Modernisation Initiative – Improving Local Healthcare

The Modernisation Initiative is a major transformational project working in South London to improve healthcare services within the inner London boroughs of Lambeth and Southwark.

The Modernisation Initiative takes a multi-agency approach, working in partnership with local partners, including Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Lambeth Primary Care Trust , Southwark Primary Care Trust, King’s College Hospital NHS Foundation Trust and NHS London together with local community groups, and voluntary sector groups. At the heart of the Modernisation Initiative’s improvement work is the involvement of service users and patients who have an active role in helping to shape services to better meet their needs.

The Modernisation Initiative is funded through a major grant from Guy’s and St Thomas’ Charity. The funding and time this affords allows the Modernisation Initiative to think differently about how services are configured, pilot new ways of working and gives flexibility to tackle the many obstacles and barriers to service improvement. Guy’s and St Thomas’ Charity has also enabled the Modernisation Initiative to share its learning with other healthcare providers locally, nationally and internationally.

For the last three years the Modernisation Initiative has focused on the transformation of kidney disease, sexual health and stroke services. These current three programmes, which ended in March 2008, have been hugely successful.

Building on the success of the last three years, Guy’s and St Thomas’ Charity has announced a new service improvement programme centred on End of Life Care services for the people of Lambeth and Southwark. This exciting new venture is due to begin in April 2008, with a formal launch in June 2008.

New ways of working

The goal of the Modernisation Initiative’s work so far has not just been about refurbishing buildings and hospital wards. Instead it aims to improve the quality of life and experience for patients and users of health services. It has achieved this through:

Putting patients and users at the centre by involving them in identifying changes

Piloting new ways of working and evaluating their effectiveness

Researching evidence to support proposed changes

Ensuring improvements are sustainable through the support of the sponsoring NHS organisations and overall care costs are not increased

Celebrating Success

Healthy diet

All participants have actively contributed in researching the best method in helping people with obesity, and over-weight. The workshop and training have also been conducted for doing tests and analyses. A focus group discussion that specifically discussed about exercises, supplements, hcg, and other diet methods, has generated an outcome that summarizes the best hcg diet on the market today, and also other methods which have proven to be effective.

Kidney Disease

Patients, carers and staff have worked together to improve the quality of life of people living with kidney disease across the patient pathway. This has included raising awareness of the need to have a regular blood pressure check within the most at risk communities, improving information and education to ensure patients understand their treatment options, and increasing the number of treatment options available.

Raising awareness of high blood pressure

Fundamental to the ethos of the Kidney Programme was the prevention of kidney disease. High blood pressure which is undiagnosed or insufficiently treated is a key factor in the high prevalence of kidney disease in Lambeth and Southwark.

In order to tackle the problem of undiagnosed high blood pressure, the Modernisation Initiative had to think differently about how it could raise awareness, particularly amongst its diverse communities where the prevalence is significantly higher. Following a quantitative baseline survey conducted by Ipsos Mori, and subsequent qualitative research amongst African, West African and White men, three distinct social marketing campaigns were devised to target men aged 35-60 from each of these groups, encouraging them to get their blood pressure checked.

Early indications from the Ipsos Mori evaluation suggest that 35,000 people are likely to have a BP check and 10,000 people may have already had a check as a direct result of the campaign. The campaigns have resulted in considerable interest including the Department of Health, the National Social Marketing Centre and Dr. Foster.

Self Care

The Kidney Disease Modernisation Initiative has been hugely successful and had a significant impact on the lives of people living with kidney disease in Lambeth and Southwark. The programme examined the whole care pathway and a major focus of the work was around dialysis.

The Kidney programme has empowered patients to make choices about how and where patients dialyse. Coupled with this has been a new drive to support patients to learn to self-care. Over 11 resources have been created to help dialysis nurses teach patients how to use their dialysis machines. Self-caring has given patients a greater sense of control over their health and wellbeing. It also saves the patient time since they avoid waiting to be connected and disconnected from the machine. The nurses’ time is also freed up to help those patients who opt not to manage their own treatment. The improvement to the patient’s quality of life is immeasurable as Cash Ryan from Camberwell says “Self-care is definitely the best option for me, I feel less dependent on others, less like a patient, and therefore less restricted by my illness.”

