Background
The elective recovery and transformation programme was established from a necessity to reduce waiting times for treatment following the immediate impact of the pandemic. The providers agreed that it was imperative to collaborate to share resources, provide support and facilitate mutual aid to ensure urgent patients still received treatment and as much elective care continued as possible.
Activities
The progress through the elective recovery programme has been manifold:
- The work is underpinned by weekly monitoring of waiting times across the system, fostering a shared responsibility for reducing variation in wait times between providers.
- A mutual aid hub/patient tracking list (PTL) team was established to track and monitor requests for mutual aid and the waiting list position within each organisation to minimise variation.
- Capacity was optimised through a theatre utilisation programme and they used risk stratification to help prioritise patients for different clinical risk factors to ensure patients were seen in order of clinical need, and that low-risk patients are treated in the most appropriate environment.
- Theatre and outpatient dashboards are used to monitor utilisation rates and cases per list, day case rates, patient initiated follow up and referral optimisation.
- A prehabilitation programme identifies patients at high risk of chest infection and contacts them to offer health coaching and respiratory physio at home and to get diet coaching and pre-surgery support.
- They have set up a health inequality working group to look into their higher 'did not attend' (DNA) rates. The group has identified correlations between areas with high DNA rates and areas with high levels of deprivation, as well as with people from ethnic minorities. They are now developing an action plan to address this.
- Cheshire and Merseyside Acute and Specialist Trusts Provider Collaborative (CMAST) established memorandum of understandings (MOUs) for staff and services to move around the system.
Outcomes
Overall CMAST has coordinated delivery of significant achievements in elective recovery through combining resources, utilising programme funding and jointly funding a programme team to lead the collaboration across these key areas.
The collaborative has realised significant outcomes. These include:
- Their work on risk stratification and prehabilitation has reduced the average length of stay by two to three days with no post-operative harm events reported for the intervention cohort that had more than 10 percent pre-operative risk of chest infection.
- Through improved theatre utilisation and efficiency, they have increased the number of people receiving operations within Cheshire and Merseyside by over 19,000 over the last 12 months through increased numbers on lists, and utilisation rates.
- Average of seven percent theatre utilisation improvement over a 12-month period across the Cheshire and Merseyside system.
- They were one of a few systems to achieve zero capacity breaches for 104 week waits in June 2022, and reduced the 78 week waits by over 30,000 patients during the last quarter of 2022/23. CMAST continues this collaboration to focus on reducing the 65 week waits.
- Another key area of focus is reducing variation in waiting times between providers, the mutual aid hub has facilitated over 6,800 mutual aid treatments, where trusts have supported each other to equalise waiting times for key procedures.
- All CMAST programmes developed programme specific dashboards for performance data, and these are now being developed further to include patient care and experience outcomes.
Enablers
- There is a programme board which is chaired by the senior responsible owner (SRO) and includes Place and primary care representatives and links to the chief operating officers which helps join people up and supports a culture of system working.
- The weekly PTL catch ups with each provider are a regular touch point with each trust. The CMAST team use these meetings to disseminate all the information to be shared that week.
- The programme aims to be a single point of contact for the NHS England regional and national teams, which means that CMAST can be a buffer for the trusts and answer questions and shape consistent messages on their behalf.
- The team provide a supporting and enabling role for and with trusts including in their interactions with the integrated care board (ICB). However, clarity of roles is important and linked to accountability with trust level performance discussions formally led by the ICB.