CF led detailed analysis and consultation on Devon’s community hospital beds, analysing the population and activity data, and establishing the demand from patients to use community hospital bed services. This led to implementation planning for a more integrated care model enabling the increased provision of home-based care.
- Community beds were concentrated onto three sites from seven
- More than 70 community beds were closed
- The funding and workforce released from bed closures were used to provide care in people’s homes
- The new care models were implemented ahead of plan, with annual recurrent savings of £5m
- Each year 600 fewer patients spend seven days or more in hospital
A fragmented care model increasing hospital stays
The Devon region historically struggled to provide high quality, cost-effective health and care services to meet the needs of its 1.2m population. More than a third of patients in hospital beds were medically fit, yet unable to return home. In community beds the proportion of patients who were medically fit exceeded 50%.
While there were discrete examples of good practice in community services, the care model was fragmented and difficult to manage for patients and staff.
Realising resource for care at home
We identified areas of local best practice with respect to delivering care at home and analysed the associated community bed base per 10,000 weighted population within best practice areas. We also established comparative levels in other areas to define the scale of the opportunity.
Applying a population health approach to the analysis enabled us to pinpoint the segments of the population driving up occupied bed-days within community hospitals. We were able to define the resources used to deliver care to these segments through community beds and the resource that could be released and redeployed as part of a home-based care model.
Defining new models of care
Once the high-needs cohort was clearly identified, we supported clinicians to develop criteria, based on best practice, that new models of care could be evaluated against. We then held a series of multi-disciplinary team workshops with over 90 clinicians from across the region to develop interventions which would improve the outcomes of care for the cohort of patients and make up the new model of care.
With clear interventions defined, we supported the development of the service delivery model. We modelled the financial, activity, capacity and workforce implications for community beds care and for rapid response and domiciliary care teams in the community who would deliver the new care model interventions.
Producing the business case
We then supported the development of a business case and delivered a public consultation in Eastern Devon, which established additional funding for the commissioning of increased services in the community to reduce the reliance on community bedded care. Our implementation plans addressed the required enablers: estates, workforce, governance, and the required information technology/data environment.
The impact on performance post-implementation was monitored: the new model of care led to a 60% reduction in delayed transfers of care across the locality, with half the number of community beds, demonstrating the clear benefit of the model to patients and the system as a whole.
For this work, we won the 2017 HSJ Consultancy of the Year award and the 2018 Management Consultancies Association Change Management in the Public Sector award.