​Lessons from the Vanguard: Procurement 

Dudley was unique within the New Care Models programme for using a large-scale procurement exercise. This exercise therefore offers lessons for both policy and practice. These lessons are set out in a short ‘lessons from the vanguard’ paper, joint-authored by the Strategy Unit and Dudley Clinical Commissioning Group.

The main conclusion of the paper is that NHS commissioners should be allowed to award an ‘Integrated Care Provider (ICP) contract’ (described below) to an NHS provider without having to undertake a large-scale procurement process. This would enable the NHS to reap the potential benefits of this contractual form while removing the costs of procurement and related concerns around privatisation. 

Find out more on our Dudley Microsite 

Lessons from the Vanguard: Innovation and Evaluation  

The problems facing health and care services are so well known as to be documented in the media most days. These problems arise from a mismatch between need and provision: a mismatch where there is no reason to assume fundamental change. So innovation – in both product and process – is needed.

Yet innovation doesn’t just happen. It must be encouraged and nurtured. It must also be supported with evaluative tools and disciplines: evidence is needed to inform decisions as to whether innovations are scaled, stopped or refined.

This short paper suggests that evaluation and innovation are two sides of the same coin. It was produced by Dudley Clinical Commissioning Group (CCG) and its partners the Strategy Unit and draws on Dudley’s experience as a ‘Vanguard’ site under the New Care Models programme. 

Lessons from the Vanguard: cultivating innovation and the role of evaluation 

Evaluation of the Dudley New Care Models Programme 

This is the final system-wide report from the evaluation. It draws on in-depth interviews with over 20 strategic level stakeholders from the Dudley system. The report looks at both the large-scale procurement process and the development of new services within the Vanguard programme. It provides an update on progress, but it also draws out lessons for both practice and policy.   

For any additional information or queries, please contact Fraser Battye (Fraser.battye@nhs.net) 

Evaluation of the Dudley New Care Models Programme -  Strategic Level Evaluation 

Dudley MCP Scenario Analysis 

Dudley is one of fourteen vanguard sites nationally developing the Multispecialty Community Provider (MCP) care model. The MCP involves the implementation of new organisational relationships that are intended to result in new system dynamics, incentivising the actions that can improve population health over the long term. The patient is at the centre of the MCP model of care. The MCP will bring together the services of GP practices, nurses, community health and mental health services, community-based services such as physiotherapy, relevant hospital specialists and others to provide joined up care in the community, improving outcomes and reducing demand.

All this takes place in an uncertain context: the challenges facing NHS systems are headline news; NHS structures are frequently the subject of organisational change and new policy directives; funding allocations are determined on a relatively short term basis; and the impacts of the wider environment on the NHS and local health and care systems cannot be accurately predicted (e.g. how patterns of trade, competition and migration may change; what technological advances will be made and how the public will respond to them; how the supply and culture of the workforce will evolve).

The Strategy Unit has been a strategic partner providing specialist support to the development and evaluation of the MCP, and the MCP Programme Board asked us to assist local stakeholders in exploring a range of plausible futures that could evolve over the intended fifteen year duration of the MCP contract. The aim of this work was not to predict the future but, through exploring a diverse set of plausible futures, to generate practical responses that would increase the effectiveness, resilience and agility of local plans, as well as providing additional assurance to regulators

Scenario work is best seen as an ongoing process: it builds social capital, provokes new insights and enables partners to explore challenging issues in a collaborative rather than competitive manner. This report is therefore only a staging post which:

• Describes the MCP strategy;
• Explores key features in the wider contextual environment;
• Presents three plausible future scenarios; and
• Records the shared learning that local stakeholders have already begun to generate following a workshop with a broad range of senior local leaders

Thank you so much to the team for this highly developed piece of innovative work.

The scenario my group worked on was very different to how I anticipate the future, so the challenge was very helpful.

The fact that there were very different perspectives in the group really helped challenge my thinking.

Well written narratives with surprising but plausible futures.

