The School Nursing Service Planner
Information for Commissioners – Q1 2014
Information for Commissioners
/A background and overview intended to provide information relevant to Commissioners and the procurement process. This addresses benefits and outcomes achieved by existing users, pre-requisites, method of implementation, project support and costs. Tendering considerations addressed include relevance to other planning methods and applicability of the single tender waiver. /
Q2 2014 /
Table of Contents
Executive summary
Development
Implementation
Outcomes
Cost
Other available options
Single tender waiver
Provider requirements
Contacts
Executive summary
Since 2010 the Benson Modelis being implemented with over 25 providers across England, and already overseeing workforce covering a significant proportion of children across England. The Benson Model is a methodology developed to provide a more dynamic, comparable, robust and objective process to inform workforce planning and support service improvement initiatives across children and adult community nursing services.
The Benson Modelis a demand led approach – starting with the needs of the local population ensuring local requirements and Healthy Child Programme objectives are part of the service offer. Demand profiling demonstratessupport requirements for the local child population in each team, sensitised in accordance with local complexity andgeographics. This identifies a theoretical workload and facilitates development of new workforce structures and assessingeffectiveness of the existing workforce.
For commissioners, the Benson Modeloffers several advantages:
- A clear and objective way of supporting optimum workforce size and configuration based on a specific service offer
- Specialist and unique expertise built on proprietary tools and experience across multiple implementations
- Costs are kept low by utilising a central methodology – no cost overruns
- Possibility to move quickly as costs fall below the common waiver level or competitive tenders may be avoided, often under a “single source of specialist expertise” clause
- Live roll out is usually achieved within three months
The Benson Model is adapting to recent changes impacting both health visiting and school nursing providers, including changes in the Healthy Child Programme, and schools transitioning to more independent status and rationalisation of the service offer to reflect core and additional services.
“the requirement for robust workforce planning is ever more important
if nurses are to provide effective care within defined budgets”
Scottish Government, 2011
Development
A DoH funded report relating to health visiting was developed to address released in 2008 included an assessmentof provider requirements for strategic planning; this found a lack of common national strategic workforce and caseload management tools[1]. Providers were aware of the need to sensitise caseloads in accordance with underlying population complexity and provide a more objective basis to support workforce allocation. Among its recommendations the report advocated development of a new, dynamic demand and supply approach:
“Develop and release a system modelling tool (including workforce, activity and finances) based on the work undertaken in this programme which is available to sites that enables the investigation of alternative and local CHPP delivery models and assess the impact on resources required”
Symmetric report for CSIP, July 2008
The Benson Modelwas piloted in Health Visiting in 2009 and has since spread across most of the country. The School Nursing model adapted from the core methodology in 2012; it was developed as a result of feedback from school nursing providers that had contact with the Health Visiting service and reported a lack of similar tools the school nursing environment.
The Benson Model database was developed in late 2013 to provide benchmarking and external validation for providers.
Implementation
The Benson Modeldraws togetherlocal and national intelligence, with profiles developed to reflectstrategy around workforce allocation and service offer. Service specifications and workforce profilesare developed to reflect the provider’s future vision of service delivery, and the core principle that service delivery should be harmonised.
Implementation of the Benson Model is usually achieved inside three months. This commences with the formation of a working group to define project objectives, scoping, configuration and data specification. A local tool is then set up incorporating children, deprivation, safeguarding, services, teams and workforce. Two to three half day workshops are organised to inform the local workforce, and agree future local service specifications and workforce profiles. Once implementation is complete the Benson Model is rolled out for live use by the provider.
Once implemented the Benson Model is owned and updated collectively by a providerworkforce board. Providers receive updates to the core model every quarter, which has evolved since inception from ideas generated by the service. A common framework also encourages external validation, innovation and sharing of ideas across providers.
Figure 1 – Benson Modeldemand and supply factors
Outcomes
Local level outcomes
Outcomes from users of the Benson Model are varied and depend on local requirements but often include service reconfiguration, new practitioner allocation, caseload sensitisation, developing a standardised service programme and specifications, external validation / benchmarking.
