Rubicon has worked with over 50 healthcare commissioners and providers on a wide range of healthcare consultancy projects. A sample of our projects are shown below – please contact any of these organisations to find out what it is like to work with the Rubicon team.
Rubicon has developed an expertise in supporting primary care developments. Our work has typically, but not exclusively, been in connection with bids for central funding from the Estates and Technology Transformation Fund (ETTF) and to date we have supported or reviewed, on behalf of NHSE, over a dozen ETTF bids.
Rubicon worked with SCW to develop a whole system activity, financial and capacity model which we jointly used to support vanguards in North East Hampshire and Farnham, and Erewash. The model formed the basis of an updated tool which we then jointly used to support STP activity and financial planning in the BNSSG, Frimley, Buckinghamshire, Western Sussex and Oxfordshire systems in 2016. Our approach has been well received by the national New Care Models Team. The modelling approach, whilst most recently, developed for vanguards, is based on over a decade’s worth of work with other health and care communities.
The Oxfordshire system transformation programme was a wider programme of work that Rubicon delivered alongside SCW. The programme was delivered through a joint SCW/ Rubicon Health Consulting consultancy team with Rubicon providing the programme director, financial modeller, an analyst and a business case writer who worked alongside SCW’s local team supporting the CCG. This was the latest in a number of jointly delivered projects which demonstrate our ability to slot Rubicon associates into larger teams.
The aim of the programme was to support the CCG and its provider partners to redesign the Oxfordshire health and care system – the programme ran in parallel with the process of developing the wider BOB STP strategic plan.
The specific support provided by Rubicon was to:
- Support service redesign, pre-consultation support and modelling. Rubicon worked alongside CCG and provider colleagues to agree new models of care across long-terms conditions, urgent care and planned care. We then modelled the impact of these changes on activity and finances before writing a pre-consultation business case;
- Build a whole health and care system activity, capacity and financial models designed to show the impact of “doing nothing” on system sustainability and of STP interventions designed to close the financial gap. The model we developed was based on a model scope agreed with the client – in this case the entirety of services commissioned for Oxfordshire residents by the CCG, NHSE and Oxfordshire County Council’s Adult Social Care commissioners. After agreeing service level activity growth, inflation and other assumptions, we were able to model a do nothing scenario which was then used alongside our work from Buckinghamshire, to inform STP returns. We then ran a series of “do something” scenarios based on more detailed activity and financial modelling done by Rubicon and CSU staff to reflect the outputs of clinical workstreams (planned care, urgent care, mental health etc). After running a range of do something scenarios, we agreed with the client, the combination of plans to comprise the STP submission;
- Draft the pre-consultation business case required by the CCG ahead of planned consultation changes in community hospitals and at the Horton Hospital.
North East Hampshire and Farnham Vanguard
In 2015 we were appointed to help the North East Hampshire and Farnham (NHE&F) PACS Vanguard with its strategic planning. One strand of our work built upon a key recommendation from our Hampshire estates strategy – that Farnham Hospital, which is in Surrey, becomes the locality hub for North East Hampshire. The recommendation was innovative in that it recommended using an out of county hospital as a hub for Hampshire services – our rationale was that Farnham is easy to access from NE Hampshire, Hampshire wanted to close beds at a small community hospital in Fleet, Farnham Hospital is a “fixed point” PFI hospital and was 26% vacant.
The wider context was the NEH&F vanguard’s need for a locality-based estates strategy focused on locality hubs that would collocated primary care, community and social care services, whilst also providing facilities for secondary care outreach. We were given the task of achieving better utilisation of the Farnham PFI in a way that supported locality integration and created the options to reconfigure community hospital beds in the area.
We formed a small project team drawn from primary care, two local community providers, mental health, the CCG, local acute and two county councils. Adopting the same methodology as used in Purbeck we reviewed opportunities to complement the integrated locality model and to bring more services to Farnham.
The project resulted in:
- The opening of an urgent treatment centre at Farnham Hospital which brought together three GP practices;
- The transfer to the hospital of the local social care reablement team;
- A proposal to transfer the Fleet beds to Farnham – this proposal was worked up into a separate business case ahead of a planned public consultation, but is currently delayed due to the need to retain beds at Fleet due to winter pressures.
