Matrix Insight

The Next Stage Review focuses on the delivery of a high quality health service in the NHS. This comes at the same time as the development of a more devolved decision-making structure with local ownership, community engagement and priority setting. The same shift needs to happen in views towards diversity and leadership. Matrix was commissioned by the NHS Institute’s “Breaking Through” team to find out how best practice organisations have achieved leadership diversity, how diverse leadership contributes to “business success” and recommend how such a change in leadership could be delivered in the NHS. This report is being considered by the Department of Health and will be published in December 2008.

High quality clinical leadership is essential in driving improvements in service quality and outcomes. Over the last 20 years clinicians have been given leadership roles, but they have not always been given the support to drive change and make evidence-informed decisions. A large health community facing the substantial challenges of a predominantly rural population, multiple hospital sites and a poor financial situation asked Matrix to help unlock the situation. The Trust needed to reshape service delivery to meet the rising, modern quality standards. Over a period of four months Matrix worked with the health community’s leaders to enable them to achieve a financially sustainable organisation and a clinically driven reconfiguration, which is now being implemented.

As leaders of the NHS locally, PCTs will inevitably have to take difficult and controversial decisions, especially in relation to the configuration of services, where they have a duty to ensure that the services they commission meet rising clinical standards of quality and safety, respond to the increasing expectations of their communities and offer the best value for money within constrained budgets. Matrix was approached by a PCT at the heart of such a controversial decision, and asked to conduct an independent review of the quality of the process of gathering and evaluating the evidence leading to their recommendation. This work had to be completed in 10 days from initial scoping to final report in time for the crucial board discussion, and it had to carry sufficient authority and credibility to provide value to the board. We interviewed all the key stakeholders, and completed our report within the deadline, confirming that good practice had been followed, but identifying key lessons both for the implementation stage and for any future review. The programme director commented “(Matrix) added value by bringing ideas and experience to the discussion, which as a client we didn’t have, and the product (report) was confident and authoritative.”

Organisations face a real challenge of drawing together clear information which helps the board to understand their performance challenges in a meaningful way. With our performance management hub in place, boards can easily identify and focus on their most important priorities at a fraction of the cost required to collate the usual monthly report. One of our clients used our dashboard to concentrate on their turnaround priorities, and the non-executive directors in particular found the combination of its simplicity and ability to support drill-down gave them much more confidence. The PCT recovered its financially position quickly and is now focusing on a wider range of board indicators.

New expectations concerning the role of commissioners are being driven by the World Class Commissioning agenda and Assurance framework. To achieve effective commissioning, each organisation must tap into the information in a more meaningful way to create the evidence which helps to show which areas have the biggest priority for improvement and investment. As their roles change, a number of commissioning organisations discover that the alignment of their business functions may make it more difficult for them to collect and use the information in the best way to review the whole spend, identify whether the current investment is being used in the best way possible, and make decisions which optimise new investments. Several PCTs have commissioned Matrix to analyse the services they currently commission, to support a needs-assessment of current and future service demand, and understand health outcomes and service performance. Our client PCTs have used this analysis to drive the development of their commissioning strategy, which in turn leads to better commissioning of service quality and improved organisational alignment with health priorities.

Influencing the behaviour of citizens is one of the major challenges for government, as the population ages and the link between lifestyle, health and well-being becomes clearer. This is a challenge for health service commissioners who need to understand what interventions will have the greatest impact on maintaining health and preventing ill health. To support this evidence-informed approach, Matrix was commissioned by the Department of Health to identify those interventions which had evidence of being value for money. We identified that from more than forty interventions studied, that eight should be considered a priority by all commissioners. The evidence has been published and is being used by commissioning organisations to inform their commissioning strategies.

Improvements in diagnostics and treatment have meant that there is great scope for reducing risk and improving outcomes for people who have had a stroke. However many services have not kept up with these opportunities because of concerns about cost, and differing views of stakeholders. Matrix was commissioned by Bexley Care Trust to accelerate improvement in a cost effective way by delivering rapid improvements to stroke services, at minimal extra cost. Within six months new services had been implemented and lives are being saved in Bexley because of the reduced risk to stroke sufferers.

This work enabled the PCT to improve their stroke services well ahead of the London stroke strategy which has now built on the local foundations.

It has been widely reported that cancer outcomes in the UK, whilst improving, are still lagging behind much of the developed world. Some of this difference can be attributed to difficulties experienced by large portions of the community in accessing radiotherapy services – which often necessitates substantial travel. New ways of working have meant that satellite radiotherapy units (centres run from a major cancer centre but placed with more convenient access for local populations) are now seen as a safe and effective way to deliver radiotherapy. Matrix was commissioned by one of these prestigious cancer centres to model the benefits of such a satellite service – to help understand how such a service may be designed, to identify who might benefit and, crucially to understand where would be the optimal service location to bring the greatest benefits to the most people. A satellite radiotherapy service is now being developed in the centre of one of our major cities. Following this success, Matrix has been supporting another hospital trust serving a large rural area to make a strong case for investment in similar services for its population.

How can the NHS benefit the most from capital investment programmes which take years to plan and deliver, when change happens on a much shorter timespan?
Both the quality of care, and the whole patient experience are benefitting significantly from capital investment throughout the NHS, but organizations involved in significant building programmes know that change in healthcare is so rapid that service needs will change many times from the design through to the point when the services go live. It is financially crippling to change schemes in mid-build, so the organisation’s leaders need to have confidence that, as the build progresses, they can accommodate new practices and changes in demand. Matrix has been helping one major teaching hospital to build a comprehensive model which accounts for the changes following from Lord Darzi’s review – more concentration of complex care into the hospital; the creation of polyclinic centres both on-site and in the community serviced; movement of simple care out into the community; adoption of new treatment technologies and improved pathways; and changing demographic demands from a growing community. This model is informing the development of an estate strategy so that the trust can understand how to maximise its use of the new facilities, and which parts of the old estate will be required for support services, so that it can release the value of unwanted buildings.