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Continuing Healthcare Webinar Series: ‘From recovery to integration: Developing the future of Continuing Healthcare’

The impact on Continuing Healthcare from Covid-19 was immediate and significant, as the implementation of new community pathways has changed how teams work, as has interim funding. 

We’re now seeing a significant backlog of patients waiting for elective surgery currently 5.6 million patients, with 293,102 waiting for more than a year (as of July 2021). This pressure impacts Continuing Healthcare by stretching scarce resources – staff and nursing beds in the community.

As we look ahead the introduction of integrated care systems provide opportunity for improvement in the delivery of Continuing Healthcare. Commissioning at the scale of an ICS could:

  • Reduce variation through improved training 
  • Allow scope to support new specialist roles
  • Give momentum for updated back-office function utilising tech and analysis
  • Support leads to work at a more strategic level 

At the centre of this is supporting patients and their families as they navigate a complex system at a time of real stress and worry. 

Since the start of the pandemic, we have run several webinars bringing together NHS teams and experts. These have been informal sessions sharing insight and experience. We know that there are many questions about the future of Continuing Healthcare so we have designed a series of webinars over the autumn and winter which will consider these.

The first in this series, Driving quality, safety and efficiency with data in Continuing Healthcare will take place 24 September.

While data is regularly used for tracking CHC costs and managing CHC budgets, we’ll look at how it can be used to identify efficiencies, support QIPP targets and help ensure patients receive safe and appropriate care. 

Facilitated by Harry Bourton, National CHC Operations Manager at CHS Healthcare, he’ll be joined by:

  • Hayley Tingle, Chief Finance Officer at NHS Doncaster Clinical Commissioning Group and Acting Chief Finance Officer at NHS Bassetlaw Clinical Commissioning Group
  • Andrew Whittingham, Associate Director of Finance, NHS Cheshire CCG

The panel will address the following questions:

  • Does the move to ICS create an opportunity to improve data quality?
  • Can we develop targets around patient safety which are specifically data related?
  • Is data being effectively leveraged for QIPP targets?
  • What are the financial risks in a number of CCGs coming together as a single ICS?
  • Are there any risks in terms of contingent liabilities for those CCGs declaring backlogs in CHC assessments and reviews?

Following that upcoming sessions will include:

  • October – Continuing Healthcare within Integrated Care Systems
  • November – Developing skills and capacity within the Continuing Healthcare workforce
  • December – Driving the effective management of personal health budgets in Continuing Healthcare
  • January – Digital platforms and best practice for reviews and assessments 
  • February – From DoLS to Liberty protection safeguards – implications for Continuing Healthcare 
  • March – Update on reviews and assessments case law and PHSO report 

To join the first of the webinar series on 24 September, visit the link here. We will update this page with more detail on the programme, speakers and invite links as they are confirmed. 

For more information on the series or individual webinars, please contact Ben Hackwell at ben.hackwell@chshealthcare.co.uk to find out more.

Reflection on ‘Build Back Better: Our Plan for Health and Social Care’

The new funding announcement by the Prime Minister is very welcome and investment in the health and social care system is badly needed. It has been a difficult time for patients: five million are waiting for treatment and the pressures on social care are intense. Although health and care chiefs have said the £12 billion a year package is still not enough money to solve the problems, this cash injection does present an opportunity to make a difference to the lives of patients and people in receipt of care.

 

Right now, all those in the health and care sector need to be truly patient-focused and work collaboratively to achieve the prime minister’s stated ambition to ‘fix the crisis in social care once and for all’. The opportunity is in the hands of the new Integrated Care Systems (ICSs) which were set up to provide patient centered health and care, bringing together organisations to work together across larger geographies. This collective includes the private and third sector whose solutions can help ICSs achieve the goal of better outcomes for patients. 

 

CHS works closely with the acute sector to provide services to help patients with efficient and timely discharge from hospital and supports colleagues in CCGs and local authorities to organise the provision of care packages, providing governance and visibility in this process with our technical innovations. 

 

But the NHS and social care will really have to start working differently and practical things like procurement need to be resolved quickly. As organisations come together, we are seeing contract sizes for these larger populations get much bigger – often tenfold – which means that commissioning services will become more complicated. 

 

The promised investment is an important step forward for health and social care and will breathe momentum into fixing the problems that the Prime Minister promised on the steps of Downing Street in 2019.  

Interim care funding: what next after September 30?

Uko Umotong

National Discharge and Community Services Manager

  • £594 million in funding from April to September 2021 provided for hospital discharge
  • Six weeks funding has been reduced to 4 weeks for those discharged up to September 30

For those working across the healthcare system in England, many will be aware that back in March, the government committed to supporting hospital discharge by providing £594 million in funding from April to September 2021.

This commitment was made to maintain flow across hospitals enabling patients to leave the hospital as quickly and as safely as possible by removing some of the traditional barriers such as funding allocation and choice delays.

National discharge funded care package & patient backlog

The £594 million in allocated funding was broken down into two duration periods to deliver post-discharge recovery as well as support services and rehabilitation.

