Winner Salford Royal Foundation Trust and Salford PCT

A new model of care for neuroscience disorders was developed in order to meet the 18 week targets.

The existing service model was overwhelmed, with 11 week waiting times for first outpatient appointment, 13 weeks for a routine MRI and a further ten weeks for follow-up.

The Neuroscience Independent Clinical Assessment and Treatment Service (NICATS) was devised as a partnership between Greater Manchester PCT, Manchester University, and The Greater Manchester Neuroscience Centre in Salford.

Referrals are triaged daily with outcomes being dispatched to the GP and patient on the same day. If an MRI scan is required, the patient is given a choice of time and day and the diagnostic is undertaken in their locality through independent sector capacity. These are reported by specialist neuroradiologists within 24 hours. The multidisciplinary team then meets with the three specialists to determine the appropriate referral pathway for the patient. This may be the referring GP, GPwSI (headache or epilepsy), specialist nurse or specialist hospital clinic.
If surgery is required, the patient on attending the specialist centre will have a pre-op assessment, and their surgery date confirmed with the consent process starting three weeks before surgery to allow the patient to digest the information before arriving on their day of operation.
This collaboration not only delivers the 18 week referral to treatment standard but also provides the highest clinical governance, audit and outcome data.

The ICAT model supports payment by results by unbundling the tariffs and making charges transparent. The PCT pays for the triage, MRI and multidisciplinary team only if the patient requires them, which means the new ICAT tariff is cheaper. The service will be rolled out across Greater Manchester over the next year or so.

The judges said: 'Achievement based on trust across organisations in the healthcare community and cooperation between management and consultants.'

'Good transferability,' they added.

Greater Manchester Neuroscience ICAT, contact jon.sussman@manchester.ac.uk

Highly Commended Royal Liverpool and Broadgreen University Hospitals NHS Trust

A ward based improvement project was developed to increase direct care time, improve safety and quality, and reduce length of stay.

Ward 3A in the Royal Liverpool Hospital was chosen for the project. Designated as a diabetes/endocrine and general medicine ward, it has 26 beds and was selected because of its keen and committed staff and clinicians, longer lengths of stay when compared to the national average and relatively high infection rates. Ward 3A is also key to ensuring good flow out from the emergency floor.
The trust launched this test programme in conjunction with the NHS Institute for Innovation and Improvement in late 2006.

Data was collected on length of stay, meal wastage, infection rates and sickness absence. The meal round was videotaped and staff were involved in hour long work sampling studies to develop baseline information on how much time was spent on direct patient care.

The whole ward team, along with support departments and organisations including catering were involved in mapping existing processes and making suggestions for improvement. Process maps and cost-benefit matrices were displayed within the ward area allowing all staff from different shifts and also patients to comment. New processes based on these ideas were trialled within two weeks.

The improvement tool ‘5S’ was also implemented on the ward, which ensures staff and patients can get the right equipment at the right time - all the time.
As a result of the project, meal wastage fell from 11 per cent in December 2006 to four per cent in April 2007.
Direct patient care time increased from 27 per cent to 40 per cent for sisters, and from 25 per cent to 45 per cent for staff nurses.

The judges said: 'Excellent example of front line redesign with good impacts.'

The Productive Ward, contact cathie.blackwell@rlbuht.nhs.uk

Luton & Dunstable Hospital NHS Foundation Trust

Staff and patients redesigned aspects of the head and neck cancer service in order to improve the experience of both groups.

Interviews were conducted with staff, patients and carers, and patients were helped to create an emotional map of their experience of the parts of the service that affected them.
Patients' interviews were filmed then edited by patients themselves to show to a group of staff, who saw parts of the pathway that were previously invisible to them.
A plan was agreed to improve 43 interactions with the service that spoilt their experience, while retaining the many positive aspects.

Improving patient and staff experience of the Head and Neck Cancer Service, contact elaine.hide@ldh.nhs.uk

Hampshire PCT

Orthopaedic Choice was developed to redesign the orthopaedic outpatient process. Patients were waiting 18 months for an outpatient appointment and a further 18 months for surgery, if required. Very few patients seemed to be waiting in the right queues for the right treatment and care.
Now the maximum wait for an opinion has been held at six weeks for routine referrals and two weeks for urgent. Patients are assessed and supported in their choice of treatment by a range of professionals who are competent to refer the right patients into the surgical pathways.
It started as one clinic a fortnight and now offers more than 20,000 appointments.

Orthopaedic Choice, contact catherine.bowell@nfpct.nhs.uk

Sutton and Merton PCT and Sutton Horizon PBC Consortium

The orthopaedic and rheumatology pathway was redesigned to allow effective triage and management of patients outside an acute hospital environment.

The Musculoskeletal Centre was established in April 2005 to reduce the number of outpatient orthopaedic attendances at the local acute hospital by providing additional capacity within primary care.

In July 2006, all staff working in the Musculoskeletal Centre were involved in the redesign of the service, including physiotherapists, podiatrists and GPSIs, and a new care pathway was agreed.

The service has reduced referrals to secondary care by 36 per cent and reduced waiting times for access to orthopaedic expertise.

Musculoskeletal Centre - redesigning the orthopaedic and rheumatology pathway between primary and secondary care, contact denver.greenhalgh@smpct.nhs.uk