Change and Transformation in the Public Sector
Due to an increase in demand on both health and social care services, and the impact and ongoing recovery from the COVID-19 pandemic, the Oxfordshire health and care system has been facing a number of performance challenges, including a delay in discharging people ready to leave hospital. Delayed hospital discharges often mean poorer health outcomes, both for the people waiting to leave beds and for those waiting for treatment, with financial and reputational costs for the organisations involved across the local system.
Without change, the health and care system could experience more frequent and sustained crises as it struggled to meet demand, as well as financial pressures from overprescription of care. Although these problems weren’t new, nothing was happening, and the system was stretched to the point where action was needed urgently. Oxfordshire County Council engaged PwC to work with itself and local providers to solve the bed problem, which PwC achieved at unprecedented speed and scale.
The operational heart of PwC’s solution was a Transfer of Care Hub (ToC), where a multidisciplinary team considered each patient’s needs, to identify and commission a suitable and speedy discharge process. However, the system’s lifeblood was the cultural change that enabled multiple agencies to collaborate and take forward a sustainable approach for making further improvements independently.
Through system-wide collaboration, the ToC would improve how acute and community hospitals and social care services worked together to make timely and safe discharges, improving outcomes for patients and creating capacity in the wider system. The solution would return more people home to regain their independence, and have their longer-term needs assessed in a familiar environment; while shorter hospital stays would reduce dependency and the potential for infection and falls. Through joining up services and working in partnerships, this would make better use of care resources, and free up more hospital beds for patients needing them.
PwC’s team blended healthcare and local government specialists with different working styles, to recognise the concerns of different organisations, and move together toward a holistic, collective outcome. The team took a ‘design by doing’ approach, which enabled PwC to make significant changes at pace through combined decision-making and a focus on performance. It allowed the firm to design and build key processes and operational procedures based on learning (e.g., workshops on patient flow), ensure quality improvement, and embed change management support through on-the-ground coaching. Each potential approach was evaluated and iterated alongside existing operations, and its qualitative and quantitative impact tracked using embedded business-as-usual monitoring.
By working at greater scale and pace than expected, the ToC Hub was operational across all applicable beds within two months of trialling. PwC also navigated a complex network of health and care organisations, to create a truly system-wide solution.
Ultimately, PwC galvanised the knowledge and expertise of different health and care organisations, helping them put the patient at the centre and do care well. The availability of beds improved, and more Oxfordshire residents could return home, experience improved health, and regain their independence.
View the PwC profile in the MCA Members Directory.