Which of the Liberating Ideas Award 2011 winners’ projects has the greatest potential to be adopted by the rest of the NHS? Alison Moore watched the final judging session.

Take three award-winning projects to improve the NHS, some of the most senior and experienced people in the health sector, and an environment designed to encourage creative thinking and problem solving and what do you get?

The hope is rapid spread of good ideas and practice across the NHS – and that was the principle behind the Capgemini/HSJ Liberating Ideas Award. Three category winners were invited to present their schemes to a group of judges at Capgemini’s Advanced Solutions Environment in London.

The Advanced Solutions Environment – think huge whiteboards, creative artists, enabling technology and the occasional teddy bear – is designed to allow ideas to flourish, be developed and challenged in a collaborative way, and be refined so that final implementation time is reduced.

The aim was to identify the scheme which had the greatest potential to be spread across the NHS – ideally reaching 100 trusts within the next year. That did not mean that the other category winners did not have the potential to also transform care – and the judges were clear that they did – but more that their impact could be longer term or they needed additional time to develop their ideas.

The winners from the three categories of prevention, primary and secondary care, had the support of their chief executives and the commitment of judges to work with the winning team, using their contacts and experience to help push the projects forward. Capgemini also offered a package of support for the overall winner over the next year.

Capgemini head of healthcare Brendan Farmer said the day was “an opportunity to pick the brains of the judges and your colleagues from other organisations”. Judges could help to “cut through the treacle” of the NHS, he added.

And the three teams took this on board, explicitly saying what they wanted out of the judges in terms of advice, help and access, and responding to some very challenging questions.

Making the case

The day started with the three very different projects being presented to the panel of judges and their competitors.

Each team had 25 minutes to talk about their projects – helped by videos and poster displays – and answer initial questions. All three projects were developed by staff who had seen a gap in services or an opportunity for improvement which would both benefit patients and offer cost savings for their organisation or the NHS as a whole.

All had some evidence that this was happening, and, crucially given the current financial climate in the NHS, all were either implemented out of existing resources or had cost relatively little to put into place.

But from then the ideas were subject to detailed scrutiny by the judges. This was not with the aim of demolishing them, but to examine areas which needed further development and to provide useful input and suggestions which could refine the ideas and identify and overcome potential obstacles.  

Judges examined each scheme in three sessions looking at the business case for the reform and its state of readiness, how the solutions could be scaled up, and how to make it happen. This provided some of the most challenging points of the day with judges asking teams to identify obstacles and how they would convince the sceptics. Often the teams were having to think across whole health economies rather than just their own organisations and to identify key stakeholders. Their assumptions about who their projects would be aimed at and who would pay were tested.

Some of the questions asked had profound implications for the NHS. How do you fund a scheme which improves care in residential homes and reduces emergency admissions? Where do the benefits lie in the system, and how can the “winners” be persuaded to pay? How do you persuade orthopaedic surgeons to get behind a scheme to improve rehabilitation for their patients without making them feel their care is being criticised? Can a scheme to identify women with a long term condition considering pregnancy be used as a way of reaching women with other conditions?

The winner is…

So what was the outcome? Colchester University Hospital Foundation Trust was the overall winner. It impressed the judges with the simplicity of its offer, its potential scope, and its ability to save the NHS £90m a year if it were fully adopted.

It has already been rolled out from the original target group – patients with fractured neck of femur – to include elective orthopaedic patients, and could benefit other surgical patients. And it is addressing an issue which is common to most hospitals in the country: how to reduce length of stay and better rehabilitate patients for independent living. It could also be implemented quickly – the initial scheme in Colchester had been put in place in four weeks.

The Winning Projects

Primary care winner: Amber Valley care home support team, Derbyshire Community Health Service

As the population ages, more people are likely to spend some time in a care home. This project helped to improve the quality of care offered to residents by offering staff training and support while also ensuring the right people were in the beds at the right time. This meant preventing emergency admissions to hospitals from homes, ensuring that patients could be looked after in homes after discharge from hospitals, and helping residents maximise their independence through the input of physiotherapists and occupational therapists. Measurable outcomes included a reduction in falls leading to hospital admissions from homes in the scheme and positive feedback from care home residents and their relatives. The team are now keen to expand across Derbyshire and beyond.

