Skip to main content

System Balance Review – Greater Manchester


The Greater Manchester systems were experiencing high levels of demand which was placing Health and Social Care services under extreme pressure. NECS Consultancy was commissioned to support the 10 localities in preparation for winter 19/20.

The work provided a detailed analysis of planned winter capacity against forecasted levels of demand identifying any mismatches at a locality level. It also helped to:

• Provide a clear indication of any forecasted surplus or shortfall in capacity against winter planning assumptions.
• Highlighted the need for any necessary adjustments of local plans and the creation of additional capacity ahead of October 2019.
• Provided a comparison with peer CCGs/statistical neighbours.
• Informed 2020/21 planning requirements for more substantial changes.

The review also provided the opportunity to highlight any duplication of service provision and opportunities for consolidation and integration of services (including services that may benefit from a single Region-wide approach).

The impact of service changes and the introduction of new pathways were also considered and modelled during the review.

This capacity and demand modelling review informed the appropriateness of the current estate in the delivery of agreed commissioned services. System Balance Review – Greater Manchester


The aim of the review was to focus on Acute, Primary, Community and Social Care services and considered:
• Demand management/admission avoidance services or schemes.
• Discharge and recovery services or schemes.
• Interface and transition of patients between services (including interface with acute services – front door and back door).

The methodology was underpinned by the system balance approach, based upon the work developed by John Bolton on managing demand in adult care which sets out the balance needed between discharge destinations required to manage a balanced system.

Relevant services were reviewed and incorporated into the system balance process considering:
• Demand versus capacity for the different services.
• Service configuration/design – does the service deliver what it was designed to deliver – planned versus actual
• The impact of any planned changes to these services.
• Opportunities to improve productivity or effectiveness of services and for resources to be used differently.

• Critical to delivery was the engagement with local systems to ensure opportunities and follow up actions are defined and owned by the local systems. To complete this, NECS worked with identified local links within the system.
• Semi-structured interviews were conducted with all key system providers
• A site visit was conducted to all Acute Foundation Trusts to undertake a clinical pathway review
• Oversight of the project was provided by an agreed steering group, consisting of key staff across Greater Manchester
• Analysis was carried out with all existing and readily available data and information from interviews and site visits


NECS carried out the work over a 12-week period in 4 identified stages:

• Stage 1: Completion of current system balance metrics at locality system level. This showed variance across the system of patients moving through the pathways. Initial contact was made with localities at this stage to identify and discuss agreed priority areas, to inform development and plan for stage 2 and 3. The data was collated by NECS’ Business Intelligence team using existing data sets. The data for Local Authority was not readily accessible, engagement and data sharing agreements were a priority.

• Stage 2: System level analysis of the 3 priority areas identified, showing variation across localities.

• Stage 3: Local level analysis of the 3 priority areas, this was the gathering of local intelligence and data where relevant to identify causes of variation and opportunities for sharing of good practice and associated benefits.

• Stage 4: Production of an opportunity system balance showing the impact of any potential changes along with a forecast of current and potential demand from 01 October to 30 March 2020.
Following the completion of data collation, analysis, interviews, and site visits the information was triangulated and reports produced for each locality.

The reports identified the gaps within the system and made recommendations in preparation for winter and a prioritised action plan was completed.

The report enabled the system to understand where their focus needed to be in preparation for the winter months, identifying duplication of services and gaps in capacity over a 24-hour period within a locality.

The team presented the findings and recommendation to each locality and advised on implementation. The findings and recommendations informed and supported the Greater Manchester winter summit 19/20.

Download a pdf of the case study here: System Balance Case Study – Greater Manchester