Keeping our clients informed on emerging governance and wider policy developments is central to our relationship strategy.
We do this in many ways, but the most visible and successful aspect of this support is through the regular networking events that we organise. We have built up a reputation for securing speakers of national and international renown to address our clients on highly topical and relevant matters. Non-executives are a key audience for us but many of our events are valued by the wider Board and senior management.
Friday, June 8, 2018
Location: Haydock Park Racecourse (Lancaster Suite)
Tim Crowley, Managing Director, MIAA welcomed everyone to the Getting it Right First Time (GIRFT) event which was run in collaboration with AQuA. The purpose of the GIRFT programme is designed to improve care by reducing unwarranted variations.
Tim introduced Ruth Tyrell, the GIRFT NW Hub Director and the NW lead on the GIRFT programme. Ruth set the scene. GIRFT is the brainchild of Tim Briggs, a leading orthopaedic surgeon who saw the variation in orthopaedic practice across the UK as he found himself doing a lot of revision surgery for procedures that had been undertaken elsewhere. He obtained funding of 200K for a pilot and he started to collect activity and outcome data for every NHS provider on their orthopaedic practice. The key findings from the pilot were that there was variation in prosthetic kits and variations in hip implants. Low volume work did not have the best outcomes and there was a failure to follow national joint register recommendations. There was a need to address theatre scheduling and ring fenced beds and variations in staffing. There was a lack of emphasis on rehabilitation and seven day physio service which had an impact on length of stay and differences in surgical site infection rates. This all was combined with a paucity of data and inaccurate coding. There was therefore a big difference between the patients that did well and the patients that didn’t, with significant unwarranted variation seen in practice and outcomes.
From the initial pilot of 200K the GIRFT Orthopaedic programme has had a massive impact with estimated savings of between 60 – 90 million over time. The programme has now been set up to expand to 35 different specialities and the GIRFT methodology was developed to ensure the work was replicable.
Phase 1: preparation – look for leaders
Phase 2: data pack production
Phase 3: National clinical lead – deep dive site
Phase 4: National report
Phase 5: review
Phase 6: move to business as usual
Ruth concluded her talk by saying unwarranted variation is no longer acceptable in the NHS. It shouldn’t be a postcode lottery from a clinical perspective. GIRFT will be funded for another four-six years supporting clinicians nationwide to adopt continuous quality improvement for the benefit of patients.
Tim introduced Dr Maire Morton who is the National GIRFT Clinical lead for Maxillo-facial surgery. The GIRFT work in this speciality started in summer 2016. So far there has been over 60 deep dive visits using the data pack but there are 127 units across England. Maire has noted that the best data has been where the consultants have the best relationship with their coder. She has also noted the complexity of service provision within this speciality with many adopting a hub and spoke model. Some of the key findings from the work to date include:
Poor basic data ( HR/Staffing and activity etc) – Some managers unaware how many staff are employed in their area.
Differences in operational practice – daycase v outpatients
Poor coding ( especially in head and neck cancers)
No awareness of Litigation (cases and learning)
A number of recommendations will be made through the national report in this area including
Smaller units should form hub and spoke arrangements with neighbours or larger units
The speciality coding needs to be corrected
Urgent need to have mandatory quality outcome audit in head and neck cancer
Develop consistent coding in head & neck cancer
The final speaker Neil Haslam is a Consultant in Endoscopist and Gastroenterologist and a Clinical Ambassador for the GIRFT programme. His presentation focused upon how we can maximise the effects of GIRFT and sustain the activity going forward. There remains unwarranted variation across Trusts and he believes we should be moving everyone to the top quartile. One of his recommendations was to propose a GIRFT oversight committee within every Trust to drive forward GIRFT activity with support from the Exec team using model hospital data and self-monitoring to improve performance https://improvement.nhs.uk/resources/model-hospital/
Neil invited everyone across the NW to do this. He believes a lot of clinicians come to work not knowing whether they do a good job or a bad job. Give them the data and they get it.
Tim finished the event by inviting everyone to challenge variation, familiarise themselves with their data and monitor to drive improvements locally.
Our next event features Jeremey Scrivens, Director at The Emotional Economy at Work and a global thought leader on 6th July 2018 at The Hive, Manchester. Bookings can be made via www.miaa.nhs.uk and click on events.
