Foundational analysis of a landmark, ICB-wide community services partnership
CF was engaged to support the mobilisation of a landmark, system-wide community services contract — one of the first of its kind in England. Faced with fragmented data, multiple legacy organisations and no credible starting point for measuring performance, CF produced a commissioner-ready “day zero” baseline across urgent care, admissions, discharge delays and outpatient activity, segmented by locality and grounded in national datasets. By mapping metrics to data sources, surfacing gaps transparently, and translating the baseline into a practical year-one performance framework, CF gave the provider a defensible single version of the truth — enabling them to align commissioners and internal leaders on priorities and demonstrate early impact with confidence.
What was the challenge?
CF was commissioned by a provider to support mobilisation of a first-of-its-kind, system-wide multi-year contract for community services across a large integrated care system. The arrangement consolidated multiple legacy organisations into a single model, transferred thousands of staff under TUPE, and granted the operator significant autonomy over out-of-hospital care, enabling pathway redesign, selective commissioning of partners, and delivery of a more integrated offer aligned to national ambitions to shift care closer to home.
However, the scale and pace of transition created significant complexity: multiple historic service models and management structures needed harmonising, and performance reporting was constrained by fragmented digital infrastructure and data, including different clinical systems across the geography. Without a clear and commissioner‑credible “day zero” position, it would be difficult for the provider to demonstrate whether early changes were producing genuine system impact or simply reflecting baseline variation, inconsistent definitions, or data artefacts introduced during mobilisation.
What did we do?
CF worked to produce an objective, locality-segmented baseline of pre-contact performance, by first conducting a structured review of national datasets to establish the pre‑contract position across the metrics that matter most to system partners, spanning urgent and emergency care (including A&E activity and waits), admissions and bed use, discharge delays, outpatient volumes and waiting times, segmented by locality and tested against historical trends where possible.
Alongside this, we mapped measures to data sources, explicitly identifying data gaps and constraints so that future performance reporting would be transparent and defensible. We complemented the quantitative baseline with qualitative system insight, engaging leaders within the provider and ICB to understand the “whole‑system” challenges the contract was expected to resolve and to validate the priority measures.
Finally, we assessed alignment to national policy direction and translated the baseline into an actionable performance framework highlighting leading and lagging indicators and recommending which measures were most likely to demonstrate early impact in year one.
The integrated care system’s rise in acute demand is driven by cyclical gaps between unmet needs and service provision
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Need is high, service access and performance are varied, and acute demand is rising
One of the localities is uniquely more deprived and diverse, which are both linked to poorer health outcomes.
GPs are difficult to access in the region, which is likely driving higher community service and UEC demand, that ultimately leads to higher admissions, more difficulty discharging and a higher likelihood of readmissions occurring until service gaps are addressed.
Community services as a system lever
Community-based services are pivotal to provide timely access to care, support healthy lives and avoid preventable acute presentations and admissions.
The data from across the region highlights the high need areas that the provider can strategically target to have a significant preventive effect and ease acute demand. Through effective segmentation and intelligence, the provider is strongly positioned to help shift the ICS from reactive to preventive care, in line with the NHS Long Term Plan.
What differentiated CF was the combination of deep healthcare system expertise with privileged analytical capability, using national datasets and rigorous benchmarking to produce an objective “single version of the truth”, and a practical, decision‑focused approach that turns complex data into a commissioner‑ready story and an implementable measurement framework, rather than a static report.
The provider inherited neurodiversity and learning disability services where waitlist demand outpaced activity
- ND and LD services have long waiting times and low capacity across the country
- Waitlists appear to be sensitive to increased activity, if this can be sustained
- In February 2025, the waitlist size decreases significantly, which is anecdotally related to referral management difficulties under the previous providers
CF’s proprietary segmentation analysis shows 19% of the ICS’ population single or multiple LTCs and could be targeted for intervention and drive 49% of cost
the population
CF supported the development of the NHS 10 Year Plan with the creation of a proprietary segmentation analysis framework that can identify the potential financial impact of targeted interventions in specific population segments.
This tool provides crucial intelligence for health systems to strategically prioritise their investments and support the left shift from treatment in acute to community settings; and moving from a treatment to prevention model.
CF has completed a segmentation analysis for the population of the region's ICB that is comparable to the analysis used in the NHS 10 Year Plan.
77% are generally healthy, with the remaining 23% having one or more of the listed conditions. An age-banded segmentation can be found on the next page.
What was the impact?
CF delivered a commissioner-credible “day zero” baseline — a single version of the truth across the integrated care system — giving the provider a defensible starting point for measuring progress and evidencing impact over the life of the contract. Grounded in national datasets and segmented by locality, this gave both commissioners and internal leaders shared clarity on where improvement effort would matter most and where unwarranted variation needed to be addressed.
The work produced a robust evidence pack spanning all priority system outcomes:
- UEC/A&E activity and waits — establishing pre-contract performance levels to distinguish genuine change from baseline noise
- Admissions and bed use — providing locality-level insight to target reduction efforts
- Discharge delays — creating a credible baseline to track the contract’s impact on flow
- Outpatient activity and waiting times — enabling consistent contract performance tracking from the outset
Measurement was made transparent and defensible by explicitly mapping every metric to its data source and surfacing gaps and constraints upfront — reducing the risk of future challenge and strengthening governance from day one.
Finally, CF translated the baseline into a practical year-one performance framework, identifying the leading and lagging indicators most likely to show early movement and aligning commissioners and internal leaders on what success looks like. This gave the provider the narrative confidence and analytical foundation to demonstrate early wins and track progress consistently.
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