Background
Following the success of two previous engagements within its Physical Health directorate, an East Midlands NHS Trust re-engaged Meridian Productivity to deliver a wide-scale performance improvement programme across its Adult Mental Health Services. The Trust aimed to deliver £580K in cost improvement savings (CIP) across Local Mental Health Teams (LMHT), Crisis Resolution and Home Treatment Teams (CRHT), and Inpatient wards—without compromising quality of care.
With services spanning 9 LMHTs, 4 CRHTs, and 9 inpatient wards, the Trust faced pressing operational challenges, including delayed discharges, high caseloads, and underutilised workforce capacity. saving of£580k across the Adult Mental Health Service, including Local Mental Health (LMHT), Crisis Resolution (CRHT), and Inpatient services.
Analysis
Meridian conducted a detailed baseline analysis, identifying critical performance gaps:
Productivity within community teams ranged from just 1.2 to 2.3 contacts per WTE per day.
Inpatient wards had prolonged lengths of stay due to ineffective discharge planning.
Communication between community and crisis teams was inconsistent, contributing to fragmented patient journeys.
CRHT teams faced staff vacancies and limited capacity visibility, delaying transitions of care.
Across services, there was limited use of structured management controls and real-time workload tracking.
The Trust needed to align care delivery with demand, improve patient flow, and embed sustainable management systems to unlock operational and financial improvements.
Implementation
Over a 26-week period, Meridian partnered with operational managers, clinical leads, and team supervisors to implement a series of tailored interventions:
Introduced management control systems across all services to track contacts, caseload intensity, and discharge readiness.
Delivered behavioural workshops to support leadership development and promote accountability.
Installed daily and weekly review meetings to enhance visibility across inpatient and community care pathways.
Developed service-specific planning and allocation tools to ensure equitable workloads and efficient home visit scheduling.
Standardised discharge planning, with each patient now having a clearly defined intended discharge date.
Meridian also worked closely with Bed Management and Community Team leads to implement a Trust-wide escalation process to reduce delays and improve cross-service collaboration.
Results
The results achieved exceeded expectations, driving both financial and operational improvement:
£3.8 million in productivity savings, mainly from reduced inpatient bed days.
69% increase in community team productivity, from 2.3 to 3.9 contacts per WTE per day.
24% reduction in average inpatient length of stay, from 50 to 38.5 days—freeing over 10,000 bed nights.
£164K saved in CRHT staffing costs through vacancy management.
£273K cashed saving in LMHTs, with a further £602K identified for future realisation.
41% reduction in patients breaching the 6-week stay target, falling from 81 to 34.
33% increase in productivity within city-based LMHTs, with caseloads streamlined from 110 to 64. £71K reduction in bank and agency spend through better rostering and resource alignment.
