1. Creating Better Health and Care Services An overview of a Better Health and Care Review process

2. Engagement is Everyone’s Responsibility Patient and Public Engagement Clinical and Professional Leadership and Engagement Organisational and Stakeholder Engagement

3. The Four Steps Step One What does “good” look like? Step Two How are we doing? Step Three What does this mean? Step Four What action do we need to take? Identifying the outcomes and standards that services should be delivering – drawing on a wide range of sources such as national service strategies, NICE recommendations, patient feedback. Assessing how we are doing against these outcome and standards. Sharing our assessment widely and testing it against people’s real experience. Identifying gaps that need to be addressed, and discussing and developing a range of options for doing this. Agreeing recommendations for ensuring safe and sustainable services, including formal consultation as appropriate.

4. The Four Steps Step One What does “good” look like? Step Two How are we doing? Step Three What does this mean? Step Four What action do we need to take? Patients, the public, staff and wider stakeholders are involved in each of the four steps. In addition to this, we work with stakeholders to agree the criteria that we will use to make decisions about the action we need to take.

5. Escalating Issues of Concern Step One What does “good” look like? Step Two How are we doing? Step Three What does this mean? Step Four What action do we need to take? Rarely in our reviews of services we may need to discuss urgent changes because the challenges to the safety and sustainability are so immediate. Urgent change is needed to ensure patient safety.

6. Making Good Decisions Well For each review it is important to develop the criteria that will be used to make decisions. This will help to ensure that good decisions are made well, in an open and transparent way. As part of each review we work with stakeholders to develop specific criteria that will be used to judge the options developed during Step 3 and Step 4. Our outline criteria are: (a) Quality and Outcomes for Patients: Services meet best practice and demonstrably improve: (i) clinical outcomes and quality of life outcomes (ii) patient experience (iii) patient safety (b) Cost Effectiveness and Financial Sustainability: Services are cost effective and financially sustainable (c) Equity: Service provision is geographically and socio-economically equitable, reaching the whole area population (d)Integrated Care Pathways: Services support the whole pathway, end-to-end, (e.g. from prevention to long term care or end-of-life care) (e)Impact on other Services: The impact on the delivery of other services has been assessed and understood. This includes assessment of the impact of patient/population flows into, and out of, the area. (f)Clinical Sustainability: Service provision is clinically sustainable (g)Feasibility: The process of change must be feasible and deliverable. Step One What does good look like? Step Four What action do we need to take? Step Two How are we doing? Step Three What does this mean?

7. Making Good Decisions Well Reviews take place with pace and engagement. The timeframe will depend on the nature and complexity of the issue, but typically it should take no more than three or four months from the launch of the review to the conclusion of Step Four (except where proposals may need formal consultation), e.g. Step One What does good look like? Step Four What action do we need to take? Step Two How are we doing? Step Three What does this mean? 200406080100120 Developing criteria for making good decisions well

8. The Four Steps The following slides provide examples of what might take place during the four steps. What do you think? How needs to be involved? How best can we involve patients, carers, communities, staff, partner organisations in shaping a successful future? Step One What does good look like? Step Four What action do we need to take? Step Two How are we doing? Step Three What does this mean?

9. Step One: What does good look like? At the heart of this step is the question “What does good look like?” This includes talking to patients, staff and wider stakeholders about the standards and outcomes that services need to meet, e.g. National Quality Standards NICE Guidance Evidence of best practice from across the NHS and beyond Cancer Peer Review standards Royal College guidance National policy and guidance (e.g. Operating Framework) The output of Step One is a description of the standards and outcomes that we will use to assess how local services are doing. Step One What does good look like? Step Four What action do we need to take? Step Two How are we doing? Step Three What does this mean?

