Background

The Devon region has historically struggled to provide high-quality, cost-effective health and care services which meet the needs of their 1.2m population.  There were some real gaps in care quality, including more than a third of patients in hospital being unable to return home, despite being fit-to-leave. There was also a £100m financial deficit projected to grow to over £400m by 2020/21, and a long history of poor working relationships across organisations.

Approach

We supported Devon through a five-phase change programme to:

  • Align around a compelling, shared case for change and vision
  • Facilitate leadership development and establishing Devon-wide governance
  • Develop care models
  • Deliver a public consultation in Eastern Devon
  • Support Devon in developing plans to continue improving

In aligning around a vision and case for change, we combined cutting-edge analysis with engagement sessions to develop a thorough understanding of population needs, desired future state and gaps in delivering that.  We supported the leadership to share this with their organisations and generated a published copy for the wider public.

A regional governance structure was designed with the client to manage delivery and bring together operational, clinical and financial leadership to form a collective voice.  To support the change in mind-set to a more regional focus, we were able to provide an experienced, impartial and objective chair to align and coach local leadership.

We facilitated a series of clinically-led workshops to develop new care models, which were attended by over 90 clinicians from a range of care settings.  This resulted in a frail/elderly care model to reduce unnecessary hospital stays and meet the vision of “the best bed is my own bed”.

The new care model proved the closure of 70 community hospital beds would save money and provide better outcomes for patients.  We supported hand-in-hand throughout the consultation process, covering the pre-consultation engagement, formal consultation and navigation of the NHS England gateways, and fulfilling the role of critical friend.

Building on the successful consultation, we also provided financial and programme management support to translate other opportunities into tangible, deliverable five-year implementation plans.  These were locally-owned, and Devon have been successfully delivering against them.

Outcomes

A real lasting legacy has been the whole region working together towards a shared vision after a period of difficult relationships. The programme fostered a strong regional working relationship which remains in place and has continued to strengthen over time, despite subsequent personnel changes.

Patients in Devon are already benefitting from a number of implemented changes. Most significantly the work on community hospitals enabled beds to be closed, not only recurrently saving over £5m annually, but also resulting in 600 fewer patients a year being stranded in a hospital bed whilst being fit-to-leave, and instead being cared for at home.

Above all, the region is delivering against a clear, locally-owned, five-year plan to improve the health, wellbeing and care of the Devon population, which has aligned leaders, staff and patients alike behind a realistic, tangible, deliverable vision for the future.