Developing Improvement Skills – Our Latest Paper on Embedding Quality Improvement

We’re pleased to announce the publication of Developing Improvement Skills; our latest paper on how health and care organisations can work with us to embed quality improvement.

The paper comes in response to two recent national publications; Making the Case for Quality Improvement: Lessons for NHS Boards and Leaders and Building Capacity by The King’s Fund and The Health Foundation, and NHS Improvement’s Capability for Improvement: Embedding Quality Improvement Skills in NHS Providers.

Speaking on the publication, Lesley Massey, Director, said:

“Quality improvement remains a major priority for health and care if we are to deliver safe, high quality and efficient care for patients, carers and service users, and we welcome the recent publication of these two reports by The King’s Fund, Health Foundation and NHS Improvement.

“Our own paper, Developing Improvement skills, sets out a clear vision for how AQuA’s work can support these recommendations, and how we can work alongside our members and customers to build capability and capacity for improvement across all staff roles and levels.”

Read our report here

In the paper, you can read more about:

• How our offers align to the 10 Lessons for NHS leaders
• Recommended capabilities, engagement and improvement outcomes for all levels of staff
• Practical approaches to embedding quality improvement in your organisation
• Key principles that guide our work with members and customers.

In March 2018 we’re also pleased to be partnering with The King’s Fund for Quality Improvement in Health and Care: Lessons on Leading & Implementing Solutions; an exciting event exploring successful approaches and strategies for embedding quality improvement in health and care.

We’ll be welcoming some of the leading quality improvement lights from across the North West, and AQuA members can also receive a 20% discount off their booking.

For more information about the event and how to claim the discount, please visit the event page.

AQuA Staff Among Latest to Join Q Community

The Advancing Quality Alliance (AQuA) is pleased to announce that its Safety & Mortality Improvement Lead Kayleigh Price is among the latest selected to join the prestigious Q Community.

Led by The Health Foundation, Q aims to bring together improvement practitioners from across the UK to share ideas, learning and best practice to support improvement projects and innovation.

Kayleigh Price, Improvement Lead

Kayleigh, who joins eight other AQuA staff who were previously selected for Q, said of the announcement:

“I’m really excited to be accepted as a member of Q and look forward to being a part of an exciting, diverse and dynamic community.

“I can’t wait to get going and start learning from others and sharing my own experiences too.”

Over the past year, The Health Foundation have been working alongside Academic Health Science Networks (AHSNs) across the UK, to coordinate recruitment to Q.

Kayleigh was part of the latest intake for the Greater Manchester AHSN area, with a previous intake held for the Innovation Agency (formerly North West Coast AHSN) footprint earlier this year.

Q now has almost 1800 members frmo across the UK, including a number from across the North West.

Our Chief Executive David Fillingham will also be speaking at the Q Community national event in Liverpool on 23 November, which will explore how members can learn from each other and do things differently to improve outcomes.

We’ll also be sharing further details about this event in the coming weeks.

For more information about Q, including a full directory of members, visit the Q Community website. You can also follow updates on Twitter via @theQCommunity.

Three Liverpool Members Awarded Health Foundation Innovation Funding

The Advancing Quality Alliance (AQuA) is pleased to announce that three of our Liverpool members have been selected for The Health Foundation’s £1.5 million Innovating for Improvement programme.

Alder Hey Children’s Hospital NHS Foundation Trust, NHS Liverpool Clinical Commissioning Group (CCG), and the Royal Liverpool and Broadgreen University Hospitals NHS Trust were among the 21 projects selected across the UK to receive the funding.

The Innovating for Improvement programme will run for 15 months. Each of the three projects in Liverpool will receive up to £75,000 of funding to support delivery, as well as the evaluation of how the innovation improves the quality of health care.

The three Liverpool-based projects set to benefit from the funding will each focus on improving a different area of health care for patients with respiratory health needs in the city.

