NHS West Essex puts patients' needs at the heart of transforming the intermediate care system

Executive summary

BearingPoint supported the West Essex Health and Care Partnership (WEHCP) to understand and redesign the intermediate care system based on patients' needs and desired outcomes. The work laid the foundation of knowledge that has become the main source for future change initiatives to provide equitable, sustainable care provision. It showed the possibility of both operational and financial improvement through the effective contracting and delivery of health and care services. The data collected and analysised has enabled a pilot of future ways of working to be launched, and the rationale for change has won the support of senior leaders across commissioners and providers.

Opening new perspectives and opportunities for improved healthcare experiences

Health and Care Partnerships (HCPs) are non-statutory organisations which bring together health, social care and voluntary sector organisations across smaller areas of our integrated care system (ICS) to work as one. They are responsible for leading the detailed design and delivery of joined-up services across their communities.

System partners recognised that current intermediate care services in West Essex are piecemeal with disjointed component services historically commissioned in isolation. This has led to inconsistency in experience and likely sub-optimal outcomes for the local population. To address these challenges, The West Essex health and care partnership have developed an Out of Hospital Model of Care (OHMC) which articulates the ambitions for integrated working across West Essex system providers to deliver better outcomes for residents and a re-focus of care from an acute hospital setting into the community to deliver integrated care closer to home.

Truly understanding the patients’ journey throughout the intermediate care system

BearingPoint offered NHS West Essex an alternative to the typical way of understanding and evaluating services which would provide system partners with a holistic and new view, enabling them to make informed decisions about the future model of intermediate care. The team completed an end-to-end review of the 12 existing services within health and social care that form the intermediate care system. This included a review of contracting arrangements, workforce requirements, strategic alignment, outcomes and effectiveness, and value for money. The techniques deployed within this review included a review of service contracts (20 contracts covering £25m of spend), quantitative data analysis (30+ datasets), geographical/demographics population analysis, interviews with senior leadership, staff and West Essex residents (200+), process mapping, journey mapping and gap analysis, and other qualitative study techniques. 

BearingPoint structured the review into a Strategic Outline Case which provided the ICS with the required knowledge, assurance, and governance to start the transition to a new model of intermediate care.

BearingPoint then established a robust information sharing agreement across relevant providers and commissioners including patient level/identifiable data in order to fully establish patient outcomes over an extended period. This allowed for the verification of the performance of contracted services against their stated measures of success, in addition to the already established KPI’s. BearingPoint worked with finance, procurement and operational teams of NHS West Essex to collect the relevant information, some extracted from databases, some collected via interview or paper review. The contract documents were examined and compared with service managers’ perceptions of the contracts. Where documentation was not available, the project team cross referenced it with other documentation such as business plans and the investment cases for the creation of services. 

BearingPoint also created a database of contract terms, dates, quantities, finances, KPIs and proposed/current staffing models, followed by an analysis of “cross-over” between contracts, as well as identifying where there were gaps in provision. This high-level analysis provided the foundation of knowledge required to support the detailed intermediate care service effectiveness and value for money review.

Improving outcomes for population through better joint-collaboration and commissioning

NHS West Essex has gained an independent, evidence-based view of its current position, enabling future decision making to transform services for the population.

The Strategic Outline Case identified a clear case for change, highlighting the need for effective cross-organisational working and a collaborative approach to the commissioning and provision of health and social care services. Significant opportunities emerged for improvement in Contracting/Procurement, Performance Management, Strategic Alignment, Operational Distinction and Integrated Working.

The work provided a foundation of knowledge that has become the cornerstone of future change efforts for NHS West Essex. It clearly demonstrated the opportunity for both operational and financial improvement through the effective contracting of health and care services. It also depicted a clear need for mature approaches to contract negotiation to enable the transformational change required to deliver equitable, sustainable provision of care. A pilot for future ways of working has been initiated using the evidence collated, and the case for change has secured senior leadership buy-in across commissioners and providers.