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Improving patient care means changing how we work so that we treat more patients sooner, working more closely with GP practices and using new technology so that patients can get hospital services closer to home.
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COVID has resulted in us having a problem with getting patients through surgery. The number of patients we can do in a day is a lot smaller, and that just means we're getting longer waiting lists and it's terrible for us and it's terrible, especially for the patients.
00:00:29:17 - 00:00:46:14
So my patients having to wait longer for elective surgery due to COVID. We're looking at different ways of working in order to tackle this problem. So we're looking at increasing our 23 hour pathway through the main day surgery and at Addenbrooke's looking at different pathways that would have required inpatient bed and up to a three day stay pre-COVID.
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We are looking at Ely and whether we can put more surgery through Ely and we're looking at weekend working and trying to do more surgeries on the weekends. Some of the changes are small, but some are much bigger, like the dedicated theater that's been built for hip and knee surgery.
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So with all these new ideas, these new procedures and new ways of working, we're getting more people through. We get more people off the waiting list and home, ready to carry on with their lives.
00:01:11:18 - 00:01:28:09
Dr Wright, who is a GP at Granta, myself and others have come together to create a virtual neurology meeting. The advantage of this meeting is that it allows us to discuss cases from around the region and we don't all have to be in the same place to do so.
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Introducing Dr Gunawardana into Ward and into primary care has allowed us to provide a much more seamless service with the patients. We get them seen by the right person in the right place at the right time. They get investigations done much faster, often with discussions with people they feel comfortable with in a setting they feel more comfortable with.
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This improves the engagement between both primary and secondary care as well.
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Cytosponge was developed by a team in Cambridge, and it's finally being introduced into clinical practice, which we're very proud of. The cytosponge is really simply a pin on a string which patients can swallow the glass of water. It goes down into the stomach. The gelatin capsule dissolves, releases the sponge, and then we gently pop up our collecting cells all along the esophagus.
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These cells can then be looked at to see whether they need further care or further investigations. So we're working with Primary Care, CCG, Clinical Research Nurses and Heartburn and Cancer UK in order to bring this to patients in the community so that they don't have to go into hospital to access this test.
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We're also setting up virtual wards in the community so the patients get expert care in their own homes, after leaving hospital.
00:02:37:21 - 00:02:52:04
One of the benefits of integrating care is that it reduces unnecessary visits to hospital and thereby saves patients time. The other major plus is that by working together as a team we really develop and strengthen this relationship between primary and secondary care.
We will work with NHS, other public sector and voluntary sector organisations to improve the health of our local population
We are proud to be part of a diverse system of health and care partners dedicated to serving our local population in the South of Cambridgeshire: GPs, community NHS teams, social care workers, public health professionals, care providers, local government, patient groups and many voluntary sector organisations.
We want all our patients to live long and healthy lives. Good health helps people to thrive at home, at work and in their community. However, our population is ageing and living for longer in poor health. Health and care services should work together to help patients stay well and spot early signs of ill health, and hospitals like CUH have a responsibility to work with others to address the wider determinants of ill health: poverty, loneliness, debt and poor housing, health risk factors such as smoking and obesity, as well as long-term health conditions. By working in this way, the NHS can support patients to thrive in their normal life, rather than simply restoring people to health when they are sick.
Each year, one out of one hundred and fifty people in our local population has an emergency admission to hospital for a potentially avoidable exacerbation of a long-term condition such as asthma. Additionally, many outpatient appointments currently performed at the hospital could be undertaken closer to home, as part of an integrated team in the community. By improving the health and well-being of our population we reduce the need for unplanned hospital care, which means we can care for more patients requiring treatment that can only be provided in a hospital.
By 2025 we want to:
- Improve the health of our local population by integrating pathways across primary, community, secondary and social care alongside the voluntary sector and local government
- Reduce unnecessary hospitalisations by supporting more patients at home during a health crisis, and enabling patients in hospital to return home as soon as they are able
- Increase the value of every pound spent to maximise the health and well-being of our population, with an increasing share of resources used to support patients outside the hospital
- Deepen trust and relationships with partners in other organisations so that we work together with energy and purpose to achieve our shared outcomes for those we serve
We will achieve this by:
- Hosting the South Place partnership of health and social care providers, local government, voluntary sector organisations and partners that will enable us to work even closer to make collective decisions, co-designed with patients, and use a shared budget to improve population health and health outcomes, share learning, expertise and resources and commission services to provide better integrated local services
- Supporting the South Place to nurture ‘integrated neighbourhoods’ that add more of our staff to single teams based around local Primary Care Networks and use data to target services where they are needed most
- Supporting the South Place to lead key operational priorities at the interface of secondary, primary, community, voluntary and social care such as admission avoidance and hospital discharge
- Implementing a change programme within CUH to ensure all of our services focus on proactively improving the health of our population and making the best use of collective resources, alongside treating patients who are currently in the hospital
- Embedding integrated care through other elements of our strategy, including our new builds and digital transformation
When patients come to the hospital in an emergency we will treat them, and help them to return home, quickly.