Stroke Services

Telemedicine

A Stroke Modernisation Initiative project to improve acute care in the treatment of stroke led to Guy’s and St Thomas’ NHS Foundation Trust becoming the first hospital trust in the UK to use telemedicine to diagnose and treat acute strokes. A screen with a mounted video camera is wheeled in front of the patients’ bed, and a consultant appears live on screen to examine them. As well as being able to examine the patient themselves, the new technology allows the consultant to view the patients’ scans remotely, helping them make a quick diagnosis. After diagnosis, the stroke consultant is able to direct the accident and emergency clinicians and nurses to make sure the patient receives the appropriate specialised stroke care straight away. The telemedicine connection is vital for patients whose symptoms make them suitable for thrombolysis treatment. Thrombolysis needs to be given within three hours, so a speedy diagnosis is crucial. The quicker the drug is given, the more likely the patient will have a good outcome. Over 24 patients at Guy’s and St Thomas’ NHS Foundation Trust have since benefited from this new technology, with four of these given the thrombolysis treatment.

New information resources

Supporting parents who have had a stroke

Having a stroke, being a parent was created for parents who have had a stroke. The resource was produced by Connect, the communication disability network in partnership with local parents and the Stroke Services Modernisation Initiative

In the DVD, parents and children share their experience of how having a stroke has affected their lives. The guide draws on the experiences of parents who have had a stroke and their families, and is full of practical ideas and tips for dealing with the many challenges that affect them.

Stroke Patient Handbook

The Stroke Patient Handbook was created to give patients more control over their condition and help them to make informed choices. The Patient Handbooks are given to all new patients before they leave hospital for rehabilitation at home. Service users say it is a hugely valuable resource and an increasing awareness is prompting new patients to ask for their copy.

Sexual Health

Mystery Shopping

Obtaining sexual health service user feedback can be challenging as users prefer to maintain their confidentiality, tend to use services infrequently and do not usually develop an ongoing relationship with services. The mystery shopping programme was devised to overcome some of these difficulties. Local residents from Lambeth and Southwark were recruited, briefed and trained to act as users of sexual health services and the results were analysed and communicated to service managers. Mystery shopping has been used in existing services and during pilots to shape the design of new services.

175 visits were made to specialist services (GUM and reproductive health) and over 75 visits to primary care (GP practice and community pharmacy). Mystery Shoppers documented improvement in their experience over 3 years. Responses to ‘yes, I would recommend the service to a friend’ rose from 47% to 68%. A Toolkit is available to support this work.

Camberwell Sexual Health Centre

The Sexual Health Modernisation Initiative devised a new model of provision that aimed to increase access and information, empower patients to self manage their sexual health and provide all basic sexual and reproductive health services in one setting.

Camberwell Sexual Health Centre was chosen as the early implementation site for this project. The Sexual and Reproductive Health Centre and GUM clinics hosted by King’s College Hospital were reconfigured with new ways of working, new staff and new technology. In addition, the premises in Denmark Hill were refurbished to make the new centre fit to deliver the new model of provision. Local service users and providers were consulted on the design to ensure the new Centre provided a setting that was welcoming and non-threatening.

The Centre is based around a self-management principle, where people can decide for themselves what level of involvement and services they need, with help from touch screen information and self service points. This system allows more people to be seen more quickly, as not everyone will need a formal consultation. More complex cases are referred to the nearby Caldecot Centre.

Working across organisational boundaries

In order to be effective the Modernisation Initiative programmes have had to operate across organisational boundaries. The lessons learned have been highlighted in a handbook entitled ‘How to Achieve Effective Clinical Engagement and Leadership when Working Across Organisational Boundaries – Practical Recommendations’. The handbook provides practical recommendations on how clinicians can lead change across organisational boundaries.

Working effectively across organisational boundaries is fundamental to enabling changes that will improve the patient experience. The guide aims to pick out the main elements that facilitate clinicians to lead change across organisational boundaries, and to offer the basic tools and techniques required whilst exploring how these can be applied.

The handbook has been well received following its dissemination and attracted considerable interest from other parts of the UK and internationally.

End of Life Care

The Charity has earmarked a total of £4.5million to improve End of Life care in Lambeth and Southwark. The programme will look at how organisations can work together to improve the end of life experience for the local population by enabling them to die with dignity in an environment of their choice. This programme will start in April 2008 and run for three years.