Transformation Unit

West Yorkshire Association of Acute Trusts (WYAAT)

Vascular Services Clinical Service Redesign

The Client

The West Yorkshire Association of Acute Trusts (WYAAT) is a collaboration of NHS trusts delivering acute hospital services from across West Yorkshire and Harrogate to drive forward the best possible care for patients. Their vision is to create a region-wide efficient and sustainable healthcare system that embraces the latest thinking and best practice to deliver consistently the highest quality of care and outcomes for patients.

The Challenge

WYAAT recognised that the provision of vascular services in West Yorkshire needed to change, not only in response to improvements in this area in other major UK conurbations but also following the Yorkshire and Humber Clinical Senate review in February 2017. The review recommended that the number of arterial centres in West Yorkshire should be reduced by one third, to two.

Following the publication of this report, NHS England Specialised Commissioning gave the Trusts in West Yorkshire an important opportunity to determine how their Vascular Services could be reshaped for the future, making them more sustainable and able to compete with the established national centres, ultimately for the benefit of patients in the region.

Our Approach

The key to the success of this project lay in the strength and integrity of partnership working. We started with an initial stakeholder engagement session, asking key questions of all WYATT’s CEOs, Medical Directors and Clinical Leads, from which we extracted main themes, key messages, drivers for change, opportunities and redesign requirements, which would be used to shape the design and content of the first clinical summit. This high-level meeting was used to map out the landscape and agree overarching objectives and to timetable the transformational steps. We established considerable consensus in what stakeholders wanted to achieve for the people of the region and their vision was called the West Yorkshire Way.

The first Clinical Summit revealed that more work was needed to make the most of the the opportunity presented by NHS England with the first key step being the development of the clinical model. It was agreed that the CEOs from the three arterial centres most affected would nominate representatives (surgeons, vascular interventional radiologists or other Vascular clinicians) to form a working group.

We then facilitated two clinical model development meetings, followed by a second Clinical Summit at which progress was fed back and clinical ambitions for the service, the overall model, and the proposal for initial collaborative work was presented. Behaviours and key enablers were explored and identified and a timeframe to secure immediate impacts were identified by the Clinical Model development group.

The TU also had to ensure that the WYAAT leadership was made aware of progress, outline the clinical group’s ‘ask’ from the Trust leadership and put forward our recommendations. Areas of consensus were shared with the executive group in terms of; principles of the Partnership, how the Partnership would work together; and what the Partnership would work together on. We also recommended that, to deliver a sustainable and thriving service, the two arterial centres should operate as one network which we knew the NHS England Specialised Commissioners would be support of. The clinicians request and the TU recommendations were fully accepted and used to develop the WYAAT response.

Throughout the project work we provided evidence for our recommendations, including analysis and guidance in the following areas:

  • Arterial centre selection and investment
  • Approaches to risk and gain
  • Initial activity modelling (including the baseline and the potential changes in activity profiles under reconfiguration)
  • The development of an implementation plan for the WYAAT Project Management Office to take forward for delivering ‘quick-wins’ and future development of the West Yorkshire Vascular Service

The Outcome

The redesign of vascular services in West Yorkshire was recognised by both WYAAT and the TU as a challenging and complex project, which would require the fostering of trust and confidence on all sides in order to succeed. Together, though, we were able to achieve rapid progress in the development of an initial clinical model and the agreement of a series of quick wins to make real improvements in patient care in the short term, and set the foundation for continued improvement in the future. NHS England Specialised Commissioning was kept informed throughout, with the result that they supported the work and proposals in full.

The provision of Vascular Services was the first speciality that WYAAT focused on to create a more efficient system and to deliver the highest quality care for the people of West Yorkshire. Together we achieved initial successes with this specialty, sharing our learning and methodology, so that it would be replicable and help more progress to their vision of creating a region-wide, efficient and sustainable healthcare system.

Feedback

“Thank you again for all your help and guidance… It has been a difficult, but actually, enjoyable process and the fact it has been enjoyable is in big part down to your collective approach and skills. I really hope we can continue to work together on this in the future as I do feel we are ‘in it together’. On a wider level it’s also been valuable learning from your experience and clear skills.”