Acute health emergencies are extremely scary for patients and their loved ones. Quick access to highly trained clinical teams and the right equipment can be the difference between life and death, and gives patients the best chance of recovery.
Major trauma is the leading cause of death for people under 40, and CUH is the Major Trauma Centre for the East of England, providing surgery, critical care, inpatient, rehabilitation and discharge services to some of the sickest patients in our region.
We are seeing the highest ever activity in our Emergency Department (ED) from our growing, ageing and increasingly multi-morbid population. Patients requiring admissions are waiting much longer because we have fewer beds available, which also leads to crowding and delays in offloading ambulances. Patients who wait the longest are often experiencing mental ill-health crisis, and we have many frequent attenders with very complex needs.
In this context we are working closely with other partners in the urgent care pathway to improve services.
By 2025 we want to:
- Reduce the proportion of patients needing to access emergency care, particularly at hospital
- Reduce crowding in the ED to ensure patients are treated, and staff are able to work, in a calm environment
- Reduce journey times through the ED to ensure patients move on to the most appropriate setting as quickly as possible
- Reduce waiting times for patients requiring admission to leave the ED and reach an appropriate inpatient bed
- Reduce excess length-of-stay for emergency admissions to ensure patients return home as soon as they are able
- Reduce ambulance handover delays to ensure the next acutely unwell patients in the community get quick access to expert clinical care
- Reduce avoidable harm in emergency pathways and increase the quality, safety and experience of patients in these services
- Ensure equitable access to high quality emergency care for all patients
We will achieve this by:
- Working more closely with primary, community and social care partners to improve population health and reduce the need for unplanned hospital care
- Streaming more patients away from the ED through different channels such as urgent community response, video appointments and NHS 111; and to quieter times of day by expanding same-day emergency care (SDEC) and bookable appointments
- Improving flow by embedding a front door frailty model to support patients most at risk, reclaiming assessment units, and maximising use of SDEC
- Modelling admissions and discharges by speciality and ward to optimise bed capacity planning
- Creating more capacity within the ED through use of temporary structures, repurposing adjacent capacity within the hospital and implementing plans rapidly to increase flow including by reverse boarding
- Improving inpatient flow and creating additional community capacity with partners in primary, community and social care
When patients need planned care we will see them as quickly and efficiently as possible.
Quick access to planned outpatient, diagnostic and surgical care gives patients the best chance to recover from ill-health. During the pandemic waiting times for these treatments increased considerably as our capacity to treat patients was reduced. Many of our patients travel significant distances for specialised treatments that can only be provided at CUH within our region or across the country, and so ensuring we have enough capacity to treat patients as soon as possible is of paramount importance.
Advances in clinical practice, new technology and different ways of working with partners mean our services are continuously evolving to deliver the best care for patients. Over the coming years this will mean working differently to ensure we can treat as many patients as efficiently and effectively as possible, increasing capacity and productivity by helping frontline teams to identify and implement improvements to care.
Access to planned hospital care is lower among the most deprived patients, which contributes significantly to stark inequalities in life expectancy and healthy life expectancy within our local population and across the East of England. We want everyone to have equitable access to our services and recognise our responsibility to work alongside patients and partners to achieve this.
By 2025 we want to:
- Increase resilience of elective capacity to withstand future Covid surges, winter pressures and other shocks
- Achieve outstanding outcomes and experience for patients, and best-in-class productivity and efficiency across all our pathways, informed by national Getting It Right First Time (GIRFT) best practice standards
- Reduce inequalities in access, outcomes and experience within our population
- Achieve national ambitions on access to care including first, follow-up and virtual outpatients plus enhanced advice and guidance, 52-78-104-week waiters, 28-day faster diagnosis standard, and 31-day decision to treatment for cancer patients
We will achieve this by:
- Increasing surgical capacity through use of new P2 and Q2 facilities on the Cambridge Biomedical Campus (CBC) as an elective surgical centre, and off-site diagnostic capacity including mobile scanners in the community
- Changing the setting of care, such as conducting more activity in primary care, off-site capacity or at smaller or independent sector hospitals; and the channel of care, such as through virtual appointments
- Using digital technology to raise productivity through remote monitoring, voice recognition and asynchronous communication through MyChart and Secure Chat
- Ensuring patients can return home more quickly and live more independently by promoting rehabilitation, utilising remote technology-enabled care, creating virtual wards and integrated pathways across organisations
- Changing pathways to reduce unnecessary referrals, such as through integration of specialist services into primary care, use of shared decision-making and advice and guidance
- Maintaining transparent clinical prioritisation processes to ensure the sickest patients are treated first and that harm to patients while waiting is minimised
- Reviewing data on access rates and waiting times between different patient groups and acting decisively where inequalities are identified
We will tackle disparity in health outcomes, access to care and experience between patient groups.