The lessons learned were similar to those in Dorset i.e. the importance of engagement and a solid evidence base, and the importance of thinking “outside the box” to consider nearby out of county premises (and non-NHS premises such as local authority sites).
A large mental health provider
Rubicon was engaged by the Trust Development Authority to carry out an external independent review of financial viability of the trust. Rubicon was specifically asked to:
Support the trust to develop a detailed description of how the clinical strategy and enablement model will work in practice and what this means for the way the trust’s mental health services;
Assess the workforce implications of the clinical strategy and enablement model, in terms of potential changes to staff numbers and skill mix; and
Review the implications of the delivery of the clinical strategy and enablement model for the trust’s estate, including modelling the potential impact of reducing (or otherwise) and re-developing inpatient sites and community premises.
Our work was delivered over a two month period and resulted in a report to the trust, its commissioners and the TDA that concluded that whilst the enablement model would make a significant contribution to financial viability, it would not close the entire financial gap.
South Central and West Commissioning Support Unit
Rubicon has a strategic partnership with the South, Central and West CSU under which the two organisations form joint teams for specific pieces of work. To date we have jointly worked on several projects for NHS England including financial assurance of CCG and specialised commissioning financial plans; the National QIPP Programme (phases 1 – 4); a financial governance review; a review of Vanguard logic models; mental health project management; and a review of System Resilience Groups. Rubicon has also placed a number of interim staff with NHS England.
We have also sub-contracted work to the CSU including the provision of activity modelling for the Western Sussex system and mapping for West Kent’s care hubs programme.
In 2015 and 2016 we jointly developed a whole system activity, capacity and financial model which was used to support vanguards and STPs across England.
NHS Foundation Trust
Berkshire Healthcare asked Rubicon to refresh the Trust’s five year strategy originally in light of the acquisition of two community healthcare providers. The brief was to undertake a market assessment followed by development of the newly merged Trust’s strategy. Rubicon produced the market assessment through a process of assessing demand and supply factors at a service level. Particular emphasis was placed on the overlap between mental and physical healthcare, including opportunities arising out of mental health support for people with long-term conditions. We then worked with executive directors to agree a strategy for the next three to five years starting with an assessment of whether or not the FT needed to grow to survive and concluding with an appraisal of growth opportunities. The refreshed strategy also covered work on service developments as well as the links to enabling strategies including workforce, estate and IM&T. The outcome was a refreshed strategy which sets out a clear direction of travel that the Trust will pursue for the next three to five years.
In autumn 2012 Rubicon was appointed to assist Berkshire Healthcare to identify efficiency savings for 2013/14 and 2014/15. We undertook a through review of costs and benchmarked performance across six workstreams ranging from community team productivity to corporate services helping the trust to identify significant potential savings for the next two years. An important outcome from our review was the trust setting up its ‘Hour a Day’ savings programme which has subsequently delivered over £3m in recurrent savings.
In 2012 Rubicon worked with the foundation trust on two business cases; one for the acquisition of West Berkshire Community Hospital, the second for an important upgrade to the trust’s RiO patient administration system. Both business cases were approved and the investments made.
In spring/summer 2013 Rubicon was appointed by the trust to work on the strategic outline case (SOC) for the replacement of RiO post-national contract end in 2015. Following approval of the SOC in August 2013, Rubicon continued working with the FT and delivered the outline business case in spring 2014. In summer 2014 Rubicon was asked by the FT to help write its information management strategy and in early 2018 we developed an inpatient demand and capacity model for the trust’s mental health services.
The CCG and Black Country Partnership NHSFT jointly commissioned Rubicon to review the implementation of the 2009 mental health strategy in Wolverhampton. The Rubicon team, which included an ex-Director of Nursing and the national lead for PbR in mental health researched best practice, assessed the implementation of new teams in the borough and held over 50 meetings with stakeholders from across the health and social care community. Our findings led to a number of recommendations designed to improve local mental health services. Our final report and recommendations were accepted by commissioners and the trust in March 2014 and form the basis for CCG commissioning intentions for 2015/16.