10. Step One: Engagement Model Engagement in Step One could include: Patients and the Public StaffWider Stakeholders Identifying or developing patient outcome measures - asking patients what is important to them. Work with existing patient/user groups. Build engagement for Steps 2, 3 and 4 (e.g. patient/user panel). Desk-top identification of relevant outcomes and standards Letter/email to staff involved in the pathway asking them to identify relevant standards and outcomes Letter/email to key stakeholders involved in the pathway asking them to identify relevant standards and outcomes Step One What does good look like? Step Four What action do we need to take? Step Two How are we doing? Step Three What does this mean?

11. Step Two: How are we doing? At the heart of this step is the question “How are we doing?” This includes talking to patients, staff and wider stakeholders about how we measure up against the standards and outcomes identified in Step One. Depending on the nature of the review this could include: Performance data Patient feedback Safety incidents Benchmarking against other health communities Desktop review The output of Step Two is an assessment of how well we are doing against the standards and outcomes identified in Step One. Step One What does good look like? Step Four What action do we need to take? Step Two How are we doing? Step Three What does this mean?

12. Step Two: Engagement Model Engagement in Step Two could include: Patients and the Public StaffWider Stakeholders Reviewing patient feedback (e.g. complaints, PALS) Survey data (e.g. inpatient survey, service-level surveys) Workshops or focus groups to discuss experience of services and expectations for the future Desk-top work to assess local services against the standards. Workshops to review and triangulate data. External / peer review against standards Triangulation Step One What does good look like? Step Four What action do we need to take? Step Two How are we doing? Step Three What does this mean?

13. Step Three: What does this mean? At the heart of this step is the question “What does this mean?” This includes reviewing the assessment undertaken during Step 2 to identify whether there are any gaps in local services and begin to discuss and develop options for addressing them. Identifying, reviewing and validating the gaps (does this make sense?) Identifying options for addressing the gaps (what could we do?) High level analysis of the options (what would it look like? would it work?) Understanding the impact of those options (on other services, on equity & access) The output of Step Three is a gap analysis and a high level discussion of the options for addressing those gaps. Step One What does good look like? Step Four What action do we need to take? Step Two How are we doing? Step Three What does this mean?

14. Step Three: Engagement Model Engagement in Step Three could include: Patients and the Public StaffWider Stakeholders Sharing the gap analysis for information, discussion and feedback Workshops and focus groups to review the gaps and discuss how we can respond Involvement in discussion and debate to develop options to address the gaps. Sharing the gap analysis for information, discussion and feedback Workshops and focus groups to review the gaps and discuss how we can respond. Detailed work on gap analysis and options development. Involvement in discussion and debate to develop options to address the gaps. Sharing the gap analysis for information, discussion and feedback Workshops and focus groups to review the gaps and discuss how we can respond. Involvement in discussion and debate to develop options to address the gaps. Step One What does good look like? Step Four What action do we need to take? Step Two How are we doing? Step Three What does this mean?

15. Step Four: What action do we need to take? At the heart of this step is the question “What action do we need to take?” This includes refining the options developed in Step Three to develop specific recommendations for ensuring safe and sustainable services. Detailed options development Options appraisal Impact assessment Recommendations Action planning The output of Step Four is an action plan for ensuring safe and sustainable services that maintain and improve the quality and outcomes of care. If this involves significant variation in the way that local health services are provided then this may involve a period of formal consultation. Step One What does good look like? Step Four What action do we need to take? Step Two How are we doing? Step Three What does this mean?

16. Step Four: Engagement Model Engagement in Step Four could include: Patients and the Public StaffWider Stakeholders Surveys, workshops and focus groups to refine and develop options identified in Step Three. Involvement in options appraisal. Possibly formal consultation. Detailed development work towards recommendations for improvement. Surveys, workshops and focus groups to refine and develop options identified in Step Three. Involvement in options appraisal. Possibly formal consultation. Surveys, workshops and focus groups to refine and develop options identified in Step Three. Involvement in options appraisal. Possibly formal consultation. Step One What does good look like? Step Four What action do we need to take? Step Two How are we doing? Step Three What does this mean?