Report to Trust Board – 3 March 2016 - Moorfields … 5i...Report to Trust Board – 3 March 2016...

Report to Trust Board – 3 March 2016Report Title Vanguard programme – value propositionReport from Johanna MossPrepared by Karen ReevesList of attached appendices (ifapplicable)

Moorfields value proposition 2016/17

Reference documents (e.g.previous reports orappendices NOT attachedherewith)

1. Brief Summary of ReportFurther to its successful application to become an Acute Care Collaboration vanguard site,Moorfields submitted an initial value proposition seeking funding for the remainder of2015/16. We were successful in receiving the full amount sought (£155k).

On 8 February the Trust submitted a second value proposition for 2016/17. This documentreflects our progress since December, including further detail of the individual work streamsand development of a hypothesis tree for our vanguard programme. The total amount offunding requested for 2016/17 is £1.9m.

The national programme team will confirm funding allocations to each vanguard site in mid-March.

Moorfields’ has appointed a Vanguard Programme Director (Karen Reeves) and will beinterviewing for a Vanguard Clinical Lead in the next few weeks. Until 2016/17 funding isconfirmed, work is progressing with interim support in other programme roles. The first keymilestone is to complete a review of previous satellite mobilisations in order to collatelearning and identify key themes which matter most to staff and patients. This will bedelivered by the end of March.

2. Action Required/RecommendationThe Trust Management Board is asked to note the content of the value proposition,anticipating confirmation of any funding awarded for 2106/17 by mid-March.

Item 5(i)

Vanguard programme:

Acute care collaboration

Value proposition 2016-17

8 February 2016

ACC Vanguard: Moorfields Eye Hospital Value Proposition 2

Contents

Section Page

Section 1: Introduction 3

Section 2: Our context 4

Section 3: Vanguard aims, outputs, programme logic model and value hypothesis tree 8

Section 4: Our programme 12

Section 5: Financial impact and costs 16

Section 5: Our proposed support package 23

Section 6: Summary and conclusion 25

Appendix 1: Workstream logic models 26

Appendix 2: Value generation assessment 29


Section 1: Introduction

Moorfields Eye Hospital NHS Foundation Trust

Moorfields is the leading provider of eye health services in the UK and a world-class centre of excellence for

ophthalmic research and education. Our main focus is the treatment and care of NHS patients with a wide

range of eye problems from common complaints to rare conditions that require treatment not available

elsewhere in the UK. Our unique patient case-mix and the number of people we treat mean that our

clinicians have expertise in discrete ophthalmic sub-specialties. In 2014/15 we saw more than half a million

patients in our outpatient services and carried out almost 40,000 surgical procedures, making Moorfields the

largest ophthalmic provider in the UK. We also provided care to 96,000 patients in our A&E department. We

treat people in 32 locations in and around London enabling us to provide expert treatment closer to patients’ homes. We also operate commercial

divisions that provide care to private patients in both London and the Middle East.

Moorfields’ innovative approach to delivering care across multiple satellite sites has been explicitly referenced in recent national policy. The Five

Year Forward View highlighted the benefits of our model in helping to sustain local hospital services and enable smaller hospitals to remain viable.

The Dalton Review categorised our approach as a contractual arrangement which it described as a service-level chain. More recently, the

Moorfields@ model has been cited as an example of franchising or networked care. Terminology will be important as we seek to describe the

models that could be replicated across the NHS. In this value proposition we use the term ‘networked care’ to describe the generic model of

collaboration between providers and the term ‘satellite model’ to describe the approach currently delivered by MEH.

Rationale for our vanguard

Acute hospitals face increasing challenges to deliver safe and cost effective care, especially in smaller clinical specialties such as ophthalmology

which often lack the benefits of scale in a local setting. In the absence of a critical mass of patient numbers or specialty workforce, provision of

care may become clinically or financially unsustainable. These difficulties are often compounded by competition generated by local commissioners

and other providers. Moorfields has developed a satellite model that provides clinically and financially sustainable local access to high quality

ophthalmic care and a sustainable model of specialist treatment. We believe that the Moorfields satellite model has potential replicability across

the acute healthcare system and a key part of our vanguard will be to gather data to test this view. The aim of our vanguard is to consolidate our

learning in delivering networked care so that we and the wider NHS can develop a clear understanding of when and how this model of care can

enable acute hospitals to become clinically and financially sustainable.

We want to describe what good looks like for networked care and how it can be implemented successfully across the NHS.


Section 2: Our context: ophthalmology as a case study of the sustainability challenge

Moorfields was an early adopter of the principle that where appropriate clinical services should be provided within local communities, establishing

high quality local eye centres where possible. We are recognised as an exemplar of a specialist provider working in a new and innovative way to

deliver local services to residents outside the acute hospital environment. We now treat people at 32 sites in and around London, which are shown

on the following map and described on page 6.

Ophthalmology in the NHS has a particular set of sustainability and quality challenges which can be described in terms of the three ‘gaps’:

Finance and efficiency: Most ophthalmology care is provided in acute hospitals where it is a relatively small speciality where small volumes of sub-

speciality care can mean there are critical mass issues. Many commissioners have sought to drive down costs and increase competition for cataract

services (the most common surgical treatment) which has resulted in a proliferation of sub-scale, poorly co-ordinated and unsustainable services. The

challenges to sustainable local ophthalmology services include rising costs, poorer access and lack of improvement in care.

Care and quality: There is evidence of variation in the clinical outcomes and effectiveness of eye care across acute hospitals that is not always

revealed or improved through local clinical governance arrangements that focus on multiple specialities. Opportunities to develop new treatments and

participate in research can be missed.

Health and wellbeing: Eye disease is linked with ageing and eye care is particularly important to older people. Any loss of local services, travelling

further for care and poorer support to chronic care will have a considerable negative impact on older people.


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The Moorfields satellite model provides eye care from 32 sites

City Road campus

Provides comprehensive general and specialist outpatient, diagnostic

and surgical services, emergency surgery and a 24-hour A&E.

5 Moorfields@ district hubs

Co-located with general hospital services, these eye centres provide

comprehensive outpatient and diagnostic care as well as more

complex eye surgery.

6 Moorfields@ surgical centres

Providing more complex outpatient and diagnostic services alongside

day-case surgery for the local area.

15 Moorfields@ community outpatients

Focusing on outpatient and diagnostic services in community-based

locations closer to patients’ homes

5 Moorfields@ partnerships

Providing medical and professional support to eye services managed

by other organisations, as well as providing clinical leadership to

various diabetic retinopathy screening services

Our satellite model has grown in a largely unplanned way, driven by

commissioner and provider requests. Our approach to assessing

each new business opportunity and implementing our satellite model

has not been standardised.

