The Benson Model for
Children’s Community
Healthcare
Information for Commissioners
A background and overview intended to provide
information relevant to Commissioners and the
procurement process. This addresses benefits and
outcomes achieved by existing users, pre-requisites,
method of implementation, project support and costs.
Tendering considerations addressed include relevance to
other planning methods and applicability of the single
tender waiver.
Q2 2014
The School Nursing Service Planner
Information for Commissioners – Q1 2014
Table of Contents
EXECUTIVE SUMMARY ..................................................................................................................................... 2
DEVELOPMENT ................................................................................................................................................ 2
IMPLEMENTATION ........................................................................................................................................... 3
OUTCOMES ...................................................................................................................................................... 4
COST ................................................................................................................................................................ 5
OTHER AVAILABLE OPTIONS ............................................................................................................................ 6
SINGLE TENDER WAIVER .................................................................................................................................. 7
PROVIDER REQUIREMENTS .............................................................................................................................. 7
CONTACTS ....................................................................................................................................................... 7
Executive summary
Since 2010 the Benson Model is being implemented with over 25 providers across England, and
already overseeing workforce covering a significant proportion of children across England. The
Benson Model is a methodology developed to provide a more dynamic, comparable, robust and
objective process to inform workforce planning and support service improvement initiatives across
children and adult community nursing services.
The Benson Model is a demand led approach – starting with the needs of the local population
ensuring local requirements and Healthy Child Programme objectives are part of the service offer.
Demand profiling demonstrates support requirements for the local child population in each team,
sensitised in accordance with local complexity and geographics. This identifies a theoretical
workload and facilitates development of new workforce structures and assessing effectiveness of
the existing workforce.
For commissioners, the Benson Model offers several advantages:
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A clear and objective way of supporting optimum workforce size and configuration based on a
specific service offer
Specialist and unique expertise built on proprietary tools and experience across multiple
implementations
Costs are kept low by utilising a central methodology – no cost overruns
Possibility to move quickly as costs fall below the common waiver level or competitive tenders
may be avoided, often under a “single source of specialist expertise” clause
Live roll out is usually achieved within three months
The Benson Model is adapting to recent changes impacting both health visiting and school nursing
providers, including changes in the Healthy Child Programme, and schools transitioning to more
independent status and rationalisation of the service offer to reflect core and additional services.
“the requirement for robust workforce planning is ever more important
if nurses are to provide effective care within defined budgets”
Scottish Government, 2011
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Development
A DoH funded report relating to health visiting was developed to address released in 2008 included
an assessment of provider requirements for strategic planning; this found a lack of common national
strategic workforce and caseload management tools1. Providers were aware of the need to sensitise
caseloads in accordance with underlying population complexity and provide a more objective basis
to support workforce allocation. Among its recommendations the report advocated development of
a new, dynamic demand and supply approach:
“Develop and release a system modelling tool (including workforce, activity and finances) based on
the work undertaken in this programme which is available to sites that enables the investigation of
alternative and local CHPP delivery models and assess the impact on resources required”
Symmetric report for CSIP, July 2008
The Benson Model was piloted in Health Visiting in 2009 and has since spread across most of the
country. The School Nursing model adapted from the core methodology in 2012; it was developed
as a result of feedback from school nursing providers that had contact with the Health Visiting
service and reported a lack of similar tools the school nursing environment.
The Benson Model database was developed in late 2013 to provide benchmarking and external
validation for providers.
Implementation
The Benson Model draws together local and national intelligence, with profiles developed to reflect
strategy around workforce allocation and service offer. Service specifications and workforce profiles
are developed to reflect the provider’s future vision of service delivery, and the core principle that
service delivery should be harmonised.
Implementation of the Benson Model is usually achieved inside three months. This commences with
the formation of a working group to define project objectives, scoping, configuration and data
specification. A local tool is then set up incorporating children, deprivation, safeguarding, services,
teams and workforce. Two to three half day workshops are organised to inform the local workforce,
and agree future local service specifications and workforce profiles. Once implementation is
complete the Benson Model is rolled out for live use by the provider.
Once implemented the Benson Model is owned and updated collectively by a provider workforce
board. Providers receive updates to the core model every quarter, which has evolved since
inception from ideas generated by the service. A common framework also encourages external
validation, innovation and sharing of ideas across providers.
