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Clinically-Led workforcE and Activity Redesign (CLEAR)

Published in 2020, We are the NHS: People Plan 2020/21 - action for us all included a key emphasis on workforce redesign; exploring new ways of working and delivering care, particularly across systems, in order to best meet the needs of local populations.

Funded by HEE, the national CLEAR programme helps health and care systems understand rising demands and helps plan how redesign of services and the workforce can improve care.

By joining the national CLEAR programme, service providers gain access to expert research and analytics for workforce and service redesign projects. Unlike other similar services, CLEAR trains frontline clinicians in data analysis and service modelling to deliver change.


Clinically-Led workforcE and Activity Redesign (CLEAR) supports up to 50 NHS projects a year, in a COVID-safe way. The programme is run by the national CLEAR Faculty, which is hosted by East Lancashire Hospitals NHS Foundation Trust, and has an experienced staff of clinicians and administrators who oversee redesign projects and training.

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.

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. CLEAR has been shortlisted 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

Benefits for organisations and system partnerships: 

  • Funded or part-funded expert redesign support – a project team with experience and skills relevant to the size, scope and complexity of the redesign project; 

  • Locally relevant and feasible workforce and operational solutions – the CLEAR process includes insight gathering from frontline staff and stakeholders. It attracts local buy-in to ensure credible findings and success in future implementation. 

  • Specialist data analytics – data scientists help the clinicians and the project sites to extract, interrogate and analyse big data with using bespoke visualisation and modelling tools; 

  • An opportunity to broaden the skill base of staff thereby improving the attractiveness of working in the NHS and creating an opportunity to improve retention. 

Benefits for individual clinicians: 

  • High-quality training in a COVID-safe environment – the online education programme helps clinicians to learn at their own pace, at the same time having access to tutorials and varied teaching sessions where they can interact with experts and other participants. 

  • Protected time, pay and conditions – joining the national CLEAR programme is through a recruitment or secondment process into full and part-time graded roles, paid under contract and providing equity across all disciplines and strong assurance for both individual clinicians and participant project sites. 

  • New skills and competencies for a portfolio career – graduates of the programme return to their clinical roles better equipped to lead service change, bringing a much-valued asset to their organisation and improving their ability to improve care for patients and support their colleagues. ​

Current CLEAR projects

Clear Anticipatory Care

NHS England and NHS Improvement, in partnership with Health Education England (HEE), is offering support to local projects that deliver innovation and education in developing local anticipatory care models. Primary care networks and ICSs are invited to submit an expression of interest in joining the National CLEAR Programme for Anticipatory Care. 

Please complete the form and send back by Friday 7 May.   

For more information about this project, please contact clear.team@hee.nhs.uk

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



For further information, please visit the CLEAR website  or  contact us at clear.team@hee.nhs.uk