North Cumbria Integrated Care NHS Foundation Trust

North Cumbria Integrated Care NHS Foundation Trust is the principal provider of acute care services in Cumbria, serving a population of 500,000 people across two leading hospitals.

The Trust saw ever-increasing waiting lists in Gastroenterology caused by excessive demand outstripping employed resource supply in a geographically remote location. The Trust was under significant pressure to reduce its RTT waiting time targets and provide safe, effective care to increasing numbers within tightening financial budgets.

Elite Teams were tasked with delivering elective and emergency endoscopies over both weekends and weekdays, and delivering gastroenterology outpatient clinics. We also managed all clinical administration associated with the clinics and endoscopy procedures to reduce the pressure on Trust staff and timely actioning of the results. We worked closely with the local administration and secretarial team to develop a robust system to ensure all the results were flagged up and dealt with within an appropriate timeframe. Establishing a clear communication line was incredibly important, and we liaised with local MDT and IBD, local endoscopy staff, specialist nursing teams and local surgical consultants to ensure seamless pathways enabling us to provide the best possible care for the local patients.

There were several significant challenges:

1. Logistical challenge of resourcing staff to a remote location during high levels of seasonality.
2. Provide adequate cover and contingency to provide a fully managed service from referral to treatment or discharge.
3. Ensuring seamless transition between our work and that of the Trusts by supporting our staff to adhere to the same guidelines and practices as the Trust. 
4. Integration with the local secretarial and administration team 

What helped us deliver a safe, effective and high-quality service:

1. An agreed detailed implementation and mobilisation plan with the full support of the Trust’s management team throughout. 
2. Regular meetings and conference calls were held with clinical, nursing, managerial and administration teams to keep track of our progress and to monitor patient outcomes and patient satisfaction.
3. Carefully chosen accredited consultants and specialist nurses. A lot of our staff were based locally
4. Maintaining a robust system for monitoring and reviewing feedback openly and constructively to identify gaps in service delivery
5. Multi-provider teams were used regularly at the request of the host trust. This involved host Trust’s own staff worked alongside our staff to provide the service. 
6. Innovative work practices with the support of our specialist nurses
7. Supporting and encouraging the staff to deliver the best possible care
8. Coordination and support at the highest level

Outcomes

1. High level of satisfaction amongst patients and local staff
2. Significant improvement in times to treatment.
3. Zero serious incident
4. Support for the acute services by facilitating emergency endoscopy
5. Value for money as the services were offered at a significant discount to tariff