Utilisation Management

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1 Utilisation Management

2 The Utilisation Management team has developed a reputation over a number of years as an authentic and clinically credible support team assisting providers and commissioners in generating insight into service challenges. The depth and validity of the analysis they offer is not replicated by other improvement support offers. Warren Heppolette, Director of Operations & Delivery, NHS England (Greater Manchester) Introducing Utilisation Management Whether you are a care commissioner or provider, the clinicallyled Utilisation Management team at Greater Manchester Commissioning Support Unit (GMCSU) can help you make the most of health data. Pressure on care systems has never been greater. With a wealth of analysis and reporting methods, we can help you identify possible issues and address them promptly. We know how important it is to understand the flow across health and social care and its effect on services. We offer tailored strategic information that supports: n service redesign n care system improvement n forward planning. Care pathway reviews identify waste and indicate appropriate resource levels, showing the effect of system pressure on patients and highlighting opportunities to improve. Experienced nurses form the core of our team, ensuring a strong patient focus in any analysis of care systems and advice based on that intelligence. As well as secondary and primary care clinical backgrounds, we have the training, technical ability and understanding to use data effectively. Our processes are approved by the royal colleges and the College of Emergency Medicine and follow Department of Health and NHS Improving Quality guidelines. Our clients include clinical commissioning groups, acute trusts, local authorities and community providers. We can produce reviews of continuing work or particular service issues within a locality whatever meets your needs. Our experience in carrying out reviews means we know what common issues they typically highlight and the benefits of addressing these. And we keep exploring new ways to produce and use intelligence. We are developing an analyser tool designed to support better integrated care. It will clarify interactions between systems and how variations in activity levels affect services and people who use them. We aim to pioneer the use of an integrated dataset and establish a baseline for monitoring the impact of new or revised systems as part of integrated care strategies. 1

3 Case study Improving care quality through utilisation management GMCSU s Utilisation Management (UM) team produce daily pressures reports for commissioners and providers across the North West of England. Through analysis of these reports, UM observed deteriorating performance at a trust against the national four-hour emergency department (ED) standard of 95 per cent. Consequently, UM alerted the respective clinical commissioning groups (CCGs) to the issue. As a result, the CCGs requested additional work from UM to establish the causes of this deterioration, and support them to resolve any issues. The aim was to improve patient care through achieving the four-hour quality standard. Using a combination of data intelligence skills and clinical expertise, UM was able to analyse and interpret a range of datasets to provide stakeholders with detailed information about waiting times, and the impact on ED performance. Clinical resource utilisation reviews were also conducted across hospital and community facilities. UM coordinated conference calls on behalf of commissioners, inviting relevant health and social care professionals to share information and agree ways of supporting each other to improve performance and pathway quality. The team also facilitated stakeholder meetings, establishing a joint approach to monitoring key issues, and developing appropriate strategies for managing activity and sharing responsibilities for performance improvement. Recommendations provided by UM enabled commissioners to take a proactive, collaborative approach, aimed at reducing ED waiting times. Representatives of the organisations involved said: Involving GMCSU has greatly enhanced stakeholder meetings; UM offered impartial expertise, advice and challenge; and worked with us to focus our attention in the right place. Daily UM reports and predictive data were invaluable in planning services and monitoring pressures. Input to meetings and the management of urgent care reviews has been helpful to the whole urgent care economy and contributed to the strong performance over Quarter 4. A real strength of UM is the clinical credibility and impartiality; they function very well as the honest broker. How we work We will work with you to provide as little or as much help as you want and need, from full operational support on a daily basis to a strategic overview over an agreed timeframe or guidance to develop your own capabilities. As well as data analysis tools, we offer Royal College of Nursing accredited training so nurses can learn how to carry out care pathway reviews. Close alignment with the NHS Interim Management and Support Service means we can bring in extra expertise as required. Each client has a dedicated account manager to act as a regular point of contact and develop an in-depth understanding of their specific needs. We will agree terms of reference for every piece of work so you know exactly what to expect. We will visit you to talk through complex analyses and recommendations. We can access reliable sources of data, including the Health and Social Care Information Centre s Secondary Uses Service and Health Resource Groups, as well as provider situation reports (SitReps) and our own databases. Our data analysis offers you intelligence about specific systems and processes. We can focus on an entire care pathway or just a particular aspect of it, feeding information back to you through daily, weekly, monthly or quarterly reports, designed to suit your needs. We can still produce tailored reports when data is not readily available, explaining the end-to-end review process from developing methodology to analysing outputs. We can look at prominent issues like mental health and dementia, such as recent bespoke work to identify ways to improve Children and Adolescent Mental Health Services. Where appropriate, we work with other teams within GMCSU to build on review findings and inform strategic decisions around provider arrangements or service reconfiguration. I have worked with the Utilisation Management team over several years on the measurement of whole systems. This has been a great collaboration. The team combines high-quality technical ability with a mature appreciation of the purpose, value and the effective use of data. David G Jones, Deputy Director (London), Social Care Local Government & Care Partnerships, Department of Health 2 3

