1. The Benson Model Safe Staffing for District Nursing
Introductory Resource Pack
Q4 2017

2. Benson Community Planning Models
TIMELINE
2010 Launch of BM Health Visiting
2012 Launch of BM for School Nursing
2013 Launch of ASC model
2014 National DN Consultation w/ QNI
2015 DN Report to QNI
Initial DN Model specification
Benchmarking reporting commences
2016 Launch of BM Social Care & MH models
2016 Q1 DN Pilot selection
2016 Q2 DN Pilot begins
2017 Q3 Launch of Benson DN model
Benson Model:
Health Visiting
Benson Model: Children’s Centres
Benson Model: School Nursing
Benson Model: Social Care
Benson Model: District Nursing
Benson Model: Mental Health

3. Benson UK Network
North Somerset
Ealing
Cornwall
& IoS
Liverpool & Sefton
Birmingham
Cumbria
Derby City
Derbyshire
Salford
Stockport
Bury
Leic & Rutland
Herts
Coventry
Essex
Beds
Surrey
Lancs
Blackburn w/Darwen
Torbay
Somerset
Bristol
Plymouth
Kent
Northants
Lincolnshire*
Warrington
Halt. St Helens
A, L & Wigan
Medway
W Sussex
E Sussex
Luton
Dorset
Norfolk
Cambs
We have implemented Benson model/s with 40+ sites in England (+ 1 in Scotland) and continue to work with several of these providers
4 DN Pilot Sites:
Somerset
Plymouth
Liverpool
Luton
More than half of our clients use more than one service model
Oxfdshire

4. Key Benefits
Allocate Staff & resources objectively using a live, evidence Based methodology
Match skills with caseload complexity by profiling local demographics
Forecast and Cost future service incorporating future developments and ageing
Identify Risk, Efficiencies and potential to improve outcomes
Link with other systems including PAS, E-Scheduling & E-Rostering

5. Organisational approach
function
Information
flows
Benson
Planning
Commis-sioning
Service analytics
Strategic devpmt
Financial
Health Intel
Bid
team
Commis-sioners
E-Sched.
& E-Rostering HR
HR System
Patient System
3rd party software
Fin. system
Costing
Bench-marking
Forecasting
Staff & caseloads
Operations
Organisational approach

6. DN: What are the challenges?
Informal / subjective allocation & decision making
Rigid standardisation – not accounting for complexity
Decentralised planning / mixed practice models
Failure to adequately address & allow for “complexity”
Not leveraging / learning off data / intelligence / systems
Incentivising quantity over quality
Failure to deliver or focus on outcomes
Commissioners want greater accountability and transparency
Tighter budgets / incentive to reduce inefficiencies
DN caseloads / funding not necessarily proportionate with populate size, geographic or demographic challenges

7. DN: What are the challenges?
So what?
We are unable to convey the situation & challenges within an objective, robust and transparent approach
Lack of objective, informed or up to date data leading to unfair staff allocation, creating gaps & risk of unsafe practice
Unhappy workforce – Too much pressure / Good work unnoticed / Gaming
Lack of outcomes focus may lead to: slow discharge / high re-referral / unhappy patients / avoidable visits / inefficient planning
Inefficient or inconsistent practice - “all hands on deck”
Not leveraging off performance data = missed opportunities

8. Benson Outcomes What have our clients used Benson models for?
Details
Contract support
Supported commissioning / bid development
Basis for co-working with commissioners
Provided a common approach promoting focused interactions and enriched communications between providers & commissioners
Rebalanced workforce/workloads
Based on objective approach focused on complexity
Scenario testing / simulation
Modelled future workforce and funding strategies, evaluation of financial and service impact
Service reconfiguration / integration
Assessing workforce & resource requirements of changing team or functional structure e.g. Night, Rapid Response, change to geographic caseloads
Better reporting
Clients generate live reporting packs based on latest caseloads, including benchmarking, demand forecasting, budgeting & costing, and variance reporting – actual vs budget
Establish fair, objective caseloads
Customised approach assessing complexity to reflect challenges using local data and national statistics to develop local profiles
Risk and opportunity evaluation
Identified areas of risk / shortfall (teams, workforce roles)
Identified areas of non-conformity or variance
Service improvement
Encouraged discussion based on possible risks & opportunities
Used to inform changes and reconfiguration in client organisations
Integration / Link with other planning areas
E-Scheduling, staff rostering, long term forecasting, HR

