Royal Edinburgh Hospital Public Social Partnership Wayfinder & Gateway Health Transformation through the Third Sector

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1 Case Example Organisational Learning Champions Gallery Royal Edinburgh Hospital Public Social Partnership Wayfinder & Gateway Health Transformation through the Third Sector In collaboration with NHS Lothian, Edinburgh Council, Queen Margaret University and the Third Sector, the Royal Edinburgh Hospital campus redevelopment programme has been identified as a major opportunity to redesign services through the collaborative application of the Public Social Partnership (PSP) Model. With support and guidance from Ready for Business, two workstreams of activity are underway and beginning to reshape the way that health services are delivered. Background The Royal Edinburgh Hospital, situated in Morningside, provides care to those with mental health problems. Plans for the redevelopment of the Royal Edinburgh Campus are currently progressing, with the aim of replacing outmoded inpatient facilities with fit for purpose accommodation that will allow the delivery of care within a modern and safe environment that contributes to the improved health and wellbeing of patients. In collaboration with local authorities and the Third sector, the Royal Edinburgh campus redevelopment programme was been identified as a major opportunity to build social value and introduce a wide ranging and ambitious number of community benefit outputs using the Public Social Partnership (PSP) Model. The commitment of partner organisations to the PSP model was explicitly stated in the Initial Agreement for the development programme approved by the Scottish Government. Public Social Partnerships (PSPs) are strategic partnering arrangements, based on a co-planning approach, through which the public sector can connect with third sector organisations (voluntary organisations and social enterprises) to share responsibility for designing services based around service user needs. Once designed and piloted, services can then be commissioned for the longer term through a competitive tendering process. Scope and focus Within the redevelopment programme, it was agreed that the PSP approach would allow NHS Lothian and partners to PSP Case Studies Royal Edinburgh Hospital 1

2 achieve a number of key outcomes. These included: Designing services which are of the highest quality, and both effective and efficient. Strengthening existing relationships and building new robust relationships with Third Sector organisations and, essentially, with service users. Building knowledge of a co-production approach to designing services which could be utilised and enhanced in later stages of the redevelopment. As a result, two workstreams were identified to pilot use of the PSP approach by NHS Lothian. These were: Wayfinder: A Knowledge Transfer Partnership (KTP) project which is focused on the redesign of rehabilitation for people with multiple and complex mental health needs. It is one of a number of change projects currently underway under the umbrella of the Transformation Station which is a unique health and academic collaboration between NHS Lothian and Queen Margaret University. Gateway: The project is focused on developing the approach to outcome planning, signposting and navigation for service users, their families and carers. The Gateway will develop pathways of self-management and or / self-directed support, while providing opportunities to access accurate and tailored information. This function is a critical component in helping individuals to self-manage effectively and to direct the way in which their support is provided. Implementation Due to the different aims and stages of the two projects, both projects have followed different approaches to delivering their PSPs. Wayfinder Evidence Based Utilising the resources and skills of Queen Margaret University, a systematic literature review was undertaken to collect and collate relevant knowledge which learning could be leveraged from both locally and globally. Much of this will be featured in 3 reviewed publications. In addition, the work is expected to be disseminated at an international level. Outcomes Based Scope - Using the Health and Wellbeing Strategy as a keystone, it was then possible to use the overarching logic model which had previously been developed. This allowed sharp focus on the outcomes which needed to be addressed for those service users impacted by the project and then supported the definition of the PSP project scope around those outcomes. Programme Structure and Governance A strong programme structure was established, clearly designing and aligning 3 PSP workstreams with the guiding strategy, which was then reinforced by a programme level decision making PSP steering group. Staff Engagement A number of Change Champions within the various organisations and services were identified, these were staff that understood the goals of the project and could not only input to the design process but champion the change within their respective areas. Together they could represent and influence all parts of the future patient journey from referral to rehabilitation. Baselining Detailed baselining is underway to better understand the patient cohort who would be affected by the change. In addition, the existing process plus assessment and eligibility criteria were captured and reviewed to ensure that the new model would address any weaknesses identified. PSP Case Studies Royal Edinburgh Hospital 2

