In this issue we focus on what the data is telling us, dispelling the myths and hearing from some of our best practice trusts on their CUR journey

1. AUTUMN 2016
We are now starting to see the benefits and
learning CUR brings, through the rich
strategic and operational information that
supports service re-design and
improvement. We are working closely with
a group of Trusts to ensure that qualitative
data and lessons learnt can be shared widely
across the CUR network. These Trusts are:
• Salford Royal NHS FT
• South Tees Hospitals NHS FT
• Kings College Hospitals NHS FT
• Norfolk and Norwich University FT
What is the data telling us?
• Summary data for Q4 2016/17 reported
271,490 daily reviews (clinical
assessments) undertaken on over 5,800
beds across 25 Trusts, (26% of their total
bed base). This represents a 78% increase
in the number of CUR assessments
undertaken by Trusts within the last
quarter. These trusts are continuing the
roll-out of CUR across their wider bed
base.
• 38% (103,465) of patients assessed did
not meet the CUR criteria for their current
level of care, i.e. these patients could be
treated in an alternative care setting.
• CUR assessments should be completed for
every patient, in every bed for every day
of their stay. Compliance rates vary across
Trusts; 61% of the expected reviews were
completed in Q4 16/17 which is lower
than the target of 85%+ compliance.
Dispelling the Myths
Most NHS providers, prior to undertaking CUR,
believe that the main reasons for
inappropriate patient stays are due to
external rather than internal reasons,
therefore limiting their ability to improve
patient flow. External delays are caused by
issues in community, primary and social care –
these can be process issues, capacity
restrictions or because services do not exist in
the first place, meaning there is no alternative
level of care for these patients.
Evidence from the 25 Trusts suggests this is
not necessarily the case; indeed, the position is
quite the opposite. During Q4 2016/17 most of
the reasons (67%) for CUR criteria not being
met (inappropriate patient bed days) were
due to internal reasons (within Trust’s control),
with a range of 26% - 94% reported. Only 6
Trusts reported more external delays than
internal.
Top Reasons for (patient stay related)
delay:
• Awaiting NHS Alternative Care
• Awaiting Social Services
• Awaiting Clinical
Intervention/Procedure
• Awaiting Clinical Assessment
What are the costs involved? If we
assumed that an average sized acute ward (25
beds), cost £1m per annum to provide the
inappropriate days caused by internal based
reasons would equate to annualised costs of
c.£30.7m across the 25 Trusts during Q4
2016/17.
The internationally recognised and evidence based
use of Clinical Utilisation Review (CUR) offers
commissioners and providers an opportunity to get
ahead of the curve in driving system-wide
transformation and rebalancing the healthcare
system. Successful healthcare organisations
worldwide have embraced this approach to reduce
variances in healthcare and improve patient
outcomes. As a result, the appropriate CUR tools
can play a significant role in supporting the
emerging new models of care and is an essential
function of successful Accountable Care Systems.
Clinical Utilisation Review (CUR) is a clinical
decision support tool that enables clinicians to
make objective, evidence-based assessments of
whether patients are receiving the right levels of
care, in the right setting, at the right time, based
on patient’s individual needs.
Use of the tool on a concurrent basis is key to
reducing delayed transfers of care, addressing
barriers to patient flow. It is an essential
component of an integrated discharge function,
supporting clinicians to adhere to clinical best
practices and helps reduce unwarranted clinical
variation, ensuring patients are cared for in the
optimal care setting.
SUMMER 2017
Clinical Utilisation Review - Reporting Outcomes

2. Page 2
Salford Royal NHS Foundation Trust
Story
Salford commenced a Phase One rollout in
February 2016 covering 407 beds as part of an
ambitious, accelerated implementation. One year
on and they have successfully embedded CUR
across 660 beds.
CUR has had a demonstrable impact in the
reduction of delays for continued stay patients, and
improvement to patient flow within the Trust.
Through use of granular level data at ward,
consultant and speciality level, the use of CUR at
Salford presents a compelling case for change for
its use in an acute hospital setting. Furthermore,
Salford have reduced the level of non-qualifying
patients by 20% in a 12-month period.
In one ward alone, as a result of a Senior
Consultant coming into post and utilising CUR on a
daily basis, the non-qualified rate on Ward L6
reduced from 73% to 29% between May and
October 2016.
