adding a new post for diabetic eye screening (#478)

Author: HarleenKDhillon

app/diabetic-eye-screening/2026/04/from-co-design-to-delivery/index.md

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+---
+title: From co-design to delivery - a phased approach to improving diabetic eye screening
+description: A phased, clinically assured approach to delivering improvements in diabetic eye screening cohorting
+date: 2026-04-24
+author: Harleen Kaur Dhillon
+tags: cascade
+  
+---
+
+To ensure a safe, effective, and practical approach to identifying patients for diabetic eye screening, the Diabetic Eye Screening programme and Cohorting as a Service (CaaS) are working with screening providers, alongside system suppliers and other stakeholders, through a phased approach.
+
+A core principle of the programme is simple: avoid large-scale change without evidence. Instead, incremental improvements are introduced through a controlled pilot model. This ensures system behaviour, workflows, and clinical safety are fully understood before wider rollout. Clinical assurance is embedded from the outset, with cohorts validated in the first phase rather than later in delivery
+
+The CASCADE operational working group (CaaS Cohorting and Diabetic Eye) has been established to bring together operational, clinical, quality assurance, and pilot site stakeholders. Regular sessions provide a forum to review pilot progress, assess impacts, and support informed decision making.
+
+A collaborative workshop held in March in Leeds supported planning for upcoming phases, ensuring alignment on system requirements, integration dependencies, and delivery sequencing.
+
+The approach builds on the existing general practice to diabetic retinopathy screening (GP2DRS) process. It improves data quality and timeliness, and strengthens integration with national services such as the Personal Demographic Service (PDS), which holds patient demographic data.
+
+Delivery Plan Overview
+
+1. Cohort definition and validation
+2. Technical integration
+3. Controlled pilot testing
+4. Rollout planning
+5. Full implementation and transition
+
+## Key phases of the delivery approach
+
+### Phase 1. cohort definition and validation
+
+This phase focuses on defining and validating cohorts to ensure the right patients are identified for screening at the right time, in collaboration with screening providers.
+
+Outputs are reviewed to ensure they meet clinical and operational requirements, including resolving discrepancies between GP and PDS data.
+
+Daily cohort refreshes provide timely updates on patient eligibility.
+
+The phase concludes when the cohort is clinically assured and accepted by pilot service providers.
+
+### Phase 2. technical integration
+
+This phase establishes the technical foundation for the cohorting model. It focuses on connecting systems so they can securely share data.
+
+Collaborative workshops define integration requirements across NHS England systems, suppliers, and services such as the Personal Demographic Service (PDS).
+
+While diabetic eye screening providers do not directly interact with cohort data at this stage, their input ensures operational needs are met.
+
+The phase concludes when systems can reliably exchange data end to end.
+
+### Phase 3. controlled pilot testing with service providers
+
+A controlled pilot involving four service providers evaluates the cohorting process using production-level data.
+
+The pilot assesses system behaviour in real-world conditions, including frequent changes in patient eligibility, their impact on the system, and related workflow adaptations.
+
+The CASCADE working group supports ongoing review and feedback.
+
+The phase concludes once an end-to-end solution is proven to be viable and accepted.
+
+### Phase 4. rollout planning with stakeholders
+
+This phase focuses on preparing for national rollout following successful pilot completion.
+
+NHS England works with screening providers and suppliers to define the rollout approach, incorporating local variations in processes and system configurations. Insights from the CASCADE working group support a clear and actionable rollout plan.
+
+The phase concludes when a national rollout plan is agreed with all stakeholders.
+
+### Phase 5. full implementation and transition
+
+This phase delivers national implementation of the cohorting model across all screening providers.
+
+Automated cohort updates replace manual processes and legacy systems, enabling consistent and timely updates across services. The approach has been validated through pilot sites, supporting national adoption.
+
+The phase concludes with full rollout across all providers, targeted for March 2027.
+
+## Collaborative governance and working approach
+
+The CASCADE operational working group meets regularly. It brings together operational, clinical, quality assurance, and pilot site representatives. It provides a structured forum for reviewing progress, assessing risks, and supporting decisions throughout pilot and rollout phases.
+
+Clinical governance is being strengthened through the involvement of the CaaS Chief Clinical Safety Officer (CSO). This ensures alignment with existing clinical safety oversight.
+
+Clinical safety leads from key suppliers, including NEC (OptoMize Software providers) and InHealth Intelligence, are also involved to ensure risks are clearly understood and consistently managed.
+
+Initial alignment discussions are underway to establish a shared understanding of the cohorting approach, associated risks, and safety responsibilities.
+
+## Key improvements enabled by service providers collaboration and pilot approach
+
+Collaboration with screening providers ensures the cohorting model reflects real-world service delivery. The pilot approach enables:
+
+- Early identification of risks
+- Real-time feedback from services
+- Iterative refinement of processes and system behaviour
+- Increased confidence in clinical safety and operational viability
+- Daily updates supported by PDS integration, enabling faster response to eligibility changes and improving patient safety and efficiency
+
+## Next steps
+
+- Finalise pilot onboarding and success criteria
+- Run controlled pilot and capture feedback
+- Prepare for transition ahead of March 2027
+- Continue engagement with service providers via the CASCADE Operational Working Group
+- Work with key suppliers, including NEC (OptoMize software provider) and InHealth Intelligence, to progress technical integration following Phase 2 planning