Dr Des Breen
Working Together Partnership Vanguard
- What does being a vanguard mean to you?
Working Together was already an established collaboration before we became a vanguard. We wanted to become a vanguard for the opportunity to share our learning and learn from other collaborations which may be facing the same issues or challenges. A central sense-check on what we are doing and whether it is a useful model that can be adopted across the NHS is also invaluable. We hope that we are contributing valuable insight, particularly as we are the only vanguard working across multiple Trusts looking at routine clinical and non-clinical services.
- What problem did you want to solve?
At the start of the process we had seven sovereign organisations who each had their own internal problems and ideas for solutions. The objectives of the Working Together Partnership Vanguard are to work together and strengthen each of the seven Hospital Trusts by sharing collective expertise and knowledge to:
- Improve quality, safety and the patient experience
- Deliver safe and sustainable new models of care
- Make collective efficiencies where the potential exists
- How did you go about it?
Prior to becoming a vanguard the seven Trust Chief Executives and Medical Directors had already committed to working together. A Programme Management Office was established in 2014. Once the infrastructure and governance were in place it was quickly possible to identify services that could have future vulnerabilities, and a list of clinical and non-clinical services where collaboration would be beneficial were confirmed.
- In practical terms what difference have you noticed and has the way you work on a day-to-day basis changed at all?
There have been early successes in non-clinical services, such as saving over £1m by working together on procurement, and in the roll out of a number of inter-trust IT systems that have enabled us all to work together across the Trusts much more efficiently. For clinical services we have established Managed Clinical Networks (MCNs) for each of the specialties we are looking at and some of these MCNs are now starting to see real changes to the way we work and service delivery. As an example we have enabled the Out Of Hours rota for Ear, Nose & Throat (ENT) services to be maintained across more than one Trust, rather than each of the seven Trusts all having their own rota that they need to fill.
- What has the reaction and what has the level of staff engagement been like?
There is a definite sense of collaboration amongst the Chief Execs, Chairs and Medical Directors. Also each Clinical project has good clinical representation from across the partner Trusts and this has crucially allowed us to engage clinicians in the development of services. I won’t pretend it hasn’t been challenging at times however most people understand the need for change and exploration of different models of delivery.
- How would you explain the way your new care model works to members of the local community?
Our model is about breaking down organisational boundaries. We are trying to deliver a local service as much as possible but working together to re-organise the delivery of that service if it is vulnerable in the longer term. In our model, each clinical project has a unique solution to itself as we recognise that one size does not fit all.
- What is already having or what is going to have the greatest impact and value for patients as a result?
We are a very unique vanguard in that we are looking at transformation in what might be considered ‘standard’ services rather than specialist. By working together we aim to improve the quality, safety, sustainability and resilience of local services. Everything we do should impact patients but often the patient won’t know that we’ve been involved and made that difference because it’s been about us making a small change in the background to increase that services’ resilience.
- Can you tell me what your most satisfying day at work has been since becoming a vanguard?
One of the most significant aspects of the vanguard development has been getting the governance structure right to allow the right decisions to be made for the whole footprint whilst recognising the fact that we are still seven individual organisations. When the seven Trust Boards approved moving from a federated approach to a Committees in Common approach it was satisfying because for me it was the biggest signal yet that the long-term commitment is there to truly work together, collaborate and for some services integrate further.
- What do you think has been the most difficult challenge or barrier to overcome?
At the start of the process we had seven sovereign organisations who each had their own internal problems and ideas for solutions. One of the biggest challenges was to change that mind-set to one of collaboration whereby one institution’s problem is the whole footprint’s issue. Once that mind-set was changed it allowed free-thinking about delivering care differently.
- Vanguards are leading on developing new care models that will act as blueprints for the future of the health and care system in England. What advice would you give to anyone looking to adopt your new care model?
My biggest piece of advice would be don’t overlook the local context when applying a new model. We have a number of models of delivery across our vanguard, each tailored to meet the requirements of the service it is delivering. The principle of our approach, in terms of collaborating and creating networks, can be applied across the board, however any model might need alteration within its own context.
- How are you sharing learning?
We are sharing our learning using a range of different approaches. We have presented our work in procurement widely, which has led to wide adoption elsewhere already. We present at national meetings, enter national awards. We work closely with our commissioners. More recently our presentation sphere has grown to include sharing our learning with more STPs.
- What do you think your vanguard and the service it delivers will look like in 12 months’ time?
I would expect to see each of the workstreams having progressed further down the journey towards even greater collaboration.
- From your work so far, what’s your one top tip (or learning) that you could share right now with us that we could learn from and implement within our work areas?
Whilst you have to have senior executive buy-in, clinical engagement and leadership, and good communications are also essential. Where we have done this well we have made the journey considerably easier.