We have been approached by several organisations to provide advice

to their eye units, including some who explicitly request

implementation of the Moorfields@ model. We recognise that

extending our satellite model is not appropriate in all circumstances

and therefore tailor our input. As a result, we also have extensive

experience of providing advice and consultancy to partner

organisations.

There is clinical and managerial consensus that we would benefit

from standardising our approach to assessing new business

opportunities and implementing our satellite model. Some progress

has been made in codifying our clinical pathways as well as

developing an opportunity analysis template.


Wider applicability of the Moorfields satellite model across the NHS

The issues described above in relation to ophthalmology are often applicable to other clinical specialties. The pressures facing smaller district

general hospitals are often complex. It is increasingly difficult for these organisations to afford to deliver high quality care across all clinical

specialties and sub-specialties. Understandably, smaller clinical specialties are rarely a high strategic or operational priority in such hospitals. The

sustainability of some smaller clinical services can be called into question by a range of factors which relate to the size and scale of the service;

Low patient volumes

This will often mean an organisation is not able to provide a full range of sub-specialty expertise, resulting in patients being referred to another

provider for more complex diagnosis or treatment. This can mean patients wait longer for treatment as well as travelling further to access

care. Low patient volumes for certain conditions can be associated with poorer outcomes.

Isolated workforce

Any service which requires specialist staff to deliver complex care on a small scale is placing pressure on its workforce. There are limitations

on the peer support available for clinicians (including training and clinical case review), issues of de-skilling planned and unplanned staff

absence can threaten the sustainability of the service. This can impact on professional development as well as the quality of care provided.

Investment in capital equipment.

For equipment-intensive specialties, it can be difficult for smaller organisations to justify the financial investment in specialist equipment.

Despite these challenges, patient and commissioner expectation is that wherever possible a comprehensive range of services should continue to

be provided locally. It is important to note that while delivering networked care can present a solution to many of these issues it can also create

new challenges to safety and the balance between standardisation and local flexibility. Our vanguard programme will examine these issues.

Opportunistic commissioning and provider competition can create barriers to transforming services as finance tends to be favoured over

sustainability and competition over co-ordination. Without a plan to adequately fund and develop specialist and tertiary services, the proliferation of

these sub-scale and potentially unsustainable services takes no account of the impact this is likely to have in the longer term.

The aim of our vanguard is to consolidate our learning in delivering networked care so that we, and the wider NHS, can develop a clear

understanding of when and how this new model of care can support hospitals in becoming clinically and financially sustainable.


Section 3: Vanguard aims and outputs

What are we trying to achieve? We want to consolidate our learning in delivering networked care so that:

the NHS can develop a clear understanding of:

(a) when and how this new model of care can support acute hospitals in becoming clinically and financially sustainable

(b) the implications of extending models of networked care more widely across the service

we, as Moorfields, can deliver sustainable ophthalmology services that meet the needs of local populations and are delivered in an effective

network

We have identified three long-term impacts that our vanguard programme will deliver:

1. Patients will have greater access to locally delivered, clinically sustainable services

2. Acute hospitals will become more sustainable by working with partners in a network model(s)

3. Networked care will be supported by effective and sustainable governance structures, underpinned by a strong organisational culture.

We want to undertake further analysis of the factors that make us more effective in some settings. We’re keen to learn what makes the biggest

difference for patients, staff and partner organisations in getting things right first time when establishing a service in a new setting. By learning from

other NHS organisations, as well as our own, we will codify the optimal approach to establishing and sustaining networked care. This will enable

the NHS to implement such models at pace and scale, realising the benefits of clinical and financial sustainability across the system more quickly.

We will undertake a comprehensive assessment of the opportunities and risks associated with an extended networked care model, learning from

our own and others’ experience. This will consider both increasing the number of satellite sites as well as widening the geographic reach of the

organisation.

We will describe, evaluate and share the learning from our work so that it can be replicated and used across the NHS.


The outputs of our work Our programme will deliver two key outputs, which will deliver benefits for the wider NHS, and for Moorfields:

A toolkit that codifies best practice in establishing the need for and implementing networked care and describes the critical success factors

required for it to succeed.

A publication outlining how the models of networked care can be extended while delivering clinically and financially sustainable services that meet

the needs of local populations.

From our experience to date, we anticipate that this will include recommendations on how to:

ensure consistent quality of care (including clinical outcomes, safety and patient experience) across multiple sites

deliver a sustainable workforce model

develop equitable educational and research opportunities for staff and patients

maintain effective partnership working with numerous providers and commissioners

protect organisational reputation

sustain the local delivery of subspecialist activity in a way which is both clinically and financially viable

balance the need to centralise (to achieve standardisation) and devolve (to achieve localisation)

For the wider NHS our programme will deliver:

a description of what good looks like for networked care

a toolkit that can be used to establish successful models of networked care in other locations

a summary of the implications of extending models of networked care more widely across the NHS.

The analysis will be available to inform national policy development and implementation in relation to viable smaller hospitals.

For Moorfields these outputs and the wider vanguard programme will enable us to determine the next phase of our service planning including:

where we should provide services in the future, how we can work with stakeholders to plan for all of the eye care for a population, how we should

partner and work with other providers, the governance arrangements required for high quality services across growing and dispersed networks,

and the organisational structures that can support this new model of care to be high performing, with a good culture and good reputation.


Logic models for the three workstreams are included at appendix 1.

Activities Outputs

Network Analyses Identify the conditions under which networked

care works well and when it doesn’t. We will work with new systems in different parts of the country

to explore how Moorfields could support the

planning and delivery of networked care

Toolkit that codifies best practice in establishing the need for and implementing networked care

Analysis of how networked care is responsive to and meets the needs of local populations

A publication outlining how the networked care model can be extended whilst still delivering

clinically and financially sustainable services

Outcomes

Rationale District general hospitals are facing increasing challenge to deliver safe and cost effective care, especially in smaller clinical specialties which often lack the benefits of scale in a local setting. In the absence of critical mass of

patient numbers or specialty workforce, provision of care may become clinically or financially unsustainable. These difficulties are often compounded by competition generated by local commissioners and other providers.

Moorfields’ satellite network model has potential replicability across the acute healthcare system. The aim of our vanguard is to consolidate our learning in delivering networked care, in collaboration with other NHS and commercial

providers, so that the NHS can develop a clear understanding of when and how this new model of care can support DGHs and health economies to be clinically and financially sustainable for small specialties like ophthalmology.

Impacts

Understand existing models Describe and define the different models of

networked care already in place in Moorfields and those used elsewhere across the NHS.

Assess existing models Assess and review the existing Moorfields models

of networked care related to clinical quality and operational effectiveness, accessibility, patient

experience, staff wellbeing, organisational culture

and activity levels

Review international networks Research and/or visit examples of successful

networks in healthcare and other industries.

