With approximately 85,000 citizens prescribed oxygen at home in England, it is essential that quality standards and processes are maintained to reduce risk and ensure patient safety.
Integrated Care Boards (ICBs) across the East Midlands recognised that improvements in the Patient Escalation Process (PEP) for Home Oxygen Services (HOS) were required to meet the services Key Performance Indicators (KPIs). Arden & GEM’s Collaborative Contracting team was commissioned by NHS Nottingham and Nottinghamshire ICB to deliver a collaborative contract for HOS across all East Midlands ICBs to improve the performance of the PEP.
We delivered a six month project that brought together the ICBs, clinicians, oxygen suppliers and patients in order to develop collaborative contracting that has improved the quality of care and health outcomes. This project also delivered efficiencies across the system while simultaneously improving achievement against Key Performance Indicators (KPIs).
The challenge
With policies and procedures setting clear contractual requirements for the safe administration of home oxygen services, most patients enter PEP because the supplier has been unable to make contact to carry out the required service over the specified number of occasions. This includes critical activities such as conducting risk assessments and concentrator servicing.
After the supplier’s first and second attempt to contact each service user, a third attempt should be made in writing to their primary address. If there is no response from the third attempt, the service user is then placed in PEP.
The issues identified during the project were:
- Lack of clarity on the approach under PEP and who should take responsibility
- Failed/ limited engagement attempts with patients
- Lack of collaborative working between service clinicians, the HOS supplier and GPs
- A resulting failure to achieve the PEP KPIs.
Our approach
Arden & GEM has managed the HOS contract for East Midlands ICBs since 2011. To initiate the improvement project, our regional lead established the Home Oxygen PEP Working Group. This included representation from all key stakeholder organisations involved in delivering the service – as improved collaboration would be a key factor in achieving a successful outcome.
Terms of reference were drafted for the group with an agreement for meetings every six weeks designed to address the service performance issues. Arden & GEM chaired all meetings with formal minutes recorded. Initial meetings focused on providing clarity on the PEP process and establishing clear responsibilities for managing both historic and future patients in PEP.
Actions were then established that could address the performance issues, with these circulated at a strategic level across all ICBs within the East Midlands and to Home Oxygen Service Assessment and Review (HOSAR) leads in the clinical network.
The oxygen supplier then produced a remedial action plan (RAP) for PEP performance improvement that included:
- Sending letters to all PEP patients and/or GPs to arrange a service or risk assessment
- Accurate recording of communications and responses
- An updated and detailed process for PEP (reviewed and signed off by the group)
- Collaborative working on scripted communications to raise the profile of PEP for patient safety
- Data analysis and breakdown of patients into specific cohorts including paediatrics, adults and disease specific groups
- Liaison with HOSAR to discuss PEP patients.
Performance against the RAP was then monitored closely by the group, with regular progress reporting for all interested stakeholders.
The outcomes
The number of patients in PEP rapidly reduced and the KPI was achieved three months ahead of the timelines detailed within the initial remedial action plan. Details of this success were shared widely across all ICBs and the HOSAR clinical network.
With KPI achievement now above the required target, the quality of care has improved, as have health outcomes for patients due to serviced and well maintained equipment at their properties.
Both patient and staff experience has improved with this collaborative working and efficiency has increased with delivery of the contract KPIs.
Next steps
As managers of the HOS contract, we continue to closely monitor the activity and the KPI for PEP as part of our business as usual.
We are currently working in partnership with NHS England on strategies to publicise our approach and learnings into other regions where HOS suppliers are struggling to achieve their KPIs.
"The joint working undertaken to resolve this long-standing issue has been superb, I wanted to add my thanks and congratulations to team on a job well done."
Mark Sheppard, Associate Director of Commissioning - Acute Contracts, NHS Nottingham and Nottinghamshire ICB
Find out more about our Procurement Support Services here.