Background
Serving over 1.5 million residents across 2,400 square miles, this West Midlands NHS Trust delivers hospital avoidance services designed to reduce unnecessary admissions and support safe, early discharge from acute settings. The service spans eight locality teams and includes clinical, therapy, care, and support staff.
Facing increasing demand, high vacancy rates, and unsustainable reliance on agency staff, the Trust partnered with Meridian Productivity to improve performance, reduce costs, and ensure that resources were used effectively across all teams.
Analysis
Meridian’s diagnostic study revealed significant variation in how teams operated, with inconsistent referral processes, regional disparities, and limited oversight of staff performance or face-to-face contact time. Management lacked real-time visibility into how capacity was deployed and where improvements could be made.
Key findings included:
Lack of consistent data capture for planned and actual activity
Over-reliance on agency staff, with weak cost control mechanisms
No standardised process for allocating demand to available capacity
Limited understanding of productivity expectations and goals
The analysis confirmed that the service had sufficient internal capacity to deliver more care hours without the need for costly external agency support.
Implementation
Meridian delivered a 14-week improvement programme across all eight locality teams. The focus was on strengthening management control and establishing a consistent, transparent way of working. Key changes included:
Defining fair and achievable face-to-face contact targets by role and band
Installing a forecasting, planning, and reporting framework to allocate workload equitably
Introducing daily and weekly scheduling reviews to track delivery and adjust plans in real time
Implementing short interval control and variance reporting to address issues proactively
Creating an agency authorisation and approval process, enabling managers to make informed, accountable resourcing decisions
Mapping referral-to-discharge pathways to create standard operating procedures and reduce variation
Training was provided to both frontline managers and team leads, fostering behavioural change and improving the day-to-day governance of performance.
Results
The programme delivered measurable and lasting improvements:
£1.5M in annualised savings, including a direct saving of £572K during the project period
14.8% increase in productivity, driven by improved face-to-face contact time
167% reduction in agency hours across key localities, with some teams reducing hours by over 1,100 per week
Standardised operating procedures rolled out across eight localities, reducing unwarranted variation
Management confidence increased through clear performance data and daily visibility of delivery against expectations This case study demonstrates that with the right tools, behaviours, and partnership approach, even large and complex services can achieve significant operational and financial gains—without compromising on patient care.