NHS Liverpool Clinical Commissioning Group (CCG) will use this funding to build on the success of Liverpool’s Advice on Prescription in Primary Care project, which was set up in partnership with Liverpool’s Citizens Advice Bureau (CAB) to help alleviate poverty, hardship and other common social risk factors that negatively impact on a person’s health. The project will identify new care pathways that would benefit from the scheme, and test it in respiratory services.

Dr Janet Bliss, Clinical Director for Community Services at NHS Liverpool CCG said:

“We are delighted with the news of these three Innovating for Improvement funding awards, each of which will be used to help develop cutting-edge health projects that will directly benefit local patients.

“The Advice on Prescription Project is a ground-breaking scheme which enables all Liverpool GP’s to refer their patients to CAB advisors for help on a range of social issues such as housing, homelessness, job loss and debt.

“Being part of the programme will enable us to continue to build on the successful work already being undertaken through this scheme, with the aim of reducing many of the social risk factors that can negatively impact on people’s health and wellbeing.”

The Royal Liverpool and Broadgreen University Hospitals NHS Trust will use funding from the Health Foundation to improve how heroin smokers access chronic obstructive pulmonary disease (COPD) community services across Liverpool and help reduce the time they need to spend in hospital.

A large number of heroin users in Merseyside are at risk of developing and dying from COPD, a lung disease associated with smoking that causes symptoms such as cough and breathlessness.

The innovative project, which is being led by consultant respiratory physician Dr Hassan Burhan, is engaging with patients by working in partnership with drug services, NHS Liverpool CCG, and 2Bio Ltd’s Impact Science Team who provide innovation services to the Trust and have supported the development of this project.

Dr Hassan Burhan, Consultant Respiratory Physician, Royal Liverpool and Broadgreen University Hospital NHS Trust said:

"Heroin users often don’t engage with community services, which can lead to late diagnosis of COPD and missed opportunities to slow how the disease progresses. Up to one in two heroin smokers have COPD, and one in eight admissions with exacerbations of COPD to our Trust are in patients with a history of heroin smoking.

“We are really pleased to have secured this award and look forward to implementing our ideas to improve COPD management and outcomes in this hard to reach group of patients.”

Alder Hey Children's Hospital NHS Foundation Trust will use the funding to help evaluate the effectiveness of their SCORE programme, a new healthcare model that empowers children with asthma to understand their condition, self-manage it and participate in activities. The model involves an initial consultation to set goals and optimise treatments, a peer-group educational intervention, and two blocks of activity.

Dr Ian Sinha, Consultant Respiratory Paediatrician at Alder Hey Children’s Hospital said:

"We are delighted to have received this funding award for this new approach to asthma treatment, which is centred around children and communities. We hope to demonstrate that it is both clinically effective and cost-effective through the programme, and to be able to share this learning more widely.

“More than ever we need to be thinking creatively about new ways of working in health, and each of these innovative projects highlights that Liverpool is a forward thinking city with regards to new models of care.”

Sarah Henderson, Associate Director from the Health Foundation said:

“We are delighted to be supporting three fantastic projects in Liverpool to enhance care for patients in the local area, with a focus on improving respiratory services. We are keen to support innovation at the frontline across all sectors of health and care services, and I am pleased that we will be able to support these ambitious teams to develop and test their ideas over the next year.

“Our aim is to promote the effectiveness and impact of the teams’ innovations and show how they have succeeded in improving the quality of health care, with the intention of these being widely adopted across the UK.”

To find out more about the Innovating for Improvement programme, go to: http://www.health.org.uk/programmes/innovating-improvement  

AQuA Launches Interactive Guide to Support Patient Safety

The Advancing Quality Alliance (AQuA) is pleased to announce the joint launch of a new interactive guide to support improvements in patient care and safety, alongside our partners the UK Improvement Alliance (UKIA), Healthcare Improvement Scotland, Haelo and the Improvement Academy.

The guide, Better Questions, Safer Care, builds on our work for the Measuring and Monitoring of Safety Framework with The Health Foundation, and contains a range of useful resources to help health and care professionals to take a more holistic approach when looking at the safety of care.

