"We need to acknowledge capacity and demand are complex" (Part two)

Gareth Jenkins is a partner at Changeology Group. For the past 15 years, Gareth has worked in health and social care both as an NHS employee and external consultant. Specialising in transformation, change, performance improvement and productivity, he has worked across the UK and Ireland delivering better outcomes for staff and patients. Changeology have been working with the Better Care Fund (BCF) Support Programme to deliver improvement support in systems. This is the second of a two part blog.

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In my earlier blog, I highlighted how knowing what demand is 'is difficult but can be done' and understanding what current capacity is 'can be done but isn't easy'. I then went on to outline some of the important steps towards achieving both. 

In this second half, I'll explore further ways to bridge the gap between oversimplifying the issue and 'paralysis by analysis', that is when demand and capacity calculations become so complex, they are unwieldy and difficult to use.

Bridging the gap

The most common answer I see to address capacity issues is the need for more staff, the need for more funding, and while there is legitimacy in this claim (where appropriate) there is a dire need to start addressing the cause, as much as the symptom.  

Is all capacity being utilised effectively?  If not, why not? This year, the NHS will likely cost more than £7billion than is budgeted. Social care will miss the mark by nearly £2bn, so there is not a huge amount of unspent funds that could be used to recruit more capacity into services.  

Across the sector, there is a sizeable financial gap and while more accurate commissioning can help, it is not going to change things dramatically because there is a (very) finite amount of money that can be spent. 

Both health and social care are intertwined – sure, the government could increase social care funding by £2bn by taking that money from health (what’s a couple of billion between friends!?) which fixes the gap, but that funding pressure would then be absorbed by health, which then will increase demands on social care, which will overwhelm their newly balanced capacity and then we are potentially worse off than before we started.

If someone is not doing as much as expected (according to ‘capacity’) then it is likely a systemic failure causing that gap. Throwing more resource at a problem is not sustainable – we must do more to improve productivity within our existing capacity.  

That could be through improving pathways and processes, it could be challenging performance and changing behaviours, it could be through reapportioning service delivery amongst teams within the same system.

Changing the culture

There is an issue with transparent and robust data across the entire sector (one of the fundamental reasons why organisations find it so difficult to articulate their position). While there undoubtedly could be a greater focus on technology and informatics support, greater change is required across the operational side of things.  

Goals, targets, transparency, reports and rigour need to become the norm. On the frontline there needs to be a cultural shift and investment in training to increase the capacity and capability of team leaders, supervisors and management to best manage, coordinate and utilise their resources. 

By developing these areas, we will grow and develop the assurance around services, which will deliver timely and robust management information within each team and department.  

As a consequence, this will enable aggregated information to be both representative and relevant which would enable strategic and commissioning discussions to be more robust and equitable.  

Having foundations of accurate information will also enable a greater level of shared understanding across services; demand for social care services should not only be measured from the point of referral or acceptance to pathway but forecast from far earlier in the patient journey.  

Intermediate care services and other social care entities should have much more clarity on their expected demand, the origins of that demand and how they can provide support at the earliest convenience.  

This is a two-way street, health colleagues must improve their understanding of social care pathways and what the real (and live) capacity of their system partners is.  

All parties need to have knowledge and visibility of the bottlenecks throughout a system – not simply that they exist but where and to what extent.

Demand modelling and capacity planning is not simple.  It is not a spreadsheet, nor template.  

It is a complex element of how a business, organisation, department, team works and to get 'it' right involves getting the way of working right.  

Until we do that there is going to be a continued vacuum between 'what the numbers are telling us' and 'what is happening on the ground' and it will continue to be a challenge across the country until we stop seeing 'it' as a standalone exercise and more as a by-product of how we work each and every day.