Background:
Following the acquisition of a community contract, a London-based Mental Health Trust was tasked with improving performance across multiple service lines, including District Nursing and Adult & Child Therapies. The Trust faced challenges with overspending, missed targets, and inefficiencies in managing demand and capacity. With the contract approaching retender, the Trust sought to demonstrate improved value and capability.
Analysis:
Meridian conducted a 48-day analysis across seven service lines, uncovering key issues such as an 18-hour-per-day paper-based allocation system, lack of standard performance targets, and limited compliance with digital clinical records. There were no clear capacity planning tools or caseload distribution processes, leading to inconsistent resource use and excessive reliance on bank and agency staff.
Implementation:
Meridian introduced a digital caseload management tool to streamline allocation and forecasting in District Nursing. The tool allowed each team to forecast workload six weeks ahead and allocate equitably. Weekly audit and variance reporting improved clinical data compliance, rising from 66% to 90%. Performance targets and planning norms were co-designed with the management team, and training workshops helped embed these new practices. An Operations Dashboard was also developed for six additional clinical services, enhancing visibility and supporting real-time resourcing decisions.
Results:
District Nursing productivity increased by 28%, resulting in £1.18M in annualised savings. Improved forecasting and scheduling reduced unnecessary bank and agency use. Other Clinical Services identified up to £40K per week in potential savings, with a proposed move to a 7-day service to maximise capacity. The Trust is now better positioned for contract renewal, having demonstrated improved transparency, performance, and use of resources.
