NHS North East - Welcome to our region

We are one of the ten strategic health authorities in England and play a pivotal role in implementing national Department of Health policies in the north east.  With around 200 staff, we are responsible for making sure that all NHS services in our region meet the highest possible standards. NHS North East oversees 23 individual NHS organisations in the region.

Our region covers an area from the Scottish border, down to North Yorkshire and across to the Cumbrian border in the west.  With a population of around 2.6 million, there are eight hospital trusts, 12 primary care trusts, one ambulance trust and two specialist trusts providing mental health and learning disabilities services.

What we do

We are responsible for making sure that health services in the region are fit for purpose, well-planned, high quality and meet all Department of Health targets. We are committed to excellence and put the region’s health and the development of high quality health services at the heart of everything we do.

Providing leadership on a number of issues ranging from quality of care and customer experience to performance measures and improvement targets, we liaise with the local NHS to ensure achievement of priorities and targets and are responsible for performance managing local primary care trusts and all non-foundation trust NHS organisations.

The functions of the strategic health authority include:

• Clinical governance
• Commissioning development
• Communications
• Research and development including evaluation
• Finance and assurance
• Market and provider development
• Workforce development and planning
• Operational and performance management
• Primary care development
• Productivity
• Programme integration
• Programme management for Connecting for Health
• Public health/emergency planning
•  Strategic planning
• Whole system development, including clinical networks

Our vision

Our vision is that...

'The NHS in north east England will be the leader in excellence in health improvement and healthcare services'.

Seven clear aims to get there

Our vision will be implemented and delivered by pursuing seven clear aims:

- No barriers to health and wellbeing
- No avoidable deaths, injury or illness
- No avoidable suffering or pain
- No helplessness
- No unwanted waiting or delays
- No waste
- No inequality

These aims will guide everyone, including all staff, patients and the public in making the best possible decisions about health and healthcare.  Each aim is underpinned by a set of principles, outcomes and measures to help ensure it is translated into real change.

Constantly striving to be the best

To become leaders in excellence we must constantly strive to be the best.

NHS organisations are agreeing principles to underpin each aim, including key aspects of the work environment, approaches to work, and individual behaviours that will be required to deliver the aims.

They are also agreeing service development outcomes for each aim to provide a benchmark for success.

Our vision, our future

Since September 2007, hundreds of staff from NHS and partner organisations across the North East have been working on the ‘Our NHS, our future’ review to inform the future of the health service in the region. 

The process has been led by doctors, nurses and other healthcare professionals and is aimed at defining standards of care and the models needed to deliver them for the next ten years. 

The review contains specific recommendations for maternity and newborn care, children’s services, planned care, acute care, mental health, long-term conditions, staying healthy and end of life care.
 
Read the full regional report to find out more.

A framework for success

Our business plan provides a framework for prioritising our work and resources and provides clear direction for our business.

Examples of our innovation

North East Transformation System (NETS)

Introduction

The North East Transformation System (NETS) is the model used by NHS North East to lead continuous quality improvement and the realisation of their vision. 

NETS is an approach that all NHS North East organisations are encouraged to follow and is built upon the three components of vision, compact and method.

• It is a philosophy to be applied at all levels, individual members of staff, teams, organisations and the system.  Fundamentally it puts the people of the North East and patients of NHS North East at the centre of the system. 
• It balances the components of vision, compact and method (see below) and delivers real change. 

Vision

NHS North East has deliberately set a highly aspirational vision supported by a number of strategies that together create the common purpose that binds all of the component parts together.  The NSR process was the catalyst for producing the document ‘Our Vision, Our Future’ that articulates the high level vision.  NHS North East has stated the vision at the highest level in terms of zero tolerance to defects in the system, and the pursuit of ideal care.  Although aspirational this vision immediately takes the NHS beyond the culture of targets and benchmarking.  It has a lot of support amongst all staff and the public:

• No barriers to health and wellbeing
• No avoidable deaths, injuries or illness
• No avoidable suffering or pain
• No helplessness
• No unnecessary waiting or delays
• No waste
• No inequality

NHS North East has traditionally done well in benchmarking and the Healthcare Commission has rated services in the North East as easily the best (over 90% are good or excellent).  However everyone knows from everyday experience that the service is not nearly good enough.  In the eight dimensions of the NSR ‘Our Vision, Our Future’ builds upon the zero tolerance approach to produce highly aspirational but achievable strategic goals which in some ways makes it quite radical compared to others in the country (for example in maternity care the vision is to achieve 168 hours consultant cover in all labour wards.  Work is actively going on to see what the implications of this are).

