Case Studies

Dementia issues

Challenge: Dementia prevalence is rising across the UK and improving dementia care was a key objective for our client – but it was not clear what the most pressing issues were for people living with dementia, their carers and healthcare professionals.

Solution: We were asked to lead a project to identify the issues faced by this wide range of people. We used two methods – traditional face-to-face meetings, which was a tried and trusted method but could only access a limited number of stakeholders, and a novel web-based tool in a social networking approach which could access a far larger number. The web-based tool also allowed people to comment on each other’s issues and vote on them to identify the ones that most needed to be addressed.

Outcome: Key dementia issues were identified and our client was able to tailor its service improvement effort and resources accordingly.

Contract management

Commissioning, Contracting & Procurement

Challenge: Support and management of the contract renewal process for a community services provider.

Solution: This included:

developing contracts for service transfer due to organisational change;
creating new contracts for services that result from successful tenders;
reviewing and revising services to and from partners in the local health economy ensuring financial viability;
presenting the case for increased funding to cover increases in demographics;
managing the impact of changes to commissioning of specialist services;
developing and agreeing CQUIN schemes;

Across all contract negotiations analysis of the available resources and manpower planning features strongly despite efforts to shift towards outcome based measures.

Driven by tight funding within the local health economy there is need to optimise use of community beds. We developed a simple RAG monitoring tool that allows instant capacity calculations of bed usage based on patient category and staffing.

Outcome: Contracts in place and agreed within mandated timelines. Successful negotiation of contract uplifts. Creation of CQUIN schemes to meet commissioner goals; incentivising positive performance; straightforward metrics, measurable against established benchmarks.

Cost improvement validation

Financial Improvement

Challenge: Our community services client required their Cost Improvement Programme (CIP) to be validated, further opportunities identified, and implementation planned.

Solution: We developed a template to capture all CIP opportunities. In addition to existing ideas we focused on the opportunities to make savings across the wider health economy by reducing emergency admissions and excess bed days in the local acute trust. This could be achieved by better use of community beds. We emphasised the importance of metrics in demonstrating improvement in performance and completed groundwork on dashboard reporting of project progress.

Outcome: We identified over £7 million of additional savings. The planning exercise left the client with identified project leads for each initiative and a timeline for implementation. The project set the client on course for merger with a neighbouring aspiring foundation trust and demonstrated the ongoing viability of many of the services.

Service integration

Change Management

Challenge: A mental health foundation trust and a community services partner looking to bid jointly for an integrated community service realised that their current offering was far from integrated.

Solution: Working with both trusts we designed and facilitated a series of workshops themed on key areas: dementia; end of life; long term conditions; child and family. With invited representatives for each work stream from both organisations we posed the question “How would you design an integrated service from scratch?”

Using a very interactive process the first workshop of each work stream took a case study provided by the delegates and designed an integrated service around the patient. The second workshop looked at what would need to happen to bring the new pathway into effect; where would be a good place to pilot the solution; and who would need to be engaged to make it happen.

Outcome: The workshops generated high level project plans for integration initiatives in all four work streams and individuals from both organisations motivated for change. These plans gave both trusts a platform for transformation projects towards an integrated future.

Urology commissioning

Commissioning, Contracting & Procurement

Challenge: Our brief was to design and manage a commissioning exercise for specialist urology services to deliver an agreed recommendation to the regional reconfiguration panel.

Solution: We designed a commissioning framework and evaluation strategy, processes and documentation; set up an independent review panel and technical work streams with terms of reference; facilitated meetings and project managed the programme..

Outcome: The agreed recommendation was achieved in six weeks, against a long-term history of delay (failure to reach agreement in the previous seven years) and a new contract was awarded to Park Street Consulting to support the implementation of our recommendations.

Governance review and reconfiguration of organisational management

Interim Management

Challenge: We provided an interim Director of Commissioning/Network Director, to: lead and advise the management team, network groups and board; deliver a reorganisation in line with recommendations from a number of governance reviews and influences from (at the time) a newly published policy document – The Cancer Reform Strategy. This included management of a TUPE transfer to another host organisation within the NHS, resolving long-standing HR and finance issues.

Solution: We worked closely with the management and HR representatives from the organisations involved and with support from the Director of HR liaised with union and legal representatives.

Outcome: This exercise resulted in a new model of clinical leadership and performance management system being implemented, improving the risk position, the capability to support commissioning, management and reporting, with better links to the new host organisation.