The Balance of Care Group


Recent Balance of Care Projects

Here are some of the projects which the Balance of Care Group have undertaken in recent years. This should give you a flavour of the range both of the areas we have worked in and the organisations we have worked with.

Some of these projects may address circumstances in your own locality or area of interest. If so, you are welcome to contact us to find out more details about individual projects and about how we might be able to help you.


30- day readmissions audits in south and south-west London (2012-14)

We have undertaken several 30-day readmissions audits on behalf of CSU South London (and prior to that the SW London PCT group) and respective CCG and Trust colleagues in recent years. These have involved development of a clinically-led notes view process with AEP admission criteria incorporated as an integral component. On each occasion the audits have provided a constructive local focus for exploring areas for developing a common understanding of issues and potential opportunities for service reinvestment. Audits have taken place in:

  • Surrey & Sussex Healthcare NHS Trust (2014)
  • Croydon Health Services NHS Trust (2014, 2012)
  • Guy’s & St Thomas’ NHS Foundation Trust (2013)
  • King’s College Hospital NHS Foundation Trust (2013)
  • Kingston Hospital NHS Foundation Trust (2012)
  • Epsom & St Helier University Hospitals NHS Trust (2012)
  • Royal Marsden NHS Foundation Trust (Sutton) (2012)
  • St George’s Healthcare NHS Trust (2012)

Please contact us for more information.


Clinical Coding and Activity Audits (2013)

With Surrey Downs CCG we have undertaken several coding audits for CCGs of services provided under ‘Any Qualified Provider’ (AQP) arrangements.

In Surrey an activity audit was carried on behalf of NW Surrey as lead CCG on community health services provided by Virgin Healthcare.

Please contact us for more information.


Hampshire PCT and Hampshire County Council Adult Services (2009)

We were engaged by the PCT and Adult Services to undertake a bed utilisation survey across hospitals in the Winchester/ Andover/ Eastleigh area to enable local health and social care organisations to understand how beds were being utilised in acute and non-acute settings and especially by older people with mental health problems. We also undertook a survey of recent care home long-term care placements to see what changes might have occurred in physical and mental capacity between admission and up to three months later. Interestingly, about a third of clients improved on at least one measure (physical/ continence/ activities of daily living/ cognition) and did not get worse on any other.


National Audit Office (2008)

Identifying Alternatives to Hospital Care for People at the End of Life

In this study we undertook a retrospective survey of hospital records of 348 of 420 people known to have died in Sheffield in October 2007. Over 50% of people died in hospital and the survey identified that this could be as lowered to 30% with a range of changes to processes and community support. Development of integrated approaches to frailty management was a major requirement. This material was used in the NAO report on End of Life Care.

Click here to download a copy of the detailed Sheffield report.

Click here to download a copy of the NAO End of Life Care full report.


Royal College of Physicians and Centre for Health Sciences, Barts & The Royal London Hospital (2008)

Asthma modelling – Review of its Feasibility

This work formed part of a wider scoping study by these organizations in association with Asthma UK for a national asthma audit for the Health Care Commission. It demonstrated the feasibility of developing a model of the impact of new interventions for asthma patients which could be used by clinicians and managers to estimate the impact of changing clinical practice on, for example, the number of asthma-related hospital admissions and re-admissions.

The model was able to bring together a range of existing data sources and research findings to predict the impact of different interventions at different levels of coverage.


Lincolnshire PCT (2008, 2007)

Commissioning Intermediate Care (2008)

Support was provided to the development of components of an intermediate care strategy across Lincolnshire. This included estimates of numbers potentially requiring intermediate care, and facilitation of local clinicians in developing the strategy aims.

Cost of Alternatives to Hospital Care for People with Dementia (2007)

Based on the 2006 bed utilisation survey (see below) this report looked at the financial implications of providing services in alternative locations and the potential savings that would accrue from people with dementia having shorter lengths of stay in acute care beds. A key finding was that the amount that could be saved from acute care was relatively small due to the structure of the national tariff in operation at the time.