Undertake stakeholder review Engage with stakeholders, including patients,

staff, provider partners and commissioners in order to assess the quality and reputation of the

existing models of networked care in Moorfields

Detailed market analysis Map activity levels and patient flow at a provider

and commissioner level across the Moorfields network, and compare the output with local

population needs assessments

Review networked care opportunities

Test the feasibility and implications of stretch

Accelerated establishment of satellite networks across the NHS

Better care for patients delivered by standardising care, improving accessibility and

minimising waste across the system

Reduction in start-up costs to establish a satellite network

More efficient use of resources through establishing satellite networks

Better decision making for organisations considering a networked care model

Replicability of best practice in delivering networked care

Widespread understanding of the benefits arising from different forms of networked care

Delivery of sustainable ophthalmology services that meet the needs of local populations and are

delivered in an effective network

Networked care will be supported by effective and sustainable governance structures, underpinned

by a strong organisational culture

Patients will have greater access to locally delivered, clinically sustainable services

Acute hospitals will become more sustainable by working with partners in a network

Critical success factors that need to be in place across a network in order for it to succeed

Better understanding of the commissioning implications arising from widespread adoption of

networked care

Moorfields vanguard programme logic model


Value generation hypothesis tree

The value generation assessment is included at appendix 2.

Clinical outcomes will be improved through replicating

best clinical practice across a

network.

Our vanguard will evaluate and consolidate learning from examples of networked care to identify the conditions which need to exist to make it effective and develop a toolkit which will enable the NHS to benefit from a more accelerated approach to setting up network models of care.

Patient experience will be enhanced by standardising

care and improving access

across a network model.

Safety and quality will be assured through setting and

spreading best practice

across the network.

Resource requirement of additional ~£1.959m in

16/17 is reasonable to

deliver the outputs and

generate the value of the programme.

Sustainability for the NHS will be improved through the

utilisation of the outputs by

organisations considering a

network care model.

• Describing and publishing the benefits of networked

care for safety and patient

experience will allow:

§ systems to understand and replicate best practice for patient

experience.

• £1.959m is the cost of delivering the programme

activities: § Programme management £651k

§ Existing models £43k

§ Assess existing models £745k

§ Stakeholder review £53k

§ International review £48k

§ Network analysis £218k

§ Network opportunities £201k

• £12.9m is the value of the knowledge, experience,

expertise and time being contributed to the national

vanguard programme.

• Disseminating lessons on safety and quality learnt

across the network will

ensure: § wider reach and application of

speciality specific lessons, resulting in faster adoption of

any changes to practice.

• Providing a clear, systemised approach to

spreading best clinical

practice across other sites

will allow:

§ systems to understand and

replicate best clinical practice.

• Providing a clear set of critical success factors for networked

care and comprehensive ‘how

to’ guide toolkit will result in:

§ reduced time for trusts to appraise options for forming or joining networks

of care.

§ more effective design and

implementation of a networked care proposal.

Impact

of

outp

uts

of

vanguard

pro

gra

mm

e

Impact

of im

ple

menting a

netw

ork

ed m

odel of care

• Ensuring consensus across the network of the

standards expected of all

services and staff will put

in place:

§ a clear set of speciality standards

that are comparable with best

published international evidence

§ improved clinical outcomes for

patients eg reduced post surgical infections.

§ Networked care allows staff to see the right volume of patients to

develop and maintain

expertise, resulting in:

§ critical mass of clinical skill across

network deployed to ensure standards are met

§ clinical skills developed to meet

future requirements for best

outcomes.

• Increasing access to care locally for patients results

in:

§ reduced travel time

§ increased patient satisfaction.

• Improving access to subspecialty expertise for

patients will mean:

§ tertiary expertise is available closer

to patients’ homes.

§ reduced inter-specialty referrals

and waiting times.

• Consensus across the network of the patient

experience standards

expected will put in place

§ clear set of patient experience

standards based on best practice across the network.

§ standards built into staff

behaviours.

• Providing standardised safety reporting which is

bespoke to single clinical

specialty will enable:

§ robust processes in place for identifying incidents and near

misses.

§ benchmarked reporting across

network eg infection rates.

§ active “worry list” of issues receiving

attention.

• Networked care allows sites

to access greater depth and breadth of speciality

experience, enabling:

§ Thorough, standardised approach to

investigating safety issue.

§ Investigations completed more

quickly and effectively.

§ A greater number of relevant safety

and safety issues identified and addressed.

• Implementing a networked model of care

with effective clinical

governance will result in:

§ reduced variation in service delivery.

§ reduced corporate overhead

costs.

§ economies of scale.

§ avoiding future cost of failure/unsustainable services.


Section 4: Our programme

Programme activities Our programme is based upon seven related activities to create the outputs listed on page 9.

Activity Description

1 Understanding

existing models

We will describe and define the different models of networked care within the Moorfield’s satellite model and those

that are used elsewhere across the NHS other sectors.

2 Assess existing

models

We will assess and review the existing Moorfield’s models of networked care in terms of clinical quality and

operational effectiveness and in relation to other aspects of the service including accessibility, patient experience, staff

wellbeing, organisational culture and activity levels.

3 Undertake

stakeholder review

We will engage with key stakeholders, including patients, staff, provider partners and commissioners in order to

assess the quality and reputation of the existing models of networked care in Moorfields and elsewhere.

4 Review lessons

from other sectors

and oversees

We will build on the research undertaken as part of the Dalton review, researching and/or visiting examples of

successful networks in other sectors and from healthcare in other countries.

5 Network analyses We will consider the themes arising from our review and identify the conditions under which networked care works

well and when it doesn’t. We will work with new systems in different parts of the country to explore how Moorfields

could support the planning and delivery of networked care.

6 Detailed market

analysis

We will map activity levels and patient flow at a provider and commissioner level across the Moorfield’s satellite model

and compare the output with local population needs assessments.

7 Review networked

care opportunities

We will test the feasibility and implications of stretch – in terms of geography and number of sites - for a networked

care model.


Programme timeline and key milestones


Programme management and governance

As illustrated in the programme timeline on page 14, the research phase of the programme runs from January-September 2016, with three key

milestones: a review of recent Moorfields’ satellite mobilisations (by April 2016) and research into national and international models and an in-depth

review of the current Moorfields satellite model (by September 2016). To deliver this research phase, three workstreams have been established:

Workstream 1: Moorfields’ satellite mobilisation review: reviewing four recent satellite mobilisations and a specialist service transfer into

Moorfields to identify lessons learned and to create a satellite mobilisation template for the toolkit and to share with other NHS organisations

Workstream 2: Moorfields network review: assessing the existing Moorfields models of networked care, including a series of

comprehensive site visits and overseeing the development of the market assessment

Workstream 3: National and international network review: Exploring the experience of other acute networks in the NHS, to triangulate and

build our understanding of how effective networked care is delivered. Reviewing the international evidence and experience of multi-site

organisations in health and other sectors.

