NHS IMPROVEMENT – COVER SHEET
This form should be used to capture ALL resources created or authorised by NHS Improvement
to store or use across health care services and/or patient care pathways.
Organisation Liverpool & Sefton PCT
Lead contact Sue McGorry
Date form completed 29th November 2011
Key Improvement Domains (please select as appropriate to the resource)
Quality and Outcomes
Clinical Effectiveness Preventing people Enhancing quality of life
dying prematurely for people with LTC
Helping people recover Positive experience Treating & caring in a safe
from episodes of ill heath of care environment and protect them
or following injury from avoidable harm
Financial efficiencies \ Savings \ Productivity
Cash releasing Non cash Releasing waste reduction or removal
Pathway (please select as appropriate to the case study)
Primary Care Referral Diagnosis Treatment
After Care End of life care Social Care Third sector
Planned Care Unplanned Care Secondary Care Tertiary Care
Other – please specify
NHS IMPROVEMENT CASE STUDY TEMPLATE
1. Title (please provide a title that describes your good practice example
Commissioning a redesigned Cardiac Rehabilitation programme for Liverpool & Sefton.
Please give a clear, concise summary that describes your good practice example in no more than 100
words. This should include key learning points, benefits and recommendations
Liverpool & Sefton PCTs are committed to re-designing the current Cardiac Rehabilitation
Service working with existing providers and following QIPP principles to deliver an accessible
service and to maximise the health benefits to patients.
The following areas are included in this case study:
Improvements in data collection
Learning from project
The service specification is complete in draft at the time of this report.
3) Context and Background
Describe the case for improvement – outline the evidence, national and local drivers, why was it
needed? Was the improvement initiated as a result of an NHS Improvement initiative or spread project or
was it locally inspired? Was commissioning a key driver for change?
The redesign of the Cardiac Rehabilitation Service has been on both PCTs agenda for several
years and it has been the introduction of the commissioning pack, being part of the pilot with the
NHS Improvement team’s support that has driven us to move this work forward. It has allowed
us time to work with our providers more closely and to learn from National sites. The CVD QIPP
agenda was also a driver for taking this forward as Cardiac Rehabilitation is integral to the QIPP
Our baseline position prior to the project:
Disparity in how we pay for CR services
No service specification
Inability to capture baseline information including activity and outcomes data
Low uptake and completion rates
Inequity of access to all phases of rehab
4) What did you do? And how did you do it?
4a) Methodology – describe your approach and underpinning principles where appropriate
How did you attempt to understand the problem? Identify the techniques that were used and the process
for validating those techniques.
It was apparent from the levels of baseline data that there was a difference in how trusts
collected, reported and interpreted the data.
What we did:
Invested the time of a data analyst to go into trusts to understand their reporting systems
and data base.
Called a meeting with representatives from the clinical CR teams and information analysts
and PCT team with the aim of having everyone present in the room to agree the
definitions of the core measures to ensure consistency in data recording and reporting.
We supported the above by producing technical guidance for information teams at the
Undertook a series of process mapping events across primary, secondary and tertiary
care providers supported by the NHS Improvement team
This allowed us to understand issues, constraints and gaps in service in anticipation of
the service specification being agreed and allow trust to be in a better position to deliver
the service once commissioned.
Draft service specification available for Clinical Commissioning group CVD leads input
and to agree inscope patients and confirm performance indicators.
4b) What resources/ investment were needed?
Investments in time of dedicated PCT analyst and project lead from PCT and time commitment
from Cardiac Rehab teams.
4c) Patient/carer/public experience
Describe your approach to engaging with patients/carers/ the public
Patient/carer experience has formed part of the Cardiac Rehabilitation team’s work. An example of this is
the testing of a heart attack recovery pack initiated by the Tertiary centre. The pack was given to patients
post MI and included detail such as cardiac catheter report and other diagnostics reports. Following
positive patient feedback the trust are planning further work on the pack.
4d) Staff engagement
Describe your approach to engaging with staff and other service providers
Commissioners and providers have worked together using the commissioning pack as a framework.