A fantastic piece of work that has taken us truly to a different place!

Scenario Planning in Dudley - Summary Report

Scenario Analysis for Dudley's Multispecialty Community Provider Strategy - Full Report 

Logic Models for Complex Programmes   

Logic models have become a standard tool for planning and evaluation. This short presentation offers a step-by-step guide to assembling logic models for complex programmes.

The Strategy Unit is well known for its use of logic models. We use them to help programmes and organisations – including Vanguard sites and Sustainability and Transformation Partnerships – to set out the thinking behind their work. Logic models clarify thought at the outset. This brings two main benefits: better design and increased ability to evaluate.

These slides, which we generally use to accompany training workshops, provide a brief introduction and a step-by-step guide to assembling a logic model. 

Logic models and complex programmes - a brief guide

​Your guide to using Logic Models 

​Evaluation and complex change 

Feedback is a vital component of any complex change programme. Without feedback, it is impossible for policy makers, programme and frontline teams to learn, adapt and improve. The Strategy Unit therefore sees evaluation as a vital part of the mix in making large-scale change.

Evaluation is all too often a late – or even an after the event – addition to programmes. Traditionally undertaken as a removed and academic exercise, evaluation has not fulfilled its potential as a tool for change.

The Strategy Unit takes a different view. We see a role for evaluation that is highly applied and focused on aiding programme development and implementation. Especially where programmes are large scale and complex, we see evaluative feedback as a fundamental part of the process of change. 

Change, complexity, feedback and the role of evaluation 

Evaluation of the Patient Activation Measure (PAM) pilot  

As a concept, patient ‘activation’ holds promise; evidence suggests an enhanced ability to self-manage long-term conditions (LTCs) and an associated reduction of healthcare use. The Patient Activation Measure (PAM) has been promoted as a tool for measuring activation. It can also be used to structure conversations with patients who have LTCs. Dudley therefore piloted the use of the PAM, backed by health coaching, in one GP practice. This report presents the results of the evaluation. It highlights the need for clarity on what can be achieved by measurement alone - and so what therefore might be needed by way of support for people looking to change health behaviours. 

Using the Patient Activation Measure in Dudley 

Evaluation of patient reported measures pilot 

There is wide consensus that the NHS needs to generate and act upon more patient reported data on outcomes and experience. These measures will also feature in Dudley MCP’s contract. A pilot to use these measures was therefore run in GP practices and evaluated. This report presents the results. It highlights the practical challenges associated with the generation of this data, showing the need for significant further efforts before this type of data becomes ‘mainstream’.

Measuring patient outcomes and experiences in Dudley 

Dudley MCP Evaluation of New Schemes   

To support the move to the MCP model of care, Dudley's Partnership Board instituted a series of new schemes. But how well implemented were they? And what outcomes did they achieve?

This report - and the accompanying presentation - summarises the results of a rapid cycle evaluation of these innovations, along with recommendation for the future. 

Dudley Evaluation of selected Value Proposition schemes 

​Evaluation of Value Proposition Projects  

Integrated Impact Assessment for Major Hospital Reconfiguration

The Strategy Unit worked as a strategic partner of the NHS Future Fit Programme in Shropshire and Telford and Wrekin from its initiation and until it was able to move to public consultation. A key output was a comprehensive Integrated Impact Assessment of acute hospital options that enabled commissioners to make a unanimous decision in a very sensitive context. This included an additional focus around women’s and children’s services.

Future Fit integrated impact assessment

Future Fit integrated impact assessment - women and childrens services

Future Fit integrated impact assessment - womens and childrens services - annexes

​Dudley MCP Public Consultation and Equalities Impact Assessment Report

The MCP will be a new organisation, with a new contract and a remit to change the way that care in Dudley is delivered. 

So what are the expected impacts of these changes? What about the inequalities: will any groups be especially affected? What does the local population think? This report sets out the results of an initial impact assessment for the MCP.

Public Consultation and Equalities Impact Assessment Report