Speaking on the announcement, Kayleigh Price, Safety & Mortality Improvement Lead, said:
“This is a fantastic resource to support colleagues across a range of clinical settings and organisations, to offer a new approach when looking at patient safety and how the framework can help support this.

“Over the past 18 months, we’ve worked closely with our partners to create this, and feel it offers a real abundance of learning and practical advice to support everyday improvements to patient safety.

“We’ve really enjoyed testing the guide across our networks, and we hope that colleagues will find it a valuable tool in their work and can come along to our upcoming events to find out more about it.”

Designed in collaboration with Ward Downham Improvement Design (WDID), the principles and learning within the guide have been tested extensively across localities across the UK, including in Greater Manchester, Cheshire, Merseyside, Yorkshire and Scotland.

It also offers detailed case studies and practical templates spanning roles from Board to ward, and across Ambulance, Acute, Mental Health, and Primary Care settings.

Download the guide

Full information about the Measuring & Monitoring of Safety Framework is available via the website www.HowSafeIsOurCare.com.

As well as launching the guide, we’re also supporting a number opportunities to learn more about the Measuring & Monitoring of Safety Framework, including:

• A series of events in Edinburgh (14 September 2017), Birmingham (12 October 2017) and London (30 November 2017).
• Monthly video calls looking at a range of patient safety themes and topics

To find out more about these opportunities, please visit the Get Involved page of the website. You can also stay up to date on social media via the Twitter hashtag #THFSMP.

If you would like more information on any of these opportunities, please contact Kayleigh Price on 07717 866 379, or Kayleigh.Price@srft.nhs.uk.

The REsTRAIN YOURSELF programme has been shortlisted for a prestigious national Patient Safety award

The University of Central Lancashire (UCLan) in partnership with the Advancing Quality Alliance (AQuA), have been shortlisted for a prestigious national Patient Safety award following their programme to reduce restraint in acute mental health, known as ReSTRAIN YOURSELF.

Paul Greenwood, AQuA Improvement Advisor

The Patient Safety Awards, which are now in their 9^th year, continue to recognise and reward outstanding practice within the NHS and independent healthcare organisations. UCLan and AQuA have been nominated in the Mental Health category. The REsTRAIN YOURSELF programme, which was funded by a grant from the Health Foundation, enabled UCLan as the lead partner and AQuA to work closely with mental health wards across the region to test and adapt an evidence based model called the 6 core strategies in the UK with a strong focus on trauma informed care. The evaluation work of this programme was undertaken by UCLan and together they have recently published a toolkit to support other organisations to reduce the use of restraint.

Paul Greenwood, Improvement Advisor at AQuA and lead for the REsTRAIN YOURSELF programmes said:

“I’m delighted that this work has been recognised by the Patient Safety awards. The partnership between AQuA and UCLan has started to build a really strong evidence base through the hard work of staff across the Trust’s in the region in reducing restraint in challenging environments. We hope that the toolkit we have recently developed will enable the learning to be spread across the UK and beyond.

“It’s an honour to be recognised alongside some other fantastic work in Mental Health and I’m looking forward to finding out the winner!”

Following their shortlist, the team will be travelling to London to present to the judges with the winners announced as part of the annual Patient Safety Congress which is being held in Manchester on the 4^th and 5^th July. 

