In 2022, NHS Medway implemented a programme titled ‘Patient First’ with the aim to drive improvement in a few, high-priority areas without overburdening staff. It was a way to deliver long-term change over time, by making small changes that have a big impact quickly.
It has provided tools, techniques and a standard approach to identifying and tracking improvement, giving staff clarity about what they need to do, every day. It also empowers them to make change happen and sets out clear and specific targets about what needs to be achieved in a fixed timescale.
Patient First empowers the staff with the skills, tools and confidence they need to make small sustainable changes that boost patients’ experience. All colleagues play their part in Patient First - whether they are out on the wards, in other clinical areas or providing essential support services. This means instilling a sense of purpose, motivation and energy at every level through the organisation – a ‘Board to ward’ strategy.
How has this been achieved?
Outcome: Positive experience for staff and patients
This improvement programme is a recognised and proven system for delivering significant long-term change within the NHS.
The Patient First methodology guarantees inch wide, mile deep focus so that top contributing reasons for causing negative impact on patient experience could be identified and improved. The changes introduced have included establishment of multi-disciplinary team reviews leading to an improvement in appropriate pathways for patients, relentless focus to ensure patients are receiving value added acute care and the reduction in variation in staff skills. Staff morale is also much higher. Some senior clinicians in the Trust have become great supporters and advocates of the approach.
Medway was named Southeast regional winner at the NHS Parliamentary Awards 2023 in the ‘Excellence in Urgent and Emergency Care’ category by improving the care of deteriorating patients and reducing avoidable cardiac arrest calls (2222 or crash calls) from an average of five calls per month to just one.
Putting tax at the centre
The tax team must define your tax determination and compliance processes, and feed into the design of other processes within the ERP system. The objective is to ensure that financial and other data in the system is complete, accurate and in the right format for your compliance requirements.
This is more important than ever as international tax regulation intensifies. Your ability to meet complex requirements – such as e-invoicing, real-time reporting and BEPS Pillar II obligations – will depend on the completeness and accuracy of the data in your ERP system.
At the same time, the system must be configured to ensure that your tax processes can:
- automate tax decisions for relevant transactions, and maximise the use of the ERP system’s tax functionality, at the very least; and
- drive business value – the ERP should contain the right data, at the right level of granularity, to allow you to enhance the organisation’s cash tax position in a cost-constrained climate.
Without the tax function’s involvement, there are real risks of errors and compliance failures; and it will be impossible to take full advantage of the new system’s capabilities.
| Key achievements from Medway NHS as a result of our work | |||
|---|---|---|---|
| Financial sustainability | Referral to treatment | Friends and family test | Wellbeing checks |
| A Trust-wide efficiency programme was launched to optimise the use of medicines and realise savings through the rationalisation of medicines use. | Neurology department managed to reduce 40-week referral to treatment waits for first appointments from 374 patients in 2022 to two patients in 2023. | Pilot designed to help inpatients get a better night’s sleep during their stay which included an audit of the wards environment to create the conditions for better sleep. | Met the target for appraisals for the sixth consecutive month in July 2023 which was 90% of staff would have an annual appraisal that included a wellbeing check. |
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