UK Ministry of Housing, Communities and Local Government (MHCLG) 
Norfolk and Waveney STP Hosiptal and Care Home Bed Flow tracker
The key objective of the project/programme is to help local people with health and care needs to get access to available beds without unnecessary delays and to save local public-sector money in the process.
Norfolk County Council are leading the development of a full system wide Bed Management Tracker primarily designed to aid in the demands on the system during winter pressures, for the Norfolk and Waveney STP footprint. The types of organisations within the footprint include 3 Acute Hospitals, 1 Mental Health Trust, 1 Community Health provider and a local authority care home provision viewpoint.
The Bed Flow Management Tracker prototype (using Microsoft PowerBI) has enabled the art of the possible to be shown and identified in terms of bed management tracking and analysis to the key Norfolk and Waveney STP stakeholders. It has also raised hypothesis on the back off the information shown, in terms of areas of interest for future iterations – Home Care availability, Delayed Transfer of Care management and reporting, Performance Management, Bed Planning, Operational use within NHS providers etc.
As a result, the prototype needs to be re-engineered based on these more detailed requirements and outcome deliverables into a fully deployed self-contained web application, and this will take a detailed programme of work to be put in place to ensure delivery. This will not only require technical expertise and project/programme management but will also rely heavily on information governance resource to enable the enhancement of the currently reduced non-identifiable generic dataset into an identifiable one to enable the more patient/patient group specific outcomes to be delivered.
We have the technical expertise at Norfolk County Council, but would use the fund to ring fence these, to employ/second project/programme resources and to ring fence IG resource from the current STP IG peer group.
Development of the fully functioning STP Bed Flow Management Tracker will be completed in-house by the NCC Data Services Team and Web Applications Team in partnership with members of the STP Digital Steering Group, with input from other IMT departments, eg Servers/Networks as and when required for the purpose of successfully delivering the complete solution.
An Acceptance Criteria will be developed as part of the project initiation to ensure the project delivers the overall objective. Successful testing, based on the test plans and scenarios will be produced, which will enable measurement that the project requirements have been met, and so hence the overall objective
Projects are governed via a 4 Gate process, overseen by the IMT Programme Board.
The programme gates are: Gate 0 – Acceptance of a request for work, Gate 1 – Approval for a project to be initiated, Gate 2 – Approval for a project to deliver its products and Gate 3 – Approval for the project to close.
The process is designed to incorporate “Think”, “Plan”, “Act” principles i.e. Gate 1 ensures that thought has been given to the requirements and potential options have been considered, before a project is initiated; while Gate 2 ensures that the solution is designed, and delivery is planned, before any delivery work is started.
The project management method is PRINCE 2 or Agile, dependent on the nature of the project. There is no direct correlation with PRINCE2 processes and the Programme Governance model.
The Project Manager will have review meetings with the project team, where Actions and Progress will be logged and monitored. Monthly the PM will produce a Status/Highlight Report on the progress of the project during the period, highlighting any risk or issues that have arisen. Project Exceptions will be acted upon promptly by the PM ensuring the Project Board are informed so they are able to make a decision on the way forward. https://www.norfolk.gov.uk/do-it-online/local-digital-fund
There will be a single view of the system and flow to underpin the system’s commitment to a Home First, discharge to assess, culture and way of working.
The tracker will allow evidence based reliable forecasting of workloads and avoid peaks and troughs which are not matched to staffing complements
The tracker will enable multi-agency teams to get ‘upstream’ of blockages and avoid unnecessary delays for people
The tracker will significantly reduce the need for reports and spreadsheets outside of the main system which build in risks for inaccuracy and unnecessary duplication. An example of this is the JPUH social work team who estimate that they produce 30 separate reports on DToC a week.
Real time information will enable a real-time response. At present, the system reacts to data which is fragmented and reporting different points in time, making our response sub-optimal
The Multi-Agency Discharge Event team (from the Better Care Fund and NHSE) described our processes as ‘linear’; a single view of the flow would support moving away from transactional ways of working to a collaborative approach centred on patients.
Clarity around the bed flow and transfers of care across the STP footprint to enable strategic and operational delivery.
Building on an initial trial deployment last winter of an Adult Service, Care Home Bed Tracker which has
- enabled quick identification of a vacancy ensuring improved turnaround times enabling social worker staff to quickly place service users
- significantly helps winter pressures and speeds up hospital discharges
- enabled NCC to use less experienced staff to identify vacancies enabling the more experienced staff to focus on arranging contracts which means we are paying providers earlier and saving around 450 phone calls a week.
- by putting contracts on early this reduces potential loss of income (i.e. service users are more likely to receive an invoice earlier, meaning advice and information is given earlier to reduce customer complaints.
