Guys and St Thomas’ partnership: supporting shielded patients

CHS Healthcare, a provider of patient flow solutions to the NHS, is delighted to announce their partnership with Guys and St Thomas’ NHS Foundation Trust to provide domiciliary phlebotomy and swabbing services to their shielded patients, in the safety of their own homes.  CHS Healthcare’s team are coordinating phlebotomy support to both adults and children who have been required to stay at home during the Covid pandemic.  The swabbing programme delivers MRSA and Covid testing in advance of elective surgical admissions. The service was established within a record two weeks and will support the ongoing care of hundreds of patients each week.

CHS Healthcare’s Chief Executive, Dr Gabrielle Silver, said of the service “ We are very proud to be able to help a leading trust such as Guy’s and St Thomas’ in their objective to help vulnerable patient groups.  We are confident that this service will provide the reassurance to those shielding in the community, whilst also ensuring they continue to receive the highest quality of care”.

The service, which commenced at the beginning of June, is enabled by a bespoke patient management system that CHS Healthcare has developed to ensure the effective tracking and follow up of all the community based patients.

Let’s get assessments and reviews back on track

Dr Gabrielle Silver, CEO

There have been numerous media reports over the last two weeks drawing attention to the issues around the reviews and assessments for older people discharged into the community under Covid-19 funding. A recent Guardian article highlighted the potential harm to vulnerable people caused through the use of easements by Councils under the Coronavirus Act. Here permission has been given to pause or stop assessments, reviews and some care with both Liberty and Disability Rights now raising concerns.

Liberty commented: “The government and local councils should be working to shore up – not weaken – support for disabled people, their carers and those who rely on social care during this pandemic. We need to come through this crisis the right way – with all of our rights intact.”

Obviously ceasing or delaying these reviews and assessments is concerning in terms of patient safety but they are also disrupting the flow of patients from intermediate care into permanent arrangements. It’s fair to say that the longer the system is in stasis the harder it will be to get moving again. And, as times goes on, so the environmental challenges increase. There are still concerns about management of Covid-19 infections in care homes, the financial viability of these homes and as we ease out of the peak of the crisis we will soon be faced with the challenge of potential further peaks and planning for winter. To be able to effectively manage capacity in the community we need to complete the reviews and assessments, so we know exactly what we are dealing with before the next phase hits.

The system and the workforce are bruised from the last weeks’ intensity. Moving forward brings new difficulties around resource management, workforce capacity and infection control. BAU activities e.g. face-to-face assessments feel new and different when they need to be undertaken remotely. But we know from the work we are doing with CCGs that remote assessments can work well – even in complex cases.

It is imperative we push ahead with these assessments. Without them the system is frozen at a time when it desperately needs clarity around capacity and finances. And most importantly we have a duty of care to do the right things for older people currently in care, as well as those that will come into care in future months.

Jennifer Dixon, CEO of The Health Foundation, said in her statement to the Health Select committee last week: ‘COVID-19 has also demonstrated how the health and care system can move fast, implement new technology and ways of working, and the deep commitment of NHS and care staff. All of these will be needed, with resources to match, to face the challenges ahead’.

I would echo her points and add that private sector partners are critical to getting the system moving. The NHS and Social Care systems are not islands and nor should they be. It’s time to embrace the breadth of the sector – and that means all of the knowledge, innovation and capacity that exists in private sector as well. We are here to help for the benefit of all stakeholders.

We have to talk about the money

By Dr Gabrielle Silver, CEO

Earlier this week, Chancellor Rishi Sunak gave an update to the House of Lords Treasury Committee on the financial impact of COVID-19.

Debt has been used strategically to support the country through this crisis, whether that has been a debt write off for trusts, an open cheque book for the NHS, funding for CCGs and local authorities to support COVID-19 preparedness, or the furlough scheme.

We all know that in the long run this debt will need to be tackled and that further borrowing will need scrutiny and debate – when is it right to use debt and when do we need to look at other ways of managing costs through measures such as tax increases? The defining line for these decisions is starting to become clearer.  It is around borrowing where additional funds are needed to deliver against urgent pandemic requirements versus funding ongoing public services which are needed regardless of COVID-19.