9. The Benson Methodology
Benson is a quantitative, demand led, live planning approach implemented with both commissioners and providers. But what does it do?
Embraces innovation, reconfiguration, service improvement and integration
Informs safe caseloads & workforce by applying dynamic, objective approach
Encourages robust & dynamic planning leveraging off health intelligence
Live system and workspaces inform planning & decision making in real time
Applies a harmonised service approach reflecting safe/good practice
Identifies & allows for complexity through analysis of patients & demographics
Benchmarking to allow comparability & external validation
Evidence base – linked to national & local intelligence
A shared system to improve and focus communication
Focuses on improvement: Identification of areas of development / inefficiency
Establishes consistent generic classifications to ensure comparability & objectivity

10. The DN Pilot Programme Why? The Pilot What happened?
We carried out national consultation in 2014/5 with the Queen’s Nursing Institute
This showed a lack of modelling catering specifically to community healthcare
Demand from DN services to use better planning tools to assist planning, costing and case building
The Pilot
The programme commenced in Q resulting in selection of four sites representing range of issues – geographics, deprivation, density, cultural etc
The intensive programme allowed the model specification to be built and tested resulting in several iterations to ensure a model fit for purpose
What happened?
A significant amount of time was spent working with the wide range of provider datasets
More than 60 iterations of the model building in improvements in line with feedback and to ensure sufficient flexibility
3 of the 4 pilot sites have now received full working version of the model and are now rolling out the models
1 site has taken the model live, and is using to allocate staff & report to commissioners
Based on feedback we have decided to proceed with the model and are in initial steps new providers regarding implementation
4 DN Pilot Sites:
Somerset
Plymouth
Liverpool
Luton

11. E-Scheduling, E-Rostering
Service Modules
Beginning in the blue zone, Benson provides an opportunity to improve information, decision making and link with related organisational functions & initiatives
Clinical data integration & development
Integration, mapping & analysis
Clinical data improvement
Demographic profiling
Patient profiling & assumptions
Insight & Planning
Benson demand and workforce modelling
Service Benchmarking
Identify Opportunities & efficiencies
Service reconfiguration
Forecasting
Multi-year forecasting & budgets
Scenario development & sensitivity analysis
Workforce supply modelling
Budgeting & Reporting
Performance:
Actual v Budgeted
Service
Costing
Financial reporting & budgeting
Tender management
Commissioning support
Bid support
E-Scheduling, E-Rostering
Finance
Bid team

12. Implementation Model configuration Data development
Client resource
Steering group
Development & Collaboration
Support from Benson
Refresh & updates
Refine & improve
Reporting & Sharing
Bench-marking
Costing
Roll-out
Reporting pack
Strategic development
Develop settings
Validation
Workshops
Data development
Data analysis
Triangulation
Mapping
Model configuration
Establish scope & objectives
Data request/templates
2 weeks
Health intelligence
2-4 weeks
Working group
4 weeks
2 weeks
Steering group
Management
Typically weeks rollout time

13. Complexity
Support environ-ment & informal care
Frailty & dementia
Patient environ-ment (e.g. care home)
Rurality, isolation, cultural, language
Complexity
Complexity = key issue evolving from the QNI consultation in 2014
Multi-faceted – not just about age or deprivation
MUST be addressed & used to sensitise caseloads
Benson objectively assesses complexity and allocates “complexity premium” – additional time to ensure practitioners with more complex caseloads can deliver outcomes
This is achieved using a weighting mechanism resulting in patients being split into three levels of complexity
Assessed quantitavely by reviewing data on the underlying patients & demographics, validated by the local working group
Complexity premium
Clinical Admin
Travel
Standard delivery allocation

14. Planning in Community Healthcare – Our approach
Work undertaken
Key considerations
PAS
Baseline report – last 12 months
Data validation:
- Check completeness & consistency
Mapping / alignment
Adjustments
Existing caseloads
Existing staffing
Service delivery
Area & Patient profiling
Benchmarking key metrics
BENSON
Modelling:
- Extrapolate baseline
- Reflect anticipated changes in service delivery
- Alignment with strategic objectives
- Balancing with funding & staffing constraints
- Scenario planning
- Comparing with actuals
1st year:
Apply delivery targets
Apply safe caseloads
Optimise staff allocation
Harmonise service delivery
Targeted service improvement
1st year Budget / Plan
Demo-graphic statistics
Forecasting:
Impact of ageing population
Changes in commissioning
Targeted service improvement
Workforce development & gaps
Costing & budgeting
Longer Term Forecast