Staffordshire and Stoke
NHS Partnership Trust
Staffordshire and Stoke is England’s largest community health provider. The Trust is pursuing a FT application and needed a market assessment to both assess risks and opportunities to its current community health service portfolio and to identify opportunities arising from its planned integration with Staffordshire adult social care. Rubicon produced a a divisional level market assessment, including a separate workstream for the yet to be acquired social care portfolio. A process of analysing demographic change, prevalence rates, local and national policy and commissioning intentions, was carried out to establish factors that would influence need and demand. This included liaison with the seven emerging CCGs as well as cluster commissioners. This demand assessment was then combined with an assessment of supply factors including existing and emerging competitors, to identify risks and opportunities to the new Trust. The product was a detailed divisional level assessment which identified risks and opportunities, and made a series of recommendations about how the Trust should response.
North Staffordshire Combined Healthcare NHS Trust
Rubicon has provided strategic advice to the Trust including work on the FT application; marketing, estate and IM&T strategies; annual business planning cycle; and service redesign initiatives. During 2011 we project managed a service redesign and public consultation concerning changes to adult and older people’s mental health services linked to the introduction of care clusters and the dementia strategy. The public consultation concluded successfully in November 2011.
In 2012 we followed up with a project concerning changes to adult mental health community and inpatient services. This work culminated in a second successful public consultation in summer 2012. The changes consulted upon were subsequently approved without challenge and have now been implemented. Together with the previous consultation changes, this project delivered £3m in efficiency savings for the Trust.
Rubicon subsequently worked on a business case for the expansion of the trust’s tier four adolescent unit which gained board approval in December 2012. Based on the success of this piece of work, we were appointed to produce a market assessment for the trust in connection with its strategic planning round.
Spire Healthcare commissioned Rubicon to support the launch of a new joint venture targeting the private and corporate markets across the UK. Rubicon assisted Spire to identify the most promising geographical markets for a phased roll out of the new venture and to understand the competitive environment. Our approach was to critically review existing private health market information and to triangulate this data with our own analysis of demand and supply in the different geographies of the UK. As a result we were able to advise Spire on which locations were most likely to be the optimal for growing the new business. Rubicon also helped write the initial three year plan for the new business.
Moorfields private is the private patient arm of Moorfields NHS Foundation Trust. Rubicon worked with Moorfields Private to assess opportunities to grow private ophthalmic activity across the south east by analysing Moorfield’s share of the private market by postcode. We then built a financial model to understand the relative profitability of each of the hospital’s key service lines. By combining our assessment of profitability with that of market share we were able to highlight those areas offering the greatest potential for growth.
Southern Health NHS Foundation Trust
When Southern Health merged community and mental health services into a single NHS Foundation Trust it needed a new estate strategy to reflect the new clinical model arising; opportunities for site rationalisation arising from the merger; the need to ensure that the whole estate is fit for purpose; and the need to make significant revenue savings over the next few years. Rubicon worked with Southern Health to agree a vision for the estate focused on delivery of the Trust’s objectives. This vision was turned into locality level implementation plans which will ensure that the Trust can reduce the number of buildings it uses by almost a third and in future deliver services from premises that are fit for modern healthcare delivery.
The Cardinal Clinic is a private hospital in Windsor. The clinic asked Rubicon to provide support to market the hospital to potential referrals in support of a medium-term strategy to sell the hospital. Rubicon produced a marketing plan identifying new sources of referrals for the hospital and introduced the owners to potential buyers for the facility.
Rubicon is the Trust’s strategic estates advisers. We worked with the Trust to write an outline business case for the development of a mental health inpatient centre of excellence which will see adult and older people’s beds centralised on one site in Leicester. Rubicon has also:
- Helped the Trust to produce an estate strategy focusing on meeting the needs of the new integrated clinical model and rationalising the existing owned and leased estate.
- Worked with the Trust’s divisions to form their 2012/13 strategies linked to the organisation’s FT application.
- Provided a ‘critical friend’ challenge to the development of the five year trust’s integrated business plan and 2012/13 annual plan.
- Provided the Trust with a project manager to support their FT application.
- Supported the production of the Trust’s five year strategy in 2014.
Our work with the trust led directly to Rubicon being invited to work with the LLR system to develop its strategic plans and to a subsequent LLR-wide business case for a single point of access.
Working with colleagues from Fusion Health we produced a review of the estate owned and leased by this newly merged mental health and community health provider. Our approach combined a desk-top assessment of information about each building provided by the client; workshops held with clinicians working in each locality; an assessment of the impact of the trust’s clinical strategy; and two workshop sessions held with the executive team and trust board. Our work culminated in the identification of a number of estate rationalisation opportunities which could save £2m per annum for the Trust. We subsequently worked with the trust to turn our earlier work into an estate strategy which supports the trust’s foundation trust application.