We'd also like to congratulate the following members who also reached the awards shortlist:

• Blackpool Teaching Hospitals NHS Foundation Trust 
• Cheshire and Wirral Partnership NHS Foundation Trust 
• East Lancashire Hospitals NHS Trust 
• Lancashire Care NHS Foundation Trust 
• Lancashire Teaching Hospitals NHS Foundation Trust 
• Liverpool Community Health NHS Trust 
• Liverpool Heart and Chest NHS Foundation Trust 
• Mersey Care NHS Foundation Trust 
• NHS East Lancashire CCG 
• Salford Royal NHS Foundation Trust 
• St Helens and Knowsley Teaching Hospitals NHS Trust 
• Stockport NHS Foundation Trust 
• The Christie Hospital NHS Foundation Trust 
• University Hospitals of Morecambe Bay NHS Foundation Trust 
• Warrington and Halton NHS Foundation Trust 
• Wrightington, Wigan and Leigh NHS Foundation Trust

Useful Links:

Blog by Paul Greenwood on the work of the programme

RestraintReduction Toolkit

Blog - Smoothing the Flow - David Fillingham

In his latest blog, AQuA Chief Executive David Fillingham shares his thoughts on adapting Lean thinking within health and social care, and how this can be supported through improving Whole System Flow.

AQuA Chief Executive,
David Fillingham CBE

Having had six years seeking to introduce Toyota thinking (where the Lean methodology was created) into healthcare at Bolton Hospital, and another six seeking to apply it more widely through AQuA, I've come to believe that it is definitely a case of needing to adapt not just adopt.

Many attempts to use lean in healthcare have floundered because people have a mental model of hospitals as factories, and therefore of patients as the raw material on a production line. And we both know, this cannot be the case...healthcare is the ultimate service industry.

Most of this work has concentrated just on hospitals and has failed to engage adequately with staff working in primary and community areas, in mental health or in social care. Many of the problems currently being experienced in A&E departments are a reflection of challenges outside of hospitals

What's worse, lean initiatives have all too often been about management consultants being employed to foist lean onto a resentful workforce.

In The Challenge and Potential of Whole System Flow, our joint paper with The Health Foundation, we seek to address this in a number of ways:

Defining the Value

Firstly, value (the aim of creating flow) needs to be defined by the customer not the provider. In healthcare this implies a huge shift towards shared decision making with patients, co-production, and asset based approaches to community development. Techniques such as experience based co-design are a valuable way of addressing this in quality improvement work.

Focusing on the Whole System

Secondly, we have emphasised the need to use all of the resources in a community, not just those of the hospital. We have also taken flow to be not solely about the flow of patients through a system (which risks detracting from a patient focused, care giving ethos) but also about the flow of staff, information and resources.

With increasing numbers of frail older people needing support to live independently, we expect there to be increased flows of those components out of hospital and into community settings.

Addressing ‘Failure Demand’

Thirdly, this helps address the lean concept of 'failure demand' which is much more relevant in service sectors than in manufacturing. Many of the patients who 'flow' into hospitals should never need to. The biggest waste in healthcare is avoidable ill health.

Engaging the Frontline

Finally, all of this needs to be done with the deep and genuine engagement of frontline workers across disciplines and across care sectors. What we need are improvement approaches that give them full ownership of designing and delivering new care systems where staff, information, resources and, where necessary patients, flow smoothly without waste, delay, frustration or harm.

Throughout 2016/17, AQuA, supported by The Health Foundation, have held a series of events exploring Whole System Flow in health and social care. For the latest updates, follow @AQuA_NHS or #WholeSystemFlow on Twitter.

AQuA and The Health Foundation Publish Joint Report on Whole System Flow

Click the image to download the report

The Advancing Quality Alliance (AQuA), in partnership with The Health Foundation, are pleased to announce the publication of a joint report on our work exploring Whole System Flow across health and social care systems.

The report, The Challenge and Potential of Whole System Flow: Improving flow across whole health and social care systems, was co-written by AQuA Chief Executive David Fillingham CBE and The Health Foundation’s Bryan Jones and Penny Pereira, and details key findings and research gained from the past 12 months of working on this new programme.

Speaking on its publication, David Fillingham said:

AQuA Chief Executive
David Fillingham

“Understanding and improving Whole System Flow should be a major priority, not just for colleagues working in the NHS, but also those across the wider health and social care landscape.

“Working on this new programme in partnership with The Health Foundation has been a fantastic opportunity. We’ve had a great response to our work so far, and this report is the product of the drive and commitment of our staff and of the many AQuA members and partners who have made such valuable contributions.

