Case Studies

Devon Success Regime

 

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.

Barnet, Enfield and Haringey Mental Health Trust

 

The issue

At the time of appointment, Barnet, Enfield and Haringey Mental Health NHS (BEHMHT) were facing long term sustainability issues. The Trust’s five-year planning assumptions would not have translated into sustainable service provision without substantial revision. The problems within the organisation were not well understood by either the provider or commissioners and a critical point had been reached where inaction was no longer an option.

The work

The clients wanted Carnall Farrar to conduct a diagnostic project which would allow key stakeholders to understand the sustainability issues being faced by the BEHMHT and across the system more broadly, and agree on a future plan for delivering sustainable mental health services across NCL.

The output

  • An in depth analysis of patient mix and spend on mental health care
  • Analysis of the quality of care, patient outcomes and access at BEHMHT and Camden and Islington NHS FT
  • An understanding of provider costs and resources to deliver services and a full financial review of providers
  • A shared understanding of the key drivers of the deficit and clinical sustainability challenges facing the system
  • A tangible and credible plan for stakeholders which related directly to the issues illuminated by the analysis
  • A set of recommendations for stakeholders to take forward

The outcomes

  • The work created a shared understanding by commissioners and providers of current performance and the clinical and financial challenges.
  • There was large variation in spend per head of population across the 5 NCL CCGs.
  • BEHMHT was performing well for the level of funding it received at the time.
  • Differences in patient mix drove the differences in the resources needed.

North East Sector Manchester

 

The issue

The four Greater Manchester North East Sector CCGs (Heywood, Middleton and Rochdale CCG, North Manchester CCG, Bury CCG and Oldham CCG) and Pennine Acute Hospitals NHS Trust (PAHT) wanted to understand the extent of alignment of potential opportunities across their respective Right Care benchmarking reports and the Trust’s Carter report.

The work

Carnall Farrar were commissioned to help the North East Sector identify these areas, and create a starting point and shared vision for future collaboration between organisations.

The output

Outputs included:

  • Reviewing the historical levels of CIP and QIPP plans, and the degree of achievement
  • Comparison of the commissioners identified by Right Care, identifying overlaps and gaps across the 4 CCGs
  • Using the Right Care Atlas of Variation to compare the CCGs
  • A comparison of provider opportunities vs those identified by Carter

The outcomes

  • Our work endowed the clients with an understanding of the shared opportunity areas which they could pursue in future
  • We also provided a set of recommendations for the way forward and an outline of the key data issues with potential solutions.

Eastern Cheshire

 

The issue

In order to address the challenges of a fast-growing, ageing population, as well as future fiscal constraints on its £220m healthcare spend, the way care was delivered in Eastern Cheshire needed to be radically re-shaped.

The work

Carnall Farrar mobilised a team with appropriate breadth of knowledge and experience to address these complex issues, working seamlessly with the other consulting firms involved. Our team drove the creation of a credible, evidence-based strategic plan called ‘Caring Together’, which delivered an integrated care system. In addition to this we led the project management and coordination work streams.

The output

  • Modelling the baseline case
  • Outlining future service delivery options
  • Setting out the plans for successful transition

The outcomes

  • The scale of the financial challenge was identified and system leaders had a shared understanding of the key drivers of the deficit and clinically unsustainable services
  • A plan for strategic transformation was produced: ‘Caring Together’. This plan redesigned services to move from reactive, acute care to proactive care closer to home
  • The assumptions contained in the final strategic plan were aligned with Eastern Cheshire’s existing strategy following the work, including high level quantification of the enablers including IT, workforce and estates to support the overall transformation programme.

Leadership Development

 

The issue

Carnall Farrar are regularly contacted to support the development of leadership teams and individuals. We have established a reputation both in the UK and internationally for supporting clients to get the most from their people, teams, organisations and systems.

The work

We take a multi-disciplinary approach to our work, bringing together strategic insight, problem solving and analysis, leadership and organisational development. Our approach is tailored to the situation of each client and developed with the relevant Board/team members.

The output

Outputs would include:

  • Ensuring there is an understanding of other people’s strengths, weaknesses and behaviour preferences within a team
  • A strategy for how to work as an effective Board/team creating a greater sense of harmony and shared ambition
  • Development of an action plan for team working which can be returned to as a means of assessing progress
  • Change Capability Assessment Tool

The outcomes

  • Our approach, combined with our experience, enables us to work with clients to ensure that Boards and top teams develop culture, working styles and leadership and engagement strategies which secures high level, effective performance.

Tower Hamlets: Primary Care Transformation for a High Performing Future

 

The issue

Tower Hamlets CCG is a high performing organisation with a reputation for innovation. The CCG wanted to ensure that it was fit for the future by undertaking a comprehensive review of its strategic priorities, capabilities, partnerships and relationships.

The work

The objective was to use this review to understand how to develop capability within the CCG to tackle an increasingly complex and demanding agenda.

The output

  • Organisational and leadership development approaches including coaching

The outcomes

  • A much more focused set of priorities
  • An organisational development strategy and a leadership development programme which will be managed internally.

NEW Devon CCG: Capability Review for Effective Leadership

 

The issue

NEW Devon was concerned that with the intervention of national regulators to re-address their financial deficit, they may face a loss of autonomy and be unable to exert effective leadership for the system.

The work

Carnall Farrar were asked to undertake a thorough capability and capacity review and to recommend changes to organisational form and structure, leadership capacity and capability and to secure support for those recommendations from key partners and NHSE.

The output

  • Extensive interview process detailed review of all relevant documentation
  • Challenge sessions held
  • Outline recommendations
  • Subsequent coaching and mentoring support to key leaders

The outcomes

  • An agreed plan
  • CCG has undertaken a process of restructuring both of the top team, the organisation and the governance processes.
  • Corporate acceptance of the need for a shared strategy across providers and commissioners.

Better Care Fund: Supporting Plans for a Better Care

 

The issue

While the initial plans submitted by Health and Wellbeing Boards (HWBB’s) in April 2014 demonstrated significant advances in plans to integrate services they were generally deemed to lack sufficient analysis and evidence of how key benefits (financial and quality) would be delivered.

The work

Carnall Farrar mobilised an experienced team and worked within a consortium team of over 90 consultants to work seamlessly with local CCGs and the County Council to deliver a completely new version of the plan, which would meet national requirements upon re-submission.

The output

  • The development of four ‘How to Guides’
  • A series of workshops
  • Eighteen x five day intensive interventions
  • Five webinars covering 200+ individuals
  • Low level support to over 50 other HWBBs for short periods

The outcomes

  • 97% of the 151 plans were recommended for approval
  • Strong feedback from the HWBB and the NHS regional teams that our support was practical and constructive
  • Feedback from the client that the consortium was strong and worked well together to deliver the requirements at all levels.

Transport for London

 

The issue

TfL faces the challenge of being a multi-modal transport utility in one of the world’s greatest capital cities where transport volumes are growing and where substantial population growth is predicted. It continues to invest in the system, in new technology and in enhanced service but at the same time expects continued pressure on public funding and upon fares.

The work

Colin Carnall worked with a group of the TfL Partners in planning and delivering a leadership development programme for 250 senior managers and he has worked with a group of those senior managers in developing a leadership programme for the senior managers at the next level of seniority. Some 250 of the latter managers at the next level will go through this programme in 2016/17.

The output

  • Extensive interview process, with over 40 interviews conducted
  • Design of multiple leadership development programmes

The outcomes

  • Longer term TfL seek to engage with the major changes facing them and the development programme has given the organisation increased confidence that it can face these challenges effectively.
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