At Salford, the CUR data has been used to make the
case for a 49 bedded sub-acute facility. Data was
collected over a 5 to 6-week period to establish the
proportion of medically fit patients that would
meet the criteria for sub-acute care. The clinical
team have developed the criteria for sub-acute
care, and the skill mix and establishment for a
workforce model to support this facility.
A full business case was developed which the Board
approved in summer 2016. The sub-acute facility
(Pendleton Suite) opened mid-October 2016 and
has 49 beds currently. CUR is in use within the sub-
acute facility and the reasons for delayed discharge
are being monitored to ensure a balance of supply
and demand and improvements in patient flow.
from Acute to Sub-Acute or an alternative setting.
New Minimum Dataset (MDS) for
CUR
The production and submission of a monthly
CUR Minimum Data Set (MDS) forms part of
the 2017/19 CUR CQUIN. The CUR MDS
defines a standard set of information
generated and submitted by NHS Trusts. The
CUR MDS was developed and piloted with the
following NHS Trusts, the results of which
concluded in May 2017: -
• Kings College Hospitals
• Alder Hey Children’s Hospitals
• Salford Royal NHS FT
• Norfolk and Norwich University FT
A final report on the findings from the pilot
was produced, and further communication on
the rollout of MDS has now been circulated to
CUR provider Trusts via their commissioners.
A phased approach to the rollout of the MDS
has also been established and shared. A series
of WebEx calls for providers have been held in
preparation for their respective “go-live
dates”.
The CUR MDS is required to be submitted
monthly and in accordance with the data
submission timetable included within the
provider contracts. This is typically around the
15
th
working day of the month.
To support healthcare providers in
implementing the MDS several support
mechanisms are available: -
• Sharing of pilot site reason mapping
codes
• One-to-one support from pilot site
providers
• Further WebEx sessions if required
CUR suppliers have worked alongside the
pilots to ensure any changes can be
incorporated into their respective CUR tools.
Any queries on the CUR MDS, please contact
england.cquincur@nhs.net
Speedy Roll-Out for Specialist
Trust
Liverpool Heart and Chest NHS Foundation
Trust is a specialist hospital based in the North
West of England and serving a catchment area
of 2.8 million. The 194 bedded Trust provides
a range of specialist services including
cardiothoracic surgery, cardiology, respiratory
medicine, and diagnostic imaging.
The hospital has recently implemented Clinical
Utilisation Review (CUR) in September 2016.
The hospital has trained a complement of
nursing staff on its wards and went live in a
phased rollout at the end of November 2016.
To support the implementation, the hospital
put in place a project team to oversee the
implementation, training of staff, and use of
the system across all its wards. The
commitment of the team enabled the hospital
to complete its implementation 6 weeks
ahead of schedule, with all beds covered by
mid-February 2017.
The hospital is really excited for the next steps
in using the data and is currently reviewing the
reason codes within their system to enable
teams to drill down into a more granular level
of detail around both internal and external
delays. This data will enhance the wider
Transformation Programme already in place
within the Trust, led by the Medical Director.
Project team members Sandra Wilson,
Matron, and Helen Turner, Executive Assistant
reviewing the system.
SUMMER 2017
Updates from CUR Trusts

3. The Trust has undertaken analysis of the
top reasons for patients who do not meet
the criteria for continued stay. These are:
• Ongoing referral to other hospital
services
• Ongoing intervention with hospital
services such as Therapies, Hospital
Social Worker
• Access to diagnostics
• IV therapy
• Continuing Healthcare
• Social Services
• Rehab
They have successfully integrated
Delayed Transfer of Care (DTOC)
reporting into the CUR tool, and have
been part of the team to develop this
resource nationally with their CUR
supplier. This has enabled the Trust to
release one Band 4 WTE back to the
wards as a Discharge Co-ordinator. All
DTOC reporting is captured within one
system and is accessible across the Trust.
There is increased visibility and the team
is now able to focus their attentions on
the un-validated delays to prevent them
becoming an official DTOC. This is far
more accurate and precise and has
enabled NNUH to quickly identify peaks
in demands.
In addition, the hospital is undertaking
SAFER and has successfully integrated
this methodology within the CUR system,
to avoid duplication of data entry for
nursing teams.