Compact

Whilst necessary, developing vision is clearly not sufficient and the NETS approach insists upon the vision being complimented in equal measure with a compact that aligns culture and behaviour as well as consistent method for continuous improvement.

The compact describes the unwritten rules, the behaviours and the signals that are sent by managers.  Understanding those behaviours often explains why important projects fail, why people resist change, why evidence based practice does not spread as quickly as expected and so on.

NHS North East again has a good track record of managing change (for example all of the national cancer improving outcomes guidance has been delivered and implemented, modern techniques for managing heart attack with immediate coronary artery intervention has been implemented etc, all firsts in the country) but to truly transform we need to go much further.  Work on ‘compact’ is primarily about aligning people and organisations to the vision. 

It explicitly sets out the ‘unwritten rules’ making them written and transparent, it sets out the expectations and behaviours that are required to be more effective in delivering change and it is mutually binding and enforced. 

It is a reciprocal contract for the ‘give and the get’.  However, its obvious common sense application to change management does not mean it is easy or quick to achieve.

Having learned from Toyota, we can express a vision that every member of staff in the NHS, and every contractor, is both a quality inspector of the services they provide and an improvement manager.  Leadership is clear and highly competent, and within the system both competition and collaboration are appropriately managed to deliver patient centred benefits as described by the vision. 

Method

How change is managed and how organisations work is fundamental to achieving the vision.  The North East Transformation System insists that organisations commit to ‘this is how we do things’ rather than trying to manage change in an ad hoc way.  We look for method that is consistent and repeatable and becomes a set of tools and activities that deliver transformational change.

NHS North East has, through NETS, got all organisations to adopt the philosophy of equal balance between vision, compact and method.  But method is a matter of choice.  Some organisations are committed to ‘six sigma’, some have clear partnerships to enable them to learn (for example Newcastle Hospitals has a partnership with the academic medical centre in Pittsburgh) and seven organisations have chosen the Virginia Mason Production System to be their method.

NHS NORTH EAST STRATEGIC PARTNERSHIP WITH VIRGINIA MASON MEDICAL CENTRE IN SEATTLE

Virginia Mason Production System

The Virginia Mason Production System (VMPS) is based on the world renowned Toyota Production System (TPS). 

The Virginia Mason Medical Centre is a medium sized hospital system in Seattle, Washington, USA.  It’s a tertiary referral centre for cancer and cardiac surgery but also provides a number of community clinics with family practice.  It is a not for profit organisation owned by the physicians. 

TPS tools have been adapted by many but not always successfully.  In parallel with NETS, TPS is not about the tools, Toyota are a very vision driven and philosophical company who put their own staff and partners very much at the heart of their business to deliver a customer focused product.  Their tool box, processes and problem solving methods together form a very mature safety and continuous improvement method which is ‘easy to understand and hard to implement’. 

VMPS is a relatively pure form of TPS which has been adapted to health care over the last seven years (initially the Virginia Mason Medical Centre learned TPS from Boeing, also based in Seattle).

NHS North East has formed a partnership with Virginia Mason based on shared passion for high quality health care and the pursuit of perfection (the zero tolerance approach) and very clear alignment to the balance of vision, compact and method. 

The contract with Virginia Mason is based on a ‘knowledge transfer’ model where they are supporting and delivering the training of NHS staff in VMPS, moving rapidly to a coaching model, such that NHS North East can support its own version of TPS within three years. 

For the seven organisations working collaboratively together the contract with the Virginia Mason Medical Centre has been cost effective and excellent value for money. Training has been provided to ‘certified leader’ status for 50 staff. Additional to formal training days there have been a number of supported visits of clinicians to Seattle, many visits of Virginia Mason staff to the North East, purchase of the intellectual property rights for internal use in NHS North East and supported training courses in Japan of TPS. 

Benefits so far from VMPS

As previously described NHS North East is delivering current targets (both financial and health care) consistently, with a lot of evidence that best practice is achieved across a range of standards (as demonstrated by the Health Care Commission).  The North East Transformation System is the evolution of a way of working in the North East which allows both competition (nearly all the acute trusts in the North East are foundation trusts) and collaboration (as discussed for example in Cancer Network or Cardiac Network effectiveness) to coexist.