“Whilst its findings may not offer the ‘magic bullet’ to solving flow that some may seek, it does offers insights into how we can work together to tackle this complex challenge, and so secure better outcomes for patients.”

Penny Pereira, Deputy Director of Improvement at The Health Foundation, said

“At its heart, improving flow is about tackling the delays and duplication that are frustrating for all those in the health and care system. Getting flow right is critical to the delivery of new service models, improving quality of care and productivity. But it’s the impact it will have on the daily experiences of service users and staff that matters most.

“We need to look well beyond seeking just quick fixes for A&E. Extending work on flow to span whole health and social care economies takes time and investment. If every organisation in each health and social care economy were able and willing to work collaboratively to design services that optimise flow, it could lead to major improvements in patient and service user experience and outcomes, as well as improved productivity. It is for these reasons that flow should be a top priority."

The report also acknowledges the contributions of AQuA staff Wendy Lewis, Andrew Wilson and David Dixon for their work throughout the programme.

Since May, AQuA have held a series of events exploring different aspects of Flow with both our members across the North West, and wider partners working across health and social care.

Download the report in full here.

Wendy Lewis, AQuA’s Whole System Flow Programme Lead, also shared her thoughts on working on this programme in her recent blog, which you can read here.

For latest updates on the programme, follow us on Twitter @AQuA_NHS or via the hashtag #SystemFlow.

Blog - To Flow or Not To Flow

Wendy Lewis is the Whole System Flow Programme Lead for the Advancing Quality Alliance (AQuA), and you can follow her on Twitter @ERPwend. Here she shares her thoughts on the current state of play behind Flow, and some things she has discovered throughout AQuA’s journey in understanding this complex issue.

Wendy Lewis, Whole System Flow
Programme Lead

Our Chief Executive David Fillingham recently led a webinar for the UK Improvement Alliance (UKIA) on the subject of Whole System Flow; a subject that we at AQuA have been working quite intensely on with The Health Foundation over the past 12 months.

Having had the opportunity to work on our Flow discovery programme for the past year, I used the webinar to reflect on some of our learning to date. Some of the discussion and questions generated also really helped me to crystallise some key points that the improvement community may want to consider and contribute to.

Our thinking has led me to these main points:

We Still Rarely Talk About Whole Systems

Language is so important when considering flow. By using the title of whole system flow but then describing a patient pathway or service level improvements as the examples, we are pulling the opportunity for learning and line of sight below the system level. This is perfectly understandable, as this is where our energy, effort and money has been spent in trying to ‘fix flow’ through our NHS services.

Throughout our conversations and local discussions about this work, we’ve used the phrase “from a patient’s front door and back again” to loosely describe the system. However, we developed this definition:

The coordination of all resources across a locality to deliver effective, 

efficient, person-centred care, in the right setting, at the right time.

What we have found really important, is that the participants can describe the system they are applying this thinking to and be clear of its boundaries. If the focus for improvement is on an acute hospital pathway or a community based service - describe it as such. Our role as improvement experts is to then support and also challenge that work, and highlight the opportunities for applying whole system thinking.

We Rarely Talk To Whole Systems

Through AQuA’s programme this year, we’ve had the opportunity to work with both a wide variety of our members, as well as partners across health and social care, and asked them to define the current enablers and barriers to flow. The overwhelming response from our first co-design event was “We need the system in the room to talk about it and improve it!” Quite right too! This is a fair challenge and one that we have made efforts to address, but it does remain an issue.

How do NHS soaked improvement organisations engage with system partners from local authority, community groups and charities? When we have new partners in the room but the examples we describe are health-based (and usually centred on acute hospitals); this really doesn’t foster engagement and shared understanding.

We call it Patient Flow!

ARGGGGHHHHHHHHHHH! If only patients did flow as they would want to, and actually as we frequently promise, then they would flow through our pathways!

