Over the last six months, two health professionals at Frimley Health NHS Foundation Trust have been leading a CLEAR project to improve urgent and emergency care (UEC) services for people living with frailty. Supported by the national CLEAR team, Louise Duvall, an advanced frailty practitioner, in the frailty team at Frimley Park Hospital, and Kate Hyett, a lead frailty pharmacist, at Wexham Park Hospital, have been seconded to the CLEAR programme two days a week. Sponsored by NHS Frimley Integrated Care Board, their focus has been on frail patients who seek UEC care at both hospitals and exploring new ways of working to reduce the number of avoidable admissions and time spent in hospital.

As they prepare to present their findings to colleagues and trust executives, they reflect on their experience of being part of the CLEAR programme which trains and enables frontline staff to be in the driving seat of change. Louise starts with her reflections.

“I didn’t really know anything about CLEAR until the first meeting back in December 2022. There was a lot of talk about ‘transformation’ which is a term I’ve heard said before by people in suits who come into our teams for short periods and typically have no real experience on-the-job. I must admit I rolled my eyes and felt quite sceptical that the project would go anywhere.
Initially there was a lot of organisation and admin, sending out invites to stakeholders and setting up meetings. I was thinking ‘how on earth will we fit in talking to all of these people?!’ But we ended up being able to talk to lots of different stakeholders which has been so interesting and given me a new perspective on my job role
I’ve been pleasantly surprised by how many stakeholders were really keen to get involved in improving the service, which makes me feel motivated to make a difference. I think it helped that people we were contacting in the trust knew who we were and that we were legitimate. We talked to a wide range of clinical and non-clinical staff in workshops, in one-to one Microsoft Teams meetings and onsite visits.

I was quite nervous about doing presentations in the early days, but we’ve done so many now that it’s given me confidence and I don’t worry about it anymore. We’ve been living and breathing this for the last six months and we know what we’re talking about.
It’s been a very positive experience and I’ve built skills I’ve never had before. I’m more motivated in my role now and I feel that I’m doing a better job since starting the project. I’ve changed my perspective of that word ‘transformation’ and I’m now thinking I’d like to carry on doing more of this in my future career.”

Kate’s CLEAR journey

“I was interested in trying something new – something I’d never been involved in before. For our first meeting in December 2022, I wrote some ideas in my notebook about ways to improve things. I wrote down about 10 things which needed improving including creating a same day emergency care service, improving the referral process, improving education about falls prevention, better understanding of each other’s roles and including contact details of social workers on discharge letters.

The first couple of clinical engagement meetings were quite intimidating but we did some role playing first with a member of the CLEAR team who has a background in amateur dramatics so we had some challenging conversations with her to prepare ourselves!

Everyone’s under time pressure in the NHS and we’re always fire-fighting so it’s been so useful to take time out to be able to see a wider perspective.
We know there’s no spare money in the pot so the changes we’re recommending aren’t that drastic and hopefully will either produce savings or be cost neutral. But they’ll improve efficiency and have a positive impact on patients, including reducing the length of time they stay in hospital.

I’d absolutely recommend frontline workers getting involved in CLEAR. You gain the kind of skills you wouldn’t normally learn without changing your career path or moving up to a higher level. It’s a unique opportunity to learn new skills without changing your job.

It’s been really helpful to have the CLEAR team looking at things with fresh eyes and a new perspective whereas, if this was purely an internal project, we’d bring all our own biases to it. CLEAR brings the blue sky thinking and poses challenges whereas perhaps we’re more realistic about what’s achievable on the ground.

When I look back at those ideas that I wrote down in my notebook at the start of the project, it’s quite spooky because they’re quite an accurate summary of our final recommendations. But now they’re backed up by all the data analysis we’ve been doing over the last six months which is what is needed to get people higher up to listen to us and act on our recommendations.”