The CUR team have close working links
with the hospital’s transformation team
and is working closely to plan appropriate
interventions to improve these aspects of
service delivery.
In addition, the Trust has contributed to
national innovations such as:
• implementing CUR in admission
areas to learn about the causes and
reasons for avoidable admissions.
The results of this work will feature
in a case study to be published in the
Autumn.
the largest and fastest
implementation in the UK to date
Norfolk and Norwich University Hospital has
achieved considerable success in its first year
of the CUR programme, with implementation
across 964 beds across 30 ward areas including
AMU (74 beds) and EAUS (33 beds) and
paediatrics (33 beds), the largest and fastest
implementation in the UK. During the period
of implementation, over 250 staff have been
trained in the use of the CUR tool with
assessments on patients being undertaken
daily by ward sisters and co-ordinators.
Compliance in the undertaking of daily CUR
assessments on all patients has remained high
throughout the implementation, with over 80%
compliance across the hospital.
Through use of CUR data, the Trust has
identified the following: -
• 59% of patients do not meet the criteria
for a continued stay in a hospital setting.
• Over half (56%) of bed days on surgical
wards are occupied by patients that don’t
meet criteria for the current level of care
(includes medical outliers)
• Over half (62%) of bed days on medical
wards are occupied by patients that don’t
‘meet’ the criteria for the current level of
care
• In Critical Care, the vast majority of
patients met the criteria for a HDU/ITU
bed – as expected. However, 22% of
patients could potentially be stepped
down more quickly to a lower level of care
(ward based)
• Almost all paediatric patients meet the
criteria for an acute hospital stay
South Tees Hospital NHS Foundation
Trust significantly improves
compliance
As a result of the live CUR software, and active
support from the CUR project team and wider
organisation, compliance has increased from 16% in
April 2016 up to 92% for the month of March 2017
across 798 beds, including their community
hospital. Whilst the Trust recognises they still have
work to do to further improve compliance, this is a
significant improvement in the use of CUR for the
hospital and its patients. The Trust is well
underway with embedding CUR, with a clear vision,
accountabilities, improved visibility and utilisation
of data. Several improvement areas have been
identified and acted upon, which has resulted in
improved utilisation of the data and its accuracy.
To learn more about what South Tees have
achieved over the last 12 months, including the
reduction of non-qualified patients by 35% in a 12-
month period and the areas in which CUR is more
widely supporting such as Delayed Transfers of Care
(DTOC).
Watch out for more information in
their Case Study
• A more detailed case study on the progress of
Norfolk and Norwich University Hospital will be
published in the Autumn.
• South Tees are currently developing a Case Study
due to be published late Summer 2017.
Page 3
Page 3
More News Updates from CUR Trusts
SUMMER 2017
Page 3

4. Page 4
The CUR national learning network met on 14th
June 2017 in London. The Learning Network has
been established to support NHS Providers in
sharing best practice and lessons learnt
throughout their CUR journey. It provides a safe
and confidential forum where providers can
network, discuss and share issues and best
practice. The network meets on a quarterly
basis and the focus of the June meeting was to:
• To update each other on progress and
identify common issues, through individual
Trust presentations;
• To present the national Q4 summary
position;
• To update on the outcome of the CUR MDS
pilots;
• To understand how CUR can be used in an
“emergency village setting”, learning from
sites who have piloted CUR in an
Assessment Unit setting. This was led by a
presentation from Norfolk and Norwich
Hospitals
• To continue to build relationships across
the network.
NHS providers who attended the June learning
network included:
• Royal Surrey County Hospital
• Salford Royal Hospital
• Basildon and Thurrock
• South Tees Hospitals
• Kings College Hospitals
• Alder Hey Children’s Hospitals
• Norfolk and Norwich University Hospitals
• Lancashire Teaching Hospital
• Central Manchester University Hospitals
The session commenced with a presentation by
Emily Wells, Matron and CUR Lead at Norfolk
and Norwich University Hospitals (below).
Emily presented on progress to date following a
rapid implementation of 964 beds over a 6-
month period at the Trust. This has been
quickly followed by a pilot of CUR in “Emergency
Village Setting” to capture avoidable
admissions.