The initial implementation in Liverpool assisted in the following areas:
“The Benson Model will continue to help us deliver on the QIPP agenda through ensuring we have the right staff with the right skills to deliver the Healthy Child Programme. The tool supports managers with key decisions around staff deployment to meet the needs of our diverse population. This helps us to ensure we have an equitable service with optimum staffing levels to improve the outcomes for our children, young people and their families.”
Doreen Porter – Liverpool and Sefton project lead
Some recent deployments have delivered the following outcomes:
- Supporting the placement or reallocation of staff
- Providing a baseline for caseload sensitisation – a departure from standardised caseloads
- Identifying workforce shortfall and optimisation by locality
- Driving greater harmonisation in service delivery, identifying service variation and targeting efficiencies
- Rationalisation of the future service offer, e.g. core, immunisations only
- Redefining workforce roles and the contribution of skill mix, including clinical and non clinical responsibilities
- Restructuring the locality zones to rebalance caseloads
- Identifying future support requirementsbased on changes in demand or supply factors
- Service rationalisation and charging for non-core services
- Validated datasets using access to independent national databases (Edubase[2]) and the Benson Model database to assist baselining of assumptions and reasonableness testing
- Driving longer term forecasting to determine future workforce requirements
More information and case studies can be accessed at:
National level outcomes
Universal approaches facilitate greaterstandardisation enabling comparison than bespoke or locally driven solutions. For the Benson Model this has lead to the development of a database used to assist information sharing around service offer, service specifications and workforce profiles. This leads to some advantages for the service as a whole, including:
- Aligning service classifications, specifications and outcomes with the guidance provided in the Healthy Child Programme 5-19[3]
- Establishing more standardised workforce profiles, a requirement highlighted by the RCN[4]
- Sharing of service programmes and specifications helps spread innovation and best practice
Cost
A single methodology ensures development and maintenance costs are minimised, increasing affordability, and avoiding costs and potential overruns associated with bespoke development. Therefore costs relate primarily toimplementation support – this involves planning, configuration, data collection and validation, running workshops, rollout and ongoing remote support.
This is reflected in the cost of astandard single implementation starting from £6,750+VAT. Costs reflect the full implementation plus maintenance and updating the Benson Model and Benson Model database:
- Initial working group meeting to establish terms of reference and objectives
- Working with information governance and data / intelligence to configure the tool
- Providing data templates, collect and validate data
- Configure the local Benson Model
- Running workshops with selected staff to develop the Benson Model
- Collecting feedback, final changes and live rollout of the Benson Model
- Providing online access and two years of remote support to assist understanding and utilisation, provide quarterly updates and access to the Benson Model database[5]
- Maintenance and updating the Benson Model and Benson Model database
The range reflects differences in support requirements to configure the local tool, align and enhance the dataset, and size of the tool in terms of number of locality teams and size of the child population.
Alternatives
Based on research of the current market in the United Kingdom and feedback from NHS Commissioners there are currently no commonly available alternatives being used within community health nursing for strategic, demand led workforce and caseload planning. Prior to development we also consultedproviders, the DoH, and reviewed available research and tools.
Providers are actively investigating and employing tools which are often extremely effective for the purpose employed and in some cases complementary to the Benson Model. For instance the Lancaster model[6] which focuses on outcomes and service quality, or scheduling tools such as the Stockport “Dominic” system[7].
The Benson Modelwas developed to address these planning needs– providing a universal approach to help providers objectively and robustly determine workforce requirements, drive discussion about future strategy and inform commissioners.
