Customer: Warrington Health and Wellbeing Board: Warrington Together
Aqua was commissioned in 2017 by the Warrington Health and Wellbeing Board (WHWB) to help co-design and implement a strategy to transform the way health and social care services were delivered in the area, as part of an initiative called Warrington Together.
To help Warrington’s public services maximise limited resources amid increasing demand on services, driven largely by an ageing population, would require a complete culture change. Both those delivering and receiving care needed to buy into a shift in thinking; from an illness-driven model, where disease is treated once it occurs, to a wellness, prevention-first model, where people are empowered to look after their own health, and shape their care.
An integrated care partnership, one focused on delivering care as close to a person’s home as possible, by practitioners working together, irrespective of organisational boundaries, was identified as the starting model.
More residents needed to be encouraged to self-manage their health and care, and for that to be facilitated through access to their personal care record and shared care plan. WHWB also wanted to encourage greater use of digital technologies to create better, smoother support pathways and more ownership of individual wellbeing.
Achieving such a broad and bold ambition meant addressing multiple challenges, including disparate governance and funding streams between organisations; overlap in service provision and workflows; differing leadership styles and values; and the need to establish one clear vision which worked for all stakeholders.
Aqua convened and facilitated multiple scoping workshops involving 34 senior practitioners, managers and directors from across the full spectrum of organisations comprising the WHWB.
The sessions brought together attendees from Warrington Borough Council, Warrington Clinical Commissioning Group, Warrington and Halton Hospitals NHS Foundation Trust, Bridgewater Community Healthcare NHS Foundation Trust, North West Boroughs NHS Foundation Trust, the Alliance of Warrington Voluntary Providers, the charity Healthwatch, primary care, and housing associations. Experts with experience of system transformation from aqua acted as a mediator, holding up a mirror to offer an impartial view.
They were able to identify conflicting leadership behaviours, and encouraging collaborative discussions based on a common language. The team also worked with the attendees to encourage collective financial accountability and shared risk-taking. Sessions explored how varied finance streams could be better aligned and, where appropriate, re-directed, while still meeting statutory requirements to deliver a balanced budget.
Aqua also employed a diagnostic tool to map the overall system, shining a light on issues, existing mismatch of population needs to service delivery, and any inefficient overlap in workstreams. It also helped the board to establish common goals, core values and to agree on an overarching vision:
“Together, we will enable the people of Warrington to enjoy happier and healthier lives by transforming the way we use our collective resources.”
Following these initial sessions, aqua closely supported the senior change team who were responsible for transforming the vision into operating principles.
Aqua’s extensive network also facilitated connections with leaders from other North West regions, who were at various stages of their own transformation journeys, to share best practice and foster collaboration.
Subsequent workshops involved managers and clinicians responsible for implementing the operating principles, along with patients and service users, to ensure their experience and preference shaped the service design.
The vision for Warrington Together is being successfully realised as an integrated place-based model of care with services provided as close to a person’s home as possible.
Integrated multi-disciplinary teams have been established in the community. Digital records and shared care plans are being rolled out across Warrington.
A highlight of aqua’s work was the establishment of a new frailty pathway for elderly and vulnerable residents, seamlessly encompassing community, social care and acute care.
The cohesion between services has been paramount to Warrington’s ability to contend with COVID-19. Senior leaders from Warrington Together have hailed the integrated, collaborative and rapid response from primary, secondary, social and voluntary services as invaluable.
Carole Hugall, director of clinical integration at Warrington Together, said: “aqua supported us as a system to develop a much more collaborative culture, and to establish our vision focused on improving our population’s health and wellbeing, using a prevention and strengths based approach.
“This work was invaluable in developing integrated services and has resulted in improved outcomes for our vulnerable residents”.
AQ: Improving Care for Patients with Sepsis in an Acute Trust
Southport and Ormskirk Hospital NHS Trust provides acute hospital services to 258,000 people across Southport, Formby and West Lancashire. Acute care is provided at Southport and Formby District General Hospital and Ormskirk and District General Hospital. Sepsis accounts for around 1,200 acute admissions to the trust each year.