The figure opposite summarises the governance arrangements that are in place to

manage the programme. A vanguard programme board has been established to take

overall responsibility for the delivery of the Moorfields vanguard programme. The

programme board is chaired by the director of strategy and business development, who is

the executive sponsor and is accountable to the trust board for the delivery of the

programme. Other members of the programme board include:

programme director – a full-time position reporting to the director of strategy and

business development, who takes day-to-day responsibility for the programme

clinical sponsor – seconded part time to the programme to provide advice and

leadership to clinical workstreams and engagement

engagement & communications lead

patient representation – from the trust membership council, ensuring patient interests are considered throughout the research and delivery

phase

the national team new care models programme lead will have a standing invitation to attend any board meeting.

Qualified clinical, nursing, allied professional and admin staff will be employed on a fixed-term basis or seconded to the programme as and when

required to meet the activities needed to produce the outputs.

Trust management board

Programme board Executive sponsor

Programme director

Clinical sponsor

Patient representative

Engagement and communications lead

Vanguard programme

director

Moorfields satellite

model review

National and international

network review

Moorfields satellite

mobilisation review

National vanguard

team - NHSE

Workstream lead Workstream lead Workstream lead

Trust board


Empowering patients and communities

The premise that patients and communities benefit from networked care is central to our vanguard programme. We will test whether and how

patients can benefit from improved access, improved outcomes and greater confidence in the reputation of their network provider. We will analyse

how networked services can respond to the needs of the local population while providing consistently high quality care and good customer service.

We will capture this in our publication, codifying best practice in the toolkit. Patients will have representation on our programme board to help

ensure their interests are considered throughout the research and delivery phases

We are developing an engagement and communication strategy which will include a sub-workstream to provide expert and dedicated time to

leading this part of our vanguard programme. This sub-workstream will undertake engagement with key stakeholders including patients, staff,

provider partners and commissioners in order to assess the quality and reputation of the existing Moorfields satellite model and elsewhere.

The national and international network review workstream will research the evidence and capture best practice in empowering patients and

communities and delivering benefits in other NHS networks, international health networks and other sectors.

Programme evaluation and replication

Our programme is focused on building the evidence for when and how networked care can support sustaining local services in addition to

developing a toolkit that supports its effective replication. Our evaluation programme will be based on gathering the evidence described in our

value hypothesis tree and evaluating the programme outcomes described in our programme logic model and workstream logic models.

Although at an early stage, we have identified a number of hypotheses that our evaluation programme will test:

networked care delivers better clinical outcomes

networked care is safer

networked care improves access for patients

patient experience is improved by networked care

best practice and service improvement are better disseminated through networked care

this programme can improve and accelerate acute trusts’ decisions to and implementation of networked care

networked care reduces variation and generates financial savings

networked care avoids service failure (unable to maintain the service) and generates financial savings

We will continue to work with the national evaluation team in light of the recently issued guidance to ensure the outputs of our vanguard can be

used both locally and nationally. We will also seek to appoint an evaluation partner who will ensure our evaluation findings contribute to the

national vanguard programme goals.


Section 5: Financial impact and costs

Hypothesis We anticipate that our vanguard programme will deliver benefits to the wider health system which can be described and quantified in two distinct

categories.

1. Benefits realised from the outputs of our vanguard

These benefits will be realised as a direct result of the outputs of our programme and will enable other organisations to make well-informed

and timely decisions about the appropriateness of implementing their own networked models of care. The toolkit will help organisations to

design and implement a network model more quickly and/or to assess and decide whether to join one. These benefits are available for all

specialities that can be networked in the 142 general acute trusts and 12 specialist trusts.

2. Benefits to be realised from implementing a networked model of care

These are the quality and financial benefits that can be realised when care is delivered through an effective NHS network.

The value generation hypothesis tree (page 12) and assessment (appendix 2) have distinguished between these two types of benefit. The

following pages provide more detail on each of these.


1. Benefits to be realised from the outputs of our vanguard programme

The outputs of our vanguard programme, including the toolkit that will codify best practice in establishing networked care and critical success

factors, will enable other organisations to make well-informed and timely decisions about the appropriateness of implementing networked models

of care. The toolkit will also help organisations to design and implement a network model more quickly and effectively. The table below

summarises the benefits we expect other organisations will realise as a direct result of using the outputs of our vanguard programme.

Benefit Hypothesis Benefit savings (£)

Reduced time

required to

research and

develop

networked care

proposals

Other organisations will have access to a comprehensive summary of existing models of networked

care, both in the NHS and commercial sector, which will reduce the time they need to spend

researching this approach to partnership working. Providing a clear set of critical success factors that

need to be in place across a network in order for it to succeed will mean organisations understand the

things they need to put in place in order set up a sustainable network model. This will reduce the time

required to develop a proposal for a new network arrangement and will reduce the risk of failure.

Assuming the annual cost of developing a networked care strategy and proposal is £500k, the time

taken can be reduced by three to six months. No attempt has been made at this stage to quantify the

benefit of reducing the risk of failure.

Up to £250k saving

for each trust using

the outputs locally.

If five trusts use the

toolkit each year for

the next five years

c. £6.25m saving for

NHS.

If 10 trusts use the


the next five years

c. £12.5m saving

for NHS.

Better informed

decision-making

Other organisations will better understand the things they need to put in place in order set up a

sustainable network model. Sharing the critical success factors that need to be in place across a

network, delivering a publication outlining how the networked model can be extended and analysis of

how networked care is responsive to the needs of a local population will aid timely decision-making

No attempt has been

made at this stage to

quantify this benefit


and reduce the risk of failure.

More effective

design and

implementation of

a networked care

proposal

Organisations will have access to a comprehensive toolkit which will offer a detailed ‘how to’ guide,

with appropriate document templates, to enable easy implementation of a networked model. This will

accelerate replication of networked care models, will make more efficient use of resources and will

avoid the need to endlessly ‘reinvent the wheel’. The benefits of the toolkit will include improved:

financial assurance: a structured planning and mobilisation guide for setting up a network

which clearly identifies likely implementation costs and likely areas for delivering economies of

scale

legal and regulatory assurance: a clear guide to the various consultations and notifications

required when implementing a network

risk assurance: a detailed list of potential risks which will need to be managed and mitigated

during mobilisation

quality assurance: a summary of ‘what good looks like’ in relation to patient engagement,

clinical due diligence and quality metrics during implementation

board assurance: a comprehensive process developed by an acknowledged leader in the field

of network models of care through local, national and international collaboration and research

to guide organisations through the implementation phase

Assuming the annual cost of a programme to deliver a networked care model is £300k, the time taken

can be reduced by three to six months

Up to £150k saving

for each trust using

the outputs locally.