4 What we offer Our range of services means we can collaborate with you to measure whole system efficiency and quality, especially in admissions, readmissions and delayed transfers of care. Intermediate care reviews We want patients especially older people to get maximum benefit from intermediate care stays and to leave hospital at the right time, for the right destination. Our reviews provide clients with information to identify inappropriate admissions, optimise length of stay, improve throughput and address obstacles to effective discharge planning. Results can include a demographic and clinical profile of your intermediate care services, map typical patient journeys from referral to discharge and identify any process delays and gaps in services. Reviews show where patients are discharged to, including how many go to residential or nursing homes, and whether these are suitable destinations. We can help you develop consistent and robust information datasets across intermediate care, and advise on alternative approaches to prevent patients being discharged to inappropriate services. Zero day length of stay reviews Reviewing patients admitted to and discharged from acute care (except for mental health and maternity) on the same day helps you understand existing pathways and processes and spot opportunities to make them more efficient, outcome focused and cost effective. It can enable you to judge the impact of accident and emergency (A&E) standards, and find suitable alternatives to urgent hospital admission, like encouraging GP referrals to same-day rapid access clinics. It can identify ways to make particularly short-stay assessments (four hours or less) more cost effective and demonstrate how many patients are admitted for reasons other than clinical risk. Reviews may highlight the need to be more proactive and responsive in managing older people s care, through better falls prevention and residential home care plans, for instance. The information can support more care being handed back to GPs, with recommendations for ongoing management, instead of discharging clinicians automatically arranging followup hospital appointments. SitRep Analyser Our online systems analyser tool enables you to look across past and present hospital activity, examine flows and pressures within local health economies and compare trust performances. This tool produce statistical process control charts for all situation report (SitRep) measures, showing whether processes vary because of how healthcare systems are organised or external factors. The analyser allows you to compare an acute trust s current activity with previous years, and predict future activity. Alternatively, you can compare activity based on up to three different (but standardised) SitRep measures for each acute trust, such as medical outliers matched against cancelled electives. Or you can look at SitRep activity across acute hospitals and compare specific areas, like the percentage of A&E department admissions. To help clients get the most from the SitRep Analyser, we provide guidance on using the tool and details of the data and SitRep measures available for comparison. Daily pressure reporting Pressure reports produced every weekday except bank holidays help clients accurately predict acute hospital activity and benchmark with neighbouring localities. This enables you to take appropriate action to manage pressure on the system, particularly in winter, and put local escalation and performance improvement measures in place. Reports are based on data from each hospital site for the previous day. A performance dashboard compares current activity in key areas with the year before, with a chart to highlight the impact of both typical and special events. A traffic light (red, amber, green) system indicates severity of events while individual graphs detail cause and effect. Clients receive a narrative briefing of the data analysis, which flags up action required to address system pressure and its potential impact on immediate capacity and performance. 4 5

5 Meet the team Where we work We may be based in northwest England, but we work all over the UK, and internationally, and have developed a wide knowledge of different systems, the pressures they face and the potential effects. Seamus McGirr, Director of Clinical Development Seamus is a registered nurse, whose previous roles include Director of Nursing and Director of Performance. His speciality expertise and academic interest is in urgent care, and he leads the Utilisation Management team. Seamus s wider responsibilities in GMCSU include leading our clinical teams, developing our clinical commissioning support offer and providing the director leadership for contracting and performance. He is a familiar speaker at national and local conferences. He lives in Stockport and is married to a local GP. Gill Cooper, Head of Utilisation Management A highly experienced professional, for 10 years Gill has been instrumental in building and developing the resource utilisation programme in the North West of England and other areas in the UK. Her clinical expertise has been gained primarily in emergency care and GP practice nursing. As a nurse, an essential element of Gill s work is to represent the patient perspective across a wide range of GMCSU s services. 6 7

6 About GMCSU At the forefront of innovation and best practice, GMCSU aims to be a key influencer in the UK healthcare economy, working in partnership with healthcare commissioners, healthcare providers and local authorities to drive transformational change. Established in April 2013 against the backdrop of the government s health reforms, we employ around 500 talented individuals with expertise and experience in specialist clinical support, healthcare commissioning and business support services. Within GMCSU s unified model of delivery, these experts are deployed in multi-disciplinary teams to design, implement, and deliver robust solutions on behalf of clients. This way of working ensures value for money, while delivering improved outcomes for clients, their stakeholders and their patient population. Our approach enables GMCSU to provide an agile and flexible service. This ensures that all our clients benefit from the resilience, innovation and economies of scale generated by a large organisation with a regional footprint, while retaining, where required, tailored service delivery at a local level. Contact us If you would like further information about any of our services, or to discuss generally how we can help you manage pressures on your services, please Gill Cooper at or call The team provides insight into both strategic and operational issues and offers solutions to address these. Their work has contributed significantly to improved performance. The daily pressures reports have been particularly useful in helping the economy take a more proactive approach to managing anticipated surges and as a consequence avoiding some of the pressures we have experienced in previous years. Hugh Mullen Director of Operations, Pennine Acute Hospitals NHS Trust 9

7 To learn more about how GMCSU can help your organisation or telephone