Health Service Executive, Republic of Ireland (2007)

This major project involved designing and training local care staff to undertake a survey at all 32 hospitals with accident and emergency facilities across the country. Data from a representative sample of patient records was analysed to explore the potential for admissions avoidance and alternative post-acute care settings. The project was carried out in association with PA Consulting (Ireland).

Click here to download a summary copy of the report

Click here to download a full copy of the report

Click here to download the report ‘s technical appendices

East Sussex, West Sussex and Brighton & Hove PCTs (2007)

Audits of Non-Elective Short Stay Admissions (2006 and 2007)

We have undertaken a number of audits on behalf of PCTS, involving clinical review of samples of patient histories for non-elective short stay admissions staying in wards in A&E departments or on Medical or Surgical Assessment Units in the three acute Trusts treating most of the PCT residents. The case mix of these patients was analysed in order to identify whether some might be treated in ambulatory settings and workshops on the findings held with local clinicians.

Wanless Report: Securing Good Care for Older People: Taking a long-term view. (2006)

The King’s Fund commissioned Sir Derek Wanless to undertake a review which sought to determine how much should be spent on social care for older people in England over the next 20 years and what funding arrangements need to be in place to ensure that this money is available and will produce high-quality outcomes. The report includes substantial coverage of the telecare model developed by the Balance of Care Group for the Department of Health with illustrative analyses based on it (see especially Chapter 7).

Click here to go to the King’s Fund website from where the Wanless report can be downloaded.

Department of Health (2005)

Telecare Business Case Model

A strategic business case model for telecare was developed on behalf of the Department of Health to support local councils formulate their bids for funding under the Assistive Technologies Grant. The spreadsheet model enables different care policies to be quickly and easily tested, using readily available local data, and quantifies resource requirements in terms of both volume and cost.

To download the model and supporting documentation click here.

This was an analysis of the inpatient bed requirements for the Outline Business Case for the redevelopment of Royston community hospital. This involved undertaking a survey of bed usage over a four-week period at Royston and nearby acute hospitals to judge the potential demand and included workshops with local clinicians and public groups to discuss the potential shape of service provision on the site, together with wider community-based health and social services.

West Berkshire Council (2004)

The Future Role of Directly Provided Residential Care Services

This investigated the potential for alternatives to directly provided residential care in West Berkshire. A special survey of residents’ needs was devised and undertaken, supplemented by analyses of existing management data. 'Extra care' housing and home-based intensive care packages - supported by improved mental health provision - were identified as significant options for future provision.

East Berkshire Partnership Board (2004)

Configuration of NHS Non-Acute Beds In East Berkshire

A combination of data analyses  - including bed usage survey data previously undertaken by the Balance of Care Group - and clinical workshops was employed to establish non-acute bed requirements across the three East Berkshire PCTs. Workforce requirements to support innovative community-based care pathways were calculated (such as staff types and whole time equivalents).

Birmingham Children's Hospital NHS Trust (2003)

Matching Beds to Capacity Demands.

Analyses of inpatient activity and bed usage in recent years identified imbalances in access by specialty, and associated operational difficulties within the hospital. Recommendations included review of ward staffing levels, and the use of 'swing' wards to accommodate seasonality of demand.

Sheffield , Rotherham and Doncaster Councils (2002)

Building Capacity & Partnership in Care

This involved working alongside independent care home sector representatives and the social service departments of each council to develop a model of care home costs. This was primarily to provide a basis for setting future care home fee levels. Analyses and discussion in a series of workshops focused on the staffing levels required to deliver given standards of care, as well as capital and other costs.

The project was extended to support consideration of the strategic development of long term care services for older people, including the role of commissioners and the role of the independent sector.

National Audit Office (2007)

Identifying Alternatives to Hospital for People with Dementia

We were appointed by the National Audit Office to undertake a case study across Lincolnshire, to see where patients with dementia are currently located in both acute and non-acute hospital beds. A point prevalence survey was undertaken with a focus on dementia and the analysis quantifies explores the potential for alternative care settings across the local whole system of health and social care.

Click here to download a summary copy of the report

EU Interreg Telemedicine Project, Southampton (2006)

For the past two years we have been working as Expert Advisors to Southampton PCT in their role as a participating centre in a European telemedicine applications project under the auspices of the EU Interreg IIIC Programme. Southampton and Eindhoven are the two principal centres with additional sites in Spain and Italy.

Department of Health Integrated Care Network (2006)

Members of the Balance of Care Group produced and presented a series of five workshops around the country on ‘Commissioning Integrated Care for Older People’ for the Integrated Care Network [link to www.integratedcarenetwork.gov.uk] (part of the Department of Health ‘Care Services Improvement Partnership’).

Click here to download a copy of the presentation.

North Hampshire PCT and North Hampshire Hospitals Trust (2005)

Commissioning Alternatives to Hospital Care

This report focused on alternative care pathways for older people and key conclusions were a quantified assessment of the potential for more integrated community-based care services; more focus on slow-stream rehabilitation service needs and mental health service requirements. Additional analysis for the local acute hospital included an analysis of their use of intensive care and high dependency unit resources.

To download the report of this project click here.

Working across the Trust’s three hospital sites and the community hospitals of the local PCTs, a bed usage survey of over 500 patients was undertaken. Analyses showed that significant reductions in bed occupancy at the acute Trust would be feasible given further progression of existing intermediate and community-based care facilities, and a focus on more active rehabilitation in the community hospital sites.

This was an analysis of alternatives to care delivery for all adult age groups across the City’s health and social care economy. Central to this was a bed usage survey of almost 1100 patients across acute and community settings. The potential for more community-based provision was quantified, including access to diagnostic and assessment services, and over 100 acute beds could be freed up as a result of implementing recommended changes

Oxfordshire PCTs & Oxford Radcliffe Hospitals (2003/4)

Identifying Demand for Intermediate Care and Community Hospitals in Oxfordshire.

This involved three related projects, beginning with the design and undertaking of a major bed usage survey covering 1054 acute and community hospital adult inpatients across Oxfordshire. The potential for significant expansion of community services as an alternative to hospital provision was quantified; a major conclusion was the need for existing community hospitals to focus on a more active rehabilitation role.

As future requirements in the north and south of the county differed further analyses were subsequently undertaken to support the development of business cases by the respective groups of PCTs

The Group also supported the development of the business case for the redevelopment of Bicester Community Hospital

To download the report of this project click here.

European Commission (2000)

Impact of Ageing on Healthcare Costs

Supported by a multidisciplinary expert panel, this project identified age-related cost drivers on healthcare costs to 2025. The most significant conclusion was that, although the number of older people will increase substantially, this will be accompanied by improvements in their health status. The net effect on total expenditure, given constant levels of access, will be small. Demography is not the problem: it will be other factors that create upward pressures on costs, for example the rising expectations of the 'baby boomer' generation.