If five trusts use the


the next five years

c. £3.75m saving

for NHS.

If 10 trusts use the


the next five years

c. £7.5m saving for

NHS.

There are 154 NHS trusts that could benefit from using our outputs in multiple specialities – an assumption that they will be used 10

times a year for the next five years could generate £20m savings in the cost and time taken to lead organisations and deliver sustainable

improvement.


2. Benefits to be realised from implementing a networked model of care

As part of our vanguard programme we will also seek to describe and quantify the clinical and financial benefits of implementing a networked

model of care. These benefits will apply to individual providers, local health economies and the wider NHS. The table below summarises the

benefits we have identified in our hypothesis, along with existing examples provided by other organisations, which support our current thinking. All

these benefits will be described and quantified more fully as an integral part of our vanguard programme.

Benefit Hypothesis Existing examples

Reduced variation Establishing networked models of care will reduce the variation

in the quality of care delivered by different providers. This is

particularly applicable in smaller clinical specialties which are

rarely a high strategic or operational priority in district general

hospitals.

The reduced variation will result in better clinical outcomes and

improved patient experience. There will also be more

equitable patient access (localised and timely) to sub-specialist

expertise.

The cost of variability in orthopaedic outcomes as detailed

in National Orthopaedic Alliance value proposition:

The improved outcomes in stroke care resulting from the

reorganisation of stroke pathways in London cited in BMJ

2013;347:f4954

Evidence that poor care is expensive (eg £4K for HCAI

(NPSA); £10.5k for grade 4 pressure ulcer and £2.5k for

grade 4 fall (Health Foundation).

Evidence from claims and litigations – mean cost of

ophthalmology claim is £32K (Moorfields research).

Reduced corporate

overhead costs

By sharing executive and operational leadership across a

network, there will be an overall reduction in overhead costs

across the system. This will also apply to corporate functions,

including governance teams.

These costs will be estimated through the vanguard

programme

Economies of

scale

Creating a network will result in better utilisation of specialist

workforce (in particular clinical staff) and equipment across the

health system.


Avoid future cost

of failure/

unsustainable

services

Where clinical services in their current configuration are

clinically and/or financially unsustainable, a networked model

may provide a solution that enables the continued provision of

those services locally and avoids the cost and impact of the

failure of those services.

Case study 1: Surgicentre, a privately-run NHS elective

surgical centre at Lister Hospital. The service was closed

after the CQC found the unit failed four out of five

standards. There had been three unexplained deaths

following low-risk orthopaedic surgery. Referrals for

ophthalmology and joint surgery were stopped and a local

service lost. The Department of Health had to pay £53m

to transfer the service to an NHS provider, plus £3.7million

redundancy costs, £3m contractual financial fees and

underwriting a £1m deficit.

Case study 2: Ophthalmology service at Croydon

University Hospital. There were multiple clinical and

operational challenges facing the service. Only two

consultants were employed for a service requiring five;

trainee doctors were removed because of inadequate

support; subspecialties were provided by people without

the required training and the workforce was demoralised

with poor teamwork. The service was transferred to

Moorfields, becoming a new satellite. This resolved the

staffing issues and the satellite now has a programme of

service development and improvement including a network

of community outpatient clinics for communities around

Croydon.

There is evidence that networked care can have a considerable positive impact on the cost of care, its quality and the experience of

patients but more needs to be done to quantify it and understand how it can be delivered and replicated. Our programme aims to build

this knowledge for the NHS and turn it into practical advice that can be used by all trusts to avoid local services failing, improve quality

and cost of care and improve patient experience.


Moorfields’ contribution to the national vanguard programme

In addition to the resources identified in our value proposition submission of 30 November 2015, Moorfields Eye Hospital NHS Foundation Trust is

making additional contributions to the national vanguard programme for which we are seeking no financial recompense. These are summarised in

the table below.

Description of contribution 2016/17

Contribution

Time devoted to the national programme:

Executive team time invested to support the vanguard programme

Attendance at national and local vanguard programme meetings

Organisational input and expert advice

£41k

£24k

£32k

Subtotal £97k

Value of historical knowledge and expertise

As its network has grown and developed, Moorfields has gained

experience and expertise that generates the value and benefits

described in this value proposition. The financial value of this could

be described as the saving we expect to generate each time our

toolkit is used (£400k) multiplied by the 32 sites in our network so far.

This is the value that we are offering to share with the NHS and turn

into practical application.

£12.8m

TOTAL £12.9m


Financial resources required in 2016/17 The table below summarises the resources required in 2016/17 to deliver the programme.

Activity 2015/16

funding

allocated

Programme management and production of outputs* £651k

1. Understand existing models £43k

2. Assess existing models £745k

3. Undertake stakeholder review £53k

4. Review international networks £48k

5. Network analyses £218k

6. Detailed market analysis -

7. Review networked care opportunities £201k

TOTAL £1.959m

*includes the costs of developing and maintaining the toolkit online to make it easily accessible across the NHS.


Section 6: Non-financial support package

The table below summarises the support we are seeking from the new care models programme and national organisations

Support package element Initial view of the support in 2016/17

Designing new models of care Care Quality Commission (CQC): help to establish whether a community thinks that a change to their

service would be an improvement, making sure a networked care model is what the local community wants

and needs

NHS England: sustainable improvement team

support to capture of knowledge to aid learning and the spread and replication of our care model

network toolkit and other resources to help network leaders and users manage their networks effectively

National voices:

building understanding of what matters to patients, service users and carers

building understanding of the evidence for what works to engage people in their care and support

building understanding of what works in engaging citizens and community organisations, in

governance, service design, and implementation.

Evaluation and metrics New Care Model (NCM): support for development of the local evaluation strategy and appointment of a

suitable evaluation partner.

Integrated commissioning and

provision

NCM: understanding what models are being developed and their potential impact/learning for the network

toolkit. Support us to consider how the network toolkit can be replicated across other programmes and

adapted for wider use.

New operating model Working with our collaborative partners, the National Orthopaedic Alliance and the Walton Centre

NCM, to help assess other new models which may have implications for the proposed network care model –


best practice, lessons learned, what can be shared.

Governance, accountability

and provider regulation

NCM: help us assess the implications for network for different types of network arrangement with different

geographical spread.

Empowering patients and

communities

Health Education England (HEE): factoring into our research and the toolkit, the principles and key success

factors for delivering long-lasting behaviour change across staff, patients and the wider public, with a

particular focus on supporting self-care and wider person-centered care.

Harnessing technology NCM:

access to published examples of what good looks like for digital success

nationally agreed standard templates for information governance

available technical and strategic support for connected digital solutions and information handling in

different clinical scenarios

Workforce redesign HEE and working with workforce redesign specialists locally.

