medicine Eyecare (NW) Community Health (NW) Champions Programme Local Vision Impairment Support (NW)

(EM) Digipen Community Midwives (SC) Centre for Third Age' in for Third Centre Cockermouth (NW) Cancer and Heart MOT: The Check it out bus (NW) access to Improving for migrants (NW) healthcare Sexual issues for children & young people (NW) (EM) NW) Walking Away from Diabetes (EM) District Nursing, Mobile Working (EM) Better Health Outcomes Improving Safeguarding IGNITE Telehealth Young People Integrated Healthcare Models (WM) for Young Offenders (EM) for Young People (EM) Pliable Drinking Straw (SW) Hub (EM) Diabetes Care Planning and Self-Care (LONDON) Tele-Wound management (Y&H) Paperless Electronic Fractured Neck of Femur (SW) Requesting System (EM) Superbed (WM) Just Checking Tele-care (Y&H)

Telehealth Solutions for (NW) Prevention Admissions (NW)

Campaign (SC) Telehealth in Lancashire (NW) Nursing Homes (LONDON) Improving Atrial Fibrillation Identification of Patient's Value 4 Vision (EM) Value One-Stop Day Surgery (SW) Informed Choices:

Service Delivery (EM) Diagnosis for Stroke cancer (NW) breast prison settings (NW) Specimens in GP Surgery (NW) Falls Detection (WM) Hospital discharge for to Improve Safety (EM) to Improve Targetted and Effective and Effective Targetted Releasing Medical Time Prevention (Y&H)

Preventing Repeat Alcohol Preventing

Innovating Rehabilitation using RF-ID Kanban (WM) Community Team Care Low Cost Teleheath (SC) Low Cost Teleheath Bone Health & Osteoporosis Transoesophageal Echocardiography Diagnostics Mental Health Anti-stigma Nutrition in Cancer Care (SW) Wii Technology (LONDON) Assessment Framework for for Personality Disorder (NW) Simulator (SC) Value 4 Vision (EM) Heart Failure Telehealth (SC) Telehealth Heart Failure Disability & LTCs (NW) 24hr helpline for Oncology (NW) PACE: Supply Chain-Led Improvements to Teledermatolgy Triage (SC) Probation Health Trainer Service (NW) Health Trainer Probation Neuro-Behavioural Rehabilitation

Met Office: Early Warning System (NW) Early Warning Met Office:

Modified Air Mattress (SW) Service Innovations (LONDON) Colonoscopy (NE) Paediatric Care in Primary Care (NW)

COPD Interactive Voice Response (SC) COPD Interactive Voice of People with ARBD (NW) Outcome - Orientated CAMHS (EM) CAMHS Orientated - Outcome Long term conditions

Healthy Eating in Pregnancy (EM) Prevention

Stroke Buddies (WM)

LTC Dragon's Den (WM) End of life care

Farming on Prescription (EoE) (WM) Simple Telehealth E-Clinics in Cardiology (NW) E-Clinics in Cardiology for Voluntary Sector (NW) for Voluntary Virtual Community Ward (SW) Virtual Community Ward Enhanced Recovery Nurse (SC)

Heart Failure Ultrafiltration (SC) Heart Failure Self Care Innovation Network Self Care Self-Health in Stockport (NW) Dried Blood Spot Sampling (EM) Urinary Tract Infection (UTI) (SW) Urinary Tract

Automated Pill Dispenser (WM) Short-stay Hip Replacement (SEC) Treatment Intraoperative Fluid Management (SC) Urgent Care GP Admissions Dataset (EM) Urgent Care Guidance Device for Episiotomiess (SW) Integrated Care for COPD Patients (SW) Integrated Care Best care for Acute Medical Patients (EM) Best care Stroke Champions in Care Homes (NW) Champions in Care Stroke Community Lower Urinary Tract Service (EM) Community Lower Urinary Tract Unscheduled Admission Virtual Ward (WM) Unscheduled Admission Virtual Ward

Transition to Adult Diabetic Services (NW) Transition ePAQ – Online Pelvic Floor Questionnaire (EM) – Online Pelvic Floor Questionnaire ePAQ

Interactions with Young People with CF (NW) Interactions with Young Mental Health Paramedic Pathfinder Triage Support Strategy (NW) Paramedic Pathfinder Triage Psychological Interventions in Eating Disorders (NW) Psychological Interventions in Eating Disorders Normalising Birth – Reducing C-Section Rates (SEC) Enhanced Technology for Speech & Language (NW) Enhanced Technology Telestroke / Delivering 24/7 Stroke Thrombolysis (NW) Thrombolysis / Delivering 24/7 Stroke Telestroke Dementia Diversity Xchange Network (DDXN) (WM) Implementing Individual Placement & Support (WM) 111 - Emergency and Urgent Care Telephone Access (EM) Telephone 111 - Emergency and Urgent Care Telemedicine enabled access to specialist clinicians (SEC) Telemedicine Multidisciplinary Revascularisation Training Programme (EM) Programme Multidisciplinary Revascularisation Training Homes (EoE) Officers (EoE) Officers

Person Centred Person Centred Crossover

Eye Clinic Liaison Dementia in Care

Programme (EoE) Programme Alcohol Care Team (EoE) Team Alcohol Care Bowel Disease Self-Help

Web-Based Inflammatory Web-Based Learning Disabilities (EoE)

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

NHS South Central 39 Annual Innovation Report 2010/11 Looking forward 2011/12 will see the SHA building new partnerships that support innovation and The proposals set out in ‘Liberating the NHS: Developing the Healthcare Workforce’ improvement whilst managing transition to new HNS structures. It will be important to include some significant changes from the existing system of planning and ensure that the knowledge and experienced gained over the last 3 years is not lost and commissioning the education and training of the clinical workforce in particular the that innovation remains at the heart of forging new and improved services. 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 RIF 2011/12 of the workforce functions currently discharged by Strategic Health Authorities and Deaneries. 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 The workforce and leadership portfolio commissioned an options appraisal in February that supports the delivery of the SHA and wider health economy “must do’s” for 2011 with a view to exploring options for the future development of local skills 2011/12. 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 It is proposed that the following are triangulated to determine how best to utilise the culture in which innovation flourishes. 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.

NHS South Central 40 Annual Innovation Report 2010/11 For further information please contact Duncan Goodes [[email protected]]

South Central Strategic Health Authority First Floor, Rivergate House Newbury Business Park London Road Newbury Berkshire RG14 2PZ

Tel: 01635 275500 www.southcentral.nhs.uk

NHS South Central 41 Annual Innovation Report 2010/11