The national CLEAR programme has reached its 50th project just five years since its launch by a small team of doctors on a mission to transform the NHS and improve the lives of both patients and colleagues.

The CLEAR (Clinically Led workforcE and Activity Redesign) programme was set up as a partnership between the former Health Education England and 33n – a team of NHS clinicians, education specialists and data engineers united in their passion to improve health care and overcome workforce challenges.

33n’s story started in a London flat with a group of friends discussing how they’d go about fixing some of the problems they saw in their daily work as NHS anaesthetists prompted by their personal experiences of poor care. Instead of just talking about what was ailing the NHS, they resolved to try and make it better. The flat number was 33n.

33n co-founder and director Dr John Jeans said:

“Since our first CLEAR project back in 2019, a lot of people have put a huge amount of hard work, enthusiasm and diligence into achieving remarkable outcomes for organisations, staff and patients. I would like to thank everyone involved in the CLEAR programme – particularly the clinicians and managers on the ground who continue to lead and support projects despite working in immensely challenging environments. Together, we’re tackling some of the biggest challenges the NHS has faced in a generation and improving lives.”

The company was officially formed in October 2017 and its small team of just six people started putting their ideas into practice in early 2018.

The vision was simple: combine sophisticated data analysis with the knowledge, skills and hunger for change of frontline clinicians to transform NHS services.

Since then, the programme has been commissioned to deliver more than 50 projects across England and empowered more than 200 people to be at the forefront of change – with recommendations for new models of care and workforce, enhancing patient and staff experience and forecast productivity savings of more than £20 million.

The projects have covered NHS England’s key priority areas for post-COVID recovery and transformation including urgent and emergency care, elective recovery, mental health, primary care and ophthalmology.

33n co-founder and director Dr Alex Monkhouse said:

“Every one of our 50 projects demonstrate the power and effectiveness of the CLEAR methodology and approach. CLEAR has been making a real difference to solving some of the huge challenges of the NHS, equipping front line staff with new skills to lead change, igniting innovation and being at the forefront of the recovery and transformation of services across the country.”

33n co-founder and director Dr Shruti Dholakia said:

“I want to thank and congratulate all those who have helped make the CLEAR programme so successful – particularly those in the NHS and 33n who have dared to think differently and innovate outside of their usual practice. Our multidisciplinary team has worked tirelessly over the last five years to grow the programme and improve the quality, safety and efficiency of NHS services. I look forward to the development of our team and delivery of the next 50 CLEAR projects, as we continue our mission to improve lives – both of patients and the workforce that serve them.”

Completed projects include:

An urgent and emergency care programme – undertaken in two phases between 2019 and 2021, involving 10 hospital trusts across England. An independent evaluation of the second phase concluded that the average return on investment from implementation of the CLEAR recommendations was £5.54 – so for every £1 invested there would be a predicted return of £5.54.

Mental health programme – involving six NHS trusts and resulting in more than 30 recommendations to reduce waiting times, improve access, extend capacity and increase staff retention. An independent evaluation found the average return on investment from implementation of the CLEAR recommendations was £2.84 – so for every £1 invested there would be a predicted return of £2.84.

Proactive care programme – five primary care networks (PCNs) across England took part in projects aimed at providing better, personalised, integrated and holistic care for some of their most vulnerable patients – the housebound and patients with long-term conditions, dementia and frailty. Forecast outcomes include reduced emergency department attendances and unplanned hospital admissions, reduced pressure on GPs and potential savings totalling more than £1.4 million.

Ophthalmology – the CLEAR project at Sussex Eye Hospital identified around £2 million of productivity gains. By investing £1m in a new workforce model for glaucoma (around 45% cheaper than the current model) the trust would be able to clear the backlog of more than 7,000 patients over a two-year period resulting in 150 fewer patients suffering avoidable sight loss.

Operating theatres – the CLEAR team worked with Queen Elizabeth Hospital (QEH) King’s Lynn NHS Foundation Trust and East Sussex Healthcare Trust (ESHT) to address challenges in elective recovery in the context of long waiting lists and increasing demand. The forecast impact of the resulting recommendations included productivity gains of around £2.5 million, better patient care and improved staff recruitment and retention.

Read more about completed CLEAR projects with details of challenges, recommendations and forecast benefits.