Driving quality, safety and efficiency with data in Continuing Healthcare

Harry Bourton, National CHC Operations Manager, CHS Healthcare

On 24 September, we held the first installation of our seven-part, monthly webinar series ‘Driving quality, safety and efficiency with data in Continuing Healthcare’.

We were joined alongside by Hayley Tingle (Chief Finance Officer at NHS Doncaster Clinical Commissioning Group and Acting Chief Finance Officer at NHS Bassetlaw Clinical Commissioning Group) and Andrew Whittingham (Associate Director of Finance, NHS Cheshire CCG); as we discussed the most pressing finance and data related issues facing CCGs today.

Consistency of data across CCGS:

We all know that data and finance play a crucial role in terms of CHC delivery for our caseloads across CCGs and across the country. But we need to be asking the challenging questions of whether we are making the most of it, can we do more with data and CHC budgets and importantly how can we use data and finance to drive quality, patient safety and efficiency with Continuing Healthcare.

As CCGs shift into becoming an ICS, there are many concerns regarding the coming together of multiple systems and processes.

“One of the main issues we’ve found is having data that is comparable or being coded and processed in the same way”, said Andrew.

“In just bringing four CCGs together we’ve found that organisations have all adopted a variety of methodologies and that processes and calculations were all very different. One of the real big challenges has been trying to make sure we all work together and conduct processes in a clear and concise way.

Because CCGs manage their processes in a very specific way, that when new processes are rolled into a new CCG it suddenly creates a very large overspend because they have historically not counted for things like overdue reviews, people on waiting lists or year on year increases in CHC. It ultimately comes down to getting the right amount of consistency to drive forward successful processes and make the financial aspects of CHC work together.”

Risk share arrangements

Looking ahead to April next year and the risk share arrangements made in advance of an ICS, Hayley noted that:

In South Yorkshire, they have yet to go through a merger and still exist as very separate CCGs even with the overarching ICS. Those risk sharing arrangements have not yet been considered as all the energy and resources is focusing on essentially closing down CCGs and looking at the due diligence of setting up a new statutory body which will be the ICB.

As we approach April 2022, Hayley does not think there will be the time to look at risk share arrangements considering that the delegation and operating model have yet to be communicated.

Hayley cannot see CCGs in South Yorkshire beginning the process of risk sharing arrangements within the next six months as focus will be on transitioning to the new organisation but does see risk share arrangements as a key to the new world beginning in April.

Risk and liabilities as CCGs merge into the ICS

When thinking about the formulation on an ICS within CHC specifically, it’s important to consider whether there are any risks or liabilities for those CCGs who may still have a backlog of CHC assessments or reviews when they enter an ICS in April of next year?

Covid-19 in general has put CCGs in a position where they may have been up to date with reviews and assessments but have unfortunately experienced a major setback in this regard due to the surmounting pressure on staff.

Relating to his own experience in Cheshire, Andrew notes the effects of Covid-19 and the difficulty it has led to in hospital discharge with nurses being pulled in every direction and unable to focus on conducting reviews and assessments.

With pressure on workloads hitting unforeseen highs, this has in turn built up a backlog to where organisations may not be able to clear it up prior to ICS integration. The inability to catch up will impact budgets going forward and if an organisation hasn’t assessed or reviewed a patient, they are ultimately deflating current CHC expenditure.

This will in turn lead into the following year when organisations will undoubtably be hit by the cost. Which is why it’s critical that we create a provision around this, as organisations will eventually feel the brunt of it when they finally catch up on reviews and assessments.

QIPP – how can data support targets?

With a number of financial risks to be considered and potential regulations around implementation, it’s also important to ask if data is being effectively leveraged for QIPP targets and how data can be used to help meet those targets?

Andrew notes how in Cheshire that they’ve been quite reliant on systems such as BroadCare and the data they pull from various reports to create a strong baseline of information. His team have already completed the QIPP work around ensuring processes are robust and follow the set framework, but when it comes to finances, they rely heavily on data to provide a baseline and use that to measure future performance.

It’s essential that stored information on patient systems is up to date and relevant. And the best way to achieve this process is through the proper staff training for sometimes complex and detailed systems like BroadCare.

Has QIPP had its day?

Another more general question to consider when discussing QIPP targets is whether they

have a place in CHC?

Hayley quite strongly noted that we should absolutely be putting QIPP targets in and we should do so continually, even if we think we’ve exhausted it every year, it’s critical that we continue to push and push.

“We are custodians of taxpayers money, and we’ve got make sure we get full value on that”, said Hayley.

How well can data predict the future?

The shift to ICS also creates an opportunity to improve data quality and lead to the question as to whether we use data enough to deliver CHC and forecast for future spikes in activity?

Many CCGs rely heavily on reports from their respective databases which in turn helps manage the sheer volume of patients and forecast those, as well as accrue for the costs we have yet incurred.

In Cheshire, Andrew notes that they use the funded care report to look and benchmark their CCG against other local and paired CCGs to help spot trends and activity. The data points and eligibility rates from a report such as that help feed the future forecasting to help organisations better understand where CHC may go in that particular year.

“By analysing the trend data and forecasting, we can then build in a percentage increase that might be either patient or price related so that we’re prepared throughout the year and understand our financial liability”, said Andrew.

To learn more about the financial and data risks within CHC and how to manage them, please contact Harry Bourton at Harry.Bourton@chshealthcare.co.uk to find out more.

CHS Healthcare has been supporting CCGs with Continuing Healthcare nationally since 2013 and are well-placed to support CCGs and local authorities to tackle their current and ongoing priorities. For more information, contact enquiries@chshealthcare.co.uk to discuss your needs.