Care Pathways and Service Delivery Transformation

Our team looks at how we currently deliver services to patients and where and how we could improve this.  We do this by reviewing care pathways - so what are care pathways?

A care pathway is a series of 'things' that happen to a group of patients over a period of time.  Sometimes, people refer to it as a patient journey, where people needing health or care services move between different teams responsible for care delivery.

Our aim is to design care pathways that are appropriate for the Island, joined up, coordinated, best value, based on best practice (for example, evidence and research) and deliver quality outcomes and experiences for our community. 

When we look at a care pathway we would include care that starts for example, with a visit to your GP and then may involve calling an ambulance, a visit to the Emergency Department, the Minor Injuries Unit or being admitted to a ward and your hospital stay.  The pathway will also look at care after discharge, when back in your home, this may involve a visit from a community nurse or social worker.  Many pathways will also include what happens when patients need to transfer off Island, for a specialist review, and how care is coordinated between the professionals involved when you return to the Island.

As we can’t do this for the whole of our health and care system at the same time, due to the volume of services provided on the Island, we need to do the reviews in clusters. We are guided by Manx Care on the priority of services they would like us to review. 

In Phase 1 we looked at 9 service areas and mapped out how we currently provided health and care, found out how others provided this (international best practice) and then described, at a high level, what an ideal pathway for the Isle of Man community might look like.

These nine areas were: Cardiology, Vascular, Stroke, Diabetes, Children & Young People with Continuing Care Needs (CYPCCN), Autism, Cancer, Eyecare and Urgent and Emergency Integrated Care (UEIC).

The process was inclusive, with health and care staff and the Third Sector (voluntary and charity staff) attending sessions and working together to identify and agree issues and opportunities.  People who use the services (i.e. patients and carers) were involved through surveys, workshops and individual meetings.

Phase 2 started in autumn 2021 when our work was re-prioritised by Manx Care and we were asked to look at three areas in more detail; these areas were Urgent and Emergency Integrated Care (UEIC), Eyecare and Cancer. For Cancer, we were asked to break down the pathway into 12 tumour site pathways. 

Working closely with stakeholders across the system, business cases with proposed recommendations have been completed for UEIC, Eyecare and four of the 12 Cancer Pathways (Skin, Upper Gastrointestinal, Lower Gastrointestinal and Gynaecology). The business cases explain how much it would cost to introduce the recommendations and highlight the benefits that introducing them could bring to patients, carers and providers. 

The Eyecare business case has been approved by Manx Care and the HCT Programme, with the final stage of formal approvals, the HCT Political Board, completed in October 2022. This work has now been handed over to Manx Care to implement the recommendations, while the HCT Programme is working with Manx Care and DHSC to agree and roll out an appropriate system to monitor and report on implementation progress. For more information about the recommendations that have been agreed for Eyecare, please view the update in the Downloadable Documents section to the right of this page.

For the six areas not prioritised in Phase 2:

• We grouped diabetes, cardiology, vascular and stroke and, working with Public Health, reviewed national screening services provided elsewhere. The purpose of screening is to find people in the community who are at higher risk of a health problem or a condition, so that an early treatment or intervention can be offered. The main outcome of this work is a proposal for a national Diabetic Retinopathy Screening programme for the Island
  
  
• Children with Continuing Care Needs (CYPCCN) – the team have worked closely with stakeholders across the system to review and update the outputs of the Phase 1 work. They have now developed recommendations to improve this service and completed a business case outlining the costs and benefits of introducing these proposals for patients and service users. (Please note, this Pathway was previously called 'Children with Complex Needs (CwCN). It was renamed further to feedback from Service Users and Carers.)
  
  
• The next steps for Autism will be developed once the DHSC led National Autism Strategy (due to be completed by the end of 2022) has been reviewed and discussed. As Autism is not only supported by health and care services, the decision was taken to wait until the strategy was completed and shared to make sure we are all coordinated in our approach

Our other work includes linking with the New Funding Project, looking at options for the long term sustainability of Nursing and Residential Care and Service Sustainability Reviews where we looked at the activity data for our surgical service delivery across all specialities.

The project temporarily paused at the end of September.  This has enabled project resources to be made available to support the efforts to seek to ensure financial balance is achieved within Health and Care for the remainder of the 22/23 financial year. 

Whilst some of the improvements proposed within the business cases could be realised by changing our ways of working and / or are cost neutral or cost saving, many of the recommendations introduce new recurring (i.e. on-going) financial commitments.  Identification of the funding required to support the business case proposals needs to be achieved, prior to resuming the approvals process and moving to implementation.

Having advanced further in the process than ever before, during this temporary pause the project will consider what has worked well and what can be improved, using that learning to redesign, where needed, the shape of the Care Pathways work for 2023 (when we plan to come off temporary pause), to further improve the delivery of the Sir Jonathan Michael’s recommendations.

More information regarding the temporary pause to the project.

We would like to thank everyone who took the time to share their feedback. Results of the surveys completed so far can be found below:

• Autism
• Cancer
• Children with Complex Needs
• Diabetes
• Stroke
• Cardiology
• Vascular

Please note that the feedback gathered in these surveys provides invaluable insight into emerging key themes across each care pathway in the surveyed areas. These themes are considered as part of the ongoing pathway re-design work and help inform proposed pathway improvements.

Should you have any additional feedback regarding the care you have received in any of these areas, or have any questions or comments regarding the Health and Care Transformation Programme, please contact HealthandCareTransformation@gov.im