At the moment, older people discharged into the community to create capacity for COVID-19 are funded via the NHS under COVID-19 provision. This funding was made available to support the pandemic emergency and facilitated the rapid discharge in March of around 15,000 people. In the pre-COVID-19 world these older people would have been assessed and allocated either as self-payers, funded via LAs or funded via the NHS (Continuing Healthcare).

As we move out of the peak of the crisis the urgent need for this emergency funding gives way to individuals’ ongoing care and therefore the system must revert to the traditional funding routes supported through taxation rather than borrowing.

The Treasury estimates that borrowing this year could reach £337bn vs £158bn at the height of the global financial crisis. Sunak said yesterday that the impact of the pandemic will cause a “severe recession, the likes of which we haven’t seen”. We all know there is a real focus at the moment on getting the economy moving again with employers working hard to design solutions for social distancing in workplaces, and we’re seeing the challenge facing public transport and schools. We’re seeing independent hospitals begin to go back to BAU, and we’re starting to see the NHS prepare for elective surgery with around 8m people waiting for operations.

It may be tough to talk about funding when social care providers and older people have been through so much and are still experiencing such a difficult time. The drive to move back into some semblance of normality in terms of funding of care is the right thing to do. The debate around social care reform will continue, and should receive priority, but in the meantime, we need to move out of emergency measures so we can understand the financial reality facing the sector as well as ensure older people are getting the right care in the right place.

And we don’t have to reinvent the wheel. We can make our lives easier by utilising existing frameworks and processes which give CCGs access to support, additional workforce and dedicated expertise to implement processes to bring the system back online.  Doing this does not negate the need for social reform – in fact it will make that reform easier to grasp and therefore more possible.

Supporting patients and their families throughout the COVID-19 pandemic

An interview with Reagan Chakki, whose mother was helped by CHS during COVID-19

In December 2019, 67 year-old Kathleen Walsh suffered a brain injury while on holiday in Spain. She was treated in a Spanish hospital and after a month was discharged and her family in England flew her back to the UK. Once she was home, her family realised that she would need further treatment and rehabilitation, so took her to the Queen Elizabeth Hospital in Birmingham where she was admitted. Her condition required specialist neuro rehabilitation and while she waited for a space in a rehabilitation centre to become available, Kathleen was transferred to her local hospital, Heartlands. She was there for two months.

Kathleen’s daughter Reagan said: “Mum was stuck in an acute setting that she didn’t need to be in, and she was deteriorating day by day.”

At the end of March 2020, Kathleen had still not been discharged from hospital and her family were becoming increasingly worried by the threat of Kathleen becoming infected with the coronavirus at the hospital. They knew that she needed to be discharged as soon as possible.

It was then that Reagan, Kathleen’s daughter, was put in touch with CHS Healthcare and was assigned to her adviser, Debbie, to help discharge Kathleen from hospital and find somewhere that would meet her immediate care needs.

Reagan said: “Debbie helped me get mum out of hospital, so she was safe and out of immediate danger of COVID. My conversation with Debbie was open and honest and dealt with my mum’s care needs. Debbie was just brilliant, not only did she keep me updated, she went over and beyond what she needed to do, and she made us feel like mum did count and she was important”.

Within two weeks, Debbie had arranged for Kathleen to be discharged from hospital and into a neuro rehabilitation centre in Northampton, where she can really start to recover from her accident.

Reagan says: “Mum’s doing really great. They have kept her safe and she has progressed cognitively.”

After Kathleen was discharged from hospital, Debbie continued to check in with Reagan and make sure that Kathleen was receiving all the right care she needed. 

The support is appreciated by Reagan: “Debbie never gave up on us. She made it her goal to get her into the right setting.”


We can’t let vulnerable people be victims of inaction during COVID-19

By Art Calder, Head of clinical services

In February, I warned about the growing backlog of our Learning Disability Mortality Reviews (LeDeR) and the vulnerability of this population group in the face of COVID-19. Regardless of the pressure on parts of the NHS at the moment it is essential all that all cases continue to be reviewed, both as a moral obligation to patients’ families and to help improve care in the future.