Local leadership and delivery Currently reviewing and will confirm.

Communication and

engagement

NICE consultancy support: using QS15: Patient experience in adult NHS services to drive patient

engagement.

NCM: examples of good external stakeholder engagement processes including patient engagement.


Section 7: Summary and conclusion

Moorfields is the leading provider of eye health services in the UK and a world-class centre of excellence for ophthalmic research and education.

Our main focus is the treatment and care of NHS patients with a wide range of eye problems, from common complaints to rare conditions that

require treatment not available elsewhere in the UK. We treat people from 32 core locations in and around London, which enables us to provide

expert treatment closer to patients’ homes.

Acute hospitals are facing increasing challenges to deliver safe and cost effective care, especially in smaller clinical specialties such as

ophthalmology which often lack the benefits of scale in a local setting. In the absence of critical mass of patient numbers or specialty workforce,

provision of care may become clinically or financially unsustainable. Moorfields has developed a satellite model that provides clinically and

financially sustainable local access to high quality ophthalmic care, and a sustainable model of specialist treatment. We believe that the

Moorfields’ satellite model has potential replicability across the acute healthcare system. The aim of our vanguard is to consolidate our learning in

delivering networked care so that we, and the wider NHS, can develop a clear understanding of when and how this new model of care can enable

acute hospitals to become clinically and financially sustainable.

We want to consolidate our learning in delivering networked care so that:

the NHS can develop a clear understanding of when and how this new model of care can support acute hospitals in becoming clinically and

financially sustainable and the implications of extending models of networked care more widely across the service

we, at Moorfields, can deliver sustainable ophthalmology services that meet the needs of local populations and are delivered as an effective networked care model.

Our programme will deliver two key outputs, which will deliver benefits for the wider NHS, and for Moorfields:

a toolkit that codifies best practice in establishing the need for and implementing networked care and describes the critical success factors

required for it to succeed.

a publication outlining how the models of networked care can be extended while delivering clinically and financially sustainable services that

meets the needs of local populations.

This value proposition requests funding of £1.959m to support the delivery of the programme in 2016/7. Moorfields is committed to

contributing its time, experience, expertise and knowledge to the national vanguard programme, at a value of £12.89m. The quantifiable

financial benefits of 10 trusts a year using the outputs from our programme locally to make decisions about implementing networked

care could save £20m over five years. Our programme will build the evidence and understanding of the further value and benefits of

networked care to quality, experience and cost and turn it into practical advice on how to realise and replicate it.kare


Appendix 1: Three workstream logic models (1/3)

Activities Outputs Outcomes

Rationale

To carry out an internal review of our most recent satellite mobilisations in order to analyse the generic themes and critical success factors which underpin the way in which we manage the

mobilisations in current form. To use this information to develop a Toolkit which other organisations can use to set up a network model of care (replicate this model elsewhere within the NHS)

Impacts

Accelerated

establishment of

satellite networks

across the NHS

Reduction in start-

up costs to

establish a satellite

network

More efficient use

of resources

through

establishing

satellite networks

Networked care will be

supported by effective and

sustainable governance

structures, underpinned by a

strong organisational culture

Patients will have greater access

to locally delivered, clinically

sustainable services

Acute hospitals will become

more sustainable by working

with partners in a network

Moorfields ACC vanguard: Moorfields satellite model mobilisation review 1/3

Document showing differences

between the planned and delivered

service created by April 2016.

Compare current service configuration against the agreed business case signed off by TMB.

Elements included, but not limited to:

• clinic timetable

• staffing per session • appointment profile per session

• activity achieved per session

• capital equipment

• rooms occupied per session

Revised and improved satellite

mobilisation checklist/plan created by

April 2016

Conduct survey with staff that have experienced the mobilisation. Elements included:

• Did they feel involved?

• Able to raise concerns?

• Were concerns dealt with? • Were they communicated during the process?

• Was the information provided helpful and

informative?

• Lessons learned and best practices

Anonymised mobilisation staff feedback

document created by April 2016

Mobilisation lessons learned and best

practices document created by April

2016

Develop business case template for setting up a satellite site linked to the revised checklist/

mobilisation plan

Notional Business case template

document created by April 2016

Review and compare mobilisation plans

Revise and update the mobilisation template to

provide a detailed and complete project plan

which represents what ‘looks good’ for effective

mobilisation planning for a new service onto an

existing site or a new satellite site entirely

Review and compare mobilisation plans against

the draft satellite checklist

Replicability of best

practice in

delivering

networked care

Better decision

making for

organisations

considering a

networked care

model




Impacts

Accelerated establishment of

satellite

networks across

the NHS

Better care for patients

delivered by

standardizing

care, improving accessibility and

minimizing

waste across

the system

Reduction in start-up costs to

establish a satellite

network

Better decision making for

organisations

considering a

networked care model

Replicability of best practice in

delivering

networked care

Delivery of sustainable

ophthalmology

services that

meet the needs of local

populations and

are delivered in

an effective

network

Networked care will be supported by effective and sustainable governance

structures, underpinned by a strong

organisational culture


Acute hospitals will become more sustainable by working with partners in a

network

Rationale To carry out a deep dive internal review of our existing satellite model in order to analyse the generic themes and critical success factors which underpin the way in which our network operates

successfully in its current form. To use this information to develop a Toolkit which other organisations can use to set up a network model of care (replicate this model elsewhere within the NHS)

Moorfields ACC vanguard: Moorfields internal satellite model review logic model 2/3

Conduct full review of Moorfields eye centre@Moorfields eye unit@, and

Moorfields community eye clinic@

Conduct desktop review of smaller Moorfields eye clinic@

Estimate onward referral value to Moorfields partnership@

Review savings of Moorfields shared care cataract pathway

Satellite premises review

Satellite patient profile review

Satellite, sub-specialty and clinic activity review

Satellite, sub speciality & clinic clinical governance review

Satellite competitor analysis

Satellite, sub specialty & clinic workforce review

Satellite, sub specialty & clinic financial stability review

Conduct stakeholder review

NHS Toolkit, including critical success factors, opportunity analysis, comms plan, demand

based service schedule, service and network

checklist, clinical governance framework,

policies reporting and monitoring, outcomes benchmark, mobilization plan, costing template

and business case template completed by

March 2017

Conduct comparative eye network review

Review satellite IT connectivity and interoperability

Review patient care impact of Croydon take-over.




Rationale

The aim of our national and international workstream is to consolidate and share our learning in delivering networked care, in collaboration with other NHS and commercial providers, so that

the NHS can develop a clear understanding of when and how this new model of care can support DGHs and health economies to be clinically and financially sustainable for small

specialties like ophthalmology.

