Clinical Service Redesign sponsored by the NHS Institute for Innovation and Improvement

"We had bottlenecks for almost everything we were trying to provide as a service," says Dr Jon Sussman, consultant neurologist at the Greater Manchester Neuroscience centre, Salford Royal Foundation trust. "Essentially we improved things by teaming up with Salford Primary Care trust and Manchester University – who had an MRI scanner on the hospital site - to introduce the Neuroscience Independent Clinical Assessment and Treatment service, a system by which we could more readily do what was best for the patient."

This involved setting up a triage system for filtering GP referrals through to the most appropriate specialists.

"Where, for example, somebody has symptoms thought to be caused by Parkinson’s disease," says Dr Sussman, "an MRI scan isn’t very helpful for making a diagnosis, so these patients can be passed straight over to the appropriate clinic. But in a case of suspected multiple sclerosis we would look to do a scan first."

In such an instance the patient is offered a choice of time and day for the diagnostic procedure. A multi-disciplinary team – neurosurgeon, neurologist and neuroradiologist – then assesses the results, before the next step is decided on.

"This makes everything much more efficient," says Dr Sussman. "The only people who go on to see the neurosurgeon for instance are those with something wrong on the scan and the net effect of this is that whereas they used to only operate on one in every ten of the patients they see that is now down to one in three."

Dr Sussman concludes: "Winning the award was a real vindication of all the hard work the project managers put in to making things happen across the organisations."

What judges want

  • Service redesigned around patients and carers – with evidence that service users views have been sought, analysed and implemented in designing service
  • Evidence-based development – has appropriate clinical and management evidence been taken into account in redesigning the service
  • Equity – ensuring the service is available to all qualifying patients within the catchment area
  • Teamwork – evidence that all staff involved in the service have had a voice in the redesign
  • Value for money – has the investment in resources or money shown a demonstrable benefit in terms of outcome quality, efficiency of throughput and capacity management?
  • Consideration of how payment by results has been taken into account in the redesigned service

Data Driven Service Improvement sponsored by the NHS Information Centre

The Leicestershire, Northamptonshire and Rutland cancer network first introduced data from the Clinical Information Analysis programme at its oncology clinical governance meeting.

"It was a way of looking at the equity of treatment across LNR and benchmarking it against cancer centres in the Thames Valley area," says Dr Elspeth Macdonald, network director and clinical lead. "We could see where we had differences, what significance they might have and where we could identify clinically guided cost savings."

"The data from the programme is well regarded and routinely collected, something clinicians feel comfortable with," she continues. "This was important not only in terms of being able to engage with them, but also as a feature of how they then went on to make the changes they did."

Oncologists examined each of the largest tumour groups in turn, agreeing where they felt evidence for good practice indicated the opportunity to take different approaches themselves.

Dr Macdonald says: "Because of their confidence in the data it wasn’t so much a case of pushing them to this as seeking their expertise and facilitating the change that they directed."

Clinicians were also able to see tangible benefits to reviewing their practice. Where expenditure was cut by switching to a less expensive but equally effective treatment, as in the case of lung cancer drugs for example, the network got the agreement of the PCT that some of the savings realised could be used to develop another part of the service.

The information in a refined form is now used to support the PCT as it examines health inequalities issues and access to care.

What judges want

The judges will be looking for the development use of high quality, relevant information and data to:

* measure and monitor service delivery

* drive service improvement and redesign

* enhance quality of care and patient safety

* measure and improve productivity