Norfolk County Council are leading the development of a full system wide Bed Management Tracker primarily designed to aid in the demands on the system during winter pressures, for the Norfolk and Waveney STP footprint. The types of organisations within the footprint include Acute Hospitals, Mental Health Trust, Community Health provider and a local authority care home provision. The Bed Management Tracker prototype (using Microsoft PowerBI) has the functionality to show a full system wide view of the bed capacity and demand across the Norfolk and Waveney STP footprint through one dashboard that can be available to all the key STP stakeholders to aid in managing bed pressures, especially winter pressures.
The Bed Management Tracker prototype has been designed to take a generic bed state dataset from the NHS provider organisations on a 15-minute cycle 24 hours, 7 days a week, 52 weeks of the year. The dataset is sent and received via a secure file transfer process and is digested into Norfolk County Council’s award-winning Data Warehouse analytical solution – GRID which has been developed to enable better business insights being key to delivering better decisions.
The key objective of the project is to help people with health and care needs to access available beds without unnecessary delays and to save local public-sector money. Longer stays can be significantly affected by DTOCs creating implications for NHS and Social Care organisations. While DTOCs account for a relatively small percentage of beds overall, the number of days each hospital bed is unnecessarily occupied is one of the factors driving up bed occupancy rates. DTOC is increasingly caused by delays in securing a residential or nursing home bed, or community care, including care to be delivered in a patient’s own home. These trends highlight the challenges facing social care, although awaiting access to other in-hospital services remains a considerable problem and the planned development of this project is directed at these key areas for both Health and Social Care organisations to identify clearly bed flow and transfers of care.
As mentioned in Q2, projects are governed via a 4 Gate process, overseen by the IMT Programme Board and this project and is reported to the STP Digital Strategic Steering Board. A set of documentation, for example PID, DPIA, User Requirements Document, Technical Requirements Document, Acceptance Criteria including Test Plans and Scenario unit testing for User Acceptance Testing, accessible demo application with User Guide will be made available along with the business case/benefits realisation. The answer to Q7 goes into the detail around the user requirements and the outputs as a result – these will be shared as part of the funding.
The prototype has been developed with the partners of the Norfolk and Waveney STP, and has been presented at the STP A&E Delivery Board and STP Workstream Delivery Group where the purpose and use were fully endorsed and a small group were asked to plan the rollout within the STP Winter Plan Office over the next couple of weeks. Screenshots of this initial prototype are already available via https://www.norfolk.gov.uk/do-it-online/local-digital-fund. As development moves on further information/rapid prototyping/data modelling will be available.
The business case will be shared and include the reason for the project being undertaken, the business benefit realisations, the risks to undertaking the project and not undertaking the project, the potential costs now and the future costs along with the project duration.
The ‘What Next?’ document will identify future aspirations and any requirements not delivered through due to the time box Agile Sprints set out within the project timescale and plan.
The project timescale exceeds the funding delivery date due to the significance in the amount of complex development required. Due to the use of the Rapid Prototyping development methodology there will be numerous prototypes to share as part of the funding programme, along with all the documentation etc as described above.
The User Requirements Document will fully develop the context around the STP Bed Flow Management Tracker and how it must visually look and work to aid the development team implement their work. We will Interview various business sources, to ensure the requirements reflect the business information about the needs for the development. The document will also include the technical requirements document and the creation of a development work plan identifying the resource requirements etc. There will be clarity about the scope explaining restrictions or constraints within the requirements document to help further guide those who are working on the development as well as setting the expectations of the user/business.
The graphical user interface(GUI) requirements are an important part of the document as they determine how the user will view the product. These will have a critical influence on the user-friendliness of the application and as a result a significant part to play in the successful implementation and adoption. Rapid Prototyping will be used as the development methodology to ensure the user/business are aware at all stages with what is being developed in terms of the interface etc. All areas of the User Requirements Document will be shared on the back of the funding stream, including the Rapid Prototype interfaces at each development cycle and the ‘What’s Next?’ document identifying the forward plan and journey direction.
This document is critical in the success of the project and the benefits to the project area; fewer defects in the application, less development rework especially true by using the Rapid Prototype methodology, faster delivery of the finished application, less unused features, lower cost of development, less miss-communicated requirements and higher levels of satisfaction from stakeholders.
Below is evidence of why this project could have a real significant impact across the NHS and Social Care. The overall NHS bed occupancy for 2017/18 was up on previous years. Evidence shows that above a bed occupancy threshold of 92% bed occupancy, the decline in A&E performance begins to accelerate. Higher proportions of patients in hospital for 21 days or more also significantly reduce performance. The gap between hospital discharges and admissions improves performance when hospital discharges are greater than admissions, it worsens performance when admissions exceed discharges. The project would benefit from key engagement mechanisms that the Local Digital Collaboration Unit can put in place with the Local Government Association, NHS Digital, NHS Improvement and NHS England to enable the project to be approved to be implemented and disseminated within other trusts and social care organisations across the country.
At no stage of the development of the STP Bed Flow Management Tracker have we applied for or received funding for its development and delivery as a prototype. It has been resourced from existing resources within Norfolk County Council and other STP partners. This application of funding is the first regarding the delivery of a production product based on the existing prototype.