Impacts

Better decision making for organisations

considering a networked care model

Replicability of best practice in delivering networked care

Widespread understanding of the benefits arising from different forms of networked care

Networked care will be supported by effective and sustainable governance structures, underpinned

by a strong organisational culture


Acute hospitals will become more sustainable by working with partners in a network

Better understanding of the commissioning implications arising from widespread adoption of

networked care

Moorfields ACC vanguard: national & international network review logic model 3/3

Conduct market analysis: • review overall market position based

on hospital activity data

Report on activity levels and patient flows at provider and CCG Level produced by April 2016

.

Populated template/tool which enables the trust to review its overall position in the market produced

by April 2016

Report on activity and market share trends providing intelligence on opportunities and risks in

the market, and a standard way of assessing the

market on a regular and ongoing basis produced

by May 2016 (To include detail on patient flows for the top eye treatments in London as a whole and

in SE England. (Using HES data)

Market analysis template produced by June 2016.

Research and identify lessons from other networks in the NHS and internationally

Template with set of consistent research questions/ key lines of enquiry that will be

used for all of the network reviews produced by

March 2016.

.

Desktop review and/or physical visits to 16-25 sites.

Site reports produced by August 2016. .

Review research and evidence on national and International networks to understand

applicability for our programme publication

and toolkit.

Key elements : • understand the structure of the service

provided – single site, multiple,

network, other

• market context (catchment/

competitors/partners)

• understand the challenges the Trust faces – commissioners and financial

• clinical governance structure in

codifying & spreading good practice

across the network

• identify similarities with Moorfields ophthalmic or generic themes

• identify opportunities for sharing

learning and innovation

• explore commissioning models

National and International network analysis review produced by end of September, 2016..

NHS publication produced by March 2017.


Appendix 2: Value generation assessment (1/5) - Clinical Primary

assertion Sub-assertion Evidence available Further evidence to

be gathered Metrics Target

Cli

nic

al

Clinical outcomes will

be improved

through

replicating best clinical practice

across a

network.

• Providing a clear, systemised approach to

spreading best clinical

practice across other sites

will allow:

§ systems to understand and replicate best clinical practice.

• Large investment in clinical governance half-days as a

protected forum for sharing

lessons and best practice.

• Research trial activity.

• Sub-speciality service improvement plans

• Review effectiveness of existing clinical

governance structure

in codifying and

spreading good practice across the

satellite model

• Review how other networks share and

adopt best practice.

• Variation in clinical practice

across the

satellite model

reviewing performance

against 30

core quality

standards.

• Identify and describe how

networked care

can improve the

adoption of best practice.

• Ensuring consensus across the network of the standards expected of all

services and staff will put in

place:

• a clear set of specialty standards

that are comparable with the best

published international evidence.

• improved clinical outcomes for patients eg reduced harm such as post surgical infection.

• Clinical outcomes measured against 30 core outcomes for best ophthalmology practice.

• Clinical effectiveness

supported by a

comprehensive list of policies, guidelines and protocols for

best ophthalmology practice.

• 200+ audits to review clinical

practice for effectiveness and

outcomes.

• Update 30 clinical outcome standards to ensure they

continue to represent

best international practice.

• Review how other networks set and

review standards for

clinical outcomes.

• Clinical outcome standards

across the

satellites - reviewing

performance

against 30

core quality

standards.

• Specify expectation with relation to

setting clear

clinical outcome standards

across a

network.

• Networked care allows staff to see the right volume of

patients to develop and

maintain expertise,

resulting in:

• critical mass of clinical skills within the network are deployed to

ensure standards are met.

• clinical skills developed to meet future requirements for best outcomes.

• summary of the secondary and tertiary clinics across the

satellite model and the clinical

expertise providing them.

• Determining right volume mix at local

level.

• Review how other networks deploy staff

to maintain and

improve access.

• Measures of casemix and

complexity.

• Vanguard output will provide gap

analyses of

network v non –

network benefits and approach to

deploying clinical

specialists across

a network.

)

A

Impact

of outp

uts

of

vanguard

pro

gra

mm

e

Impact

of im

ple

menting a

netw

ork

ed m

odel of

care


Appendix 2: Value generation assessment (2/5) – Patient experience

Primary assertion

Sub-assertion Evidence available Further evidence to be gathered

Metrics Target

Pati

en

t exp

erie

nce

• Patient experience

will be

enhanced by

standardising care and

improving

access across

a network

model.

• Describing and publishing the benefits of networked

care for safety and patient

experience will allow:

§ systems to understand and replicate best practice for patient experience.

• Evidence from core clinical outcomes,

incident reporting and

improved access across

the satellite model (cross-referencing the clinical

and safety and quality

assertions).

• Qualitative research of patients perception of

the benefits of networked

care for them.

• Evidence from other networks.

• Qualitative assessment of

patient

confidence and

experience of networked care.


networked care

can improve

patient confidence.

• Increasing access to care locally for patients results

in:

§ reduced travel times.

§ increased patient satisfaction.

• Quantitative evidence that more attendances

take place away from the

City Road (central) site:

• 55% of new outpatient activity currently takes place

in other (non-City Road) satellites.

• Calculating “travel burden” for patients to

describe access benefit

of network.

• Reviewing other networks’ approach.

• Comparison with non-networked access.

• “Travel burden” measurement for

different services

and populations.

• Inter-network national “Friends

and Family” benchmarking.


networked care

can improve

access compared with

non-networked

care.

• Increasing access to subspecialty expertise for

patients will mean:

§ surgical expertise is available

closer to patients’ homes.

§ reduced inter-speciality referrals

and waiting times.

• Quantitative evidence that more surgical activity

takes place away from

City Road:

• 55% of surgical activity currently takes place in the

other non -City Road satellites.

• Inter speciality referral waiting times for

network and non-

networked service

models.

• Other networks’

approach to this.

• Comparison with non-

networked access.

• “Travel burden” measurement for

different services

and populations.

• Referral waiting times for sub-

speciality clinics across networks.


networked care

can improve

access to sub-specialist

services

compared with

non-networked

care.

• Consensus across the network of the patient

experience standards will

be put in place:

§ Clear set of patient experience standards based on evidence of best practice across the network.

§ Standards built into staff

behaviours & team development.

• Friends and family and survey measures from

across the network,

benchmarked internally

and with NHS.

• Team-based improvement

plans from the “Moorfields Way”

behaviours programme.

• More work to compare experience feedback

across Moorfields.

Satellite model and with

other national and international ophthalmic

providers.

• Other networks’

approach to this.

• Inter-network friends and

family

benchmarking.

• Inter-network staff survey of

friends and family

recommendation.

• Identify and describe how to

optimise the

opportunities of

network networked care

to enable

excellent patient

satisfaction.