The use of VMPS is producing excellent early results.  In the process of the training, over 30 ‘rapid process improvement workshops’ have taken place and are now beginning to happen routinely in the participating trusts.  The results of these process improvements are impressive and include:

• A mental health acute ward with six months consistent result of halving length of stay and significantly reducing staff sickness.
• Complete turn around of sluggish poorly designed systems into very rapid processes. For example an orthopaedic department discharge letter system reducing from a 6 week to a 36 hour turn around time; An IT innovation has resulted in some surgical day case booking arrangements reducing from up to 12 weeks turn around time to virtually instantaneous.
• Safety innovations in ward drug rounds.
• Productivity successes in domestic arrangements.
• Much improved and highly rated (and externally assessed) new induction processes for three PCTs.
• Fundamentally, using VMPS creates a method for all staff to become engaged in improvement and change management, understanding concepts like the removal of waste, the adding of value to patients experience, flow, ‘built in safety’, etc.  All staff involved have had a very positive reaction.

Organisations Currently Using VMPS Methodology

There are seven organisations currently experimenting with VMPS and we expect four or five more to join as a second wave during 2009/10.

NHS North East
NHS County Durham
NHS South of Tyne
North Tees and Hartlepool Foundation Trust
Gateshead Health Foundation Trust
Tees, Esk and Wear Valley NHS Foundation Trust (mental health)
Northumberland, Tyne and Wear NHS Trust (mental health)

NETS – The Future

NHS North East has also learned however that some early successes does not make us experts.  There is no desire to declare success too early and most of the successes have been achieved by thinking small rather than thinking big.  The question therefore arises as to how NETS can stay ‘vital for the long haul’.  The continuing partnership with the Virginia Mason Medical Centre is part of that process.

The National Institute for Health Research through its service development office has commissioned an evaluation of NETS which will commence early in 2009.  Initial evaluation carried out by partnership between Durham University and Newcastle University Business School is positive. 

The balanced approach to vision, compact and method has been used in the NSR as part of the development of clinical leadership.  It is a common sense approach with works and appeals to all clinical and non-clinical staff across the full range of disciplines and grades.

Part of the evaluation of NETS will be to see what part VMPS plays as against organisations that, whilst working on vision and compact, have chosen a different method to achieve their service improvement.

Partnership between NE SHA and the Tony Blair Sports Foundation

The north east population has the worst health and a greater reliance on hospitals than any other region in England.  Promoting health choices is therefore imperative if we are to achieve the region’s health vision to become one of the healthiest places to live and work and break the cycle of this over dependency on our hospitals. Read more

The Tony Blair Sports Foundation and the North East Strategic Health Authority have been working together over the past 12 months to identify opportunities to work in partnership, with the clear objective to widen participation in sport in a sustainable way and tackle these health inequalities that exist from a local level.

Targeted specifically at children, the Strategic Health Authority has agreed to work in partnership with the Tony Blair Sports Foundation to fund concept2 rowing machines within 10 schools in Gateshead.  The objectives for this activity will focus on:

What makes this innovative?

The NHS in the north east is focused on influencing positively the lifestyle choices of the population they serve.  Too often health promotion tactics are driven by intangible health messages in a ‘one size fits all’ approach to engagement.  This project is different as it is tangible with clear measurable outcomes in a relatively short period of time.  Not only is it targeted at children, but those children who are less likely to excel at normal accessible sports programs, will be more likely to succeed within a rowing environment due to upper body strength.  

The Gateshead Schools Sport Partnership offers a comprehensive support program designed around making the sport more attractive with online/real-time competitions.  Some schools have also formed partnerships with local rowing clubs, ensuring the sustainability of the project and enabling children, from all backgrounds, access to competitive rowing in a way that they would never have had in the past.

This partnership approach is also innovative.  No longer is NHS North East purely looking inwards.  Over the last few years the north east is, and has consistently delivered, the best healthcare in England.  This is great for the north east and affords us the opportunity to look outwards and forge sustainable partnerships which will ultimately benefit the health of the region in the longer term.

All four partners, Tony Blair Sports Foundation, North East Strategic Health Authority, Concept2 and the Gateshead Schools Sports Partnership are committed to ensuring what is put in place is sustainable.  Not only will this partnership be an opportunity to widen participation in sport but it will also focus on key health messages and enable those 14-19 diploma students to gain valuable, on the job training, with a range of children from a variety of backgrounds.

Key messages

1. Celebrate the proactive partnership approach for the longer term
2. Focused on widening participation in sport
3. Focused on impacting on health outcomes and tackling obesity
4. Measuring and learning to be used to evolve and adapt future approaches