  • Between April 1, 2021, and June 30, 2021: people discharged would receive up to six weeks of funded care
  • Between July 1 – September 30: eligibility for funded care following discharge was reduced from six to four weeks
  • With the reduction in the period for funded care for those discharged from July 1onwards, it’s essential that patients receive the necessary assessments and planning within the four weeks, meaning D2A processes must be efficient and effective
  • The picture for funding after September 30 is unsure. Without any additional funding agreed all funding will return to core system budgets. Stakeholders including NHS Providers are making the case for why the funding must be maintained as a key driver of patient flow.

Why is this all so important? This wind down in funding is happening against a backdrop of the elective surgery waiting list reaching 5.3 million, with 336,000 waiting for more than 52 weeks with fears it could reach 7 million by the end of the year. This sits alongside an ongoing threat from Covid with seven trusts having over 10% of their occupied adult general and acute beds taken up by Covid patients on the 3rd of August. The additional funding provided by the government throughout the pandemic has been seen as an enabler for improved discharge out of the hospital because it removed systemic issues which have slowed flow down in the past.

So, what for the future? 

The move back to core budgets has the potential to stifle patient flow at a time when it is critical it’s maintained. We all remember the challenges of DTOC and super-stranded patients. But we also know from before the pandemic that patient flow can be realised through a dedicated and methodical focus on processes as well as intense engagement with patients and families.

We work with NHS organisations across the country and have over 20 years of experience focussed on hospital discharge. We know how hard NHS teams work and how challenging the last 18 months have been. With increased demands and increased complexity, the expectations on NHS teams have never been higher.

We can bring dedicated and focussed support:

  • Securing the right D2A capacity on behalf of commissioners and managing this capacity so that the right beds are available at the right time
  • Supporting patients out of the hospital, e.g., arranging TTOs
  • Working with providers and the NHS to make sure assessments and rehabilitation for individuals happen as soon as they can, following up when they don’t occur and preparing patients for long term care
  • Supporting families to help them make decisions. This includes being available after hours and at weekends to talk through options and discuss what is best for their loved ones

We have a singular focus – making patient flow work. We are experts in family liaison and have an unparalleled understanding of local care provision. We understand the NHS, and We work on an ongoing basis or for a dedicated period.

With undoubtedly another difficult autumn ahead for the NHS we must apply the know-how gained before and during the pandemic to avoid issues like delayed discharge or stranded patients, which would lead to even further months on waiting lists for those in need of elective care.

Continuing Healthcare: Getting it right first time Key takeaways from the Parliamentary and Health Service Ombudsman’s report

The Parliamentary and Health Service Ombudsman (PHSO) released its report, Continuing Healthcare: Getting it right first time, in November 2020. The report is the culmination of the PHSO’s review of complaints concerning NHS Continuing Healthcare (CHC) between April 2018 and July 2020. 

CHC cases are reviewed by the PHSO when they are not otherwise resolved by NHSE. The PHSO’s findings are shared publicly, with the goal of holding organisations to account and offering opportunities to learn from past mistakes. In this report, failings were identified on the part of CCGs both in the planning of care and support as well as in reviews of previously unassessed periods of care. On the former, failings in care and support planning paired with poor communication resulted in families bearing additional costs for care. On the latter, failings in reviewing previously unassessed periods of care resulted in families facing long periods of uncertainty about finances, as well as financial and reputational risk for CCGs. Getting these reviews right and ensuring past mistakes are not repeated is critical.

Having identified these failings, the PHSO made a series of recommendations, including:

  • Supporting the skills of NHS CHC practitioners, to ensure that staff have the skills and experience necessary to undertake CHC assessments
  • Sharing learning nationally, through a review of the current CHC learning opportunities and tools, and delivering additional educational opportunities for the workforce
  • Supporting people and providers through the NHS CHC process, by ensuring that everyone involved is aware of funding arrangements and additional service requirements
  • Developing national guidance for reviewing previously unassessed periods of care to clarify CCG’s obligations
  • Ensuring that CCGs have the capacity to meet these obligations

The report and its findings arrive during an incredibly complex time for the NHS and CHC alike. As a result of COVID-19, the Government announced a pause on CHC reviews and assessments between March and August 2020 and implemented interim funding for hospital discharge and care placements. Throughout the pandemic, organisations across the country have been adopting various approaches but in the midst of another lockdown and ongoing pressures on the system, ensuring that review and assessment processes are being undertaken efficiently and effectively is critical – both for current cases as well as those previously deferred. 

The key to achieving this will lie in effectively implementing the PHSO’s recommended measures; ultimately it is about ensuring the specialist skills and the capacity to manage this process are in place and clear communication is maintained throughout. CHS Healthcare is uniquely placed to support this process, having provided clinical support, advice, and consultancy in CHC to over 100 CCGs, and holding the largest CHC footprint in England, with services across all 7 regions.

You can read the PHSO’s report here

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 Jody.Collier@nhs.net

 

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.”

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