This NHS Foundation Trust, based in the North East of England, was formed in 2006 and serves a population of 1.4 million. It employs approximately 6000 staff over 60 sites covering a 2200 square miles. The project was the fourth programme of work undertaken with the Trust following successful initiatives in Allied Health Professionals (AHP) and Psychology Forensic Inpatient Teams, Acute Mental Health Inpatient Ward Management and the Call Handling Teams.
The Children and Young People’s Service (CYPS) consists of approximately 320 WTE staff with a budget of circa £14.8m and provides specialist community mental health and learning disability services for 0 to 18 year olds across three localities. The Trust engaged in an analysis with Meridian to identify opportunities to redesign CYPS’s community services and ultimately increase productivity through a reduction in agency, bank and overtime spend.
The analysis required 35 resource days across the CYP Service, across three localities.
The study identified the following within the community service;
- Significant fluctuation in productivity between service lines
- A lack of consistency within and across management systems
- Unwarranted variations in size and skill mix within teams across all services
- Poor workflow systems
- No standardised understanding of measurement of true performance and productivity
The project sold was a 33-calendar week Improvement Programme with a proposed Return on Investment (ROI) of 6.4:1.
The overall goals of the project were;
- A 22% improvement in productivity through matching capacity to demand
- A redesigned service to align with service user and Trust needs
- Improved quality of service through realignment of caseloads to appropriate skill mix
- A reduction in spend on bank, agency and overtime based on the achievement of above.
Meridian’s engagement with the Service’s management was essential to deliver the overall goals of the project. Workshops were conducted to develop and agree the required systems and behavioural changes with staff having opportunity for discussion, critique and contribution. During sessions, new clinical pathways were designed to maximise the capacity of staff to deliver quality and productive levels of work. In addition, a new robust management control system was designed to ensure effective running of CYPS. This control system is now owned by all managers involved.
The key focus was to facilitate the service redesign and implement management controls enabling a reduction in overspend and large scale behaviour change. Integral to this was that all levels of management fully understood the planned and actual performance of their service against the target; taking the appropriate corrective action where necessary. The installation included:
- A robust Named Patient Contacts planning process to ensure visibility of plans to enable constructive challenge where actual activity does not meet the target
- Visibility of the achieved contacts and associated measures to establish variance against the plan
- A weekly review in which all key stakeholders are in attendance to provide authoritative decision making along with the option for each level of staff and management to escalate issues/concerns
- A weekly management report containing Service KPIs with actuals against plan and target, which aids the follow up process for senior clinical management and team managers
- A monthly caseload cleanse in order to control and manage the service demand and minimise the required capacity;
- Bank, agency and overtime caps and controls to minimise the overspend
The redesigned service including the installed management control system and new clinical pathways better equipped CYPS managers with the necessary systems and processes to manage the demand with reduced capacity. Ultimately this resulted in a significant reduction in the use of bank, agency and overtime usage.
Further benefits were realised through Meridian’s expertise in supporting the delivery of underlying improvements in management skills and behaviours. The intensive and collaborative programme of workshops, group sessions and 1:1 coaching augmented the new management control system to perpetuate the productivity gained during the life of the project.
Having increased productivity and implemented overspend control, the managers have worked closely with Meridian to ensure they are able to better manage the existing demand with reduced capacity. The financial benefits yielded from the project were as follows:
- After 2 weeks, a recurring weekly saving of £18,495 was achieved, with an increased saving every week, with a total of £1.4 million saved during the programme (£3.6 million annualised – 160% of the proposed savings).
- 45% productivity improvement
- The project value was returned in savings exceeding the fee by four times.
- The actual ROI of 10:1.