About Birmingham Community Healthcare NHS Foundation Trust
Birmingham Community Healthcare NHS Foundation Trust (BCHC) delivers over 100 NHS services to Birmingham’s 1.1 million residents. In response to the government launching its 10-year plan to create a Neighbourhood Health Service, BCHC was appointed to lead a transformation partnership programme of work across Birmingham and Solihull to meet the goals of the plan: to move care out of large hospitals and closer to people's doorsteps, shift focus away towards preventing illness and move from analogue systems to more efficient digital technology.
The challenge that the KTP was set up to address
The transformation partnership brings together Birmingham and Solihull’s acute and community hospitals, local authorities, general practitioners and voluntary, community and social enterprise organisations into one integrated health and care system.
It will move aspects of health and care delivery from hospitals into communities, with staff working across a series of neighbourhood health centres to deliver face-to-face services.
The transformation is designed to ensure that health and care services are better equipped to prevent ill-health, provide care equally and fairly to people across the city – both digitally and in-person – and reduce administrative burden for staff. It involves community partners working together in more integrated ways to deliver care and support, and relies on data being shared effectively across teams and systems.
As this integration progresses over the next 8 to 10 years, it will need to be evaluated to determine whether redesigning services in this way delivers the intended benefits and improvements for both patients and staff. BCHC does not have the expertise to develop an evaluation on this scale, as it needs to be capable of incorporating data from multiple NHS trusts, neighbourhood teams and their community partners throughout Birmingham and Solihull.
Why a KTP is the ideal route
This project is the first known attempt to evaluate the development of a city-wide integrated care system. It will involve creating and embedding data-driven thinking and evaluation metrics across all areas of Birmingham and Solihull’s integrated health and care system, and it will be designed to ensure that evidence-guided improvement becomes the norm for staff.
BCHC is partnering with Aston University’s Institute of Health and Neurodevelopment (IHN) for this project. The Institute brings internationally recognised expertise in developing qualitative and quantitative research methods in psychological and health sciences. This includes developing and deploying data-driven approaches to evaluate organisational health services and community care projects, through partnerships with NHS paediatric services and a previous KTP with the Aston Villa Foundation. Staff from the Aston Business School and Aston Pharmacy School will bring expertise in organisational change, workforce evaluation and big data methodologies.
What the research will involve
This project will use a combination of qualitative methods, systems mapping and big data to measure outcomes as each health and care service is integrated using the Locality and Neighbourhood Health Service model, co-designed by staff and patients
The evaluation framework will focus on three distinct areas:
- Patients: Measuring patient experiences and preferences of care and whether clinical and health outcomes are being achieved.
- Service delivery: Mapping how efficiently and easily patients are able to move between hospital, community and home.
- Workforce: Measuring staff wellbeing, caseload, travel burdens, retention and sickness as staff move into community hubs across the city.
A key part of the project will be setting up shared data flows between hospitals, the community and primary care. These will feed into a new, joined-up electronic patient record that can be readily accessed across the integrated system.
The Aston University academic team will compare anonymous, aggregated patient records to an extensive national patient database, creating a way to quickly assess patient outcomes in Birmingham and Solihull against the rest of the nation. These will be monitored by staff as changes and improvements take effect over time.
The research team
Professor Rachel Shaw leads the KTP at Aston University. She is associate director for researcher development (academic) at Aston University’s Institute of Health and Neurodevelopment. Professor Shaw brings deep NHS and qualitative research expertise to the project and a passion for research on staff wellbeing. She has a wealth of experience as a clinical researcher in the NHS and will lead the work to embed evidence-based evaluation into the transformation work. This will ensure the integrated care system can continue to improve beyond the life of the KTP.
The KTP is supported by Dr Megan Jarman, public health nutritionist and lecturer in psychology at the IHN. Dr Jarman specialises in using systems modelling approaches to understand complex problems and programmes, and she has collaborated on numerous international research projects and public health initiatives.
Professor Aoife McDermott of Aston Business School brings expertise in health workforce and change management. She will lead an assessment of the Birmingham and Solihull health and care systems’ readiness for change, working to identify staff perceptions of barriers and enablers to embedding a culture of evidence-based evaluation.
Regius Professor Ian Chi-Kei Wong at Aston Pharmacy School will lead work to develop a big data approach for comparing patient outcomes with the rest of England.
The KTP will be led at BCHC by Dr Robbie Dedi, chief medical officer and supported by Kymm Skidmore, transformation programme lead.
We welcome our new KTP Associate, Zeba Khadhijah, to the project team. Zeba comes with a strong academic background in psychology and data science, and relevant professional experience in evaluating the impact of NHS funded community-based services within the charity sector. She is passionate about making healthcare more accessible for people living in Birmingham and Solihull.
What will change as a result of the KTP?
The evaluation framework developed through this KTP will deliver insights on multiple fronts. It will:
- provide the necessary data to show whether outcomes improve, worsen or remain the same as services transform and whether change is delivering value for money.
- support health and care managers and leaders to see how well services, data flows, and organisations connect, and where to target change.
- show how improving services impacts patient outcomes, such as reducing the likelihood of falls, preventing acute and critical illness, or better managing chronic conditions. Beyond outcomes, it will also show whether moving care closer to people’s homes improves their experiences of care.
- give a view of where patients are in their journey from admission to discharge and follow-up, so staff can intervene quickly if there are delays or bottlenecks.
- give patients a voice through embedded patient surveys, so patient experiences can better inform how future services are designed.
- support the shift from siloed services to integrated neighbourhood teams, informing more streamlined ways of working across hospitals, community and primary care.
Broad benefits and impacts
The NHS was originally founded on the ethos of continuous improvement so that health and care services are delivered in ways that are fair and accessible to everyone. This KTP will enable the Birmingham and Solihull health and care system to deliver and continuously improve a genuinely integrated, data‑driven Neighbourhood Health Service that is better for patients, more sustainable for staff, and robustly evidenced.
Guided by data, staff will see the effect of redesigning each health and care service and clinic, with learnings that can be applied elsewhere. Over time, staff will be equipped to continuously improve their services based on robust evidence.
As other UK towns and cities look to redesign their health and care services in response to the UK government's 10-year plan for the NHS, the Birmingham and Solihull model could offer a blueprint for others to learn from.
What the partners say
Dr Robbie Dedi, chief medical officer, BHCH:
“Making it easier for citizens to access the care and support they need, when and where they need it, is the driving force behind the city’s transformation of health and care services. Our partnership with Aston University will be critical for enabling us to better identify and tackle health inequalities, so we can make services fairer and more accessible for everyone. The new monitoring systems we’re setting up together will guide us in what works, what needs to be improved and whether we’re managing our resources effectively. This will be the first major evaluation of how integrated care functions across Birmingham and Solihull.”
Professor Rachel Shaw, associate director for researcher development (academic) at Aston University’s Institute of Health and Neurodevelopment:
“Every NHS system is unique to the community it serves. We’re building an evidence-based way to monitor and guide the redesign of a health system that will be fit for the future and reusable for other organisations. Effective evaluation will support staff tasked with running health and care services across Birmingham and Solihull and empower them to continuously improve those services based on evidence. We want to see how staff as well as patients can benefit from care in the community, so that this programme can be a guiding light for other health and care systems across England.”