Continuing Healthcare

New PM Boris calls for a focus on social care

by Dr Gabrielle Silver

It’s been a busy period in Westminster with our new PM setting out his focus for the coming months.  It was encouraging to hear social care high on his agenda recognising that action is needed urgently.  We’re excited to work together with policy makers and other providers across the public and private sector to support this challenge.  One of the issues that sits at the centre of this, and is something that can be improved without delay, is family liaison – making sure families have the information they need to be able to make decisions to help people into the right care as quickly as possible.

Over the last 20 years we’ve seen the difference this can make to families and services in being able to move out of hospital as soon as they are medically fit.  Empowering people at this point – which can be a very anxious time –  gives confidence and reassurance.  Effective family liaison also means better quality referrals for care homes helping them to come back quickly on decisions about availability supporting the discharge process.  Last year East Riding of Yorkshire Council undertook an independent evaluation of our coordination of hospital discharge and the results showed how much care homes valued our dedicated family liaison service.

Our approach to family liaison is built around dedicated engagement with hospital and local authority teams alongside support for families including  after hours and on the weekend, getting to know the person who is being placed in care so we can understand which local homes will be best for them as well as showing families around care homes so they can decide what is best for their loved one. Getting family liaison right is what motivates our teams every day because they can see the impact it has on finding the right home for each individual and helping them out of hospital as quickly as possible.

The next phase for social care is going to be challenging but the opportunity to contribute to making social care work and supporting people to have security and high quality care in their old age is hugely inspiring – we’re excited to contribute.

CHS Healthcare grows the Continuing Healthcare provision with acquisition of BroadCare

CHS Healthcare has acquired BroadCare, a widely commissioned and highly rated database for NHS funded Continuing Healthcare information.

This exciting new development reflects our commitment to invest in and grow our business.

This acquisition, together with our existing product Caretrack, greatly enhances our CHC provision as a business and the range of services which we can offer. Our CHC data management services now accounts for approximately 75 per cent of all provision to clinical commissioning groups (CCGs) throughout England.

The BroadCare database will continue with all CCG contracts unchanged and employees working on and supporting BroadCare will also continue in their same roles, wholly focused on BroadCare.

We will be continuing to operate both systems as we recognise that Caretrack and BroadCare are very well established and highly valued platforms within the Continuing Healthcare field and we will continue to support and develop both as individual products.

Dr Richard Newland, chief executive of CHS Healthcare, commented: “This acquisition places our company in an even stronger and more dominant position within our field.  Our company vision, supported by our investors BGF, is to grow our company and for our services to be integral to the NHS and the social care sector.”

British banks backed Business Growth Fund invests £10 million in CHS Healthcare

CHS Healthcare has received a £10 million investment from Business Growth Fund (BGF), a major investor in British businesses.

BGF are the most active investor in small and medium sized businesses, supporting growth across all sectors and all regions in Britain and Ireland.

The funding will be used to expand CHS Healthcare infrastructure and operations, supporting the provision of services to the NHS nationwide. We currently contract with more than 60 NHS services, including 28 in-house hospital discharge schemes.

Dr Richard Newland, chief executive of CHS Healthcare said: “BGF’s decision to invest in CHS Healthcare is a huge endorsement of our company and all the work we do.

“We can feel very proud of everything we have achieved: we are the leading provider of hospital discharge services in the country and the largest resource of expertise in continuing healthcare, working nationwide.”

BGF is backed by British banks and is wholly focused on supporting small and medium sized British and Irish businesses, making long term investments and not taking a controlling share of companies.

Dr Richard Newland said: “We are absolutely delighted to embark on this partnership with BGF, who recognise the strengths of our business with this investment and equally, bring the highest calibre of business expertise to support the work we do.”

Gurinder Sunner, investor, BGF said: “CHS Healthcare has developed excellent relationships with its customers by focusing on quality of delivery and care and operational efficiency. We are pleased to be supporting Richard and the wider team as they continue to grow the business and their services across the UK.”

CHS Healthcare has a new hub of specialists located in the renowned Royal Hospital for Neuro-disability in Putney, south-west London

CHS Healthcare has a new hub of specialists located in the renowned Royal Hospital for Neuro-disability in Putney, south-west London.

The team of ten experts in continuing healthcare have moved into the RHN, which has a distinguished 160-year history of meeting the needs of people with profound disabilities.

The move enhances the existing partnership between CHS Healthcare and the RHN. A two- day module in continuing healthcare, developed and delivered by CHS, takes place in the lecture theatre at the RHN.

Carol Groves, Head of Contract Management at the RHN, explains: “From our perspective, the main benefit of this partnership is the knowledge of our client group that CHS Healthcare brings.

“Our residents are at the heart of everything we do, together with their families, who we work with and support very closely.

