For a recent HTN webinar, we were joined by Saj Kahrod and Paul Charnley from the NHS England Blueprinting Team, along with Sue Houston (associate operational commander OCC) and Sue Luff (associate director UEC and OCC) from Kent and Medway ICS, to talk about their operational control centre blueprint.
In April 2021, Kent and Medway ICS transitioned their COVID incident coordination centre to an operational control centre model to support the operational response to emerging incidents across regional health and care providers. In this session, panellists shared how designing a clinically-informed escalation management process in conjunction with visual whole-system monitoring, has enabled the region to collaborate and utilise system capacity more effectively, positively impacting patient flow and safety.
Paul began with a brief introduction to the blueprinting team programme around sharing work being done across the NHS and exemplars of best practice, in an “online resource within NHS Futures” that provides assets and artefacts relating to projects across a wide variety of different areas of transformation.
Saj also shared some insight from her role as assistant director of programmes with the blueprinting team, highlighting work on “strengthening the learning ecosystem and knowledge sharing”, alongside “accelerating and embedding digital maturity”.
Kent and Medway ICS
Sue Luff started by sharing background to the situation in Kent and Medway, and some of the challenges that the region was facing prior to the introduction of the operational control centre.
A registered nurse by background, Sue talked about her “dual role”, spending two days in the operational control centre (OCC) and three in wider transformation. Kent and Medway, she shared, was formerly made up of eight CCGs, before coming together as an ICS covering “a diverse population” of 1.9 million people. The main challenges Sue mentioned for the region were around beds in the system and a shortage of GPs.
Sue Houston highlighted the challenges brought about by COVID, as well as historic operational challenges such as long ED waits, noting that the OCC model’s main benefits were improved relationships and communication across providers.
“We bring them together on system calls three times per week”, Sue went on, “with the ability to step that up should the system need it, and we’ve had reduced declarations of OPEL 4 and business continuity; ambulance diverts are no longer an issue; on the 4-hour target we were aiming for 76 percent but last month it was about 84 to 86 percent; and we’ve made improvements around discharge planning between acute, community and social care.”
On the practicalities of keeping the OCC up and running, Sue Luff talked about the importance of having a “director on call” with operational experience, as well as having a clinical rota, “which is helpful in case we need some clinical advice”.
“We’ve put escalation processes in for things like 12-hour waits for mental health, we’ve just signed off our primary care OPEL structure, and we support training across the system. We do have a physical office, where at the moment we’ve got four screens with all our data on there. We have formal reporting three times per day, which is important as otherwise you’re going to lose people.”
In approaching this type of collaboration, Sue discussed how it’s important to be “supportive and respectful”, adding, “it’s about what we can do as a system to help the organisation for the greater good of our patients. Previously, it would have been a convoluted process to get hold of anybody, but we have much better communication now, and they pick up the phone, they work with us if an organisation is in trouble, and they come together to try and sort it.”
Predicting trigger points and being able to prepare, Sue said, is one of the main benefits of the OCC, and priorities for the next 12 months include continuing to build on the data collected, focusing on “getting that really granular detail, as well as the headline figures, particularly around primary care”; working with colleagues across the ICB to continue building the OCC team; streamlining repatriation processes; working on proactive demand planning; looking more closely at shared risk and collaborative working; and continuing to focus on patient safety and experience across the system.
Moving on to present a slide featuring a picture of the OCC team at work, Sue Houston pointed out features of the OCC including hospital handover dashboards, and the space for collaborative working alongside an NRS provider and a 111 commissioner.
“The tools we use are quite dramatic, so for ambulance handovers we work with the systems to offload ambulances safely with an aim of getting them offloaded within 30 minutes; our system response to OPEL where we’ve now got all our providers talking to each other; we work with mutual aid, and we had requests yesterday from out of area for mutual aid for intensive care; we’re working towards OPELs for critical care, paediatrics, maternity; we’ve got an adult mental health escalation process; and then we have robust weekend planning, public holiday planning, and industrial action planning.”
The OCC has developed “triggers” for systems for OPEL scoring, and Sue Houston shared slides detailing the ICB’s elective cancellation steps, ambulance handover escalation, and 12 hour in emergency department escalation.
Key learnings and challenges
Responding to a question from our live audience about the kinds of challenges that the team faced in rolling-out the OCC, Sue Luff mentioned the lack of resources and the small team size, sharing that they tackled this by trying to take advantage of the “huge workforce the ICB has to call upon”, adding that, “part of the conversation was around what the OCC is, because if you haven’t had that background it sounds quite scary, and people perceive it to be something it isn’t”.
The other challenge, Sue said, is “getting organisations to speak to each other”, and there are providers who are more difficult to communicate with due to the pressures they are under, so the team focuses on “having offline conversations with them, and maybe doing a little bit more than we would usually, just to get them on board and help them”.
“The other thing is that it’s good to go on site sometimes and just see it from their eyes, and see the pressures; to physically see that, to understand what’s going on and what you’re trying to achieve, because otherwise it ends up being a bit of a paper exercise.”
Answering another audience question about data quality, Sue Houston shared how data is sent through from each trust’s BI team, and each acute provides a live written update on current status three times per day. “Live data is not so much a problem,” Sue Hess continued, “I think it’s the written data we sometimes have problems with”.
Sue and Sue closed the session by inviting anyone interested in learning more about their OCC and the approach in Kent and Medway to reach out to them and arrange a visit, advising that they are more than happy to share their learnings with others from across the NHS.
To learn more about the Blueprinting Programme and to access the blueprint library, please click here.
You can find details on upcoming HTN events over on our HTN Now events page.