3 Invitation to Engage In order to ensure the PSP process is inclusive and transparent, an open invite to join the PSP provider group was issued through established key networks. The providers were then able to self-select themselves to be part of either the core design group or as part of the consultation group. The groups have now been selected and approved by the REH PSP steering group. Provider Forum The Wayfinder project has now established itself as part of the Local Mental Health and Substance Misuse Providers Forum. It will report progress and invite input and challenge from a group of over 15 providers currently providing care to Mental Health patients with complex needs within Edinburgh. Future Process Created By reviewing, with input from key stakeholders, the existing process alongside its strengths and weaknesses, it was possible to create a new high level process which prioritised care set within the community wherever possible. Commissioning Group Engaged Work has commenced on the new delivery models and mechanisms for commissioning future services, with involvement of health commissioners who are charged with commissioning and evolving services to meet current and changing needs in the future. Gateway Redesign of the Progressive Neurological Disorders Service Completed A key dependency of enabling the gateway was the completion of the redesign for the Progressive Neurological Disorders (PND) service and patient pathway. This has defined a new approach to delivering services to those with PNDs and will now allow the signposting of service users to other services which can meet their outcomes. Scoping The gateway has now commenced scoping. This includes beginning to map out the services which could be in scope of a gateway and how they could be managed and the processes and skills needed for an effective signposting mechanism for those who use services, their families and carers. Key Challenges Capturing learning was a key part of the PSP programme. The two following points were acknowledged as key lessons which other PSPs can benefit from addressing. Using the correct model of change Understanding which delivery model to apply and when to apply it was vital for the success of the PSPs within the REH project. Although some projects were initiated as PSPs, it was identified by the steering group that this was not the right model of delivery and another approach better suited to the project was chosen. Using PSP is not a simple solution it requires significant focus and for stakeholders to be fully aware of what is required. Where this is not possible, other mechanisms should be given priority. Attracting providers to the initiative It is vital to ensure that provider messages are correctly communicated in order to gain buy-in from providers. It is key to myth-bust some common misconceptions at the first opportunity. For example, this is not a procurement process; rather it is the start of a collaborative service redesign commissioning journey. It is also critical to ensure that the correct medium of communication is used when reaching out to providers, existing e-networks should be exploited, but this is best supported by face to face briefings directly to providers. Outcomes Use of the PSP approach has delivered a number of key benefits to the REH PSP Programme to date. These include: PSP Case Studies Royal Edinburgh Hospital 3

4 Better Outcomes for Patients - The goal of the Health and Wellbeing Strategy has been to engage patients, carers and providers in helping redesign services that genuinely improve the lives of patients and their families. This has been at the heart of both the Wayfinder and Gateway projects. The right service in the right setting By bringing service users and providers into the service design process, it has not only been possible to create a new process, shape the eligibility and assessment criteria, but also to reflect this onto the settings of care and ensure that the service moves away from traditional longterm facility based models of care to community care wherever it will improve outcomes. in addition to a projection of demand on the service increasing in the future. The collaborating organisations involved in the redesign are responsive to these pressures and are moving towards a service design which prioritises the community elements of service provision, thereby maximising the output from the resources available. Structured Planning Due to the strong underpinning driver of a major capital reinvestment programme, there has been a strong emphasis on structured planning. Although priorities have changed throughout the duration of the REH redesign, the underpinning plans were always reorganised quickly and accurately to reflect the path ahead and the impact on the PSP and partners. Critical success factors There are a number of critical success factors which have underpinned the positive delivery of the model to date: Strong Governance Strong governance and leadership was established with well connected senior stakeholders from the initiation of the PSP strand of the REH redesign. This was absolutely key to setting the pace for all projects, in addition to identifying interdependencies and aligning with changes in the REH redesign priorities. Equal partnership working The project has successfully brought together a number of organisations and faced them towards a common goal. By bringing together multiple organisations including NHS Lothian, Queen Margaret University, Edinburgh Council and EVOC, it has been possible to pool the knowledge and skills to redesign services holistically, to create a pathway which will deliver benefits across organisational boundaries and, most importantly, to the service user. Ensured demand and sustainability There is already existing demand for the service and a budget to fund it post pilot, Future ambitions The next steps which the partnership will focus on the following; Wayfinder Memorandum of Understanding (MOU) The MOU is in the process of being coproduced by the providers. It will go on to articulate the behaviours and governance of the partnership. Service User Engagement on the Detailed Design Although service users have been consulted throughout the process, a phase of detailed design will be taking place with co-production at the heart of it. Commissioning Behaviours and Process A new model is currently being developed to ensure that the new way of working is integrated with commissioning within each of the partner organisation. Wider Provider Consultation At the heart of the PSP process is open and honest transparent communication. There will be a number of workshops (hosted in already established forums and groups) to ensure the wider cohort of providers who have chosen not to directly be part of the PSP Case Studies Royal Edinburgh Hospital 4

5 design process are informed and can feedback views and suggestions. Gateway Planning Work will be taking place to understand the steps needed to progress through the PSP journey. Communications The communications strategy and plan will be developed in collaboration with providers and service users, and then implemented. For further information, contact: David Fogg Assistant Programme Manager, Developing Markets Programme T: E: PSP Case Studies Royal Edinburgh Hospital 5