“Understandably, families find the process of continuing healthcare assessments and reviews extremely stressful. It is very challenging too for the funding NHS organisations. The whole process can create a sense of ‘us and them’ between families and assessors.

“Having a resource of experts in continuing healthcare here within the RHN is a real strength; both for us as a service to support our own understanding of this critical arena and equally, is good for our residents and their families.”

The CHS Healthcare team at the RHN is currently commissioned to provide an end-to-end continuing healthcare service for Wandsworth clinical commissioning group.

This encompasses managing all new applications for continuing healthcare funding, all reviews of existing funding and appeals, together with all aspects of CHC administration and management. CHS Healthcare also provides end-to-end continuing healthcare services for Swindon CCG.

In a recent benchmarking exercise, both end-to-end services for Wandsworth and Swindon were shown to deliver outcomes consistently within national median levels (if continuing healthcare funding awards are either extremely high or low, compared with national averages, the application of the national framework is likely to be incorrect).

The CHS Healthcare team located in the RHN is commissioned by Wandsworth CCG. They are currently responsible for continuing healthcare services for Wandsworth patients only, but future collaborations with other CCGs are possible. As a highly specialised hospital, the RHN has patients funded by CCGs all over the country, many of whom are a long distance from the hospital, so patients are assessed by nurses located hundreds of miles away.

Lynn Cunningham, Chief Operating Officer at the RHN said: “We are always keen to collaborate and to build partnerships, but these are frequently used terms; you need something tangible to bring collaborations to life.

“Research and education has a very important place for us, so we recognised the value of the two-day module in continuing healthcare developed by CHS Healthcare. Many of our staff have completed the module and benefitted from this experience.

“Moving forward to having a team located here in the RHN, we both share a vision which is about quality, specialist knowledge, values and development. This partnership feels very fortuitous and mutually beneficial.”

Harry Bourton, CHS Healthcare regional manager leading the team in Wandsworth, commented: “We are deeply appreciative of the way the RHN has supported us, both in terms of accommodating our team and in hosting our continuing healthcare module.

“We are very proud to be working with the RHN which has such a distinguished history of working with people who have profound disabilities. It is a very special place and we are delighted to be working here.”

Open day marks new era for continuing healthcare centre of excellence

We are holding an Open Day to mark a new phase for our Stoke centre of excellence in continuing healthcare services.

NHS commissioners and local services are attending the event on May 24th to open a new training centre and base for our highly respected continuing healthcare team.

The CHS Healthcare service in Staffordshire was first established in July 2015 as an administration hub commissioned to manage the backlog of retrospective claims for continuing healthcare funding. The team, commissioned by 19 clinical commissioning groups, managed one of the largest caseloads of its kind in the country.

Within five months, their work was nominated for an NHS Inspiring Change Award. The caseload was completed within the agreed framework during 2016.

“I am incredibly proud of our team in Stoke, who have consistently met challenging targets from the start,” comments Art Calder, Head of Clinical Services for CHS Healthcare.

“As a result of this experience and the extensive values based training and education every member of staff has undertaken, we have a proven centre of excellence in continuing healthcare in Stoke.”

The team of 23 in the Stoke continuing healthcare hub now provide ongoing continuing healthcare support services to nine clinical commissioning groups across England. In addition to assisting CCG’s directly with clinical review and assessment processes, the team also provide valuable support in the management of inevitable challenges, including appeals and new requests for retrospective review.

They moved to a new headquarters in April 2017 to meet the needs of the growing team in facilities which include a training centre.

Business Development Manager for the Continuing Healthcare Hub, Stoke, Jody Collier, said: “We see the Open Day as a celebration not only for our team, but of many strong partnerships we have built across the NHS and social care sector.

“Several of our neighbours in Park Hall Business Village are home care services who are joining us for the Open Day, together with NHS partners. We can be very proud of the fact that Stoke has this centre of expertise in the highly specialist field of continuing healthcare, providing support to NHS services throughout England.”

CHS Healthcare is one of the largest independent providers of continuing healthcare services to the NHS in the country, and the only one with CHC service contracts operating within all four regions of England.

The Open Day will include a talk by Art Calder, who is acknowledged as a leading national expert in continuing healthcare and lunch will be provided.

If you and your colleagues would like to attend the open day, which takes place from 12 noon to 2pm, please contact Jody Collier on 01782 467921 or 07471 357160


Chief executive praises our new service in Dorset following many messages of thanks

One of our newly commissioned services has received so many messages of thanks that the trust chief executive has singled it out for praise.

Hospital discharge family advice and support services in Dorset County Hospital have been praised in the trust’s chief executive bulletin, stating:

“Messages of thanks and praise have been received from patients, relatives, staff and other organisations for … The Care Home Selection team at Dorset County Hospital for supporting patients discharges from the Stroke Unit.”