AQ: Aintree Improvement Journey for Patients with Alcohol Related Liver Disease
Aintree University Hospital NHS Foundation Trust joined the Advancing Quality (AQ) programme at its launch in 2008 and is currently participating in eight clinical focus areas (CFA), this includes Alcohol Related Liver Disease (ARLD).
AQ: Reducing Avoidable Harm through Patient Assessment & Escalation
In patients who are, or become acutely unwell in hospital, there is evidence that deterioration is not always recognised or it is not acted on rapidly enough (NICE, 2007). The Walton Centre NHS Foundation Trust wanted to improve observation recording, recognition and response to deteriorating patients using the NEWS assessment tool.
AQ: Reducing Mortality in Community Acquired Pneumonia (Liverpool University Hospitals NHS Foundation Trust)
The NICE (2014) guidance publication ‘Pneumonia in Adult: Diagnosis & Management’ covers diagnosing and managing Community Acquired Pneumonia (CAP) in adults. Its aim is to improve the accurate assessment and diagnosis of pneumonia to help guide antibiotic prescription and ensure that people receive the right care. It estimates a mortality rate between 5% and 14% for patients admitted to hospital with CAP.
AQ: Serum Lactate in the Treatment of Sepsis
he Royal Liverpool & Broadgreen University Hospitals NHS Trust (RLBUHT) identified an opportunity to improve the early diagnosis of patients with sepsis. Evidence suggests that the sickest sepsis patients have high levels of serum lactate. Timely measurement of serum lactate levels in patient pathways can improve early diagnosis which will lead to improved outcomes.
AQ: Embedding Early Assessment In Out of Hours Primary Care
Sepsis and deterioration is a huge clinical problem and 70% of sepsis cases originate in Primary Care. In the last five years we have experienced a culture shift in primary care; from seeing sepsis as an acute condition that is difficult to detect, to recognising the need to actively assess patients where infection could be causing significant illness or deterioration.
AQ: Effective Management of Frailty in Hip & Knee Replacement (Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust)
NHS England defines frailty as ‘where someone is less able to cope with and recover from accidents, physical illness or other stressful events’1. As the population ages, so frailty rates increase, presenting challenges to care systems. Elective hip and knee replacement patients undergo pre-surgical checks to ensure they are able to cope with their procedure.
AQ: Improving the Management of Acute Kidney Injury (AKI)- Role of the AKI Pharmacist
The 2009 NCEPOD report, Adding Insult to Injury, reviewed outcomes for patients with acute kidney injury (AKI) in hospital. The report found that medication was the most common AKI risk factor not assessed and only 15% of patients had their medication altered to renal doses. The national AKI programme Think Kidneys advises that medicines optimisation is essential to reduce the risk of AKI and mitigate its severity if it occurs.
Sepsis is a life-threatening condition which has in recent years become a high priority for healthcare providers. Early recognition and prompt management of sepsis can improve outcomes for patients, reducing the risk of mortality and morbidity. This could potentially save 14,000 lives and result in 400,000 fewer days in hospital for patients every year, according to estimates by the Sepsis Trust.
AQ: A Collaborative Approach to the Management of Acute Kidney Injury (AKI)
Southport and Ormskirk Hospitals NHS Trust has established a steering group to improve care for patients with AKI. The group is using the care bundle data from the Advancing Quality Alliance (AQuA) Advancing Quality (AQ) AKI programme to monitor care delivery for patients with AKI and to provide a framework for improvement.
AQ: Improving the Ultrasound Scanning Process for Patients with Acute Kidney Injury
Acute kidney injury (AKI) may sometimes be caused by an obstruction in the urinary tract, which can require treatment with a nephrostomy. It is important that people with AKI who are suspected of having a urinary obstruction receive an ultrasound scan early in their management, as outlined in national guidance (NICE, 2019).
AQ Insight Reports: Case Study
More patients are admitted to hospital as a result of pneumonia in the north of England compared to the south. In the North West in 2019, the rate per 10,000 population was 58.5. To help reduce unwarranted clinical variation and health inequality, capture best practice and share evidence-based insights to AQ members across the North West, the AQ team created ‘Insight Reports’.