Case study summary

The Cheshire and Merseyside Cancer Alliance (CA) shares the lessons learned in reducing endoscopy waiting times by adopting a digital tool to enable efficient planning of endoscopy lists. The tool was developed, in collaboration with an IT platform provider, with support from local clinicians who stressed the need to increase productivity, enable efficiencies in waiting list management and accelerate the cancer pathway via early diagnosis. The approach to spreading this innovation was further developed in response to increased waiting list pressure during the pandemic. The Innovation Agency, the Academic Health Science Network for the North West Coast (AHSN), is ensuring this work is evaluated and its impact shared.

What was the problem or opportunity?

In 2017 the Cheshire and Merseyside CA prioritised endoscopy as a key area for improvement in accelerating cancer diagnostic pathways. St Helens and Knowsley Teaching Hospitals (STHK) expressed interest in taking forward work to improve efficiency and was commissioned to host an endoscopy improvement project on behalf of the CA.

As part of this project an independent review was commissioned which highlighted the challenges associated with monitoring productivity due to inconsistent data collection within and across sites and the potential for significant improvements in productivity within endoscopy units.

How did this support innovation adoption and spread?

To facilitate consistent collection of productivity data, clinicians from STHK worked with an IT platform provider to develop a tool to monitor endoscopy unit usage and help staff manage patient lists and room allocation. The cloud-based tool holds non-identifiable patient data (meeting GDPR requirements and information governance standards) and produces reports which can be used by operational teams to help inform and shape approaches to improve efficiency.

The tool is based around the British Society of Gastroenterology (BSG) points system which takes into consideration the time needed to undertake a particular procedure. This allows greater understanding of the nuance around the impact of procedure complexity on waiting times; and a shared understanding of how the composition of a waiting list impacts the clinical skills and experience required to manage each patient on the list. This ensures that service quality and equality of access remains central to managing endoscopy lists.

Funding for initial development of the tool (a version of which was already commercially available for use in non-healthcare settings) came from Cheshire and Merseyside CA. Once it had been designed and trialled and the potential for adoption was established, further funding was provided by the CA to the Endoscopy Network to support its spread into other Cheshire and Merseyside trusts. The funding covers the cost of the tool licence for each of the endoscopy units. Further funding from the Cancer Alliance is being provided to the Endoscopy Network for programme management to ensure the tool is used consistently.

What were the results?

By the start of 2020, three endoscopy units had adopted the tool and were using it according to their individual operational processes. The impact of the COVID-19 pandemic further highlighted the need to address capacity and demand imbalances across Cheshire and Merseyside endoscopy units, which led to the CA and the Endoscopy Network coming together to form the Endoscopy Operational Recovery Team. The nature of this team’s work emphasised the need for consistent and accurate monitoring of productivity data.

The CA has identified improved productivity where units are using the tool consistently. Based on this, they have built improved productivity requirements into their resource allocation decision making processes which has incentivised trusts to implement a productivity monitoring tool.

Ultimately, implementation of the tool has potential to improve patient experience via reduced waiting times, and more equitable access to endoscopy services across the system.

To date, the tool has been adopted in most of the units in Cheshire and Merseyside, with those remaining signed up to follow this year. 

What were the learning points?

The Cheshire and Merseyside Endoscopy Network is a success story. Since its beginnings as a small service improvement project hosted on behalf of the CA by St Helens and Knowsley Teaching Hospitals, it has grown into a highly effective network of clinicians and operational managers supported by a core team, leading an ambitious transformational programme.

The Endoscopy Network has built clinical connections, enabling a network approach to service improvement; and the use of the tool has brought a clear and shared understanding of the use of data relating to service delivery and efficiency.

A community of practice has been set up as part of the Endoscopy Network which has facilitated collaboration and shared learning. The Endoscopy Operational Recovery Team has also provided support to individual units where required.

Open conversations about topics such as BSG points per list, turnaround times and shared infection control procedures have taken place which has brought consistency of data recording allowing meaningful benchmarking between units.

The support NHSE provides to AHSNs and the CA more generally has facilitated regional joint working which has had a positive impact on this programme of work. 

Access to reliable WiFi was a barrier to implementation in some cases and the considerably more stringent infection prevention and control guidelines in response to the pandemic led to more fundamental issues around productivity, which meant the tool could not be used to its full capacity.

Challenges establishing consistent use of the tool across all units also created difficulties in establishing a consistent approach to monitoring and allowing the calculation of accurate benchmarking between units. This learning when reviewing BSG points and benchmarking will be valuable as it takes account of procedure complexity.

Next steps and sustainability

The CA continues to fund the Endoscopy Network which reports into the CA’s governance structures. A Diagnostics Board has recently been established within the ICS to bring together the diagnostics networks including endoscopy, pathology, imaging and cardiology under one umbrella. The Endoscopy Network will continue to have strong links and support from the CA, but it is hoped that the new Diagnostics Board will cement its long-term future. There is also potential to adapt this type of tool for other clinical environments beyond endoscopy units.

Ensuring data reports are used as key tools to support reset and recovery is a priority for endoscopy across the Cheshire and Merseyside area. More broadly, the ability to collect this type of data allows a better understanding of where further work is required to improve efficiency and ultimately ensure a high quality service for patients. The aim is to offer patients a choice in the location of their treatment, to reduce the impact of variable waiting times and optimise access to diagnostic services.

Another area within our region, Lancashire and South Cumbria Endoscopy Network, has expressed interest in local implementation and have tested the tool.

The Innovation Agency has supported this innovation with commercial expertise and funding for a real-world evaluation, the findings of which (including an assessment of economic impact) are due to be published in late 2022, with the aim of increasing adoption and spread. 

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Contact details

Cancer Alliance: jon.hayes1@nhs.net 

Innovation Agency: ed.millensted@innovationagencynwc.nhs.uk