Friday, May 11, 2018
Location: Haydock Park Racecourse (Lancaster Suite)
Tim Crowley, Managing Director, MIAA welcomed everyone to the event – Where Next for Commissioning? He introduced the partners who have collaborated on designing and funding the event. The Association of Directors of Adult Social Services (ADASS), a charity who aim to further the interests of people in need of social care by promoting high standards of social care services and influencing the development of social care legislation and policy, and AQuA, a North West NHS health and care quality improvement organisation who are at the forefront of transforming the safety and quality of healthcare and MIAA who work with a wide range of public sector organisations to improve their governance, assurance, performance and outcomes.
Tim welcomed Professor Paul Corrigan, Independent Consultant who has a long history in commissioning practice and policy. Paul focused his talk on what commissioners are meant to do and what actual powers they have to do it. He gave a commentary of his personal history with commissioning and the fact that commissioning has never achieved the potential it has to improve health outcomes. Paul believes commissioning is a transformative skill and although the policy framework sets out a bold agenda, it is set within a fragmented system of disjointed pathways, where co-ordinated personalised care is what matters to patients and the public typified in the following statements ‘I want to tell my story once, ’ ‘I want services where and when I need them.’
Trying to move towards the integration of health and social care in a way that delivers personalised care, at a time of financial restraint, makes things much harder he believes. If you don’t work with the public it is difficult to get the outcomes in health and social care that the public want as professionals tend to focus on different things influenced by the restraints that the challenging context provides. Commissioning for outcomes is a real challenge that hasn’t happened in reality, although it is what a system should be doing. Paul in his experience has seen little evidence of commissioning for outcomes but has seen commissioners doing lots of other things.
Social prescribing has the potential to have a really big impact on the commissioning agenda addressing the social and psychological components of co-morbidities. Patients and the public will be the drivers for change through collaborating and co-designing services. Paul’s final statement highlighted the importance of getting people active in their health and health care. If commissioning doesn’t focus upon transformation, moving us towards an asset and community based approach that empowers patients as change agents around their own care requirements, then we will continue to have a problem! This is a different role for commissioners.
Tim introduced Charlotte Ramsden, Strategic Director for Children and Adult Services, Salford City Council who presented the vision for the integrated care organisation across Salford. She emphasised the importance of getting the vision right first around a moral purpose and then presented progress to date towards the vision through creating neighbourhood models to achieve the change. Engaging with the local community and the people of Salford to listen to what the public wanted was key to the neighbourhood model scheme although delivery is at an early stage. The next phase is to link this to a whole population approach. Charlotte finished by saying how hard it has been but what has been important has been having a vision and building the relationships that will make it happen.
Carey Bamber, Senior Programme Manager, Coalition for collaborative care presented an approach to asset based commissioning and the importance of embedding co-production. She challenged the audience to consider that services remain largely unchanged, despite a policy framework that has favoured personalisation and that we haven’t been great at getting the input of those that use services to help drive transformation. There is an emerging movement that is helping to shift the system towards asset based commissioning and enabling people and communities to come together with organisations to become equal co-commissioners. She finished by a further challenge that the audience could take small steps and she urged everyone to read Asset based commissioning – Better outcomes, better value found here
Rob Bellingham, Managing Director, Greater Manchester Association of CCGs was the final speaker. He described the new commissioning system in Greater Manchester and the direction of travel based upon the outcomes of the Greater Manchester commissioning review. The single commissioning system is based around three themes – place, scale and support. He was clear however that the ‘magic’ is happening on the ground in local communities and that whilst structure was important, local is where it is at.
Tim closed the event with final messages from the panel:
How do you enable local innovations to spread and be sustainable?
How do you build strong trusting relationships between individuals because this is what enables change to happen?
How do you enable citizens to take responsibility for their health and care and collaborate to co-produce services in an equal relationship with staff?
How do you build leaders that ‘protect’ from above and ‘reach across’ to integrate health and social care?
Friday, May 4, 2018
Location: Ernst & Young Office - Manchester
Building Healthy Places and Communities through Scaling up Innovation and Transforming Housing, Health and Care
Wednesday, May 2, 2018
Location: Manchester University (The Barnes Wallis Room)
Tim Crowley, Managing Director, MIAA opened the joint event between MIAA, ADASS and the NHS in Greater Manchester on Building Healthy Communities. He emphasised this flagship event in MIAA’s 2018 events calendar and the importance of strengthening the interaction between health and housing.
