Increasing access to manage demand: designing away from rationing health care

A 60 minute Workshop by:

Jonny Mallinson

Innovation Unit

Sarah Dew

Innovation Unit

About this Workshop

Across their lives, many people are spending long periods of time in tier 4 targeted and acute services. For example, looked after children in the care system, young people in alternative provision and people with mental health issues in residential care or inpatient hospital care. In general, spending long periods of time in tier 4 targeted and acute services is associated with very poor outcomes for the individual and their family, and very high costs to the taxpayer.

If we are to a) improve people's life chances and outcomes, b) increase their independence and c) reduce the costs of failure to the taxpayer and create sustainable, affordable public services, we need to better manage the flow of people into and out of tier 4 acute and specialist services. This means supporting people to spend less of their lives in highly institutionalised, high cost environments.

In Doncaster, we're developing a new operating model to better manage the flow into and out of tier 4 targeted and acute services. We've started by working with adults with multiple and complex needs, many of whom are homeless or at risk of homelessness. The model manages upstream and downstream flow of service users not through closing doors and raising thresholds, but through providing a much wider range of flexible support, to many more people, much earlier in their journey. We're now thinking about how we can work with vulnerable adolescents in Doncaster that are in care and on the edge of care to apply similar principles to the way in which the council supports them.

We'll share insights about how we're developing this model for managing the demand for care from people with complex lives. Taking participants through from the early research stages and co-design of the first model, through to the development of the model and adaptation for a new cohort, we'll explore what this new approach could mean for designing new solutions to healthcare challenges more broadly. We'll invite input and reflection from service design colleagues in the room on how our methodology can be scaled and spread, and what it means for other fantastic work happening in this space.

About the Speakers

Jonny Mallinson

Jonny leads Innovation Unit's work developing new partnerships with ambitious change makers in the UK and beyond. He also leads projects with health and local government partners, including supporting Doncaster Metropolitan Borough Council in the development and implementation of a place based strategy focused on transforming outcomes for vulnerable populations. He is a key part of the delivery team on the Bloomberg Mayors Challenge Programme, providing support and guidance to cities across Europe as they seek to implement and scale a range of innovations.

Prior to joining Innovation Unit, Jonny worked as a researcher and project manager in the social enterprise sector, supporting communities to take on the management of natural assets such as canals and rivers through the Waterways Project (now Shared Assets), and working with big corporates on the development of their corporate social responsibility strategies with the social innovation consultancy, Volans. Jonny has also worked as a researcher at Nesta.


Sarah Dew

Sarah is a researcher and project co-ordinator at Innovation Unit, with particular expertise in scaling innovation in health and social care. She is the 'researcher in residence' for the NHS Innovation Accelerator, capturing and communicating insights from the programme on how to scale the use of innovation in the NHS. This practical work is grounded in theoretical understanding from her work with The Health Foundation. Sarah was part of the team researching innovations that have scaled successfully in the NHS, developing an understanding of how the system can better foster and spread innovation.

Sarah is also working on Better Endings, a year-long innovation programme for end of life care in Lambeth and Southwark supported by Guy's and St Thomas' Charity. Sarah led the research to understand the health and social care context that has informed the programme, and has gone on to support and coach the prototypes that have been developed through the project.