East Sussex, West Sussex and Brighton & Hove PCTs (2007)

Audits of Non-Elective Short Stay Admissions (2006 and 2007)

We have undertaken a number of audits on behalf of PCTS, involving clinical review of samples of patient histori0es for non-elective short stay admissions staying in wards in A&E departments or on Medical or Surgical Assessment Units in the three acute Trusts treating most of the PCT residents. The case mix of these patients was analysed in order to identify whether some might be treated in ambulatory settings and workshops on the findings held with local clinicians.


Wanless Report: Securing Good Care for Older People: Taking a long-term view. (2006)

The King’s Fund commissioned Sir Derek Wanless to undertake a review which sought to determine how much should be spent on social care for older people in England over the next 20 years and what funding arrangements need to be in place to ensure that this money is available and will produce high-quality outcomes. The report includes substantial coverage of the telecare model developed by the Balance of Care Group for the Department of Health with illustrative analyses based on it (see especially Chapter 7).

Click here to go to the King’s Fund website from where the Wanless report can be downloaded.


Department of Health (2005)

Telecare Business Case Model

A strategic business case model for telecare was developed on behalf of the Department of Health to support local councils formulate their bids for funding under the Assistive Technologies Grant. The spreadsheet model enables different care policies to be quickly and easily tested, using readily available local data, and quantifies resource requirements in terms of both volume and cost.

To download the model and supporting documentation click here.


Royston, Buntingford & Bishop’s Stortford PCT (2005)

Royston Community Hospital Redevelopment

This was an analysis of the inpatient bed requirements for the Outline Business Case for the redevelopment of Royston community hospital.

This involved undertaking a survey of bed usage over a four-week period at Royston and nearby acute hospitals to judge the potential demand and included workshops with local clinicians and public groups to discuss the potential shape of service provision on the site, together with wider community-based health and social services.


West Berkshire Council (2004)

The Future Role of Directly Provided Residential Care Services

This investigated the potential for alternatives to directly provided residential care in West Berkshire. A special survey of residents’ needs was devised and undertaken, supplemented by analyses of existing management data. 'Extra care' housing and home-based intensive care packages - supported by improved mental health provision - were identified as significant options for future provision.


East Berkshire Partnership Board (2004)

Configuration of NHS Non-Acute Beds In East Berkshire

A combination of data analyses - including bed usage survey data previously undertaken by the Balance of Care Group - and clinical workshops was employed to establish non-acute bed requirements across the three East Berkshire PCTs. Workforce requirements to support innovative community-based care pathways were calculated (such as staff types and whole time equivalents).


Oxfordshire PCTs & Oxford Radcliffe Hospitals (2004, 2003)

Identifying Demand for Intermediate Care and Community Hospitals in Oxfordshire.

This involved three related projects, beginning with the design and undertaking of a major bed usage survey covering 1054 acute and community hospital adult inpatients across Oxfordshire. The potential for significant expansion of community services as an alternative to hospital provision was quantified; a major conclusion was the need for existing community hospitals to focus on a more active rehabilitation role.

As future requirements in the north and south of the county differed further analyses were subsequently undertaken to support the development of business cases by the respective groups of PCTs

The Group also supported the development of the business case for the redevelopment of Bicester Community Hospital. To download the report of this project click here


Sheffield , Rotherham and Doncaster Councils (2002)

Building Capacity & Partnership in Care

This involved working alongside independent care home sector representatives and the social service departments of each council to develop a model of care home costs. This was primarily to provide a basis for setting future care home fee levels. Analyses and discussion in a series of workshops focused on the staffing levels required to deliver given standards of care, as well as capital and other costs.

The project was extended to support consideration of the strategic development of long term care services for older people, including the role of commissioners and the role of the independent sector.



Lincolnshire PCT and Lincolnshire County Council (2009)

Supporting development of the older people’s dementia strategy

Areas covered in this work included estimating dementia prevalence in the county and an attempt to reconcile nationally produced estimates with local prevalence data, including detailed analysis of data derived from GP dementia registers. A classification of dementia stages in the population was developed and used as a basis in a resource planning model to explore potential resource consequences of different strategies. This work was undertaken in close association with local health care professional colleagues.


South-east London PCTs - ‘A Picture of Health’ (2008)

Lewisham, Greenwich, Bexley, Bromley

A large-scale reconfiguration exercise (‘A Picture of Health’) recently took place across these south-east PCTs and associated acute hospital sites. A bed utilisation survey first conducted in Lewisham at the end of 2007 was the basis on which similar surveys - covering acute and non-acute settings - were conducted in mid-2008 in Greenwich, Bexley and Bromley.