Thomas Maloney, NW ADASS Programme Director welcomed everyone and identified that there are some ready-made solutions out there to integrating health and housing which will be part of the conference programme. He encouraged everyone to debate this further in their discussions throughout the day.
Tim introduced Danny McDonnell, Strategy Programme Manager, NHS England. NHS England wrote the 5 year forward view which is where the Healthy New Towns programme sits. Danny provided a historical view of the connection between housing and health and a recognition that although people are living longer, their healthy life expectancy is not extending with it. Being healthy is linked to the places we live and the built environment.
The programme has 10 demonstrator sites across England chosen from 114 applications. The sites are led locally, mostly by local government with the purpose of creating healthier places through evidence of what works and building from the ground up improved population health creating opportunities for people to make healthier choices.
The programme has 3 key aims:
Shape new towns, neighbourhoods and communities to promote health and wellbeing, prevent illness and keep people independent.
Radically rethink the delivery of health and care services
Spread learning and good practice
October 2018 will see the launch of the Healthy New Town principles based upon the learning.
Tim introduced Neil Revely, Co-Chair ADASS Housing Policy Network. Neil shared that some of the biggest changes in people’s health are to do with housing and there needs to be a paradigm shift in the NHS to move from a medical to a social model. His presentation went on to provide the connections between policy, strategy and practice. Strategic commissioning is vital to achieve this vision to build the strategic case for change, as is; learning from different delivery models where there is evidence they have worked, housing services that are part of the integrated system and strengthening partnerships. He shared examples of good practice across England that are detailed further on the slides. In summary, working with housing is good for health, the policy framework is strong and there is growing evidence where housing interventions are making a difference for health outcomes.
Jeremy Porteus, Managing Director, Housing LIN facilitated table top discussions on innovations that can be introduced locally based upon the discussions throughout the morning. The feedback covered a range of issues including: there are massive opportunities for a whole system approach to achieve health outcomes; we are not doing enough and everyone can be social leaders and catalysts for change; we need to pay more attention to co-production and co-design; we need to do the basics well because sometimes we lose sight of the fact that good quality standard housing is what is needed by the majority of people as we focus on innovation.
The next speaker Sara McKee, Founder & Market Innovation Director, Evermore leads an organisation that has designed a new model of retirement living for older people. She challenged us to get rid of the labels and to focus on needs so we really get into co-design and co-production with the consumers and not for them. Her vision is a ‘life in full colour full of love’ for the residents of Evermore. ‘If you create it together and deliver it together it gets embedded’ was her parting message together with ‘let’s develop thousands of little pockets of brilliance.’
Tricia Grierson, Head of Independent Living, Johnnie Johnson Housing shared how with partners, her organisation has worked to create innovative ideas for independent living. She shared a number of projects that were part of the independent living strategy. In particular she demonstrated how technology enabled care can work to support people to keep their independence.
Stuart Cowley, Director for Adult Social Care and Health at Wigan Council talked about the work of Greater Manchester (GM), setting out the vision for supported housing in the context of adult social care transformation through 6 themes. The NW Care Market analysis he referred to concluded that we cannot continue to support people in the same way and that now is he time. We have the evidence to make the change across GM and there is an opportunity to bring housing, care and health together aligned around a vision and a strategy.
Jeremy summarised the learning for the day into - It’s all about me, you and us, challenging us to engage in our active civic duty to design the future of communities that enable us to live healthier for longer.
Finally, Andy Burnham, Mayor of Greater Manchester gave the closing address. The debate you are having is of the moment he asserted. In GM the strategy - Our people, Our place - sets out a clear and simple goal – a decent safe, affordable home for everyone because good health starts in the home. The evidence of the housing crisis is homelessness which he believes is a scandal and a complex reflection on modern living with insecure work and insecure housing. Mental health is the 21st century health issue and it only takes a few bits of bad luck before people end up sleeping in doorways. He posed the question how do we develop a housing policy that is also a health policy that focuses on wellbeing?
The housing crisis has got worse over the last 3 decades. Decent safe housing is a human right as is health care and education. There should be legislation he believes to turn this into a reality. He described how GM are working to put a roof over everybody’s head every night of the week. He asserted we don’t want private landlords to provide substandard accommodation. Currently 4 out of 10 private landlords in GM provide accommodation that is substandard and that GM needs to have a policy which is about solving the housing crisis not simply building more homes.
