Total Place

    Bournemouth, Dorset and Poole was one of 13 national total place pilots. The pilot was steered by a project board bringing together senior representatives from the two PCTs, the county council and two unitary councils, the district councils, police and fire authorities, the voluntary sector and older people themselves.

    The focus of the pilot was on services for older people. It looked in particular at the large proportion of older people that were avoidably admitted to hospital and explored alternative ways of meeting their needs at less cost at or near their homes. The work showed that if 15% of older people currently admitted to hospital had their needs met in alternative ways, the savings in hospital care would be around £18m a year and the cost of alternative provision would be around £7.5m, including increased investment in preventative activity.

    The pilot also showed that if this level of savings was to be achieved a whole system approach was essential, ranging from reconfiguring hospital provision through to the increased investment in community services and greater voluntary action at a very local level.

    The work including a range of activity including small workshops, a number of working parties, two Total Place Assemblies, a simulation day and an external challenge event as which participants from government and other councils contributed to the pilot\’s work.

    In common with the other pilots, the Bournemouth, Dorset and Poole pilot identified a number of significant challenges that must be addressed if improved outcomes are to be achieved at less cost. They include:

    • High quality local leadership, for example around the shape of hospital provision;
    • Organisational and cultural change, such as the alternative to hospital care being available 24/7;
    • Governance and financial management issues, such as how to enable on organisation to spend a little more to enable others to save considerably more.

    There are a number of lessons from this work which can inform other projects designed to use the pressure to reduce costs as a spur for innovation. They are:

    • Buy-in is critical;
    • Keep it clear, if not simple;
    • Maintain the levels of ambition;
    • Keep up the momentum.

    Client: Dorset County Council

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