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Better, Together

Derbyshire Healthcare NHS Foundation Trust was the overall winner at the QIPP Awards and Conference in Manchester on June 28, chaired by Sir Muir Gray, for its ‘Better Together’ collaboration initiative. Here, Nick Hodson, head of service improvement and programme assurance at the trust, describes its work with the independent sector.

Sir Muir Gray absolutely pinpointed the reason why we have been so successful here at Derbyshire Healthcare NHS Foundation Trust in delivering efficiencies.

Delivering efficiencies sustainably requires an underpinning assurance process which embeds QIPP (Quality, Innovation, Productivity, Performance) as business as usual, and not some transient initiative that will eventually go away.

‘Better Together’, our trust’s offering, describes how we minimised risk and maximised opportunity through working with the independent sector.

The NHS is often guilty of ‘trying to hang the curtains before the foundations are dry’ when responding to change, but in addressing the QIPP agenda, success is more likely when underpinned by a solid process of assurance. Our experience of the process of gaining FT status brought us to an understanding of the crucial importance of the triangulation of plan, position and evidence, from which we developed a robust assurance process for our efficiency plans.

Above all this process enables us to evidence that quality is at the core of change. Assurance for us means removing all reasonable doubt and that the position reported to the trust board is correct.

The two key components in our assurance process were recognising, nurturing and embedding project management skills in the operational workforce and developing an Excel-based reporting system which captured and reported every efficiency plan from inception to one year post-delivery. The success of the process has gained us recognition from Monitor, KPMG and the Department of Health, prompting visits from other trusts across the country.

Knowing our limitations, whilst recognising our strengths, led us to seek to replace our by now rickety (56,000 links) Excel system. We sought a private sector partner who specialised in project management software and whose systems were close enough to our methodology for us to seamlessly adopt.

We found this in ProjectVision, developed by CoraSystems. Using our organisational ethos of ‘Better Together’ we worked in partnership with CoraSystems to utilise their functionality with our assurance process to develop an efficiency module within ProjectVision. The intuitiveness of the system facilitated a seamless progression from the old to the new systems, maintaining organisational engagement.

It’s quite amazing how having a clear, single, transparent process changes your ability to deliver efficiencies and protect quality. One of our standing boasts is that as a trust ‘We don’t do Amber’: efficiencies are either delivering or not, to Quality, Time and Benefit. As an organisation we have never missed a delivery target in 25 months, fully delivering our savings targets whilst increasing our productivity and protecting and improving the quality of our services.

One of our key components is ‘Harvesting Seedling Ideas’, irrespective of their origin, and putting them through our process. An innovation left un-nurtured often dies on the vine, but the process of involvement which our system promotes ensures organisational ownership, which we believe provides a fertile growing environment.

One such innovation which formed the second component in our ‘Better Together’ offering, winning the LinkGov QIPP Award, was the introduction of digital-pen technology from Destiny. Our community services had struggled for some time with ensuring the timeliness, accuracy and completeness of their activity data with consequences of increased clinical risk, an inability to manage performance, poor contract compliance, restricted decision making, inefficiency and poor quality assurance.

Understanding that ‘old technology and old solutions’ were part of the problem, ensuring that any new solution would not only immediately improve this position, but also future-proof us, was key in our decision making. To this end we identified Destiny’s digital-pen technology as an ideally placed small step change in technology to move a large workforce (800) towards contemporaneous accurate recording.

Once the initiative was established, and data improvement objectives were being achieved, they were used as part of a productivity efficiency project which reduced the time taken when seeing a patient from 1.5 hrs to 1.25 hrs. The time reduction was entirely on the administrative component and protected the face-to-face time with the patient.

There was a total net savings in excess of £500,000 in less than two years.

Together with Destiny we have further developed the digital pen functionality to collect, analyse and determine the correct ‘clustering’ of patients for Mental Health PbR (Payment by Results), which informs our clinicians, PAS and governance structures, ensuring users of our services receive the right intervention from the right skilled clinician in the right setting at the right time with the right payment being received.

We look forward to future opportunities to build on the robust partnership foundations we have put in place, continuing to demonstrate we are ‘Better Together’.

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