Using Band 4 roles to build a team around the patient – NHS Employers Case Study

This case study looks at the work of Chesterfield Royal Hospital NHS Foundation Trust (Chesterfield Royal) in using new models of care to overcome workforce supply challenges.

Despite running proactive campaigns recruit to nursing posts, the trust was unable to make up for the shortfall it was experiencing in the number of registered nurses in its workforce. Using the concept of building a team around the patient, based on identified skills needed to deliver best care, the trust looked at how it could make use of newly introduced band 4 roles, such as the nursing associate and the assistant practitioner.

This case study outlines how Chesterfield Royal engaged its staff to help develop the new team structure, addressed the issues this presented, and has got to a position where other wards are now looking to adopt model.

Download and read the case study in full.


Guide to reducing long hospital stays – NHS Improvement

Our ‘how-to’ guide offers practical steps and tactics to support the NHS and partners to use an optimal approach to managing hospital length of stay.

Nearly 350,000 patients currently spend over three weeks in acute hospitals each year. Many are older people with reduced functional ability (frailty) or cognitive impairment. The benefits of reducing hospital bed occupancy are clear, but achieving it has proven difficult, particularly during winter.

Our guide goes beyond principles and suggests more concrete tactics to reduce unnecessarily long stays in hospital for patients.

Link to article page here

Therapy Stroke Groups: Improving patient activity on the stroke unit and efficiency of the workforce – NICE case study

As part of a review of the national guidelines for stroke (NICE Guideline ‘Stroke Rehabilitation in Adults’ CG162 – recommendations 1.2.16 and 1.2.17), it was decided to assess the implementation, effectiveness and perceived benefit of group therapy sessions on the stroke rehabilitation unit.

The project was completed on the 28 bedded inpatient stroke unit at Leighton hospital, part of Mid Cheshire Hospitals NHS Foundation Trust. This comprises of 20 stroke rehabilitation beds and 8 acute stroke beds, providing care for people living in Cheshire and beyond.

The Stroke Rehabilitation therapy team introduced group therapy sessions as a project in September 2017 and initially audited the results for 1 month.

Stroke therapy group sessions were implemented in order to:

  • Improve patients experience, improve the 24 hour rehabilitation approach-by increasing therapy input patients receive.
  • Reduce patient time spent inactive on the ward.
  • Promote rehabilitation to wider MDT.
  • Facilitate training of therapy assistants and junior members of the team in a supportive environment.

Initially the groups were carried out over 4 days a week allowing for attendance at the MDT meeting, but this was increased to 5 days at the end of September 2017. The groups included upper limb group, a bed exercise group, gym ball group and a balance group.

This example was shortlisted as a finalist for the ‘NICE into Action’ category of the Chief Allied Health Professionals’ Officer Awards 2018.

Guidance the shared learning relates to:

Link to article page here

Developing a new pulmonary rehabilitation program tailored for interstitial lung disease with Newcastle upon Tyne Hospitals’ Interstitial Lung Disease service – NICE Case Studies

COPD Clinic teaches patients to breathe again
Image: GoogleImages Copyright free

The Newcastle upon Tyne NHS Foundation Trust has a Specialist Interstitial Lung Disease (ILD) team serving patients in the North East and Cumbria region. The mutli-disciplinary service includes Consultant Physicians, an ILD Specialist nurse, Specialist Palliative Care clinicians and pulmonary rehabilitation physiotherapists. Annually, the service diagnoses over 500 patients with ILD, with around 200 patients being diagnosed with idiopathic pulmonary fibrosis (IPF).

This example was shortlisted as a finalist for the ‘NICE into Action’ category of the Chief Allied Health Professionals’ Officer Awards 2018.

Guidance the shared learning relates to:

Under pressure: safely managing increased demand in emergency departments – CQC report

Emergency dept
Image: GoogleImages copyright free

Winter 2017/18 saw an unprecedented demand for health and care support services. Emergency departments bore the brunt of this demand.

This report features practical solutions from staff. Frontline clinicians attended workshops to help us understand the issues they face. They identified what needs to change to keep services safe when facing surges in demand.

It calls for wider action for health and social care services to work together. A joint approach will help the whole health and care system to manage capacity as demand grows.

The same approach can encourage early and effective planning – for all periods of peak demand.