The Staffordshire Cluster of PCTs wanted to understand why referrals into an autism assessment service were running at three times the contracted volume resulting in a contract dispute. Rubicon provided support focused on understanding the factors which may have accounted for the increased referral rate. We compared historic and current trends, and investigated changes to referral practice. The result of our investigation was a reconciliation of referrals and a series of recommendations linked to resolving the contract dispute.
A south of England community and mental health FT
Our client wanted a programme of work to; understand service risk and opportunity at service line level; create a methodology for measuring service line ‘value’; produce a detailed service line market assessment for core services; and to undertake an analysis of opportunities within the private patient market. The client also wanted skills transfer to their recently established business development team.
Working with clinicians, service managers, the Trust Board, corporate staff and colleagues from Consilium Consulting, Rubicon undertook a rolling programme of work starting by identifying which services where most at risk or had the greatest growth opportunities. The programme then focused on an appropriate marketing response for three core services; forensic psychiatry; children’s services; and integrated community service teams setting out risk mitigation and growth strategies for each. Rubicon also assessed opportunities for the FT to establish a private patients business in either community care; mental health or planned care. The final element of the work was to work with individual directors and non-executives to understand what constitutes ‘value’ to customers and the trust, and to agree how the ‘value add’ of each service could be measured. The result was skills transfer to the FT’s business development team including a standard methodology for service line market assessments. The Trust Board were provided with an assessment of risks and opportunities by service line and with a strategic response for key services. Finally the client has an innovative methodology to assess value at a service level which will be used to assess new business opportunities and to identify services where the organisation needs to improve ‘value add’ or exit the market.
Working through the FTSN brand Rubicon and associates reviewed the potential for this midlands based FT to grow its business outside of healthcare by utilising a core competency based approach. Our work focused on identifying the organisation’s competencies and how each could be transferred to non-healthcare markets. Our final report identified four opportunities for growth which we then prioritised against already identified healthcare market opportunities.
In 2013 Rubicon was asked to assist the trust in formulating its ten year strategy with a particular focus on long-term clinical and financial sustainability. We engaged with each clinical division and support departments to identify opportunities for growth which were then researched further through a market assessment and shortlisted for inclusion in the trust’s strategic plans. We also researched the evidence base for savings resulting from mergers and assisted the client in understanding which services were most likely to generate merger savings. Our work became a major element of the trust’s year plan published in June 2014.
Rubicon worked with commissioners and providers in East Berkshire on the Shaping the Future programme in 2011/12 and 2012/13. Our work included agreeing new models of healthcare across urgent care and long-term conditions as well as paediatrics and MSK through an approached based around co-design with local clinicians, analysis of activity and financial data, and the review of the evidence for new models of care and their potential applicability to Berkshire. We also wrote the business case for changes to service provision at Heatherwood Hospital and assisted the health community with the resulting successful public consultation.
In summer 2012 Rubicon was asked to work with the three local CCGs to work up QIPP plans for 2013/14 based on the implementation of the new models of care agreed in our earlier work.
Rubicon supported this new CCG to write its 2013/14 annual plan making the case for changing models of care based on local needs and national policy. this included drawing together a large number of individual initiatives spanning six programme areas such as urgent care, long-term conditions and planned care. Our work subsequently became an important element of the local health community’s strategic planning.
The Royal Berkshire NHS Foundation Trust
Rubicon worked with the Royal Berkshire, local CCGs and two other providers to identify services which could be suitable for relocation into The Royal Berkshire’s Bracknell Clinic an under-utilised facility owned by RBH. The review identified 12 services which were suitable for transfer as measured against a series of benefits criteria. For each we identified potential barriers to change such as the ‘fit for purpose’ of Bracknell Clinic; potential opposition including consultation requirements; and implementation costs.
Rubicon worked with service leads from the CSU to assist GEM’s bid to become a national framework provider for the supply of commissioning support services. The bid was successful.