Preventive care winner: Pre-conception care for diabetic women, Derby Hospitals Foundation Trust

Diabetic women are at higher risk than the general population of poor outcomes in pregnancy. Identifying diabetic women who are considering a pregnancy and offering intervention before they conceive can improve their chances of a good outcome. This scheme used a “teams without walls” approach to reach as many women as possible using both primary and secondary care clinicians. Women with diabetes were given a personalised plan including, for example, education programmes to help them better control their diabetes before getting pregnant. Early analysis suggests that more women are being reached before they are pregnant, they are more likely to attend appointments and the stillbirth rate has fallen. As well as better outcomes for the women and their children, the project has the capacity to reduce and shorten hospital admissions.

Secondary care winner and overall winner: Colchester Orthopaedic Rehabilitation Protocol, Colchester Hospital University Foundation Trust

Patients with fractured neck of femur typically spend a long time in hospital and may need intermediate care before they can return home. This project assesses each patient and offers them appropriate rehabilitation, aimed at getting them mobile and able to do everyday tasks such as washing and dressing themselves, and able to return home. Staff from nursing and therapy backgrounds have worked across boundaries to deliver the new service. Length of stay has reduced from an already below average 17 days to 11.5 days with 78 per cent of patients returning straight home, compared with 42 per cent before. At a conservative estimate, this approach could save £400,000 a year for this target group of patients alone – but the trust is now rolling it out to all orthopaedic wards, where it is seeing average stays reducing by a day. The trust is also having fewer falls on wards and feels the rehabilitation approach offers improvements in patient dignity and privacy – patients wear their own clothes, are encouraged to dress and toilet themselves, and have communal meals around a dining table.

HSJ editor and judge Alastair McLellan, said it had been a difficult decision but “the judges were unanimous that this was a project which had clear and real benefits and was ready for rapid spread”. And it was an idea which was right for the challenges the NHS faces in the next 12 months.

Mr Farmer of Capgemini explained the process which the project would now go through – development to make it easy for other locations to implement it, adapting to the judges’ input and, importantly, the need for commitment from the trust itself to carve out time for the staff to work on it.

“It’s always amazing to see what the NHS is capable of,” said Richard Stubbs, project director for NHS Innovation Challenge Prizes at the NHS Institute. “There is no doubt that the three teams all have ideas and solutions which are vital for the NHS. The real thing is how do we take this and get support and enthusiasm.”

South Essex Partnership University Foundation Trust chief executive Patrick Geoghegan praised the process that the three teams had been put through. “We had an opportunity not only to read the documentation before we came but to meet the people and to probe with questions and challenges, and to be allowed to give some advice and input, a bit like being a mentor.

“These are very experienced judges which can help them take it to the next level – and that’s unique.”

The judges

  • Alastair McLellan editor, HSJ
  • Brendan Farmer vice president and head of healthcare consulting, Capgemini
  • Ali Parsa chief executive, Circle
  • Geoff Alltimes member of the Future Forum and former Hammersmith and Fulham PCT and council chief executive
  • Dr Gordon Coutts chief executive, Colchester Hospital University Foundation Trust*
  • Dr John Coakley medical director, Homerton University Hospital Foundation Trust
  • Lorraine Bewes director of finance and information, Chelsea and Westminster Hospital Foundation Trust
  • Richard Stubbs project director for NHS Innovation Challenge Prizes, NHS Institute
  • Dr Patrick Geoghegan chief executive, South Essex Partnership University Foundation Trust
  • Sir Nick Partridge chief executive, Terence Higgins Trust

*Although Dr Coutts took an active part in the day’s proceedings he took no part in the final vote as his trust was one of the three sector winners