We designed an innovative, flexible procurement process to support transformation of a discharge pathway.

Background
Leicester, Leicestershire and Rutland (LLR) Sustainability and Transformation Partnership (STP) wanted to improve reablement services so that patients could safely return to their usual residence with as much independence as possible. Previous procurements had failed due to a lack of interest from the residential and care home market.

Action
Successful procurement for this project required an innovative, flexible approach. On behalf of LLR STP, we developed a procurement process to support transformation of the whole pathway.

We designed a procurement process to:

• ensure a joined-up approach between STP partners (by creating a steering group with representation from each partner)
• engage the provider market
• involve local providers in development of the service model and specification.

We reviewed the financial package and developed a more attractive pricing structure to stimulate interest from a wider sector of care homes. We proposed two different offerings: a single provider to deliver a 14-bed unit and a multi-provider local framework to deliver beds for more complex patients. These different elements of the pathway were tendered for separately and independently. In addition, there was a separate open procurement for the therapy unit to support the other two services. This approach gave providers flexibility and meant there could be some provision even if there were no bids for other elements.

We held a separate market engagement event for each element to ensure that local providers were fully engaged in a two-way dialogue with commissioners. This helped with effectively shaping a service model and specification that supported higher interest in the procurement.

In addition, health commissioners worked closely with local authority partners to ensure that there was a joined-up approach to engaging with the care home market.

Impact
Contracts were awarded following a competitive process with an engaged market and the new services for all three elements of the pathway commenced on 1 April 2018. The procurement process has resulted in a sustainable ‘Home First’ model for providing reablement and assessment, including ‘discharge to assess’ options in a bed-based facility.

Performance of the pathway has improved by:

• delivering a shortened length of stay (LOS) – prior to the procurement the average LOS on the pathway was about 40 days. As of December 2018, the average LOS on the framework discharge to assess is 33 days and in the reablement beds is 25 days
• reducing the number of long stay patients in the acute trust – University Hospitals of Leicester has significantly fewer long stay patients with 161 in December 2018 (201 in 2017/18).

Within the first nine months almost £800,000 had been saved – the target saving for the whole financial year.

This procurement has improved patient and carer satisfaction through decreasing the ‘waiting time’ in the patients’ journey, with patients and carers feeling that this is an opportunity to help them or their loved one regain independence prior to returning home.
Gill Staton | Head of Nursing Patient Flow and Discharge, University Hospitals of Leicester