Midlands Heart Failure Stewardship Programme

The Midlands Cardiac Network wanted to ensure that they were using NHS resources wisely to get the best outcomes for patients in the region with heart failure while delivering care equitably.

Arden & GEM’s Health and Care Transformation team designed and facilitated a workshop programme to enable two Integrated Care Systems (ICSs) within the network to adopt and deliver a culture of stewardship. The ten month programme brought together heart failure stewards so that each system now has agreed aims, outcomes and measures for this population segment and a roadmap for taking this forward.

The challenge

The Health and Care Bill 2022 enshrined in law a duty, commonly referred to as the Triple Aim, for decision-makers across all NHS bodies to collectively consider the impact of their decisions on:

• Increasing the health and wellbeing of everyone in the population they serve (including inequalities in health and wellbeing)
• The quality of healthcare services for all the population they serve (including inequalities in benefits)
• Sustainable and efficient use of NHS resources.

However, successfully delivering the Triple Aim requires more than just structural or technical changes; it requires a new way of thinking, behaving and working together – a culture of value and stewardship.

The Midlands Cardiac Network, part of the Cardiac Pathway Improvement Programme (CPIP), has radical ambitions to improve outcomes for people with heart failure. NHS England (NHSE) Midlands region wanted to support the Midlands Cardiac Network in adopting a value and stewardship approach in their decision-making around the heart failure pathway and associated interventions.

With experience of working with ICSs across the country to design and deliver stewardship programmes, Arden & GEM was tasked with delivering a heart failure stewardship programme in the Midlands.

Our approach

All of the Midlands ICSs were invited to express an interest in taking part in a programme to adopt a value and stewardship approach for heart failure. Of the four systems that put in an expression of interest, Derbyshire ICS and Leicester, Leicestershire and Rutland (LLR) ICS were chosen to join the programme based on the information submitted.

Designing workshops
To deliver on a culture of stewardship, five tasks need to be undertaken:

1. Thinking in populations
2. Designing in populations
3. Working in populations
4. Leading for populations
5. Optimising personal value.

The Arden & GEM Health and Care Transformation team designed and facilitated a series of regional workshops to support the two systems in agreeing the overall scope, aim, outcomes and measures for people with heart failure across the Midlands.

Delivering the sessions
The first two workshops took place in autumn 2022 and brought together heart failure ‘stewards’ from Derbyshire and LLR to understand their envisaged culture and responsibilities. Stewards represent those groups with a responsibility for resource allocation including frontline clinicians from primary, acute and community care, and finance leads.

The sessions were tailored to system need but addressed the following core issues:

• Workshop 1 – What do stewardship, the Triple Aim and the four purposes of an ICS mean for us as a group and me personally? What do we know about the population segment for whom we are stewards and what resources do we have? How do we relate to other population segment groups?
• Workshop 2 – How will we define success for our group? How do we make resource decisions as a group? What and who is in our network and how should we operate? What do we need to do as leaders to support a culture of stewardship?

In the third workshop, Derbyshire and LLR were supported to map all the heart failure interventions delivered in their system, also mapping the activity and cost attached to each intervention. Where applicable the quality adjusted life years (QALYS) that NICE had attributed to these interventions was also explored.

Taking stewardship forward in Derbyshire
Derbyshire ICS agreed areas of focus for a further workshop which involved a wider group of stakeholders. The session was co-designed with the Arden & GEM team to focus on the socio-technical allocation of resources.

The fourth workshop, which took place in May 2023, covered what Derbyshire needs to do to stabilise the use of interventions at their current level, which interventions they want to reduce activity for and which ones they want to possibly increase as they have shown to add more value for patients.

Taking stewardship forward in Leicester, Leicestershire and Rutland
In their final workshop, LLR agreed on several improvement projects to take forward including possible cost improvement initiatives.

Outcomes

Two ICSs within the Midlands Cardiac Network now have the knowledge and groups in place to adopt a deliver a culture of stewardship for heart failure patients in the region.

As well as their ongoing work to evaluate resource use take forward improvement projects, the systems will also be supported by NHSE in monitoring agreed outcomes through the development of new dashboards.