The Four Localities Partnership of health and care providers and commissioners in Bury, Oldham, Rochdale and Salford was selected as one of the six NHS England discharge frontrunner programme sites.
When the pilot programme, led by Northern Care Alliance NHS Foundation Trust, needed support to evaluate financial benefits, NHS Arden & GEM’s finance transformation team stepped in. A financial evaluation of four pilot initiatives was undertaken, focusing on cash-releasing and non cash-releasing benefits, by analysing data and interviewing stakeholders.
The programme team is now better able to make informed decisions about the continuation and expansion of ‘tests of change’, with independent evidence for business cases and funding reviews.
The challenge
Finding new and innovative ways to safely discharge patients from hospitals helps to ease pressure on the health and care system, reduce waiting times and improve outcomes, particularly for older people.
The NHS England discharge frontrunner programme identified six sites to explore innovative ways of improving patient flow across their local area and then share their learning with others. The Four Localities Partnership – which brings together a range of health and care providers and commissioners in Bury, Oldham, Rochdale and Salford – was selected as one of the sites.
The partnership shares a single acute and community healthcare provider, Northern Care Alliance NHS Foundation Trust, with four hospitals and a range of associated community service across the four localities.
The discharge frontrunner pilot began in 2023 with a focus on supporting people over 65 home from hospital sooner and improving care for people with dementia. The pilot is trialling a range of new initiatives in these focus areas and needed support to evaluate the financial benefits of the new services and pathways.
Our approach
The Arden & GEM team brought together expertise in finance transformation with Allied Health Professional experience. The team’s objective was to provide a financial evaluation of the ‘tests of change’ – the new initiatives being delivered as part of the programme.
Out of 13 tests of change identified, four had progressed far enough to have the necessary data available and were included in the scope of this evaluation. These included:
- Setting up specialist dementia units
- Identifying people living with dementia in A&E and treating and supporting them at home
- Recruiting a team of exercise and independence facilitators to deliver light exercise programmes on wards
- Creating standard operating procedures for discharge.
Defining the scope of work
By working closely with the programme team, the scope of the evaluation was focused on cash-releasing and non-cash releasing benefits. This would inform a business case for scaling up successful tests of change at an organisation and system level.
Collecting evidence
Through weekly meetings with the programme team, access to data was secured from the test of change teams and analysed alongside data from the NCA dementia dashboard and National Commissioning Data Repository (NCDR).
A qualitative review was also undertaken, including a series of stakeholder interviews, to understand and capture the impact of change more fully. Research was undertaken by the team beforehand to define Key Lines of Enquiry (KLoE) which could then be used as a common basis for questions during semi-structured interviews. Interviewees included representatives from the frontrunner programme, Trust staff implementing change initiatives and partners from Age UK.
Presenting findings
The evidence collected was presented back to stakeholders to test and validate findings before being included in a final report which was presented to the Four Localities Board. Alongside the financial evaluation completed by the Arden & GEM team, Healthwatch also undertook a qualitative evaluation with patients and public. The two pieces of complementary work have provided a holistic picture of impact.
The outcomes
Over a three month period, Arden & GEM worked closely with the local discharge frontrunner programme team and tests of change stakeholders to quantify benefits and service efficiencies. Where these were shown to be positive, the evidence was included in a programme business case for further funding to continue testing or scale the initiative in other localities.
Read more about our support services for programme evaluations.