North Ayrshire Social Services
The Scenario
North Ayrshire, on Scotland’s west coast, has a population of around 136,000 and spans an area of some 340 square miles. North Ayrshire Social Services (NASS) has a continually changing and expanding remit providing services to people in need of care and support.
The Aids and Adaptations service operated by NASS supplies disabled and elderly people with equipment and tools that allow them to continue to live at home. NASS wanted to reshape the management of this service to improve efficiency in the face of increasing demand and resource constraints.
NASS also needed to work to improve their inter-agency approach dealing with hospital patient discharges as studies had shown that 8% of hospital beds in Scotland were occupied by patients awaiting discharge. This had knock-on effects on the NHS as ‘bed blocking’ reduced the effective admissions capacity of hospitals.
The Challenge
NASS faced two separate challenges:
- To improve the response times to Aids and Adaptations requests for the disabled and elderly despite increasing demand. Each request had to be considered, regardless of suitability and this created processing problems as high priority requests meant that low scoring requests clogged the system – resulting in an average processing time of 50 days.
- To reduce delays in hospital patient discharges. The hospital admission and discharge process is highly complex, relying on multiple interacting factors both internal and external to the hospital. Patient discharges are delayed for any of several reasons such as locating and funding care places, delays in assessing care needs, financial assessments and legislative requirements. Possible solutions included speeding up these processes and assessment by social services earlier in their ‘journey’ through the hospital – but this would require a new “whole system” approach.
The Solution
In both cases Paragon worked with NASS to produce ‘process maps’ of the whole system. It was the first time that such a rigorous and holistic approach had been taken to collecting and applying data. Then simulation models of the systems involved were produced, accurately modelling the processes involved, sources of delay, congestion points
and the interactions between services. Paragon concentrated on eliminating waste (tasks started but not completed quickly) and elimination of rejects (requiring rework).
Paragon designed the models to allow NASS to gain a better understanding the reasons and causes behind slow processing times and delayed patient discharge so that management would know where to focus their attention.
The Benefits
NASS was surprised by the number of opportunities for delay that was revealed by the models. These delays were shown to be not consequences of the processes, but an integral to them, as currently configured. The Aids and Adaptations model helped identify nine major changes to deliver significant improvements in the service. It was demonstrated that a 14-day minimum in-system processing time was achievable. Two key changes were identified:
- If resourcing & capacity in one specific area were doubled the overall service delay would be reduced by 10%.
- If NASS policy was changed so that low or medium scored requests were immediately declined, the service delay would be reduced by 15%, with no change to the process.
Before the project had even finished NASS management decided to implement the first change involving purchase of equipment and the redeployment of resources from elsewhere in the service. Predicted service targets were quickly met and other suggested changes have subsequently been adopted.
“The Paragon study demonstrates that the interface between the NHS and the Council within the acute hospital setting is crucial in achieving faster decision making and earlier care or support arrangements” - Bernadette M Docherty, Corporate Director (Social Services), North-Ayrshire Council. The model was then used to investigate where best to spend time and resources to reduce specific delays and which alternative paths through the patient discharge system should be promoted. The results form the basis of a continuing coordination process with the NHS.