Last week the HSJ reported how, as clinicians are needed on the frontline in the fight against COVID19, the reviews have stalled yet again. And at the same time referrals to the programme has risen since 19th March 2020.

We know from the Shielded Patients list that many of our learning disability patients are vulnerable because they live with co-morbidities. This risk is escalated through social distancing required within their day to day care and the fact that many people with learning disabilities lack appreciation of the need for social distancing especially when this contact is critical to their own mental wellbeing.

At CHS, we haven’t let COVID19 get in the way of our LeDeR programme. Our teams continue to review all cases that come in our direction. To make sure we are delivering these safely we have adapted our approach and are undertaking these remotely, getting families involved through calls to explore the care their loved ones are receiving and understand any concerns or issues they have or remaining questions they may want answers to.

These reviews are more important now than ever. Only last week we heard alarming news over the dubious application of ‘blanket’ Do Not Resuscitate (DNR) forms being used for particularly vulnerable acute hospital patients presenting with a learning disability.

We have adjusted our clinical reviews to ensure that such circumstances are fully explored in the course of each review.

At CHS we will not take our eye off the ball. We’re concerned that high quality care for people with learning disabilities will suffer during this pandemic and alongside their human rights too. We’re working remotely to make sure we can continue to maintain contact with all of our patient services. And this is true too of our LeDeR casework. As healthcare professionals we know this is the right thing to do and so do families.

We should be judged by how well we support the most vulnerable through this pandemic – we believe we can do right by them and right by their families.

Getting back to normal is the last thing we need.

By Gabrielle Silver, Chief Executive

The NHS is ‘getting back to normal’ with preparations underway for routine operations, getting cancer screening services running again and encouraging people to attend A&E or see their GP with any health issues.

‘Normal’ is an appealing idea at the moment but one of the things we have learned over the last weeks is that the old normal wasn’t perfect. In exiting this phase of the pandemic we need to ask how we can move forward and shake off old habits and ways of working that didn’t always deliver the best outcomes for older people and their families. We need to move forward, support and grow better ways of working making sure the health and care we provide for older people is more resilient and fit for the future.

There are three things which stand out for me:

  1. This crisis has highlighted cases where older people have been left to the elements in an underfunded and poorly coordinated care system. This can’t be allowed to happen again. The tales of horror taking place in UK care homes are repeated in Spain, Canada and the US. This issue is not unique to the UK but we are unique in that we have a universal single health and care system, one that is world-leading in many respects, but the gulf between the care provided in a traditional health setting vs that in the community has been exposed. This isn’t about a lack of commitment from the people working in the community but rather indicative of consistent underfunding and a lack of functioning cross-sector working. It’s time to challenge how social care is delivered, funded and incentivised.
  2. There will be much to unpick from what was missed in the last two months and how acute care was prioritised over everything else. We’ve highlighted the importance of maintaining visibility of the 15,000+ people discharged under Corona Act. For these people their care is currently being funded by the NHS. This will not last in perpetuity. Where records were not maintained or assessments not undertaken it will prompt concerns about where these older people will live and be cared for in the long term as well as who will pay? This will add to the stress for families, older people and providers as well as slowing the system resetting.
  3. Private partners are central to the solutions and progress needed to ensure the health and care system can thrive. The challenge that support from private partners is optional and can only be temporary needs to be put to bed. We’ve seen the private sector step up and help throughout the pandemic with commitment, insight, investment and innovation. A modern, fit for purpose health and care system needs to harness all the private sector has to offer and leverage that for the benefit of patients, their families and the staff that care for them.

We don’t need to return to normal, we need to move quickly and with focus to a better, more integrated care sector, where systems and processes ensure better care for the elderly.