Our service in Dorset was launched at the start of February. We have recently expanded our work on the south coast, additionally commencing a service in Bournemouth in January. This is in addition to our longstanding and very well regarded hospital discharge service in Southampton.

Susan Adams, CHS Healthcare Regional Manager (south), commented: “We are very pleased to receive this excellent feedback so soon after our service commenced in Dorset. The service is managed by our very experienced business manager Melissa Allin and we have really strong teams in place in both Dorset and Bournemouth, as this feedback shows.”

What factors make a hospital more at risk of pressure and escalation? Taking a look at the evidence

By Harry Bourton

With a focus on the relentless pressure facing the NHS currently, it may be valuable to approach the issue from a slightly different angle. While the whole system is under enormous pressure, it is also apparent that some hospitals are at greater risk of escalation and delayed discharges. Why might some hospitals have higher or lower levels of risk?

Researchers from the University of York’s Centre for Health Economics considered this in a major study published last summer, entitled Delayed discharges and hospital type: evidence from the English NHS Researchers looked at data for delayed discharge over a three-year period for all hospitals to see whether any patterns were apparent according to hospital type.

They concluded hospitals that are foundation trusts had lower rates of delayed discharges and suggested this could reflect better practice among foundation trusts. They also found a correlation between local availability of care home beds and lower rates of delayed discharges.

Overall, mental health trusts had the highest rates of delayed discharges, perhaps reflecting lack of services and variation in service availability within the community, researchers suggested.

The close correlation between availability of long term care beds in the local community and delayed discharges is cited several times in the report. However, the authors do state: “Hospitals can also reduce bed blocking by good discharge planning and communication with long term care providers.”

In other words, while there are factors which are out of hospitals own hands, there are measures that can be taken to achieve greater control over discharge.

The Health Service Journal also recently produced data which illuminates the theme from a different angle. They considered which trusts had declared level three and level four alerts, the highest escalation under the OPEL framework (Operational Pressures Escalation Levels Framework) from December 1, 2016 to January 20, 2017. During this period, hospitals issued a total of 830 OPEL alerts.

They found ten trusts were responsible for more than a quarter of all level three and four alerts. The south of England region was particularly over-represented, producing more than half of all alerts. Yet London hospitals produced a tiny proportion of total alerts, issuing just five during the measure period.

What does this tell us? Debate which followed the data suggested London hospitals are under-reporting pressure, perhaps due to their view of what issuing a level three or four alert will achieve. Why is the south of England so over-represented among hospitals reporting the highest levels of pressure? This perhaps correlates to the University of York’s hypothesis that delayed discharges are associated with lower availability of care home beds in the local community. Certainly, there is an acute shortage of care home beds in many parts of the south of England, although equally, this is a problem that is not confined to the south and is widely evident elsewhere.

Some commentators suggested the best measure of real pressure would be a figure not yet widely used: for each trust, the percentage of blocked beds as a proportion of the hospitals overall (non specialist) bed numbers. This seems a measure which would be very helpful. The question that follows from that would be: looking at those blocked beds, is expediating discharge within the control of the health and social care system? Working in this area for 20 years, we would argue that while some factors like provision of community beds in care homes may be outside of control, discharge management can be improved with the focused, dedicated services we provide. This includes working very closely with care homes to establish exactly what availability there is and partnership working to optimise the use of those community beds.

“Everyone is well meaning but no-one is in charge of the process”. Learning the lessons of Iris’s six-month hospital delayed discharge

Media interest in the issue of delayed hospital discharges recently found an individual focus in 89-year-old Iris Sibley.

Iris spent six months in hospital waiting for a care home place where her nursing and dementia needs could be met.

She was in hospital in Bristol and although the length of her delayed discharge is particularly concerning, trusts across the country would recognise there are many others like Iris facing very long stays because they are unable to safely move into community based care.

Iris’s story was told on Radio Four’s Today programme, with health representatives talking about staff making a “more or less daily effort” to call care homes.

Radio Four presenter Justin Webb concluded: “Everyone is well meaning but no-one is in charge of the process.” This is echoed by Iris’s son John, who says: “It is just a system where you are going from one organisation to another and no-one seems to be co-ordinating.”

They struck me as very insightful comments. Both the family and the presenter were not blaming the staff involved, but were clear that the flaw lies in the process; in trying to accomplish a very challenging task without co-ordination.

Working in this field for 20 years, we recognise that hospital discharge for patients with complex needs requires relentless focus and co-ordination.

We expect the process of co-ordinating discharge to take at least 25 phone calls (often on a single day) for patients moving from hospital into a care home, if their needs are fairly moderate.

We have previously described how care for people with Iris’s needs, both nursing and dementia care, is particularly scarce. For patients like Iris, we would expect our care advisers to be making at least 40 phone calls simply to source an appropriate care home and that is before the process of arranging discharge begins.