The table below lists the differentiating characteristics of current tools compared with the Benson Model:
Existing alternatives / Benson ModelOperational focus –weekly / monthly scheduling / rostering to maximise efficiency from the existing workforce based on existing service and workforce profiles / Strategic focus: demand/supply focus based on a full year, allowing re-assessment of services, roles and deployment of the overall workforce
Analysis is provider specific / Analysis is locality specific
Non-scalable, non-replicable, non-standardised – bespoke, single purpose development / Scalable, replicable, standardised – flexible with different provider requirements, enable comparison
Supply side focus: aggregated estimates on the demand side, using indexes to estimate complexity and weight caseloads / Demand and supply side focus: analyse complexity of the overall student population using measures of deprivation, safeguarding and special needs
Owned by a researcher or consultant, produced as a one-off or not regularly updated / Owned by the provider with remote assistance as required, regularly updated
One size fits all, caseloads are based on a presumed service offer and do not allow the local service to explore the impact of changes / Allow for future profiling to observe how changes on the demand or supply side impact workforce effectiveness
Qualitative: focus on service performance, quality and outcomes / Quantitative: Focus on number of hours required by local students (demand) and available from the workforce (supply)
Focus on school nurses only, not skill mix; focus on clinical responsibilities only / Multiple workforce profiled including specialists and skill mix, reflecting unique clinical & non-clinical responsibilities, travel
Using a standardised caseload approach, they do not reflect caseload complexity / Demand profiled to ensure caseloads are sensitised in line with underlying complexity (deprivation, safeguarding, geographics etc)
Several workforce specific paediatric tools with acute or specialist focus have not been considered[8]. These are deemed to not apply to community based services. For a more comprehensive summary of paediatric tools, refer to the RCN’s paper “Defining staffing levels for children and young people’s services”[9].
Single tender waiver
The Benson Model will usually avoid the requirement for a competitive tender a single tender, due to cost threshold or its uniqueness as a specialist methodology. This will depend on local policy.
Waiver clause / Benson Model applicabilityBelow threshold requiring a formal, competitive tender / Single implementation of the Benson Modeloften falls below this threshold
Specialist expertise is required and is available from only one source / The Benson Model is based on a unique methodology; the process and reporting are not replicated by other currently available national tools (see prev. section)
The task is essential to complete the project, and arises as a consequence of a recently completed assignment and engaging different consultants for the new task would be inappropriate / As developers, Benson Wintere are the only consultants with experience implementing the Benson Model
There is a clear benefit to be gained from maintaining continuity with an earlier project (where such continuity outweighs potential financial advantage to be gained by competitive tendering); / Providersmay replicate the outcomes from own HVSP, or another provider’s Benson Model. Benefits:access to an approach unable to be replicated, providing benchmarked data, achieved at a relatively low cost
The work is time sensitive / The Benson Model is developed and generally implemented in less than 3 months; developing or adapting a new approach would take significantly longer
As commissioning and decision making arrangements will differ, weinvite enquiries forfurther clarification, or where examples of commissioning arrangements from other projects are required.
Provider requirements
The Benson Model has no direct systematic or IT requirements, and simply requires access to Excel version 2007 or above. The Benson Model is based in Microsoft Excel and coded using Visual Basic (VBA) language. Excel was selected as a suitable platform to ensure universal compatibility and access for providers, increase flexibility and ease of upgrades to the core tool.
Implementation requires a steering group representing key stakeholders, as well as the time of workshop attendees, and from there an ongoing process and commitment to collectively review and update the tool.
Links and contacts
School NursingHealth Visiting
/ For more information contact:
Michael McGechie
Director – Benson Wintere
0796 9199 920
References
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[1] Health Visiting, Leading and Delivering the Child Health Promotion Programme, Symmetric SD Ltd, July 2008 commissioned by Care Services Improvement Partnership (CSIP)
[2]ibid
[3]
[4]The RCN’s UK position on school nursing, Feb 2012 (page 8)
[5] After the two year support period ongoing remote support of the above types will not be charged. Once determined costs will be confirmed in a formal quotation document.
[6]
[7] Currently used in District Nursing; developers intend to focus on School Nursing in the future
[8] e.g. SCAMPS, PANDA, CAMHS-AID
[9]