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Figure 1 – Benson Model demand and supply factors
Outcomes
Local level outcomes
Outcomes from users of the Benson Model are varied and depend on local requirements but often
include service reconfiguration, new practitioner allocation, caseload sensitisation, developing a
standardised service programme and specifications, external validation / benchmarking.
The initial implementation in Liverpool assisted in the following areas:
“The Benson Model will continue to help us deliver on the QIPP agenda through ensuring we have the
right staff with the right skills to deliver the Healthy Child Programme. The tool supports managers
with key decisions around staff deployment to meet the needs of our diverse population. This helps us
to ensure we have an equitable service with optimum staffing levels to improve the outcomes for our
children, young people and their families. ”
Doreen Porter – Liverpool and Sefton project lead
Some recent deployments have delivered the following outcomes:
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Supporting the placement or reallocation of staff
Providing a baseline for caseload sensitisation – a departure from standardised caseloads
Identifying workforce shortfall and optimisation by locality
Driving greater harmonisation in service delivery, identifying service variation and targeting
efficiencies
Rationalisation of the future service offer, e.g. core, immunisations only
Redefining workforce roles and the contribution of skill mix, including clinical and non
clinical responsibilities
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Restructuring the locality zones to rebalance caseloads
Identifying future support requirements based on changes in demand or supply factors
Service rationalisation and charging for non-core services
Validated datasets using access to independent national databases (Edubase2) and the
Benson Model database to assist baselining of assumptions and reasonableness testing
Driving longer term forecasting to determine future workforce requirements
More information and case studies can be accessed at:
www.bensonwintere.com/hvsp
www.bensonwintere.com/schoolnursing
National level outcomes
Universal approaches facilitate greater standardisation enabling comparison than bespoke or locally
driven solutions. For the Benson Model this has lead to the development of a database used to
assist information sharing around service offer, service specifications and workforce profiles. This
leads to some advantages for the service as a whole, including:
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Aligning service classifications, specifications and outcomes with the guidance provided in
the Healthy Child Programme 5-193
Establishing more standardised workforce profiles, a requirement highlighted by the RCN4
Sharing of service programmes and specifications helps spread innovation and best practice
Cost
A single methodology ensures development and maintenance costs are minimised, increasing
affordability, and avoiding costs and potential overruns associated with bespoke development.
Therefore costs relate primarily to implementation support – this involves planning, configuration,
data collection and validation, running workshops, rollout and ongoing remote support.
This is reflected in the cost of a standard single implementation starting from £6,750+VAT. Costs
reflect the full implementation plus maintenance and updating the Benson Model and Benson
Model database:
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Initial working group meeting to establish terms of reference and objectives
Working with information governance and data / intelligence to configure the tool
Providing data templates, collect and validate data
Configure the local Benson Model
Running workshops with selected staff to develop the Benson Model
Collecting feedback, final changes and live rollout of the Benson Model
Providing online access and two years of remote support to assist understanding and
utilisation, provide quarterly updates and access to the Benson Model database5
Maintenance and updating the Benson Model and Benson Model database
The range reflects differences in support requirements to configure the local tool, align and enhance
the dataset, and size of the tool in terms of number of locality teams and size of the child
population.
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The School Nursing Service Planner
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Alternatives
Based on research of the current market in the United Kingdom and feedback from NHS
Commissioners there are currently no commonly available alternatives being used within community
health nursing for strategic, demand led workforce and caseload planning. Prior to development we
also consulted providers, the DoH, and reviewed available research and tools.
Providers are actively investigating and employing tools which are often extremely effective for the
purpose employed and in some cases complementary to the Benson Model. For instance the
Lancaster model6 which focuses on outcomes and service quality, or scheduling tools such as the
Stockport “Dominic” system7.
The Benson Model was developed to address these planning needs – providing a universal approach
to help providers objectively and robustly determine workforce requirements, drive discussion about
future strategy and inform commissioners.
