We worked with commissioners, providers and other stakeholders across Stoke-on-Trent and Staffordshire to improve the quality of service for patients and cut costs across planned care.

Background​

Planned care is a top priority for Staffordshire and Stoke-on-Trent Sustainability and Transformation Partnership (STP). The current acute cost is £348million and has been growing by 14 per cent over the last four years, well above the rate of population increase. National standards are not being met and backlogs are increasing. The target is to improve quality and patient experience in addition to delivering savings of £14million by 2020/21.

Action​

• A planned care workstream was set up with clinical and management representatives from commissioner and provider organisations, and other major players​
• National and local data was analysed and ophthalmology and musculoskeletal (MSK) conditions were prioritised as the two highest-spend areas where changes could most easily be made​
• Engagement events were held with a wide range of stakeholders, and guest speakers from NHS England universities and other trusts​ were brought in
• Seven task-and-finish groups were created, focusing on specific ophthalmology and MSK conditions​
• Site visits by the groups were arranged to map current processes and then use improvement techniques – such as the five whys – to determine why activities were not adding value. Action plans were then established.

Impact

• The programme is predicted to save between £1.9m and £4.4m per annum across seven pathways
• Data sharing at a system level has led to a greater understanding of the way planned care has been provided and has led to changes in practice
• Standard service specifications have been introduced
• The referrals process has been improved and the number of referrals has been reduced
• We have noted improved theatre productivity
• Unnecessary scanning and injections have been eliminated
• Commissioning around pain management has been improved
• Follow-ups are now being carried out in the community, closer to patients’ homes.

During our Planned Care project in Staffordshire, it was clear we needed to forge much stronger relationships across a number of organisational boundaries and change cultural thinking. The CSU has been instrumental in helping us put clinical engagement at the centre of our work. Organising, facilitating and designing workshops to gain insight and involvement; the CSU also invited guest clinicians to share learning. This was not an easy process but together we worked hard to share expertise and design pathways to bring real benefits to patients. 

Mark Seaton, Staffordshire and Stoke-on-Trent STP Planned Care Workstream Programme Lead