Andy believes the health service hasn’t been set up to meet 21st century need. His measure of success is having a health service that treats dementia as well as it currently treats cancer. The cultural shift needs to be about moving from a medical treatment model to a social preventative model. The next stage would then be financial reform and an entirely new model of support is needed for the elderly to develop a year of care approach. Clear thinking about new models of support around the home are needed, with GP’s and technologies at the centre and appropriate homes with assisted living technologies. A health policy supported by a housing policy will provide the solution. He finished by stating there is an urgency now about better ways of independent living that work for both the person and the family.
Friday, April 6, 2018
Location: Haydock Park Racecourse (Lancaster Suite)
Tim Crowley, Managing Director MIAA opened MIAA’s 5th Annual Health Check on the state of the NHS and Social Care by introducing Steve Wilson, Executive Lead, Finance and Investment, Greater Manchester Health and Social Care Partnership.
Steve presented an account of the realities of devolution from the perspective of what was happening at Greater Manchester (GM) as they worked to get better alignment between the growth of the economy and investment in public services. Their strategic financial plan provided an opportunity to ‘take charge’ and it is supported by a comprehensive framework of transformation. In reality however each of the 10 localities across GM is at a different stage in their transformation journey. The future commissioning/provider relationship is still being explored and different options for local care organisations within a fully accountable system are being considered. The future is about leaving an enduring legacy of devolution with an understanding of what needs to be done to sustain the transformation and to ‘supercharge’ projects within different localities so they get on with things.
Anita Charlesworth, Director of Research and Economics, The Health Foundation decided to explore a different question. The Prime Minister has committed to a 10 year settlement for the NHS to mark the 70th anniversary for the NHS in July this year. Anita used her presentation to explore:
• How much money?
• The scope of the commitment – is it all of health and social care?
• What to spend it on?
• How to fund it?
The UK is about average for European countries for health spending but we have a big gap in social care funding. The UK economy is growing the slowest because we have low productivity. There is evidence however that life expectancy would be increased by as much as 3 years through greater investment in health spending. Mortality is influenced by the health system. The priorities for investment Anita believes should be addressing:
• Healthy life expectancy gap
• Child outcomes
• Mental health
• Cancer survival
• Outcomes for women
Anita believes that it is important that we craft a convincing and compelling vision of what the health system can deliver over the next 10 years to persuade people that raising taxes by 4% - the amount Anita thinks is necessary -possibly through National Insurance contributions will be acceptable to the general public. It is a big ask she believes, to ask the public to pay more tax and an even bigger responsibility to use that money really well to decide what it should be spent on.
Chris Hopson, Chief Executive, NHS Providers reinforced the fact that we are in the middle of the longest and deepest squeeze in NHS history and that the pressure on the NHS continues and the size of the financial challenge enormous. It is becoming increasingly clear that this is not a sustainable way to run the NHS and the consequences are beginning to stack up. There are high levels of concern in the system about the deliverability of the 18/19 provider task expected and difficulties in the finance and performance ask. There are real risks around setting providers an impossible task and seeing a cycle of perpetual failure based upon a difficult culture of pretence where provider executive teams sign up for targets they can’t deliver. However we are on a promise of extra funding for the NHS of a multi-year settlement with a plan before the next spending review and the plan would be generated by a government led process with NHS involvement.
There are according to Chris 5 obvious tensions
1. Afordability and need
2. Health and social care
3. More performance or recovery
4. Reform or stabilise – the 5YFW is no longer fit for purpose
5. Whose approach will be followed
Chris reinforced the need for a compelling vision of what the NHS is going to deliver in the future and provided 6 suggestions for a local level macro strategy.
Recognise the NHS is in a period of financial and performance challenge and calibrate accordingly.
There are lots of opportunities to do things better – have a clear strategy to do this with staff participation at the heart
Life is better and easier without the regulators on your pitch although they are getting better at offering support.
Don’t sign up to anything that isn’t deliverable – if you are pressured into it have a full audit trail.
Engage as effectively as you can in your local STP.
Leadership capacity and capability seems to be one of the scarcest resources so prioritise accordingly and grow some more.
Tim chaired a question time with the speakers with the audience and finished before lunch describing the event as honest and challenging as providers, commissioners and the system grapple for solutions whilst the promise of increased funding looks like it is around the corner.