Redesigning the health funding journey in social care
How could we create a consistent, auditable service that ensures eligible clients are funded correctly?
Overview
Continuing Healthcare (CHC) is a nationally defined NHS funding pathway for people with significant health needs. In Barking and Dagenham, eligibility was getting missed, meaning the local authority had been incorrectly funding care that should be NHS-funded -- creating financial risk and poor outcomes for social care clients.
I led the redesign of the CHC funding journey within Adult Social Care, addressing a fragmented, high-risk service spanning multiple internal teams and NHS partners. An internal audit identified that inconsistent processes, unclear ownership, and limited tracking were contributing to annual losses of over £1m, with eligible cases going unclaimed.
The redesigned service is now live, used by operational teams, and delivered through agile, GDS-aligned delivery.
The problem and risk
The existing CHC service was difficult to navigate in practice. It:
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lacked a clear end-to-end process
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relied heavily on individual knowledge and manual workarounds
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had unclear ownership across teams and handoffs with NHS partners
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provided limited visibility of case status, progress, or outcomes
As a result, staff were often unsure how to initiate or progress CHC, leading to inconsistent uptake, delayed decisions, and avoidable financial and clinical risk for both the council and clients.
My role
Service Design Lead
I led the end-to-end redesign of the CHC funding journey, working with 30+ stakeholders across Adult Social Care practitioners, operational leads, finance colleagues, NHS partners, and system designers. I was responsible for framing the problem, leading research and co-design, shaping delivery priorities, supporting implementation into live service, and articulating impact and value.
Delivery
Discovery
To understand where and why the CHC service was breaking down, I conducted qualitative research with practitioners, operational leads, and finance colleagues. This focused on how the service operated in practice, where risk accumulated across the pathway, and what staff needed to manage CHC safely and consistently.
From this work, I defined a small set of design principles to anchor the redesign, focused on:
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streamlining processes to reduce rework and inefficiency
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formalising communication and handoffs to reduce drop-offs between teams
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strengthening record-keeping and tracking to support oversight and audit
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embedding quality assurance into day-to-day delivery
In parallel, I synthesised statutory guidance and national policy and translated this insight into end-to-end service blueprints and journey maps, making front-stage and back-stage activity visible across the full CHC pathway -- from identification of need through assessment, referral, decision-making, and disputes.
These artefacts helped stakeholders develop a shared understanding of gaps, dependencies, and failure points, and created alignment on where change would have the greatest impact on safety, auditability, and value.
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Alpha
I planned and facilitated co-design workshops with council teams and NHS representatives. Using live service blueprinting and structured ideation, we:
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identified critical points where cases stalled or were dropped
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agreed priorities for intervention
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explored future-state options that balanced user needs, operational reality, and policy constraints
The focus was on testing service concepts and decision logic before committing to delivery.
Beta
I worked closely with system designers to translate the future-state service into delivery-ready prototypes. These focused on the supporting infrastructure needed to run CHC safely and consistently, including tracking, handoffs, quality assurance, and visibility across teams.
We tested these prototypes through multiple rounds of iteration with a small but representative group of staff from across Adult Social Care, including frontline practitioners, CHC specialists, and operational managers. Testing used real and near-live cases to surface where the redesigned process still created confusion, friction, or risk.
Feedback from each round was used to refine ownership, decision points, information flows, and the practical support staff needed to progress cases confidently. This iterative approach helped de-risk the service before wider rollout.
A snapshot of the prototype
Live
The redesigned CHC service is now live and in active use by Adult Social Care teams. To support adoption and sustainability, I worked with teams to:
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develop clear guidance and training materials
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define troubleshooting and escalation pathways
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embed feedback loops so issues could be surfaced and addressed quickly
The service continues to be monitored using operational data and staff feedback, with ongoing iteration to maintain consistency, compliance, and value over time.
Impact and value
The redesigned CHC service is improving consistency and reliability across the funding pathway, reducing reliance on individual knowledge and making decision-making easier to track, audit, and review.
Based on analysis of previously missed or delayed CHC claims, the service is estimated to deliver ~£1m in annual value, by improving identification and progression of eligible cases and reducing the risk of the council incorrectly funding care that should be NHS-funded.
Impact is being monitored on an ongoing basis by comparing live performance against historic baselines, including:
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number of CHC cases identified and assessed
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number of referrals submitted and accepted
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number of disputes and resolution outcomes
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total value of CHC funding secured
This approach allows the team to understand not just whether the service is being used, but whether it is changing outcomes over time, and to iterate further where gaps remain.
Learnings
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Iterative testing with a cross-section of practitioners and managers revealed distinct failure modes -- from day-to-day usability and workload issues to governance, oversight, and assurance gaps. Addressing both was essential before moving the service live.
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Financial value in regulated health and care systems often comes from preventing missed decisions, not speeding up individual tasks. Designing for consistency, follow-through, and good practice can unlock disproportionate savings by reducing leakage and error over time.
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Bringing senior leaders, operational managers, and frontline staff into the same design conversation was critical to making change stick. Operational buy-in mattered as much as strategic intent.
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Co-created artefacts like service blueprints, design principles, and journey maps were essential for surfacing hidden complexity, building shared understanding, and accelerating decisions across organisational boundaries.