We worked with OUH over a period of three years to develop a suite of strategic outline business cases, outline business cases and a full business case for the development of two satellite radiotherapy centres. Rubicon’s role was to provide financial and economic modelling using the five case model for business cases. This involved complex income and cost modelling working closely with the trust’s corporate and clinical staff. The project was delivered in collaboration with colleagues from Health Strategies and WT Partnership. The full business case for investing £16.5m in the Swindon satellite was approved by the OUH board in July 2015. Rubicon is now working with the same colleagues and the trust on the outline business case for a second satellite unit.
Rubicon was asked to work with this acute trust on its site and estates strategy. Working with clinicians, commissioners and the trust’s estates team we drew up plans focused on reconfiguring the main hospital site to zone services between planned and unplanned care, and on wider health economy plans to create at health campus at the Paget site. The estate strategy was approved by the trust board and has proceeded to business case.
Dorset CCG and Dorset Healthcare
Purbeck is a district council area in Dorset which has a population of 46,000; the CCG/ Dorset Healthcare Purbeck locality is smaller having a GP registered population of 34,000. There are two much-loved community hospitals with beds in the locality. The project was to agree a new integrated health and social care model for service delivery across the locality, with the aim that Purbeck would be a pilot for the rest of Dorset. The “system” had aborted a contentious public consultation six months before we started work and there was significant local distrust of NHS planning.
We ran a process structured around five workshops involving colleagues from primary and community care, patient groups, social services and the local acute trust, to work through a process of:
- Confirming the “as is” start position – activity at the community hospitals; community service data, patients in secondary care; capacity utilisation; costs; workforce; estate issues etc.
- Reviewing strengths and weakness to identify “the problem” to be resolved;
- Researching best practice in integrated care;
- Agreeing the application of best practice to Purbeck – gaps analysis; constraints and dependencies;
- Reviewing opportunities to repatriate work from Poole Hospital to the locality e.g. outpatients, day treatments, minor surgery;
- Making recommendations about future service mix at the two community hospitals;
- Modelling the potential impact on capacity at each hospital;
- Assisting with implementation plans including how to integrate NHS and council services given the different “definitions” of “Purbeck”.
Our recommendations were approved by the CCG and community trust, and formed the basis of the integrated community service element of Dorset’s clinical services review which was successfully consulted on in 2017. The recommendations for Purbeck, which included closing beds at one community hospital, were accepted and we are now working on a business case linked to implementation of the proposals. The non-consultation elements of the new integrated model e.g. merger of NHS rehabilitation and council reablement teams was implemented ahead of the consultation.
The key lessons learned were the value of engaging with clinicians and patient representative from the beginning of the process and the importance of having a robust evidence based of what works elsewhere.
Hampshire estate strategy
We had worked for Hampshire’s community provider, when it was part of the PCT, to develop an estate strategy. Following merger with mental health services in the county and the expiry of the old estates strategy we were asked back to develop an estates strategy for the merged trust.
The strategy needed to be an enabler for the organisation’s new clinical strategy which focused on an integrated model of community health, mental health and social care delivery across locality populations of approximately 70,000. The strategy also needed to set out a route map to resolving condition and legislative compliance issues across the trust’s estate, which includes forensic mental health. The strategy needed to take due account of travel times for patients and staff, which are particularly relevant in the more rural east and west of Hampshire. Finally the strategy had to deliver financial savings through rationalisation and disposals, whilst taking account of a number of fixed points (predominantly PFI and LIFT premises).
Our approach to delivering the estate strategy was structured around six workstreams
- Agreeing the vision and principles to guide the strategy’s development and implementation – these included a commitment to a timescale for reducing backlog maintenance and a statement on preference between owning and leasing buildings;
- A review of the existing estate plans and background data such as ERIC returns and the six facet survey. This workstream answered the “where we are now” element of the estate strategy to create a picture of the issues facing the combined estate which needed to be addressed in the strategy;
- A programme of interviews and mini-workshops with clinical services to understand their clinical plans and to translate these into estate requirements. Core to this was understanding the new integrated service model and what services needed to be collocated and which shouldn’t be collocated.
- Estates issues solutions – we set out how estate issues could be resolved within the timescale of the strategy – this formed part of the “how we will get there” element of the estates strategy and included setting targets for future estate performance;
- Locality options – a workstream that focused on appraising different options for delivering a hub and spoke model for the locality-based estate. We used the criteria illustrated below to understand barriers to achieving goals.
- The final step was reporting our findings and recommendations through the full estates strategy and supporting appendices.