In all PCTs the data were used for local capacity planning analyses and, in addition, data were analysed at a system-wide level across all four PCTs. This enabled cross-boundary PCT flows to be incorporated into discussions on capacity requirements and formed a major input to the subsequent report of the Independent Reconfiguration Panel.


Sutton & Merton (2008, 2007)

Audit of Critical Care Units, Epsom and St Helier Hospitals (2008)

This review was concerned to identify how the units identified dependency levels of patients, and whether this was a reasonable reflection of resource needs, and of requirement for HDU and ITU beds.

Audit of non-elective short stay admissions at St Helier and St George’s hospitals (2007)

The same survey methodology was conducted at each hospital separately to identify reasons for inpatient stays on short-stay, non-elective patients who were discharged up to 1 day after admission, and to determine the extent to which the diagnostic and treatment processes undertaken might have been undertaken in an alternative setting. This is of particular concern to commissioners because of the financial implications of large numbers of short stay non-elective admissions under the Payment by Results (PbR) tariff.


Royal Borough of Kingston upon Thames (2007)

Developing New Models Of Integrated Community-Based Care In Kingston

This involved support across a range of tasks including conducting workshops with health and social care professionals; running a major workshop ‘Your Say, Your Kingston’ with 60 older people from across the Borough; data analysis and an outline strategy for integrating health and social care services, information flows and working practices.


National Audit Office (2007)

Identifying Alternatives to Hospital for People with Dementia

We were appointed by the National Audit Office to undertake a case study across Lincolnshire, to see where patients with dementia are currently located in both acute and non-acute hospital beds. A point prevalence survey was undertaken with a focus on dementia and the analysis quantifies explores the potential for alternative care settings across the local whole system of health and social care.

Click here to download a copy of the detailed Lincolnshire report.

Click here to download a copy of the NAO full report


EU Interreg Telemedicine Project, Southampton (2006)

For the past two years we have been working as Expert Advisors to Southampton PCT in their role as a participating centre in a European telemedicine applications project under the auspices of the EU Interreg IIIC Programme. Southampton and Eindhoven are the two principal centres with additional sites in Spain and Italy.


Department of Health Integrated Care Network (2006)

Members of the Balance of Care Group produced and presented a series of five workshops around the country on ‘Commissioning Integrated Care for Older People’ for the Integrated Care Network (part of the Department of Health ‘Care Services Improvement Partnership’).

Click here to download a copy of the presentation.


North Hampshire PCT and North Hampshire Hospitals Trust (2005)

Commissioning Alternatives to Hospital Care

This report focused on alternative care pathways for older people and key conclusions were a quantified assessment of the potential for more integrated community-based care services; more focus on slow-stream rehabilitation service needs and mental health service requirements. Additional analysis for the local acute hospital included an analysis of their use of intensive care and high dependency unit resources.

To download the report of this project click here.


Maidstone & Tunbridge Wells NHS Trust, SW Kent PCT, Maidstone & Weald PCT (2004)

Potential for Changes in the Care Pathway for Older People

Working across the Trust’s three hospital sites and the community hospitals of the local PCTs, a bed usage survey of over 500 patients was undertaken. Analyses showed that significant reductions in bed occupancy at the acute Trust would be feasible given further progression of existing intermediate and community-based care facilities, and a focus on more active rehabilitation in the community hospital sites.


Sheffield PCTs, Sheffield Council, Sheffield Teaching Hospitals (2004)

Development of Integrated Care Services in Sheffield

This was an analysis of alternatives to care delivery for all adult age groups across the City’s health and social care economy. Central to this was a bed usage survey of almost 1100 patients across acute and community settings. The potential for more community-based provision was quantified, including access to diagnostic and assessment services, and over 100 acute beds could be freed up as a result of implementing recommended changes.


Birmingham Children's Hospital NHS Trust (2003)

Matching Beds to Capacity Demands.

Analyses of inpatient activity and bed usage in recent years identified imbalances in access by specialty, and associated operational difficulties within the hospital. Recommendations included review of ward staffing levels, and the use of 'swing' wards to accommodate seasonality of demand.