The challenge
A Welsh local authority operates six council-managed residential care homes for older people, with a combined registered capacity of around 200 beds. Like many local authorities across Wales, the council was facing mounting pressure on its in-house care services: squeezed budgets, rising complexity of need, high sickness absence, and an operational environment that had been shaped by years of reactive change rather than planned investment.
The council needed an honest, evidence-based picture of what was happening on the ground – not just in one home, but across all six – to identify where pressure was greatest, where risk was highest, and where targeted investment could make a real difference. Critically, the findings would need to be robust enough to support a business case to cabinet for funding.
Carrying out this work internally was not a realistic option. Operational managers were already stretched to capacity, and an internal review would lack the independence needed to deliver findings that could credibly inform investment decisions at cabinet level.
Our approach
Practice Solutions assembled a multidisciplinary team, bringing together associates with complementary skills: compassionate, relationship-based engagement alongside rigorous analytical methodology.
Listening to the people closest to the work. We conducted structured site visits to all six homes, spending time with registered managers, deputy managers, frontline staff and, where possible, residents and families. Our engagement approach was deliberately appreciative – asking staff not just what was going wrong, but what a good service could look like if the right support were in place. This unlocked ideas and insights that a deficit-based approach would have missed, and ensured staff felt heard rather than inspected.
Building a robust evidence base. Alongside fieldwork, we carried out a comprehensive programme of stakeholder interviews (from the Director of Social Services to the Head of Digital Transformation), desktop review of policy and data, and direct observation of systems and processes in practice. Every finding was tested for both reliability – did the same issue present independently across multiple homes? – and validity – could we trace the problem from cause to consequence through real evidence?
Designing the analysis for action. The review was structured to deliver findings that the council could act on immediately. We identified systemic themes (issues that appeared consistently across all six independently managed homes, pointing to system-level causes rather than individual management failings), assessed impact levels, and organised recommendations into three tiers: quick wins, high-impact investments, and structural change.
Key findings
The review uncovered a consistent picture across all six homes: committed, capable staff delivering good care in spite of their operational environment, not because of it. The systemic issues included:
Administrative burden consuming management time. Rota, timesheet and payroll administration alone was consuming an estimated twelve manager-days per week across the six homes – the equivalent of more than two full-time registered managers lost to paperwork. This was traced to a temporary pandemic workaround that had never been reversed, compounded by five changes to timesheet procedures in six years.
Paper-based processes in an increasingly digital world. The homes were operating in what was described as “almost Greenfield” digital territory. All care plans, referral records and medication information were held on paper. Managers had no access to the council’s primary case management system and were making admission decisions based on static PDF documents that were sometimes a year or more out of date.
Sickness absence at unsustainable levels. Some homes were reporting absence rates of up to 50% – far exceeding the sector norm of 7–9% – managed entirely through manual tracking with no system support and limited HR feedback.
A corporate support gap. Equipment testing, estate compliance and other corporate functions were not proactively managed for the care homes, leaving registered managers carrying the compliance burden and the regulatory risk for actions that were not their responsibility.
The result
The review delivered a comprehensive report with prioritised, costed recommendations that the council could take directly to cabinet. The findings provided the evidence base for investment in these services – framed not as a cost, but as a spend-to-save case with clear returns.
Among the headline recommendations:
- Automating rota-to-payroll processes – with potential to recover the equivalent of two full-time management posts currently lost to manual administration
- Extending the council’s existing digital transformation programme to include the care homes, building on a recent procurement of a dedicated system for domiciliary care that demonstrated both the need and the organisational appetite for purpose-fit solutions
- Strengthening sickness management through system configuration, clearer HR partnership and cultural change
- Establishing a formal escalation framework to replace the current reliance on informal relationships, giving managers a rights-based route to secure action from corporate functions
The report was accepted without amendment. The council’s Director of Adult Services confirmed that the findings were consistent with senior leaders’ own observations and reflected a recognisable picture of the operational environment.
Why it mattered
‘The information she was able to garner from participants by taking that approach was far beyond what the client had anticipated.’
Caitlin Snuggs, Lead Researcher, Practice Solutions
This project demonstrated the value of bringing together independent expertise, robust methodology and genuine engagement to produce findings that are not just credible, but actionable. The council received an evidence base strong enough to support a cabinet-level business case – delivered within a compressed timeframe and at a fraction of the cost of recruiting an internal resource to do the same work.
For the staff in the homes, the review was an opportunity to be heard. For the council, it was the foundation for a programme of investment and transformation. And for the residents, it was the first step toward the operational improvements that will allow the people who care for them to spend less time on paperwork and more time on care.
About this work
Practice Solutions’ operational and business process reviews help local authorities and health boards in Wales build the evidence base they need to invest wisely in their services. Our associate model means we can assemble teams with the right combination of research skill, operational experience and sector knowledge for each commission – and deliver at a pace and cost that in-house alternatives cannot match.
Interested in how a review like this could support your service? Start a conversation or email contact@practicesolutions-ltd.co.uk.
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