I’ve become increasingly aware of the language used about the recipients of our services, our patients, our customers within this work on flow. Bed blockers, delayers, usual suspects, frequent flyers… commonplace in our language as well as in the media. How should we lead the change in language that demonstrates respect and outdated, non-paternalistic, approaches to care provision?

Through our work this year we’ve described four elements that have to be understood alongside each other, in order to understand flow through our systems and how we might improve it:

• Patients 
• Workforce 
• Information 
• Finances 

And again, like with not having the system in the room to generate the right level of discussion, by not paying attention to these four elements in parallel throughout flow work, we run the risk of re-shaping a problem, rather than clearly defining and understanding it.

Reality check

The systems and services that we hold dear are under extreme pressure, with improvement priorities coming out of their ears. Where does a new improvement offer add value, not distract from mandated priorities, and support real transformation when capacity to even think about it is occupied? Applying new thinking to a highly reactive and defensive system -a challenge or unhelpful task?

In improvement we teach “go where the energy is”. I think in reality we in the NHS are seeking to fix what’s hurting us the most right now: A&E waits, delayed transfers of care, financial compliance, to name a few. Going where the energy is for improving the system is not the same as following the energy currently being spent on these pernicious problems. How do we support both? How do we create the head space for applying different and new thinking?

We also need to acknowledge how colleagues in our own improvement communities feel about flow. A lot of us have been involved in a whole range of these over recent times; some with support and drive from national structures, and others from local or regional initiatives.

Our differing levels of success and/or sustainability create a new issue; there is frustration, scepticism and even cynicism about creating another offer around improving whole system flow within 'Us Improvers.' However, there are sources of energy and support outside the NHS that could really help us refresh and reframe our thinking.

So – how do we respond to these points? How should we act on them? If we focus for another year on whole system flow - where will we get to?

AQuA Chief Executive David Fillingham CBE, alongside colleagues from The Health Foundation, will shortly be publishing a joint report on Whole System Flow. For more information, please visit the AQuA website or follow @AQuA_NHS on Twitter.

Blog - The Challenge and Potential of Improving Whole System Flow Across Health and Social Care

AQuA Chief Executive,
David Fillingham

In his latest blog, AQuA Chief Executive David Fillingham shares why he thinks a focus on improving Whole System Flow could offer solutions to major challenges currently facing the NHS,

This is ahead of a forthcoming report alongside The Health Foundation, looking at the challenges and potential of flow in the health and social care sector.

What does whole system flow within health care mean?

Anyone who’s been a patient, or had an elderly relative go through the health care system, will know what a lack of flow looks like: frustrating delays and wasted resources. Sometimes patients and families can feel like they are the only people pulling the different parts of the system together. That absence of a smooth effective flow of patients, information, resources and staff has big knock on implications for patient experience, but also for safety, outcomes, and productivity.

There have been many attempts to improve flow, but projects have tended to focus on only one part of the system and usually on hospitals, particularly emergency departments. When we talk about ‘whole system flow’ we mean something broader. We need to start looking at what’s going on in other parts of the health and social care system, and to improve things using all the resources in a community. It’s a much bigger challenge.

How can focusing on whole system flow help with improving care quality and reducing costs?

At the moment people in England are busy working on their Sustainability and Transformation Plans (STPs) and developing new models of care. But none of this will deliver results unless we find a way to move patients and resources around the system in a more effective way. I feel really strongly that tackling whole system flow provides the underlying principles for developing new models of care more effectively.

There are three huge benefits to improving flow:

1. Patients get a better experience and outcome. If an older person with a number of long-term conditions can’t get to see their GP, they may deteriorate and need to be taken to A&E. Before you know it they've spent hours waiting to be admitted, and then they’re in hospital weeks or months longer than necessary because they can’t get discharged. That’s a very poor experience.
2. High-quality care is delivered using fewer resources. Had we got the right intervention in place at home much earlier for that person they would never have been in hospital in the first place. This is often called failure demand, which represents a big part of the pressures on our services, as we explore in the report (to be launched soon).
3. Better flow leads to happier staff. Patients aren't the only ones who feel frustrated by bits of the system not joining up properly, it really impacts on staff as well.