Our advisers contact care homes by calling them; we don’t use automated systems or email for first contact. We offer to visit and transport families on care home visits, which is highly valued by families and enables our advisers to build up strong relationships with homes.

We recognise the need to ‘go the extra mile’ to achieve discharge. For example, when there was a delay in a Fast Track hospital patient being assessed because the care home manager had been on holiday, our adviser visited the care home and persuaded a manager from the same care home group to do the hospital assessment instead.

Crucially, our advisers work evenings and weekends. This makes an enormous difference in reducing delays, particularly as this is often the time when working families are able to spend time choosing and arranging care. Our advisers always contact families within 24 hours of a referral being made and once an adviser is allocated a patient, they are wholly responsible for taking charge of their discharge.

Going back to Iris: hospitals need a service wholly focused on discharge. It is not realistic to expect hospital based staff, who have other priorities, to do the huge amount of time-consuming work to achieve complex discharge in a timely way. Equally, it is easy to see how this challenging task becomes fragmented when different professionals and individuals provide input but no one person is in charge of the whole process.

Read more about our hospital discharge service including key performance indicators, evaluation and service user feedback.

Family Support Work Is Commissioned In Nine New Hospitals

We are pleased to launch a range of new family support for hospital discharge services spanning the south coast to the north of England.

We are providing new services in nine different hospitals, focusing on helping families to make care choices, together with care co-ordination work.

“With the NHS under enormous financial pressure, together with the impact of winter, we are pleased to be able to provide this additional support,” commented Dr Richard Newland, chief executive of CHS Healthcare.

During the past month, we have been commissioned to launch new family support services in nine hospitals, in addition to our existing schemes. This means CHS is now working in 35 hospitals across the country.

“Our hospital discharge services are well known, proven and highly regarded. This credibility is reflected in the very significant increase in demand for our support that we have recently seen.”
Family support for hospital discharge is a service CHS has been providing in the NHS for 20 years. It is for patients and their families when the patient needs care and support in order to leave hospital, such as finding and choosing a care home. Our advisers work flexibly, including evenings and weekends, meeting families, helping them to match their preferences with care availability and supporting them with all the arrangements required.

Our key performance indicators are: family is always contacted within 24 hours of referral, home choice is made within 48 hours and discharge is five days after referral, substantially reducing DTO (delayed transfers of care).

New family support for hospital discharge has been commissioned by Medway NHS Foundation Trust, University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Berkshire Trust and Dorset (county-wide, encompassing four hospitals).

We are also highly experienced in discharge to assess services, co-ordinating care for individuals who move out of hospital into commissioned beds in order for further assessments to take place.

This service has been recently commissioned by NHS Nene Clinical Commissioning Group and the Royal Free London NHS Foundation Trust (service for Barnet Hospital).

Lord Carter visits Royal Surrey County Hospital to see a CHS hospital discharge service

Lord Carter visited a CHS Healthcare hospital discharge service at the Royal Surrey County Hospital to see the model he praised in his landmark review of the NHS.

The Royal Surrey County Hospital is one of 29 discharge services CHS Healthcare operates throughout England. Our service at the Royal Surrey County Hospital is for patients who are fit for discharge but are moving into 24-hour care or need a package of care in order to return to their own home. Lord Carter visited the hospital and saw how the service operates on November 1.

We provide focused support and advice for the patients and their families to help them choose a care home and co-ordinate all arrangements.

In his report, Operational Productivity and Performance in NHS Acute Hospitals: Unwarranted variations, Lord Carter urged hospitals to take “matters into their own hands” by commissioning models such as those run by CHS to reduce the rate of delayed discharges.

Lord Carter commented: “The national strategy should encourage trusts to do more of this to find rapid local solutions to the problem of delayed transfers.”

Dr Richard Newland, chief executive of CHS Healthcare, explained: “Since inclusion in this landmark report, I have been pleased to have the opportunity to meet Lord Carter several times as part of his ongoing work to drive forward and support transformation in the NHS.

“We were delighted to be able to show Lord Carter how our hospital discharge service works in practice; the multiple steps required to achieve a timely discharge when there are often complex needs and how we meet all the challenges.

“We would like to thank our partners at the Royal Surrey County Hospital, particularly chief executive Paula Head who also met Lord Carter. We are proud of our strong and effective partnerships with the NHS organisations who commission our services.”

Susan Adams, regional manager of CHS Healthcare for the south of England, showed Lord Carter how CHS operate a flexible working model, including evening and weekend working, to ensure key performance indicators are met. Patient and/or family is contacted on the same day as referral, care home is chosen within two days and transfer to the care home achieved within five days.

Mrs Adams commented: “This is one of our core services that we have been providing for 20 years. We typically reduce DTOC (delayed transfers of care) by five to ten days, depending upon previous performance and in so doing, save hospitals hundreds of thousands of pounds, as evidenced in Lord Carter’s report.”

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