15. Benson Model (DN) Overview
Demo-graphics database
Patient Profiling
Staff Profiling
Reporting
Local demo-graphics
Patient complexity
Complexity premium
Bench-marking
Existing capacity & risk
Referrals
Care Pathways
Patient Outcomes
Venue & visit rates
Staff duties & capacity
Optimum (Benson) workforce
Team Caseloads
Clinical Inter-ventions
Staff require-ments
Legend
Input
Forecast & costing
Local commissioning
Local config.
Activity time allowances and benchmarking
Model process
Output

16. Complexity premium Complex caseloads require more time to manage
Complexity is multi-faceted and measuring it required facts about our patients and their environment
Patients are graded into 3 levels of complexity depending on various critiera (see complexity)
Activities time allowance are represented by a range, for instance wound care minutes
Research shows more complex patients are more acute, volatile and less compliant
They therefore receive a higher intensity of care taking longer
The scales use in Benson reflect this
Other inflators include language, cultural, rurality and travel
Simple
Moderate
Difficult
Level 1
Level 2
Level 3
Trend
Patient complexity
Activity grade

17. Project workspace Intralinks is our online file sharing provider
Secure & NHS friendly
Each provider has their own folder
Allows users to upload and download the model, reports & related documents
Each user access by login/password
Enables remote support, changes and updates to be made by Benson Wintere

18. Updating the model
The provider and/or commissioner develop a process to collaborate and oversee development
The Working group & Benson Wintere as administrator access the live model on the project workspace
Provider and commissioner may agree process to release reporting pack e.g. quarterly
The models are replenished with updated demographic data and benchmarking by Benson Wintere
This process ensures the model is always “live” and secure
Reports are shared with key stakeholders as a PDF pack
Benson Wintere support development and reviews of the models either in person or remotely by webinar (shared screen teleconferences)
The client will identify target areas in the model over time for development

19. New developments: DN
Benchmarking key metrics to help external validation
Delivery time for each clinical intervention / other services
Clinical admin & travel time
Patient mix
Staff clinical responsibilities
Staff clinical capacity
Caseloads
Referral rates
Patient longevity (days active)
Patient intensity (rate of care interventions)
Enhanced forecasting & costing reporting
Development of commissioner support module
Testing our new web platform later in 2017

20. Supplementary Material

21. Modelling Clinical Demand
Referrals
Caseloads & pathways
Services & Activities
Time Allocation
Clinical
resps
Staff required
External factors
Scope, GPs, Acute
Local demogs
Scope
Complexity premium
Benchmarks
Historic patterns
Best practice
Future modelling, changes
Internal factors

22. Consultation: Common Issues
Key issues confronted raised by DN services in workshops during QNI Consultation:
How do our referral/discharge rates and caseloads look like against other areas? Why are they different?
What is going to happen in 5 years time? Will demand be higher? How will our service respond?
Are we accepting referrals that are outside the scope of our contract?
What is driving our workload? Why do we keep getting busier?
What number and mix of staff do we actually need to meet the needs of our patients?
Are we able to effectively use our own data to make objective, evidence based decisions?
Are we recording clinical activity completely and consistently? Is there any point?
How do we allow for areas with greater caseload complexity?

23. Our Community Care strategy
Initiative
Details
Community focused
Community care requires a different approach to acute & specialist services – e.g. different constraints, more demand focus, unable to use waiting lists to regulate demand
Safety
An objective basis to determine safe caseloads and workforce structures, reflecting good practice and harmonised delivery
Evidence based
Incorporate national demographic data, statistics & research, local activity data; refreshed regularly
Objective & comparable
Develop generic classifications for service user groups, staff and interventions to ensure comparability and allow benchmarking
Support integration
- across modules (e.g. joining services together; e.g. scheduling is linked to workforce planning)
Grow network organically
A larger network offers benefits to users as it enhances benchmarking and increases credibility; all implementations instigated by NHS / Commissioners
Ease of use
Avoid complexity; ensure focus on key metrics to encourage sharing between providers and commissioners; use online shared workspaces; work towards transitioning to central web-based application
Modular approach
(see next page)
Allow clients to pick and choose scope & support; including comprehensive planning tools & support across community healthcare and social care
Ongoing assistance
Continuous support both onsite and remote allowing clients to understand, operate and collaborate to maximise benefits