Redesigning the health funding process in social care
How could we redesign the council's fragmented and inconsistent process of applying for NHS funding for social care clients?
Project brief
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Continuing Healthcare is a package of care for adults which is arranged and funded solely by the NHS. Accessing this funding involves social care practitioners identifying clients with health needs, applying for funding, and participating in the assessment and decision making process. If the decision is that the client is not eligible for the funding, social care practitioners can dispute the decision and ask for further reviews.
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The process in Barking and Dagenham was fragmented and inconsistent, lacking a standardised approach across teams and staff. There was a lack of documentation and record keeping, lack of clarity of roles and responsibilities and oversight processes, and lack of communication between stakeholders.​ This likely resulted in millions in losses for the council, as social care wrongly funded the care for clients with acute health needs who should have been receiving Continuing Healthcare funding.​
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The Social Care department wanted to define and redesign their end-to-end processes and design software solutions to aid the process/service.
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Team: Service designer (me), transformation lead, social care service leads, health representative, software designer​​​​​​
Discovery process
​​I conducted scoping interviews with the service to understand their needs and key challenges. I drafted ​a set of design principles to guide the redesign based on findings from the interviews:
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Streamline processes to improve efficiency
Use formalised communication channels to reduce drop-offs and improve collaboration between stakeholders
Establish robust record keeping and tracking to monitor and evaluate the process
Develop quality assurance mechanisms to ensure good practice
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I synthesised statutory guidelines and policy documents to develop a high level service blueprint of the ideal process across identification of needs, assessments, health funding referral pathways, decisions, and disputes.​ I structured the blueprint with the design principles in mind, highlighting certain aspects of the process that were crucial to the redesign, such as quality assurance and system design solutions.​​
Design process
I facilitated a series of co-design workshops bringing together a range of different stakeholders across service operations, senior leadership teams, the NHS, and system designers. The initial workshops were aimed at validating the design principles and aligning thinking of stakeholders on high level processes as stipulated by national policies. The workshops that followed were aimed at zooming into the different processes and working through the design of front stage and back stage processes. We also identified bespoke solutions to plug gaps and improve the delivery of the service.​
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Service blueprints of the redesigned process
The service blueprints were co-developed with stakeholders, outlining the new process in detail across front stage and backstage activities. Key changes included:
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New role: The creation of a new job role called the 'Continuing Healthcare Lead' who will manage referrals, have oversight on all cases, and provide expert guidance to practitioners.
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Quality assurance: Process of quality assurance built into the process where key actions and decisions will require review and authorisation.
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Software solution: Improvements made to Liquid Logic (case management software used by practitioners) to digitally record all actions and decisions, enable better tracking of referrals, and ensure staff follow a consistent process.
Continuing healthcare process: Assessments
Continuing healthcare process: Referrals and decisions
Joint funding process: Referrals and decisions
Dispute process
Prototype of the software solution
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After the process was redesigned, I worked closely with the system designer to develop software solutions that digitised parts of the process. I translated user needs and process requirements to product improvements. I worked alongside the transformation lead to drive the implementation of the changes, by conducting usability testing and qualitative feedback sessions.​​​