The issue

In mid 2015, the combined NHS commissioner and provider economy in North, East and West Devon was forecasting a deficit of £40m for 2014/15 and a recurring deficit of £87m into 2015/16. Further, the system was failing to deliver many of the key performance standards. The key providers and commissioners in Devon lacked a detailed fact-based understanding of why healthcare services in Devon were clinically and financially unsustainable.

The work

A team from Carnall Farrar, led by Ben Richardson and Ruth Carnall, was initially brought in to develop a detailed case for change which would set the scene for a programme of strategic change. This was to be supported by a capability and capacity review of the system to evaluate how prepared organisations across the system were for strategic change. Following this initial phase, Carnall Farrar secured the first part of the second phase of work (phase 2a) which involved working with all the stakeholders to appraise the options for meeting the clinical and financial challenges outlined in the case for change.

The output

  • Identified the key drivers of the deficit and the areas of clinical unsustainability
  • Produced a case for change
  • Identified and quantified the opportunities to close the clinical and financial gap. Prioritised these opportunities into 16/17 and longer term opportunities.
  • Provided an expert chair for the meetings of system leaders
  • Conducted a capability and capacity review with seven organisations across the system
  • Moved from a long list of service model options to a short list

The outcomes

  • Following both phases of work Devon was left with a shared understanding of the problem, shared ways of working, clinical models and a vision for the options which do not require consultation and a short list of options for services which do require consultation.
  • Carnall Farrar secured the next phase of work in Devon, and will be supporting the system until 2017.
  • Supported the creation of a new leadership coalition in Devon with an identified Chief Executive lead.

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