Maintaining visibility of older people discharged into the community, supports care now, and in the future

By Uko Umotong, National Discharge and Community Services Manager

The health and care sectors are responding to the coronavirus pandemic at unprecedented speed. Reflecting long held ambitions, they are developing new ways of working, such as digital primary and secondary care, being integrated almost overnight. At the back door, an accelerated pathway for discharge from hospital for medically optimised older people is well underway. Making sure these older people are able to leave hospital and receive care in the community is critical at this point – both for their own heath and to create capacity for those with coronavirus.

However, as with all changes within the health system, it’s critical to consider broader impacts.

What happens once these older people are placed in community? How are their ongoing care needs being met? What are their funding arrangements?  Who referred them? When are they due to have their care reviewed?

Failing to track older people discharged into the community under Covid-19 funding, puts us in danger of losing visibility of some of the most vulnerable people in our community. This could create problems for them that may not be realised for some months.

An immediate issue is how do we assure ourselves that they are not at risk of readmission? And for the future post-pandemic world, do we have the right information in place to quickly assess care and funding needs and reduce disruption and additional stress for older people and their families.

We provide patient management systems, Broadcare and Caretrack, to over 75% of CCGs.  These systems are used to record critical information on older people placed in the community. We also developed and run the NHS England national database for Independent Reviews for CHC funding.  We have now developed these databases to accurately track and monitor all patients receiving interim funding due to the Covid-19 crisis.

This means that we can remind CCGs when older people are due health and care assessments, we can record the outcome of those assessments and when Covid-19 funding is no longer available, it will be easier to understand what funding is available for care.

We track:

  • Demographic patient data (including NHS Number, registered GP etc)
  • Covid-19 test outcome data
  • Referral data – where the referral has come from (acute hospital, including ward)
  • Date of funding agreed
  • Discharge arrangements
  • Costs of care
  • Breakdown of actual care delivered
  • Contracts agreed with care providers – when sent out and when returned
  • Payment reporting on actual payments made to care providers
  • Alert/reminder functionality to ensure patient is reviewed at a minimum of 12 weeks
  • Ongoing assessment timeframe once crisis is over
  • All patient documents to support funding

There are a lot of unknowns at this time and the focus is rightly on helping those who are medically fit to be discharged from hospital and into care. Good crisis management however requires a focus on planning for exit from the acute phase. After the Covid-19 crisis, we will need to ensure that we understand the wider picture of care for older people and that information exists to support longer term decisions.

NHS England asks Trusts to move 15,000 super stranded patients out of hospital and into community by end of week

By Uko Umotong, National Discharge and Community Services Manager

NHS England have asked Trusts to move 15,000 super stranded patients out of hospital and into the community by the end of this week to create urgent capacity for the coronavirus. We can help. We work with over 50 trusts across all D2A pathways, CHC and trusted assessor. We have a totally remote workforce who can start immediately. We can also support through the coming weeks with visibility on patients in the community to help make sure they don’t return as an unplanned admissions. We have unparalleled knowledge and insight of local care provision, we can support ongoing capacity by providing dedicated hospital discharge support throughout this challenging time

We need to make sure older people get the right care in the community to reduce demand in the long term

By Gabrielle Silver, Chief Executive

Sir Simon Stevens has said he wants people who have been in hospital for over 21 days to be discharged urgently to release capacity for coronavirus. This is the right thing to do, but it’s equally important older people get the right care in the right place to avoid unplanned readmissions. Bouncing back into hospital will expose them to risk of infection and put further pressure on hospitals facing unprecedented demand. Our deep local knowledge and insight means we can make sure older people get the right care in the right place. #coronavirus #rightcareintherightplace

Creating capacity now with our rapid discharge services

By Uko Umotong, National Discharge and Community Services Manager

We are patient discharge experts and can help support older people put of hospital and into the right care for them now.

With more than 20 years’ experience supporting the NHS, CHS Healthcare can help create capacity for coronavirus patients in NHS Trusts during this pandemic. We have deep knowledge and insight of local care and are able to support discharge at pace. Hospital is not the right place for a recovered older person, and it is especially urgent they are moved out of hospital at this challenging time – both for their own health as well as releasing capacity.

We’re keen to help the NHS at this time – please get in touch.

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