The Balance of Care Approach
With the difficulties there will be in financing health and social care services over the coming years the challenge will be how to innovate to enable continuous improvement in the quality of care provided while at the same time managing costs, improving quality and maintaining morale.
Leadership is crucial in this: enabling innovative and creative ideas to be generated, developed and applied which focus on integration at both organisational and departmental levels. Improving the flow of patients through local health and social care systems by removing bottlenecks and doing so across the ‘whole system’ is the key to freeing up resources, creating new ways of delivering services, and tackling quality issues.
The figure above is a simplified diagram mapping out our general approach which is about defining and understanding levels of demand and supply of health and social care services, and how they interconnect. This applies across many different areas of interest and client groups and brings together both clinical and non-clinical dimensions.
Much of the interest lies in establishing the details of those key elements and how they relate to each other. Establishing ‘demand’ – usually a client group and any appropriate subdivisions of it – is often a key focus of work, sometimes requiring original local survey work to ascertain.
Given demand, then there is likely to be a range of appropriate care pathways that can be specified. Our work here incorporates resource and quality implications of applying, for example, local development ideas or best practice models from elsewhere to explore interesting ‘what if…?’ questions.
In this way, new care pathways can be modelled to test the potential resource - and care quality – consequences and see their potential impacts on the agencies and organisations responsible for commissioning and providing the services.
What is the potential for alternative care settings?
This is a particularly important question which lies at the heart of the drive for innovation. Whilst patients can expect to receive excellent clinical care, the potential remains to deliver this in alternative, and potentially more cost-effective, care settings. For example, many patients currently in acute hospital beds might either have avoided an admission in the first place, or could receive their post-acute care in other settings – including their own home – if those services existed.
The Balance of Care Group have been leaders in applying the Appropriateness Evaluation Protocol (AEP) in large-scale local surveys addressing these particular issues. The surveys provide a very rich mix of data which, together with local skilled, clinical input, helps to identify the types of patients and how many might be capable of receiving care in other locations based on their clinical and social circumstances.
Importantly, they also require – and engender – a whole system view at the local level encompassing acute, community and social care services in the same project and enabling a ‘seamless’ analysis of resource issues.
Take a look at our recent projects and you will see that this approach has now been used in many different locations.