There was input from the following areas:
Cardiac Rehab nurses
Working with these teams has raised the profile of Cardiac Rehabilitation and has had a positive impact
on the relationships between commissioning and provider teams. The providers have demonstrated
improvements in patient pathways even though the redesigned service has yet to be commissioned.
Providers are now in a much better position to be able to deliver a new service.
4e) How was the project led and managed? Describe the role of clinical leadership
The project has been led by Commissioners and cardiac rehab nurses with input from their teams in
hospital and the community.
5a) Overall impact and benefits of the improvement, how this benefits patients, staff and the organisation
E-referral – resulting in improving the quality of referrals and the speed in which patients
are referred to rehab
Technical guidance – resulting in an improvement in data collection and reporting
CR redesign included in PCTs commissioning intentions
Development of a financial model to facilitate tariff negotiation and model activity and
Improvements in pathway – resulting in reduced waiting times. Improved patient
experience and staff satisfaction
Increased profile of Cardiac Rehabilitation at all levels
Draft specification in place – Once commissioned will realise the benefits to patients
experience and outcomes
5b) How was the improvement measured?
How was the baseline established? How was progress against the baseline measured?
Evidence (data/charts if available), number of patients affected and their levels of satisfaction (attach
images if available)
There have been difficulties in establishing a robust mechanism to collect baseline data and core
measures. What we did:
Worked with CR teams and information teams and produced technical guidance thus enabling
teams to report against the core measures (part way through the project)
One team reduced the length of wait for CR by:
Working with Consultants and the CR team an agreement was reached to stop undertaking
ETT on patients prior to commencing phase 3. This greatly positively impacted upon waiting
Tertiary centre introduced E-referrals following many months intensive input from their teams to
streamline the referral, improve the timing and quality of referral and ensure the patients were referred to
the CR programme closest to home. Their report shows the improvements in referrals made and quality.
5c) Potential/actual cost savings
Potential cost savings:
Reduction in re-admissions (e.g. emergency re-admissions for non-specific chest pain)
Improved value for money
Overall reduction in costs due to locally agreed tariff
6) Sustainability and Spread
6a) Current position of the good practice – where is the service today?
Provider’s teams have worked extremely hard and have shown great commitment to this project
and are continuing to make changes and redesign within their services. The project is at the
commissioning/contracting stage pending agreement of the specification and tariff.
6b) How has improvement been sustained?
Improvements have been sustained through redesign of the service which has impacted upon the patient
pathway and the introduction of E-referrals from the tertiary provider thus improving referrals trusts
external to this project as well as those participating.
6c) Has the improvement been spread? Does it form part of an earlier initiative ? Will the
improvement be spread further from your local work ?
The improvement has impacted upon hospital trusts external to this project through the introduction of E-
referrals. The progress of the project and the commissioning pack has also been discussed at cardiac
network meetings, Primary PCI meetings, Heart failure pathway meetings and all of these groups include
hospital trust manager, consultants, GPs external to the project.
This work is also included in the CVD QIPP work programmes which now covers the Merseyside cluster
7) Lessons learnt
What ideas were successful / unsuccessful, what you would have done differently? What were the top
The areas listed in section 5 demonstrate the successes of this project.
Keeping all parties included in the discussions, proposals and supporting information has been
key to the project it has enabled there to be good working relationships.
Project delivery has been slower than we would have liked. The pace was determined by the
changing structures and not the willingness of providers.
There have been immense pressures on our Clinical Commissioners and this has impacted on
progress of engagement and agreement on the specification. This has been unintentional as
there is strong commitment to the project and we feel we are overcoming this and things are
now progressing with Clinical Leads for CVD now identified.
8) Future plans
What are your next steps?
Agree specification, including scope of patients and outcomes
Commission the CR service
Engage with social marketing team to promote CR
Further work with Clinical Commissioners
Work with Local Network to standardise patient information.
9) Further information
Please list other sources of information, e.g. research papers, newspaper articles etc