CUR LEARNING NETWORK UPDATE
Several hospitals rolling out CUR in 2017/18 are
planning to introduce CUR onto Assessment Units.
The Trust’s key learning points included: -
• Establishment of a robust CUR project team
in place at the commencement of the
project;
• Early identification of the CUR reporting
structure;
• The requirement for regular feedback on CUR
data to the wards (monthly newsletters,
outcome data);
• The requirement for data analytic input as
part of the CUR team
• Involvement and engagement of doctors,
matrons and therapists
A full slide deck of Emily’s presentation is available
– if you would like a copy please contact
Melanie.Andrew@integralheatlhsolutions.co.uk
The Learning Network also received a
presentation from Jo Jones at Kings College
Hospital and Natalie Pryor at Alder Hey Children’s
Hospital. Both Trusts presented on the CUR
Minimum Dataset pilot. News on the MDS is
presented on page 2 of this newsletter.
Each site presented their progress to date,
highlights include: -
• High volume of bed numbers where CUR is
now in use, and further being developed
across 2017/18. By the end of March 2018,
CUR will have coverage on over 11,000 beds
across 25 Trusts.
• Several trusts who wish to explore use of
CUR in an “Emergency Village” setting in
2017/18 including South Manchester
University Hospitals, Central Manchester
University Hospitals and Norfolk and Norwich
University Hospitals.
• The potential opportunities that the CUR
data affords Trusts when used across the
system, given the granular level of data to
hand: -
- South Tees Hospitals has now removed
the discharge facilitator data-base and is
using CUR as the one, single version of
the truth for all patient flow
information.
- Norfolk and Norwich University
Hospitals has identified gaps in
community service provision for IV
Antibiotics / OPAT, equating to 1867
bed days with an approximate value of
£235,000.
- Developed a business case for
negative pressure wound
therapy, identifying 432
inappropriate bed days and
potential cost savings of
£54,000.
• Alder Hey Children’s Hospital is not
currently funded for rehabilitation
beds. However, CUR has revealed
that 4 beds are being used for
rehabilitation purposes. This has
therefore flagged a wider issue
across the Trust that needs to be
addressed.
Full copies of all presentations are
available via the CUR Extranet site, or via
email from
Melanie.Andrew@integralhealthsolutions
.co.uk
The network evaluated very positively
with 100% of the audience indicating they
were satisfied with the content, and level
of discussion at the network session.
If you would like more information on the
CUR network, and how to get involved,
please contact
Alison.Johnson27@nhs.net
SUMMER 2017

5. CUR TEAM MEMBERS
UPCOMING EVENTS
Don’t forget to visit the
CUR Extranet site for all the latest
documents, briefings, case studies
and supporting information. Please
contact denise.edwards13@nhs.net
for access.
For further information on any of the
articles published in this edition of
CUR news, please contact a member
of the CUR team.
CUR will be featuring at The Health and Care
Innovation Expo on Tuesday 12
th
September
2017 where we will be talking about the great
progress being made across NHS Providers as
well as the opportunities and benefits CUR
affords.
The next National CUR Learning Network
Event is on 18
th
October 2017 – look out for
the sharing of materials on the CUR Extranet
site. For further information, please contact
Alison.Johnson27@nhs.net
Page 5
SUMMER 2017
We would particularly like to thank our
colleagues at Liverpool Heart and Chest NHS
Foundation Trust, Salford Royal NHS Foundation
Trust, Norfolk and Norwich University Hospital,
and South Tees NHS Foundation Trust for their
newsletter/case study contributions.
A BIG Thank you to all those who attended and
contributed at the CUR Learning Network.
The delivery of the CUR
programme is supported by
a national team who are:
HILARY HEYWOOD
National Programme Director
T: 07717 467483
E: H.heywood@nhs.net
ALISON JOHNSON
Relationship Lead
T: 07810 752876
E: Alison.Johnson27@nhs.net
MICK DOLAN
CUR CQUIN Lead
T: 07875 363263
E:
Mick.Dolan@integralhealthsol
utions.co.uk
MELANIE ANDREW
PMO Lead
T: 07798 888999
E:
Melanie.Andrew@integralhealths
olutions.co.uk
DENISE EDWARDS
Communications Lead
T: 07806 780409
E: Denise.Edwards13@nhs.net