Impact

of outp

uts

of Vanguard

pro

gra

mm

e

B

Impact

of im

ple

menting a

netw

ork

ed m

odel of care


Appendix 2: Value generation assessment (3/5) – Safety and quality Primary

assertion Sub-assertion Evidence available Further evidence to be

gathered Metrics Target

Safe

ty a

nd

qu

ality

• Safety and quality will

be assured

through

setting and spreading

best practice

across the

network.

• Disseminating lessons on safety and quality learnt

across the network will

ensure:

• wider reach an application of speciality specific lessons, resulting in faster adoption of any

changes to practice.

• Aggregate and themed analysis comparing all

incidents, complaints and

claims across whole

network.

• Local quality forums held

across the network designed to review quality,

supported by dedicated role

of network quality partners.

• Themes arising from other organisations

(ophthalmology and

other).

• What learning is shared.

• Evidence that lessons learnt reach all satellite

sites.


• Incident reporting

outputs.

• Staff survey measures of

safety

processes and lessons

learned.

• Analyses as to whether a

network offers a

better learning

opportunity

• Analyses as to

whether learning leads

to long-term

action/change

• Providing standardised safety reporting which is

bespoke to a single clinical

specialty will enable:

• robust processes for identifying safety incidents and near misses

• benchmarked reporting across

the network, eg infection rates

• an active “worry list” of the top

quality and safety issues receiving attention in the

network.

• In 2014/15 there were 6,575 reported safety

incidents across the

network.

• Approximately half of these incidents occurred at City

Road and the rest across

the other satellites.

• Infections following

cataracts and intravitreal

injections are monitored for all sites.

• Undertake comparison of quality and safety

assurance with a “good”

CQC-rated DGH to further

assess and understand the benefits of a single

speciality network.


• Safety incident reporting.

• Infection rates following

cataract

surgery and

intravitreal surgery.

• Analyses as to whether

network model

improves

quality and safety

reporting.

Where there is

evidence that it

does – how is

this best achieved?

• Networked care allows all sites to access greater

depth and breadth of

speciality experience

enabling:

• thorough standardised approach to investigating safety issues

• investigations completed more

quickly and effectively.

• a greater number of quality and safety issues relevant to sites.

• The quality and safety assurance model sets out

the incident investigating

and reporting system for

the network.

• The regular global quality

and safety report details the

themes and lessons for the

network.

• Individual investigation

reports detail the findings

and lessons.

• Undertake comparison of quality and safety

assurance with a “good”

CQC rated DGH to further

assess and understand the benefits of a single

speciality network.

• Measure timeliness of completion of

investigations across the network.


• Adherence to standard

safety

investigation

guidelines and timescales

• Analyse differences

across different

organisations

(single specialty in DGH/single

specialty

network/multi

specialty DGH /

multi - network

C

Impact

of outp

uts

of

vanguard

pro

gra

mm

e

Impact

of im

ple

menting a

netw

ork

ed m

odel of

care


Appendix 2: Value generation assessment (4/5) - Resource requirements

Primary assertion Sub-assertion Evidence available Further

evidence to be

gathered

Metrics Target

Resou

rce r

eq

uir

em

en

ts

• Resource requirement of

additional ~

£1.959m in

16/17 is reasonable to

deliver the

outputs and

generate the

value of the

programme

• £1.959m is the cost of delivering the

programme activities: • Programme management

£651k

• Existing models £43k

• Assess existing models

£745k

• Stakeholder review £53k

• International review £48k

• Network analysis £218k

• Network opportunities £201k

• £12.9m is the value of the knowledge,

experience, expertise

and time being contributed to the

national vanguard

programme.

• Detailed costing undertaken of all of the activities required to deliver the

outputs for year 1 of the vanguard

by March 2017

• Programme management include the costs of developing and maintaining

the toolkit as an on-line tool that is easily accessible across the NHS

• As its network has grown and developed, Moorfields has gained

experience and expertise that generates the value and benefits

described in this value proposition.

The financial value of this could be

described as the saving we expect to

generate each time our toolkit is used (£400k) multiplied by the 32

sites in our network so far. This is

the value that we are offering to

share with the NHS and turn into

practical application.

Achieve milestones and

deliver

outputs.

D


Appendix 2: Value generation assessment (5/5) - Sustainability

Primary assertion

Sub-assertion Evidence available Further evidence to be gathered

Metrics Target

Su

sta

inab

ilit

y

Sustainability for the NHS will be

improved by

supporting NHS

organisations to evaluate,

implement and

deliver the

benefits of

networked care

faster.

• Providing a clear set of critical success factors

for networked care and

a comprehensive ‘how

to’ guide toolkit will result in:

• reduced time for trusts to appraise options for

forming or joining networks

of care

• more effective design and implementation of a

networked care proposal.

• Anecdotal evidence that it can take a year or more for trusts

to appraise network options

and make a strategic decision

to proceed. Trust boards can be concerned about whether

they have sufficient

information to proceed and

implement a new network.

• Anecdotal evidence that implementation of networks

can take a year or longer to implement.

• Whether there is empirical evidence of

the time it takes

trusts to decide to

network and the subsequent success

rate in implementing

networked care.

• Whether there is empirical evidence of

how long it takes to

implement new networks.

N/A • >£400K per organisation and per speciality saving

based on reduced decision

taking time and reduced

time to design and implement.

• 154 trusts have potential to

use outputs for multiple

specialties.

• 5 trusts a year over 5 years

saves> £10m.

• 10 trusts a year over 5

years saves > £20m.

• Implementing a networked model of

care with effective

clinical governance will

result in:

• reduced variation in service

delivery

• reduced corporate

overhead costs

• economies of scale

• avoiding future cost of

failure and/or unsustainable services.

• There is evidence that poor care is expensive:

• A hospital acquired infection adds

£4,000 to cost of care (NPSA).

• A grade 4 pressure ulcer costs

£10,500 and a grade 4 fall £2,500 (Health Foundation).

• Average litigation cost at

Moorfields is £32k.

• Case study of service failure at

Lister hospital cost DH £7.7m.

• Case study Croydon

ophthalmology services taken over by Moorfields, resolved

staffing crisis and improved care

and access.

• Examples and evidence of the link

between networked

care and quality and

cost.

• Gather further

evidence of risks of sustainability in small

providers and whether

networked care

provides an

alternative and avoids the cost of failure.

N/A

• Savings could be considerable across the NHS

– and the programme will

seek to identify and

estimate the potential savings.

• The cost of service failure is

considerable – cost, quality,

access and experience.

• Could apply to the 30

smallest and 45 small general acute trusts

identified by Monitor.

Impact

of

outp

uts

of

vanguard

pro

gra

mm

e

Impact

of im

ple

menting a

netw

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ed m

odel of care

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