Planned Care Innovation Programme

About the Planned Care Innovation Programme (PCIP)

Responding to the urgent challenges presented by the Covid-19 pandemic, the Planned Care Innovation Programme was launched in April 2022 to support people working in the health and care sector to take forward innovative ideas, opportunities and ways of working to improve planned care services across Wales.

Led by the Bevan Commission, Wales’s leading health and care think tank, in partnership with the Welsh Government and wider stakeholders, the programme aimed to tackle some of the greatest challenges facing the delivery of planned care services in Wales, including reducing waiting times and improving access to high quality care for patients and their families.

Building on the success of the Bevan Commission’s Exemplar Programme, the Welsh Government awarded funding to support 17 innovative projects from across health and care in Wales to deliver their innovative solutions and work towards the adoption and spread of these innovations nationally. The projects focussed on a wide range of specialties including urology, ophthalmology, gastroenterology, oncology, orthopaedics, surgery, diagnostics and therapies.

Each project team has worked tirelessly to develop and test the new ways of working with support and coaching from the Bevan Commission and key stakeholders, with the aim of reducing the planned care backlog, increasing and sustaining service capacity and providing high quality patient-centred care. The following describes some of the innovations and outcomes to date.

Projects associated with service pathway redesign:

The following projects have demonstrated increased efficiencies resulting in reduced waiting lists, increased clinical capacity, high quality patient care and impressive cost benefits realised and predicted should the projects be scaled and adopted.

• Cardiff and Vale UHB and Swansea Bay UHB POPS projects (Perioperative medicine for Older People undergoing Surgery). Patients over 65 years of age waiting for surgery are screened for frailty, those scored as frail are invited into clinic or to a virtual appointment for a comprehensive geriatrician assessment. Outcomes include optimisation of medication with increased patient safety and reduced cost per patient, new diagnoses, arrangement of investigations and development of treatment plans (all managed by a single specialist rather than multiple). There have been 14-17% reductions in some elective surgery lists for this patient cohort, where through shared decision-making patients have opted not to proceed with surgery. Patient post-operative complications, length of stay and mortality rates should all improve as a result of this patient-centred, quality focussed intervention. The Morriston project has predicted a cost benefit of just under £1 million over 12 months if the project is scaled to the four major surgical pathways – colorectal, urology, laparoscopic cholecystectomy and hernia.
• Borth Integrated Care project (Hywel Dda UHB) has employed a clinical coordinator to coordinate patient care and lead multi-agency team (MAT) meetings based in primary care. As a result of the MAT meetings 553 hospital bed days have been saved due to anticipatory care planning and facilitating early discharge from hospital, releasing approximately £250,000 net benefit. In addition, the Borth practice frequent attendance rate reduced to below average due to the patient-centered meetings. The innovation has been scaled to another practice and work to achieve wider adoption is progressing.
• Cwm Taf Morgannwg UHB Paediatric Speech and Language Therapy has launched a new Prudent Social Communication Pathway. The pathway provides workshops to parents and Early Years Practitioners to help them support young children with pre-intentional social communication difficulties. This pathway has already reduced clinical caseloads and increased service capacity by directing suitable referrals into workshops where those closest to the children can provide the support they need until they are ready for treatment.

Projects associated with new roles:

The new roles have led to reductions in waiting lists, improved patient outcomes, provided clear benefits to staff who work in paediatric services and resulted in cost benefits.

• In Cwm Taf Morgannwg UHB the Radiology Navigator project role has dramatically improved the vetting to booking time frames for CT referrals (from five days to one day), releasing 996 hours of radiology and management time and increasing overall CT booking capacity by 118%. This has led to an additional 531 patients being scanned and reduced urgent waits from thirteen days to four over the project period. Additionally, patients have reported a high quality of care and a very positive experience.
• In Betsi Cadwaladr UHB, the Dietician Led Gastroenterology Clinics project has demonstrated suitability to divert one third of the gastroenterology waiting list (patients with functional gut issues), to be assessed and managed by an AP Dietician. For this patient group non-urgent waits reduced from three years to four months, releasing consultant capacity and costs of £108,000 a year in Wrexham Hospital.
• In Cardiff and Vale UHB, Paediatric Orthopaedic Clinics have been trialed in primary care. 70% of patients triaged into clinic were seen within two months contributing to a 59-week reduction in the waiting list to secondary care. Additionally, an MSK paediatric training programme has been established for GPs and GP trainees to support referral decision-making and patient care.

Highly innovative projects:

The projects below have been able to gather vital evidence to support future service delivery which will help to transform the landscape of health in Wales, creating more modern outpatient services and ensuring the best possible care for patients.

• A First for Wales – Aneurin Bevan UHB have trialled Genicular Artery Embolisation procedures for patients with mild to moderate osteoarthritic (OA) knees. Early clinical data suggests its suitability in the clinical management of OA knees with interest expressed from orthopaedics and physiotherapists. The Grange University Hospital has been awarded exemplar status in recognition of this pioneering work.
• Replicating a trial in England, Welsh Ambulance Services NHS Trust and Betsi Cadwaladr UHB have collaborated and demonstrated proof of concept – an ability to provide a mobile Xray service in the person’s home in North Wales. The project is still gathering data and further work will be required to evidence the benefits prior to operational implementation.

The project outcomes were shared at the Planned Care Innovation Programme National Showcase on 20^th September 2023 at the National Waterfront Museum in Swansea.

Please refer to the Programme Compendium for summary details of each project and their outcomes. You can view full details for each project by accessing the project webpages below, as well as watch the introductory remarks to the showcase from Eluned Morgan MS, Minister for Health and Social Services and Judith Paget CBE, Director General of Health and Social Services/ Chief Executive NHS Wales.