Make Change Happen

Six Vital Steps

Step 4: Set clear and realistic goals

Business cases for improved services will need to be informed by robust modelling of the likely impact of service change on patient outcomes, costs and savings. 

Robust data collection can inform commissioners of likely demand, identify areas where resources can be used more productively, and reduce financial risk.

The cost of service improvement can be minimised by making better use of existing resources. For example, some areas have released podiatrist time by using healthcare assistants to perform administrative tasks and undertake roles such as escorting patients to transport. Others have trained podiatrists as independent prescribers so patients do not need to visit their GPs for foot medications.

The cost of service improvement, the potential for improved outcomes, and likely savings will vary from place to place, and will depend in part on baseline service provision, outcomes and costs. Case studies such as Somerset suggest that savings can substantially outweigh the cost of service improvement. 

It is important to be realistic about timescales for savings. If reductions in ulcer duration and associated hospital admissions can be achieved, it is likely that savings will be made relatively quickly. Reductions in amputations, and associated savings, can take longer;  some areas say 3-5 years. 

Rachael Rowe is the lead diabetes commissioner at Somerset CCG

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