Every patient is a unique and equally valued individual. We recognise and value the diversity of all our patients and strive for every patient to have equitable access to our services so that they can live healthier and more fulfilled lives. Age, disability, gender reassignment, race, religion or belief, sex, and sexual orientation have a significant impact on people’s health; and, despite our aspirations for equity, significant and long-standing disparities in the actual experience of patients in our communities and in hospital remain, and in some cases are growing.
Deprivation and geography also play a significant role in excess mortality and morbidity of our population, with the poorest areas having higher rates of health risk factors, fewer GPs and lower rates of access to planned care.
For example, the life expectancy of traveller communities is approximately 10 to 12 years less than non-traveller populations.
Tackling these inequalities is a growing focus across the NHS, with the Government’s focus on ‘levelling up’ across the country; the NHS’s ‘Core20PLUS5’ framework targeting the most deprived fifth of the population and the five biggest service areas to address inequalities (maternity, severe mental illness, respiratory, cancer and hypertension); increasing focus on racial disparities including through the formation of the NHS Race & Health Observatory and many other initiatives. We are committed to playing our role, and working with others, to ensure every patient receives the safe, kind and excellent care that we aspire to. We achieve this directly through our clinical services, and indirectly as an ‘anchor institution’ that employs people, purchases goods and services, owns assets, advocates for causes and works with partners.
Other commitments in the strategy also present opportunities to tackle inequalities for patients, inequalities for staff, targeting care to the neediest patients, improving air quality and many others.
By 2025 we want to:
- Reduce the gap in avoidable mortality and morbidity between different population groups in our local and regional population
- Reduce the gap in access to and experience of care at CUH between different population groups
- Maximise the positive impact of our core activities to address the wider determinants of health as an ‘anchor institution’
We will achieve this by:
- Increasing data completeness and using data to identify and understand disparities in outcomes, access and experience, including using the Equality Delivery System Tool (EDS2) to assess our performance
- Collaborating with staff and partners with lived experience to improve our services including through staff networks, partners in our ICS, Healthwatch and other patient engagement groups
- Playing our role in the five Core20PLUS5 priorities
- Identifying opportunities to address inequalities at each stage of planned care pathways, and working with partners to improve models of care to address these inequalities locally
- Maximising the wider impacts of our core activities to improve the health of our population as an employer, partner, asset-holder and purchaser
- Working with a range of organisations to build inclusive leadership capability
Quality, safety and improvement
We will continuously improve the safety, quality and experience of all our services
As one of our values, safety is a core priority at CUH. Hospitals provide care for people at a time when they are vulnerable and many clinical interventions carry risk.
During the pandemic protecting patients from a highly infectious virus was one of our overriding priorities, and CUH had among the best outcomes for Covid patients, and the lowest rates of in-hospital transmission, in the NHS. We also introduced innovative ways of working to sustain the quality and safety of services during ongoing and unprecedented disruption, but the increase in waiting times across our pathways brings many challenges for quality and safety.
We strive to create a culture accompanied by robust processes that sustainably and continuously improve the quality of services that we provide, investing in improvement capability in leaders and teams, listening to patients and staff, identifying and learning from errors, and sharing good practice.
By 2025 we want to:
- Continue providing consistently high-quality care to all patients in line with our values, plus CQC and other professional standards
- Continue to learn from safety incidents and promote a process of transparency and learning
- Embed a culture of sustainable continuous improvement where staff are empowered and equipped to lead change
- Create a just culture environment for learning
- Achieve a CQC rating of Outstanding
We will achieve this by:
- Embedding accreditation, safety huddles and quality board reports in all wards and departments
- Implementing the new NHS Patient Safety Strategy including the Patient Safety Incident Response Framework and Patient Safety Partners
- Managing corporate quality processes such as harm reviews, clinical prioritisation and surgical prioritisation groups to prioritise care for patients in greatest need
- Implementing Digital Consent to support a consistent and safe consenting process
- Actively seeking feedback from patients and their loved ones through our Patient Engagement Group, survey data, Patient Advice and Liaison Service (PALS) and other engagement channels
- Refreshing the CUH Mental Health Strategy in line with ICS plans
- Creating a just culture of psychological safety, encouraging reporting of incidents and errors without fear with a focus on learning and improvement
- Evolving the ‘Learning from Deaths’ process to identify further improvements to quality and safety
- Embedding After Actions Reviews as an approach to learning
- Investing in leadership training for clinical and non-clinical staff
- Training staff in improvement techniques, supported by the Institute for Healthcare Improvement (IHI)
- Delivering improvement projects across the hospital, supported by the improvement team, or by teams utilising those techniques directly
- Building capacity in divisions to give staff the time, resources and skills required to focus on improvement
- Celebrating and sharing best practice improvements