Background
The Cheshire and Merseyside Acute and Specialist Trusts Provider Collaborative (CMAST) established memorandum of understandings (MOUs) diagnostics programme includes all diagnostic tests such as pathology, imaging, endoscopy, screening programmes, cardiorespiratory, neurophysiology and covers 70 tests for patients of all ages across mental and physical healthcare.
There are seven pillars that make up the diagnostics programme:
- imaging,
- pathology,
- endoscopy,
- physiological measurements,
- community diagnostics centres,
- primary care,
- mental health.
The scope of the work includes all activity for patients registered with a GP in Cheshire and Merseyside, but also includes care delivered to patients through the CMAST providers who live outside of the integrated care system (ICS). The diagnostics programme's work influences both physical and mental health and reflects their transformation ambitions beyond any one single organisation.
They are responsible for:
- Driving up efficiency, productivity and implementing best practice.
- Supporting service sustainability.
- Transformation at scale beyond a single organisation.
- Performance and outcomes.
- Connectivity and matrix working.
Activities
- The senior responsible owner (SRO) reset diagnostics delivery within Cheshire and Merseyside, establishing a coordinated programme while simultaneously acknowledging there was already some very good primarily network focussed work going on.
- They were very clear on setting out the scope of the system-wide diagnostics programme and followed this up with extensive engagement including focussed conversations with key stakeholders, including chairs and chief executives. The SRO was also clear on what the diagnostics programme could offer to providers, but also what the providers would need to offer the collaborative.
- They are focusing on productivity and asset optimisation by maximising the number of tests they can do with the staff and machines they have.
- Clinical leadership is really key to their success, and they have clinical leads for endoscopy, imaging and pathology who gather the combined view of their peers across the clinical networks. An example of this working well is where the endoscopy network has agreed and supported implementation of the number of patients that should be booked on each list across the collaborative which has driven productivity.
- The diagnostics programme team have weekly patient tracking list (PTL) meetings with each trust individually on productivity measures.
- They support each other through collaborative innovation by doing things once and then spreading good practice across the providers e.g. single operating models and guidelines on the numbers of biopsies for each endoscopy.
Outcomes
- 100% reduction in patients waiting 79 weeks or more.
- 74% reduction in patients waiting 26 weeks or more.
- 12% increase in MRI use.
- 17% increase in gastroscopy use.
- 21 % increase in diagnostics waiting times and activity (DM01) tests between 2021 and 2023.
- 11% productivity gain since moving from multiple echocardiogram (ECHO) guidelines to one single ECHO guideline.
- There is increased capacity and patient choice through 10 new community diagnostic centres meaning people can have multiple tests done at one appointment which is helping to get a diagnosis faster.
- £4m per year has been saved in reducing unnecessary endoscopies.
- £2.5m cost avoidance per annum since the introduction of a radiology reporting out of hours hub.
- Progressing toward a strategic direction for pathology consolidation.
Enablers
- They have a single coordinated programme with great depth and breadth.
- Getting the right person into the SRO role has been critical to bringing together multiple disparate strands of established and new networks through regular and clear engagement with key stakeholders.
- There is a very strong 'system first' attitude and culture that comes from the SRO of the diagnostics programme which helps to galvanise support from the chief executives, who are very engaged and supportive of the programme and see it as a helpful enabler.
- They have been strategic in successfully securing £119m of new capital investment in digital pathology, digital imaging, endoscopy build, imaging kit, community diagnostic centres.
- CMAST is well linked in with system-wide professional groups and the diagnostics team have a regular slot to update medical and nursing directors and chief operating officers among others.
- The integrated care board's (ICB's) supportive and positive relationship, as well as its sponsorship of the programme is a vital enabler for their work.
- They have plans for a collaborative staff bank to reduce their reliance on agency staff.