Lead Commissioner

Edinburgh, Health and Social Care Partnership, 2023 - 2024

James performed duties of the Director of Strategy and Planning during a restructure of the Partnership's leadership team.

Performance improvement at the Royal Edinburgh Hospital

The Royal Edinburgh is a 570-bed hospital serving 1.2M people in Lothian. It provides predominantly psychiatric services, among them intensive care; acute care for functional illness and dementia; forensics; and inpatient rehabilitation.

In autumn 2023, occupancy in the hospital's acute wards exceeded commissioned capacity due to exceptional demand among other things. With hospital professionals, the Partnership's social workers and the NHS Lothian Executive, James led an urgent programme to improve flow.

By April 2024, the programme achieved its occupancy target through improvements in discharge processes. It further defined longer-term programmes to reduce admissions with more help in the community to avoid crises and investment in step-down accommodation.

Care home market management

Our substantive appointment to define an Older People's Pathway for Edinburgh coincided with increasing care home fees due to inflation and strong demand from self-funding residents. The Partnership relied increasingly on its own homes and those independent homes that offered nursing and dementia care at fees compatible with its budgets.

These factors limited flow from the City's hospitals and caused exceptional demand for large home care packages that is not seen in comparable places. The issues could not wait for long-term measures to create affordable care home capacity from the Older People's Pathway programme.

James developed three programmes with the Partnership's commissioners to improve support for, and oversight of, the City's care homes.

1. Engagement

James worked with the Partnership's commissioners to increase the frequency and quality of their engagement with independent care homes, and better understand their business-aims and offer incentives, such as guaranteed occupancy, that encourage discounted fees.

2. Oversight and central brokerage

The scarcity of dementia and nursing beds urged a real-time, comprehensive view of care home capacity and central purchasing. James worked with the Partnership's Transformation Team to create a universal care home booking service, comprehending all of the City's 75 care homes. Besides helping the Partnership find suitable services quickly it has also helped it standardise pricing and improve the timeliness and quality of transfers of care.

3. Care home map of Scotland

Expanding Care Bookings asked the Partnership's brokers to work with more care homes in Edinburgh, and occasionally elsewhere in Scotland.

Sphere used its Intelligence platform to develop a comprehensive datawarehouse of the care home markets in Scotland and the north of England, with routine information about vacancies, quality and price. We presented the data to the Partnership's Brokers in simple, searchable Web-based maps. The improved the accuracy and speed of decisions and significantly reduced the cost of administration.

Read more about practical uses of Sphere Intelligence in the Intelligence page.

Commissioner

Barnsley Metropolitan Borough Council, 2020 - 2021

Barnsley Council wanted to make its home care services more responsive to the needs of local people. James was appointed to lead a review of the home care market and to help it move from conventional home care, to care that supports people to live independently at home for longer.

Building domiciliary capacity during the Pandemic

The Council's plan for home care was quickly directed to meet a surge in demand due to COVID and maintain flow in Barnsley hospital. In March, James's role moved first to a project estimating the point at which infection in the care workforce at large would leave insufficient capacity to meet needs. This graduated to the development of supplementary reablement and "bridging" services to support people leaving hospital, and compensate for the suspension of admissions to most care homes. Throughout the Pandemic, James kept communications with home care providers and distributed government support grants.

Care home sustainability

Early in 2021, deaths from COVID and infection control brought demand for care homes to a low-point, with no indication when or whether it might recover. At the Local Government Association's request, James prepared a detailed sustainability analysis of care homes in and around Barnsley.

It was clear that traditional methods of demand-forecasting for care, which depend on only gentle and predictable variations from year to year, did not suit conditions where admissions were near zero and occupancy falling. James therefore used "exponential smoothing," a method more often used to forecast the price of equities, to estimate near-term demand for care homes. This method was accurate until COVID restrictions eased.

James presented his findings, which at the time indicated indefinite decline in demand for care homes, to providers. The exercise helped care providers estimate resources and revise their business plans. It began the co-production of new commissioning intentions for residential care.