The table below lists the differentiating characteristics of current tools compared with the Benson
Model:
Existing alternatives
Benson Model
Operational focus – weekly / monthly scheduling /
rostering to maximise efficiency from the existing
workforce based on existing service and workforce
profiles
Analysis is provider specific
Non-scalable, non-replicable, non-standardised –
bespoke, single purpose development
Supply side focus: aggregated estimates on the
demand side, using indexes to estimate complexity
and weight caseloads
Owned by a researcher or consultant, produced as a
one-off or not regularly updated
One size fits all, caseloads are based on a presumed
service offer and do not allow the local service to
explore the impact of changes
Qualitative: focus on service performance, quality
and outcomes
Strategic focus: demand/supply focus based on a full
year, allowing re-assessment of services, roles and
deployment of the overall workforce
Focus on school nurses only, not skill mix; focus on
clinical responsibilities only
Using a standardised caseload approach, they do
not reflect caseload complexity
Analysis is locality specific
Scalable, replicable, standardised – flexible with
different provider requirements, enable comparison
Demand and supply side focus: analyse complexity of
the overall student population using measures of
deprivation, safeguarding and special needs
Owned by the provider with remote assistance as
required, regularly updated
Allow for future profiling to observe how changes on
the demand or supply side impact workforce
effectiveness
Quantitative: Focus on number of hours required by
local students (demand) and available from the
workforce (supply)
Multiple workforce profiled including specialists and skill
mix, reflecting unique clinical & non-clinical
responsibilities, travel
Demand profiled to ensure caseloads are sensitised in
line with underlying complexity (deprivation,
safeguarding, geographics etc)
Several workforce specific paediatric tools with acute or specialist focus have not been considered8.
These are deemed to not apply to community based services. For a more comprehensive summary
of paediatric tools, refer to the RCN’s paper “Defining staffing levels for children and young people’s
services”9.
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Single tender waiver
The Benson Model will usually avoid the requirement for a competitive tender a single tender, due
to cost threshold or its uniqueness as a specialist methodology. This will depend on local policy.
Waiver clause
Benson Model applicability
Below threshold requiring a formal, competitive
tender
Specialist expertise is required and is available from
only one source
Single implementation of the Benson Model
often falls below this threshold
The Benson Model is based on a unique
methodology; the process and reporting are
not replicated by other currently available
national tools (see prev. section)
As developers, Benson Wintere are the only
consultants with experience implementing the
Benson Model
The task is essential to complete the project, and
arises as a consequence of a recently completed
assignment and engaging different consultants for the
new task would be inappropriate
There is a clear benefit to be gained from maintaining
continuity with an earlier project (where such
continuity outweighs potential financial advantage to
be gained by competitive tendering);
The work is time sensitive
Providers may replicate the outcomes from
own HVSP, or another provider’s Benson
Model. Benefits: access to an approach unable
to be replicated, providing benchmarked data,
achieved at a relatively low cost
The Benson Model is developed and generally
implemented in less than 3 months; developing
or adapting a new approach would take
significantly longer
As commissioning and decision making arrangements will differ, we invite enquiries for further
clarification, or where examples of commissioning arrangements from other projects are required.
Provider requirements
The Benson Model has no direct systematic or IT requirements, and simply requires access to Excel
version 2007 or above. The Benson Model is based in Microsoft Excel and coded using Visual Basic
(VBA) language. Excel was selected as a suitable platform to ensure universal compatibility and
access for providers, increase flexibility and ease of upgrades to the core tool.
Implementation requires a steering group representing key stakeholders, as well as the time of
workshop attendees, and from there an ongoing process and commitment to collectively review and
update the tool.
Links and contacts
School Nursing
www.bensonwintere.com/schoolnursing
Health Visiting
www.bensonwintere.com/hvsp
For more information contact:
Michael McGechie
Director – Benson Wintere
[email protected]
0796 9199 920
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References
1
Health Visiting, Leading and Delivering the Child Health Promotion Programme, Symmetric SD Ltd, July 2008
commissioned by Care Services Improvement Partnership (CSIP)
2
ibid
3
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publicationsandstatistics/publications/public
ationspolicyandguidance/dh_107566
4
The RCN’s UK position on school nursing, Feb 2012 (page 8)
http://www.rcn.org.uk/__data/assets/pdf_file/0004/433282/School_nursing_position_statement_V5FINAL.pd
f
5
After the two year support period ongoing remote support of the above types will not be charged.
Once determined costs will be confirmed in a formal quotation document.
6
http://www.thelancastermodel.co.uk/deliver-school-nurse-development-model.php
Currently used in District Nursing; developers intend to focus on School Nursing in the future
8
e.g. SCAMPS, PANDA, CAMHS-AID
9
http://www.rcn.org.uk/__data/assets/pdf_file/0004/78592/002172.pdf
7
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