Clinically-Led workforcE and Activity Redesign (CLEAR)

About CLEAR

CLEAR, which stands for Clinically-Led workforcE and Activity Redesign, is the only programme of its kind in the UK, which solves complex health and care problems by simultaneously providing workforce and service redesign, and training clinicians to deliver it.

CLEAR offers service transformation benefits for NHS organisations and integrated care systems; and work-based learning for clinicians. Participants are assigned to live projects, with education and supervision by the national CLEAR Faculty, and support from data scientists who work closely with each participating organisation to extract and visualise the relevant data.

CLEAR projects address local, regional, and national challenges in priority themes which enables organisations and systems to enact transformation to address the key challenges relating to the restoration and recovery of NHS services.​

CLEAR projects are supervised by the National CLEAR Faculty which is hosted by East Lancashire Hospitals NHS Trust.

Development of CLEAR 

CLEAR evolved from health and care transformation work in north west England, which experimented with ways of visualising, interrogating and modelling data and putting this together with the real experiences of frontline clinical staff. This identified the effectiveness of clinicians as skilled leaders in transformation.

In order to apply these techniques more widely, in 2019, HEE funded a national pilot to identify seven hubs to build and develop capability across regions. The first projects were focused on service innovation and workforce redesign in urgent and emergency care (UEC) which delivered the following outcomes:

• £12.3 million potential savings identified through workforce redesign across the seven projects
• New models of workforce and service delivery with evidence-based improvements in efficiency and care for patients
• Trained 64 clinicians to lead transformational change in their local health and care system. 

Feedback on the programme was extremely positive, both from participants and Board level sponsors. Furthermore, CLEAR was shortlisted as a finalist for the Best Educational Programme for the NHS at the HSJ Partnership Awards 2020.

In March 2020, CLEAR was quickly adapted to support the pandemic response. This provided redesign capacity within NHS organisations and online training and development for the NHS workforce, including training for over 2,000 non-ICU staff who transferred to ICU to support overstretched staff in critical care. This course was Highly Commended for the Regional Covid-19 Response Partnership Award at the HSJ Partnership Awards 2021. The award recognises outstanding dedication to improving healthcare and effective collaboration with the NHS.

Benefits of CLEAR

By registering your redesign project with the National CLEAR Faculty, you are joining a national programme that provides:

• A clinical project team, including participants from your organisation, if available
• Senior clinical innovators and data scientists to work with your organisation
• Bespoke data analytics and modelling tools
• Nationally approved standards of project assurance and information governance
• Shared information and experiences from similar projects in your region and across the nation

Current CLEAR projects

Clear Anticipatory Care

The National CLEAR Programme is supporting the development of Anticipatory Care approaches across Primary Care Networks (PCN) and Integrated Care Systems (ICS). Anticipatory Care is designed to support those patients who are at high risk of unwarranted health outcomes to live well and independently for longer, through structured proactive care. This supports the prevention of ill health in line with the NHS Long Term Plan, with the ambition that people will be able to enjoy at least five extra healthy, independent years of life by 2035.

Each PCN and ICS taking part in a CLEAR project will have the ability to deliver proactive personalised care in the community to patients with complex needs. It will improve partnership working between the health system and community providers and develop a standardised approach in identifying patients, with the ability to use this to support wider system redesign. CLEAR will build capability of participants to perform workforce redesign with its own permanent workforce in other tenants of anticipatory care.

This work is contributing to a shared learning exercise of anticipatory care across England in partnership with NHS England and NHS Improvement and Health Education England.

CLEAR Intensive Care

Projects are currently active in four ICUs in London at University College Hospitals, Royal Free Hospital, Imperial College Healthcare and Barts Health. The work is supported by NHS Health Education England and part of the London Transformation and Learning Collaborative (LTLC) to increase critical care capacity in London.

Frontline clinicians working with the National CLEAR Programme in ICU have published Managing the COVID Surge in ICU: 10 Quick Wins that can be Adopted in 48 Hrs.

You can download the summary checklist and more detailed findings in 'related documents' below.

CLEAR Mental Health

Mental health trusts in six of the HEE regions are currently preparing to start CLEAR projects covering:

• Adult severe mental illness

• Adult crisis alternative

• Adult common mental illness (IAPT)

• Perinatal mental health

• Children and young people’s mental health

• Therapeutic acute mental health inpatient care

• Adult liaison mental health, A&E and ward liaison mental health services

Urgent and emergency care

Improving urgent and emergency care services is a national priority highlighted in the NHS Long Term Plan. To support organisations in reaching these goals and the restoration and recovery of services, Health Education England has commissioned a National CLEAR Programme for urgent and emergency care.

For further information, please visit the CLEAR website (clearprogramme.org.uk)  or  contact the CLEAR team by emailing clear.team@hee.nhs.uk

The CLEAR model: how a CLEAR project works