How does change happen in complex systems and how can improving flow help?

We've found there are a number of quite hard-edged things we need to do to get systems to work together effectively, including developing supportive financial incentives, information systems and service design. But there are also ‘softer’ things around leadership, culture and relationships which are absolutely crucial.

Some of the Health Foundation’s work through their Flow Cost Quality programme in Sheffield really helped us learn about how you can engage frontline staff in improving flow, and they got some great results.

The Wigan Deal is also particularly interesting. Wigan Council led a programme to reform care and wellbeing services. Appreciating that they were dealing with a complex system, they invested in training large numbers of staff in the principles of the deal, giving them permission to think differently and work in a different way with local residents. They’ve now developed a number of new care and support packages in the community that are more person-centred, much less expensive, and better meet residents’ needs. This has helped them identify over £8m in permanent revenue savings so far.

Wigan has now created an integrated care partnership organisation, bringing health and social care providers together. It’s definitely an area to watch.

The NHS in Scotland and Wales are also looking at improving whole system flow, so it’s been great to work with colleagues from across the border on this. Find out more in our forthcoming report, which will include case studies on their work, as well as examples from further afield.

Where should people start if they want to improve whole system flow?

People often just think about the patient journey. This is the right place to start, but on its own it doesn’t show a full picture. You also need to think about how the people working in each of the services along that patient journey will be equipped with the skills and support to bring about improvements. And if you want to have a wide and sustained impact you have to work at system level too. That’s about engaging senior leaders, so they understand how parts of the system need to work together and can tackle the big barriers they have the power to influence.

In our report we will set out a model for whole system flow, which shows that we need to be taking action on four different levels:

• Patient
• Frontline team
• Local health and social care economy
• The national system

Is current national policy supportive of improved whole system flow?

In England, we’re seeing a very healthy direction of travel on this through things like the sustainability and transformation planning framework, and the new single oversight framework from NHS Improvement and CQC. It’s all encouraging a more integrated system.

I have two big worries though. 

Firstly, the basic funding shortfall in the NHS, which is enormous. People are spending so much time firefighting. The second thing is social care funding, because while there is a squeeze on the NHS, it’s been much tighter for longer on local authorities. Social care can’t play their part if the money just isn’t there.

This sort of whole system transformation takes time. Is there enough patience around for this kind of approach, bearing in mind the NHS’s current financial situation and other big challenges?

Changing senior leadership is often seen as the solution in places with large deficits and big performance problems. That makes whole system transformation hard, as it disrupts relationships within the local community, and new leaders will naturally focus on quick fixes.

However, I am a relentless optimist. Places like Wigan, that have been allowed to build a constancy of purpose and consistency of leadership over a longer period of time, are really starting to prove that agencies can work together effectively with impactful results. Their results show that a two year timescale is long enough to start to demonstrate initial results.

What we need to do is drive that forward, and help people demonstrate their success. This will then become a model for work in other parts of the health and social care system.

This blog was originally published on The Health Foundation website. For the latest updates and activity on Whole System Flow, please follow #WholeSystemFlow on Twitter.

AQuA Staff Latest to Join the Health Foundation Q Community

Advancing Quality Alliance (AQuA) staff are among the latest to join an exciting new community from The Health Foundation, designed to support continuous improvements in the quality of care for patients.

From left - AQuA staff Emma Walker, Amanda Huddleston, Liz Kanwar & Elizabeth Bradbury

Elizabeth Bradbury, Emma Walker, Amanda Huddleston, and Liz Kanwar were recently invited to join the Q Community, which brings together improvement practitioners from across healthcare management, commissioning, research and policy, to share ideas, skills and collaborate on improvement projects.

