Stocktaking and adaptation – it’s all part of the process Cranstoun

Peter Glass, Executive Director of Operations

We recently, as we often do, took stock of Cranstoun’s whole-system integrated services. ‘Stocktaking’ is part of ongoing performance management and development, a continual process applied throughout the lifetime of any contract. Even with this mature and robust framework in place, general reporting cycles of KPIs or outcome and output data can fail to recognise some of the more macro aspects of delivering whole-system services, as well as the wider panacea of service evolution, often spanning up to five years. This is one of the reasons Cranstoun developed and continues to refine its Mobilisation, Implementation, Transformation, Exit (MITE) framework, a tool within our governance structure that considers wider operational aspects linked to service development.

While integrated services contain common core elements, each offers individualised, unique aspects that are significant both in the immediate locality and in relation to building an extensive collection of ‘what works best’. For example, in our countywide service across Worcestershire, which covers both rural and urban populations, the latest (Q4) NDTMS completions report shows significant improvement since the contract started on 1 April 2015:

  • Opiates improved from 4.8% to 8.5%
  • Non-opiates improved by 21%
  • Alcohol improved by 22%

Since implementation, PHE data analysis shows the following improvements in numbers accessing in-house Hep C treatment:

  • A substantial reduction in ‘did not attends’ (90+% to 20%)
  • An increase in treatment numbers (0 p/month to 3 p/month)
  • A reduction in test-to-treatment time (12 weeks+ to 8 weeks)

Since embedding the shared care service across Worcestershire, the service has seen an increase of 32% in prescribed clients accessing shared care.

In its 50th year, Cranstoun remains a leader in the sector; we have learnt a lot from our wide-ranging current and historical portfolios. While our approach will always be to learn and evolve, each service we manage assumes a local focus, seeking to co-produce, partner and complement local strategic and operational plans, systems and processes. Demography and geography are perhaps obvious factors within the planning and delivery for each service, but it’s when we start to consider other layers of overall operational and support requirements that we see a more representative picture of the sheer complexity of the task at hand.

People who use our services often present with a range of issues – homelessness, significant physical and mental health problems, contact with the criminal justice system, debt, to name a few. Indeed the whole sector has witnessed higher levels of presenting complexity over the last ten to 15 years. What particularly strikes me is how, despite deep and enduring financial constraints, there is sustained momentum to continually strive to improve and try new and innovative approaches.

Cranstoun’s Brighton and Hove service, Pavilions represents an excellent, real multi-agency partnership where Cranstoun is the lead organisation. Examples include:

  • Prescription collection – we have changed the culture from one where clients collected their prescription from pharmacies to collecting it from Pavilions. 70% of clients engaged better with one to one appointments than previously.
  • Mobile needle exchange – by providing needle exchange on the streets we have doubled engagement rates of the number of people rough sleeping and using the night shelter who have entered treatment as a result of a needle exchange interaction over the past nine months.
  • Peer-led group work – the totally peer-led ‘Speakeasy’ group is an excellent example of co-production, running five days per week with 65 regular attendees.

There are similar threads across all of Cranstoun’s services, with many excellent illustrations of how our provision evolves. By utilising co-production as a cornerstone of design and by ensuring relevancy and flexibility with built-in review periods, we create an environment that accommodates an adaptive and dynamic development process.

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