Transformation Unit

Healthier Lancashire and South Cumbria Integrated Care System

Developing a Clinical Redesign Approach

The client

The Lancashire and South Cumbria Integrated Care System (ICS) has set out a vision to deliver improvements across its footprint with the clear aim to reduce variation, improve quality, and create sustainable services. It covers a large geographical area featuring four acute trusts (made up of ten hospitals), a large mental health and community trust and eight CCGs.

The challenge

The L&SC region is beset by pockets of significant public health issues. Much of this can be attributed to avoidable long-term health conditions brought about by high smoking prevalence, alcohol intake and poor lifestyle and diet choices. However, figures also highlight other issues such as poor cancer survivorship and health problems in children.[1]

In 2016 it was calculated that without action existing gaps in funding will worsen significantly and reach £572m by 2020/21. The Carter Review[2] and RightCare Commissioning for Value[3] reports identified £294m worth of potential efficiencies around the same time.

In response to the challenge, L&SC ICS designed a Strategic Framework with 12 refreshed programme areas within three overarching categories: Strategic Portfolios; Clinical Change Portfolios; or Enabling Portfolios. Within the Clinical Change Portfolio, six priority workstreams were included within the Acute & Specialised Programme.

The six workstreams were Stroke, Urology, Vascular, Head and Neck, Diagnostics and Paediatric HDU. They were at various stages of maturity and the evidence underpinning their selection as priorities was inconsistent.

We were commissioned to develop a Clinical Redesign Approach to define a consistent methodology for the six workstreams that would lead to an objectively co-designed set of deliverables in each case and a clear governance process for project leads to follow.

Our approach

Each of the six workstreams had a project lead in place with a programme management team overseeing their activities. The TU spent time with each of these leads to get an informed view of why each workstream had been selected as a priority; what progress had been made; whether the workstream was being clinically led; what governance process they were following; what timeline they were working to. This information was used to design a bespoke methodology for the Acute & Specialised Programme that would ensure consistency and transparency across the workstreams – leaving them less open to challenge at the point of implementation.

The outcome

The TU delivered a Clinical Redesign Approach on time and within budget.  This provided L&SC ICS with a methodology for implementing their portfolio of work that suited their existing framework. The key features of the paper included:

  • A set of consistent deliverables for the Scoping and Design phases of work.
  • Advice on NHS England assurance criteria for any major service change.
  • Descriptions and templates for each of the recommended deliverables.
  • A consistent and transparent framework for appointing a Professional Lead to lead each workstream.
  • Description of the Clinical Professional Lead role
  • A framework for wider clinical and patient engagement.
  • A proposed governance process to review and endorse / challenge clinical deliverables with appropriate hurdle criteria.

On review L&SC accepted the approach described not just for their Acute & Specialised Programme but for all of their Clinical Change Portfolio.

‘Working with the TU provided access for us to a range of skills and views that allowed us to work in partnership to shape and deliver a necessary business process to help govern and coordinate our work. TU colleagues were receptive to our feedback and queries and open to debate and challenge in order to ensure the work outputs fully met our needs.  Work was delivered on time and regular updates on progress were provided.  I would not hesitate to access their skills and resources again.’

Talib Yaseen O.B.E, Director of Transformation, Healthier Lancashire and South Cumbria

[1] Healthier Lancashire and South Cumbria. Sustainability and Transformation Plan 2016/17-2020/21 Draft (v7.7 Oct 2016).
[2] Department of Health and Social Care. Productivity in NHS hospitals. (Feb 2016).
[3] NHS RightCare. Commissioning for Value – Where to Look Pack: Lancashire and South Cumbria – STP area. (Dec 2016).