It presents the findings from:

  • our inspections of emergency departments over winter 2017/18
  • workshops aimed at understanding the issues facing staff and what needs to change

What we found

The report shows that our inspections have found:

  • evidence of good practice at emergency departments
  • examples of hospitals that planned for and managed increased numbers of patients
  • the quality and safety of urgent and emergency care remains a concern with:
    • 50% of urgent and emergency services rated as requires improvement or inadequate overall
    • 8% of services rated inadequate for safety

We found:

  • specific concerns around delayed ambulance handovers
  • people waiting for long periods of time before their first clinical assessment
  • patients who needed urgent care were not always identified in a timely way

Escalation policies were generally in place. These were not always followed or were not effective in coping with increased demand.

We found many hospitals caring for patients in inappropriate spaces, such as corridors. There were no plans in place for alternative safer accommodation.

Our recommendations and next steps

A whole system approach is needed to tackle the problems created by increasing demand.

The report recommends solutions which focus on:

  • what can be done to help keep people well and reduce visits to emergency departments
  • what emergency departments can do to manage how patients flow through the hospital
  • ways to help avoid unnecessary admissions and ensure early discharge

The timeliness of the planning process needs to improve. As does the extent to which all partners across the system are involved in planning.

Across the country, there are examples of good practice in action at hospitals. These build on the best practice guide published by CQC in November 2017. Our report presents solutions alongside those examples of good practice.

Link to report page here

A language specific and culturally adapted pain management programme – NINCE Shared Learning

The creation of a tailored language specific and culturally adapted pain management programme, which was in line with the beliefs, attitudes and understanding of a group of South Asian patients.

The programme demonstrates how quality statements 1 and 2 in the NICE Quality Standard 167 for Promoting health and preventing premature mortality in black, Asian and other minority ethnic groups can be used in practice.

Guidance the shared learning relates to:

Key findings

The project met the initial aims and objectives. Patients made improvements in self-efficacy, anxiety and depression following the programme.

There was a statistically significant change in anxiety (t(3) = 4.7, P < 0.01), depression (t(3) = 5, P < 0.01), and self-efficacy (t(3) =8.18, P < 0.001) following the programme. There were 8 patients initially listed for the programme, 2 did not attend the first session and made no further contact. A further 2 patients attended the first session but did not bring their questionnaires with them nor continued on; 1 due to financial commitments and 1 patient due to ill health. The remaining 4 patients made the programme through to completion.

The Reliable Change Index (RCI) was used, and this found that 25% of patients made a reliable change in anxiety and 75% of patients made a reliable change in depression. Our project increased the services equality and diversity output, by catering to a large proportion of the population, whose needs were being unmet, by current service provision.

For staff, it meant a much more comprehensive service being brought together, to benefit patients, rather than being seen individually through interpreters. For patients, they felt they finally were beginning to understand their long term pain condition and how they could make positive behaviour change. All this was achieved in a way that was culturally appropriate to the population group.

Link to article page here 


Following the announcement of the second wave of Integrated Care Systems (ICSs), NHS Providers, the NHS Confederation, NHS Clinical Commissioners and the Local Government Association reflect on how lessons learned by members from across from the four organisations will support the journey to integrated care.  

Here, Chris Hopson (chief executive, NHS Providers), Niall Dickson (chief executive, NHS Confederation), Julie Wood (chief executive, NHS Clinical Commissioners) and Cllr Izzi Seccombe (chair, Local Government Association Community Wellbeing Board) discuss why it is vital that the legacy of the vanguards is shared.


The national new care models programme was seen by some as a “game-changer” when it was launched by NHS England in 2015 – setting the template for patient care in the 21st century.

Its vision was to deliver lasting change in the way that people access and use local health and care services in line with the ambitions set out in the Five Year Forward View.

Niall Dickson, of the NHS Confederation, describes this challenge as “enormous”. He adds that the health and care system needed to recognise “that unless we manage demand by providing the right support at the right time, the system cannot be sustained, even with more staff and more funding.”

Chris Hopson, of NHS Providers, added that the programme itself needed to recognise “that large-scale transformation in health care requires funding, implementation support, time, and the permission to make mistakes and learn from them”.

The vanguard sites across England have made strides towards realising those ambitions and setting out a blueprint towards integrated care. Many have introduced innovative approaches to delivering care that can be shared and spread at scale, while also building strong partnerships across traditional boundaries, overcoming complex governance challenges and involving staff, patients and the public in service change.

Three years on it is time to consider the legacy of the vanguards and to ensure that the lessons learned by those involved will make a positive contribution to health and care in the future.

NHS Providers, NHS Confederation, NHS Clinical Commissioners and the Local Government Association have produced a briefing series to help share learning from the vanguards.

This article was first published by National Health Executive on 29 May 2018.

Link to full article page here