Skip to main content

The challenge and potential of whole system flow: Improving the flow of people, information and resources across whole health and social care economies

Improving the flow of patients, service users, information and resources within and between health and social care organisations has a crucial role to play in driving up service quality and productivity.

If every organisation in each health and social care economy were able and willing to work collaboratively to design services that optimise flow, it could lead to major improvements in patient and service user experience and outcomes.

The importance of flow is increasingly recognised by practice leaders and policymakers throughout the UK. For example, there have been recent flow improvement programmes in both Scotland and Wales. The concept of improving flow is also referenced nationally and locally, across the UK, in strategies for service configuration and for tackling emergency and elective access challenges. Where providers have been able to match capacity and demand and enable better flow between departments and organisations, there have been impressive results.

However, while there are positive examples, and while flow has become common parlance in health service management, it is important not to underestimate the scale of the challenge facing those who want to realise the full potential of flow improvement. To date, virtually all attempts to improve flow have focused on single organisations or pathways. Hardly any have sought to improve flow across the entire primary, acute and social care spectrum. The task of bridging the entrenched cultural differences between professions and bringing together organisations that have often been governed, funded, inspected and regulated in isolation has been too daunting for most.

Nonetheless, this report argues that local health and social care economies are now well placed to improve whole system flow. Not only is there now a good understanding of the methods and skills needed, but the financial logic for tackling expensive and resource-intensive bottlenecks in the flow of patients and service users between organisations is hard to resist.

The aim of this report is to provide leaders and improvement teams in local health and social care economies† across the UK with a guide to the activities, methods, approaches and skills that can help to improve flow across systems. It also describes the steps that policymakers and regulators at a national level need to take to create an environment that is conducive to change on this scale.

To support this, the report sets out an integrated, multi-level organising framework. This is supported by four case studies of innovative and effective practice: the Sheffield and South Warwickshire-based Flow Cost Quality programme; the Darlington Dementia Collaborative; the ‘Wigan Deal’ for adult social care and wellbeing; and the Winona Health Transformation programme in the US.