In 2012, bed occupancy at Sheffield Health and Social Care NHS Foundation Trust (SHSC) was up to 120% with 160 total beds per night including out-of-area placements. That year, acute inpatient beds consisted of two 22-bed older adult wards, four 24-bed adult wards and one eight-bed PICU (a total of 148 beds, serving a population of 550,000).
Over a 4-year period, a series of coordinated initiatives across inpatient and community services transformed this to a total of 82 beds (four 18-bed acute wards across adults and older adults, and a new, award-winning 10-bed PICU). Since then, admissions have been managed in the city, eliminating the need for out-of-area placements
In 2012, bed occupancy at Sheffield Health and Social Care NHS Foundation Trust (SHSC) was up to 120% with 160 total beds per night including out-of-area placements. That year, acute inpatient beds consisted of two 22-bed older adult wards, four 24-bed adult wards and one eight-bed PICU (a total of 148 beds, serving a population of 550,000).
Over a 4-year period, a series of coordinated initiatives across inpatient and community services transformed this to a total of 82 beds (four 18-bed acute wards across adults and older adults, and a new, award-winning 10-bed PICU). Since then, admissions have been managed in the city, eliminating the need for out-of-area placements (see Table 3 below).
Table 3: Adult acute bed occupation in SHSC between 2011 and 2016
2011/12
2012/13
2013/14
2014/15
2015/16
Apr–Sep 2016
Total beds (adults of all ages, including out-of-area)
141.8
127.8
116.1
104.7
84
68.7
Number of out-of-area bed nights due to lack of capacity
2939
1190
557
444
0
0
While wards have reduced in size, staffing has stayed the same, so patient-to-staff ratios have improved. Because of the reduction of wards, SHSC has been able to significantly reduce the use of agency staff, which has improved continuity of care on inpatient wards. There has been no rise in incidents throughout this process.
Towards the end of the project, around £2 million was invested in community services to ensure its sustainability. This included investment in IHTTs and new services for people with highly complex problems often associated with a diagnosis of personality disorder. In addition to this reinvestment, cost savings of over £1.5 million were made.
The following initiatives were key to this achievement:
Risk-sharing agreement between SHSC and the Sheffield CCG. SHSC took responsibility for the budget for out-of-area placements, so while it now bore the risk of further overspending on out-of-area placements it also had access to a portion of any savings made, to be reinvested in services with agreement by the CCG.
Efficiency programmes were instigated across the SHSC. They were particularly successful on inpatient wards, and supported a reduction in average length of stay from 56 to 31 days. Work focused on improving time spent with patients on the wards, having discharge facilitators on every ward, planning for discharge on admission, particularly in relation to social factors and daily bed management meetings with consultants.
Quality initiatives were implemented alongside the efficiency programme. These included: psychology posts on inpatient wards; the introduction of reflective practice supervision for staff; reduction in seclusion and restraint; and a service user-led, all-staff training programme to improve the management of violence and aggression.
Bed management was improved through weekly bed-management meetings chaired by the clinical director, and including all consultants, ward managers, discharge coordinators, partner services (crisis house, respite provision, community teams). Meetings use live data and focus on patient flow.
Improved intensive home treatment throughout the project. This included investment towards the end of the project, and also improved management of the system. Bed-management processes were applied, to manage the flow of people. This resulted in fewer people accessing home treatment, and smaller team caseloads but more intensive treatment for those who were receiving care.
A whole system approach was vital to the success of the programme. This included: partnerships with other agencies (for example, Rethink provided a crisis house and helpline, and Wainwright Crescent provided respite and step-down beds); fully joined-up management of the programme between inpatient and community services, with governance systems set up and developed to support this; live data that looked at the flow across the whole system; and engagement with service users, carers and staff throughout.
