Background
As a Primary Care Trust transitioned into an Arm’s Length Provider Organisation, it assumed responsibility for all community services across Outer North East London. With the goal of demonstrating efficient, well-managed services, the Trust engaged Meridian to assess performance in Health Visiting, District Nursing, Bed Management, and Rostering systems.
Analysis
Meridian conducted a 3-week study examining bed utilisation, nurse rostering, and internal productivity. Findings showed inconsistent bed occupancy (60%–100%) and average productivity of just 64%. The biggest causes of inefficiency were delays linked to external factors such as funding and social care. Rostering templates were misaligned with demand, overly rigid, and overly influenced by staff preferences, leading to inefficiencies during key hours of the day.
Implementation
A suite of management tools was developed to support daily, weekly, and long-term planning across community services. Meridian also introduced roster redesign based on demand modelling, standardised handover protocols, and clearer expectations for shift scheduling. Staff management training was delivered to improve accountability and match staffing levels to actual service activity.
Results
The project delivered £3.5M in total identified cost savings, including: £2.59M from better bed use and ward closures, £620K from revised rostering across 27 WTE, and £286K from higher-value use of existing beds. Surplus bed capacity allowed the Trust to release 50 beds, improving flow while cutting cost per patient. Service capacity also increased, enabling over 1,000 additional patients to be treated annually at the target LOS.