Speaking of the announcement, AQuA Chief Executive David Fillingham said:

“I’m delighted to see my colleagues join the Q community, alongside our Safety and Mortality Lead Andrea McGuinness, who was among the founding members.

“This is a real testament to their knowledge and experience in improving the health and quality of care, not just with our members in the North West, but also with our partners across the country and beyond.

“AQuA work closely with The Health Foundation across a number of initiatives, and I look forward to seeing our staff work alongside some of the leading individuals from across the health and social care landscape.”

Amanda Huddleston, Quality Improvement Lead for Safety & Mortality, said:

“Being invited by The Health Foundation to join the Q community is a real privilege. This is a great initiative to help grow and invest in quality improvement skills and expertise, and I’m looking forward to working with so many talented colleagues from across health and social care.”

Q is also supported by NHS Improvement, which was established in April to oversee and support NHS Trusts across England.

Staff join a community of 261 improvement experts from across the UK, and The Health Foundation hope to grow this number with further opportunities over the course of the next 12 months.

For more information about Q, please visit The Health Foundation website, or follow updates on Twitter @theQcommunity.

AQuA Welcomes Delegates to First Event on Whole System Flow

Last week we welcomed over 80 delegates for an exciting first look into Whole System Flow, as part a new programme of work between AQuA and The Health Foundation.

Delegates join us at the Samlesbury Hotel, Preston for our first event on Whole System Flow.

Colleagues from both AQuA member organisations and wider afield joined us at the Samlesbury Hotel, Preston to learn about our latest developments around this work.

At the event, our Chief Executive David Fillingham discussed the need and context behind developing this new offer, and how we hope to take it forward over the coming year.

Speaking after the event, he said “As this new piece of work begins to gather pace, it was fantastic to see so many of our members and colleagues from across health and social care join us to hear how we hope to take this forward.

We know that solving the complex issues behind Whole System Flow will require a joined-up approach across different organisations, services and staff, and we’re really grateful such a positive input from delegates to help shape our next phase of work over the coming months.”

Whole System Flow describes the coordination of all resources across a locality to deliver effective, efficient, person-centred care, in the right setting, at the right time.

Also referred to as Patient Flow, it is considered a priority for the NHS if we are to understand and solve the complex issues behind delays in services, and make efficient use of staff, services, equipment and information.

Throughout the day Wendy Lewis, our Programme Lead for Whole System Flow, also led a number of workshops and activities with delegates; reflecting on the benefits behind system thinking and exploring how organisations might better work together to understand systems of care and design innovative solutions.

We were also joined by Christine Owen from the Improvement Hub at Healthcare Improvement Scotland, who gave an overview of their work on Flow in Scotland, as well as Bryan Jones of The Health Foundation.

In September, The Health Foundation will be publishing a paper on David’s initial findings on Whole System Flow. We will also be discussing this further at a second event to be held in October, with further details to follow in the comings weeks.

Below you can find a collection of tweets throughout the day:

Exploring Whole System Flow event - 5 July

As part of an exciting new programme with The Health Foundation, we'll be hosting our very first event exploring Whole System Flow, 9:00am - 3:30pm on  5 July at the Samlesbury Hotel, near Preston.

Whole System Flow describes the coordination of all resources across a locality to deliver effective, efficient, person-centred care, in the right setting, at the right time.

Also referred to as Patient Flow, solving complex issues behind bottlenecks and delays in services is seen as a national priority for the NHS, if we are are to make efficient use of staff, services, equipment and information.

At the event, we'll be sharing our latest learning and developments on our work so far, and exploring some of the benefits of improved system thinking on safety, outcomes, productivity and experience as part of a whole system community.

We'll also be working with members to better understand the complexities behind their different systems of care, as well as looking at some of the key issues affecting flow and how we might work together on innovative solutions to these.

This event ideal for system leaders, senior decision makers, finance directors and informatics leads.

Please download the event flyer for further information, or book your place here.

If you have any queries about the event or would like to find out more, please email AQuA@srft.nhs.uk, or call 0161 206 8938.