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Trailblazers in the North West help implement patient-clinician shared decision-making

We have been helping the recovery of elective care activity in the North West region, using innovative techniques to support engagement with NHS trusts for the national programme of clinical validation to prioritise inpatient elective waiting lists.


After the first wave of the COVID-19 pandemic, NHS England and Improvement (NHSEI) instructed NHS trusts in England to carry out a programme of clinical validation for inpatient waiting lists. Trusts were asked to embed the Royal College of Surgeons’ shared decision-making model methodology across all inpatient specialties.

This method actively involves both patients and clinicians in clinical prioritisation. Patients are put at the centre of decision making and are informed of the timeframes, while GPs are also notified of the outcome.

This was a huge task for trusts who had to contact, on average, 6,000 patients within the ambitious timescales set by NHSEI, as well as develop efficient and effective ways to implement, record and report on the outcomes of the clinical reviews.

Photo of Michelle Chappell

Michelle Chappell, Head of MLCSU’s North West Regional Delivery Team


The North East Commissioning Support Unit (NECS) and the Midlands and Lancashire Commissioning Support Unit (MLCSU) worked in collaboration to develop innovative solutions for contacting patients, and train trusts on the e-Review digital solution to record clinical validation outcomes.

Taking the lead, we used a two-way communication medium unique to the North West to engage with the 23 NHS trusts in the region.

A weekly Virtual Network Forum encouraged trusts to share best practice and seek collaborative solutions to their challenges.

  • Encouraging trusts to identify specific topics for discussion and share ideas.
  • Feedback via live interactive Microsoft Forms polls, adding value to meetings and informing the team of areas to focus support.
  • Using an in-meeting chat function inspired peer engagement and confidence among trusts, with discussions continuing after the call.
  • Further follow-on support external to the Virtual Forums for Trusts that requested it.
  • Sessions were open to anyone in the North West system interested in understanding the Clinical Validation Programme.


  • The highly successful work and innovation of MLCSU’s North West Regional Delivery Team, combined with engagement and enthusiasm from NHS trusts, resulted in the North West becoming the quickest progressing region in the national programme.
  • Over 30 sessions took place with more than 200 delegates across the North West attending, at all levels including CCGs, ICS leads and regional NHSEI leads.
  • Up to 30 people were present at each of the Virtual Network Forums, showing their value amid pressures due to COVID-19.
  • Continued commitment to the programme from trusts demonstrated the understanding that clinical prioritisation is really critical to moving forward.

The North West was the first region to move on to the second phase of the programme – diagnostics. Trusts are now considering becoming pilot sites for the diagnostic element (within imaging and endoscopy modalities) of clinical prioritisation. The learning from this will inform the national programme and support other regions as part of this second phase.

“I have been so impressed by this team, they have been so responsive, and really engaged with providers and this has given really great results and the feedback has been excellent.”

Sue Moore, Programme Director for Clinical Validation, NHS England and Improvement


“The team have been pleasant, approachable and professional in their conduct despite the challenging circumstances. Although the remit being asked of trusts was a massive piece of work, they have risen to the challenge and understood the difficulties involved with this requirement and have been very sympathetic yet positive and have encouraged where needed. Their support has been fantastic, and they have been quick to respond to any request for support, or a meeting – nothing is too much.

“We would quite simply have been floundering if it wasn’t for the support of the team.

“I would like to pass on a big thank you to the team from all at Warrington and Halton Teaching Hospitals NHS Foundation Trust.”

Tom Coalbran, Referral To Treatment (RTT) Manager, Warrington and Halton Teaching Hospitals NHS Foundation Trust