Turnaround

We design, build and implement system turnaround that are deliverable, transformative and responsive to customer needs as they relate locally, regionally and nationally.

Attain delivers in partnership with customers to design, build and implement new models of care that are ambitious, transformative and, most importantly, responsive to customer needs.

The NHS Five Year Forward View sets out a vision for the future of the NHS to 2020 and beyond, with implications for all organisations involved in the delivery of health and care services and for the people that use them. Central to this vision is the requirement for health and care systems to simultaneously deliver against the following aims:

  • Improve population health outcomes

  • Improve the quality and experience of care for individuals

  • Maintain or reduce per capita care costs

Commissioners, providers, and systems find themselves in real financial challenges that require a turnaround approach to tackle the underlying cost issues for a sustainable future. Tackling true cost reduction across a system is a new challenge.

System turnaround can support system aims through a commitment and approach to care planning and delivery which includes:

  • Shared system outcomes, accountability and risk; through shared decision making and shared governance structures

  • True cost and spend reduction through deliverable productivity, headcount reduction, and savings schemes that benefit both commissioner and provider spend without impact on service delivery

  • Improved population profiling, care planning and co-ordination across care organisations

  • Benefits realisation from the inter-dependencies and opportunities that exist between health and care system stakeholders, for example through economies of scale and reduced duplication of function

  • Creating an outcomes-based care approach that shifts focus to affecting the wider determinants of health

  • Supporting innovation, patient empowerment and the adoption of evidence-based interventions that improve health outcomes

  • Facilitating collaboration within and across care systems to respond to enduring challenges related to an ageing population, increased multi-morbidity and disease chronicity, and public expectation of care

Developing system turnaround

For local health and care economies, moving from vision to reality in delivering true system turnaround and financial benefit requires a phased approach that starts with aligning understanding the cost drivers in the system, taking short term tangible actions, and aligning long-term change and solutions strategically and with quantifiable benefits.

We believe that developing this system alignment is essential, prior to making organisational changes to provision – otherwise there is a risk of putting immediate short-term prior to transformational change; ending up with a solution that does not match local population needs; and spending long periods of time focusing on internal cost cutting that fail to achieve tangible changes to the way in which care is delivered for the benefit of the population.

For example, in our experience of developing system turnaround approaches, tangible short and intermediate milestones may be represented first through the definition of a shared system understanding of the baseline situation, cross organisational impact, and true underlying position both now and planned delivery. Then rapidly moving onto a situation of agreed longer term change including the detail of short and long term financial, contractual, and agreed benefit pans.

How to make it happen – key considerations:

  • Rapid “As Is” Assessment
  • System Commitment

  • In Year Plan

  • Multi Year Plan

Equally, it will be important that commissioners and providers alike recognise the key enablers of change that will support the transition to a system financial cost reduction plan and provide the foundations for system sustainability. These enablers will likely include:

  • Agreeing proposed governance structures and ensuring that these are deliverable
  • Early and sustained engaging with patients, citizens and staff in order to ensure that the accountable care model of care delivers real and necessary change, for the right reasons

  • Understanding benefits to be achieved and how they will be realised

  • Understanding real ‘distance to travel’ to achieve a financial sustainability so that realistic plans can be implemented and identified gaps closed

  • Delivering an evidence-based needs analysis, that recognises the wider determinants of health outside healthcare

  • Developing a clear performance and analytics system with a financial framework that allows cost benefits to be realised

  • Recognising and addressing challenges relating to choice, competition and collaboration within a system turnaround approach

How we provide support

There is a clear recognition that “one size does not fit all” in undertaken system turnaround and addressing the current challenges facing health and care systems. Attain delivers in partnership with customers to design, build and implement system turnaround that are deliverable, transformative and, most importantly, responsive to customer needs as they relate locally, regionally and nationally. For example, Attain’s work in facilitating system thinking and supporting changes in short and medium savings plans and financial models to encourage cost reduction collectively as a system.

Our service teams provides expert support in system turnaround both at scale and pace as well as acting in a delivery partner role to embed and sustain change and benefits for the long-term. Each service provides hands on support separately as set out below, or more commonly we provide a multi-disciplinary approach and combine our teams to develop new models of accountable care capitalising on our end to end organisational knowledge base:

Strategy
System vision, strategic objectives, scope, stakeholder engagement and governance arrangements

Service Transformation
Current state review, service analysis and benchmarking, defining desired outcomes, service delivery model and programme management support throughout implementation

Commercial
Commercial models, payment models and incentives, collaboration and competition, ongoing supply chain management