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CHS Healthcare acquisition announcement

CHS Healthcare and Acacium Group are pleased to announce that Acacium Group has completed the acquisition of CHS Healthcare. The support of Acacium Group will provide a catalyst for delivering innovative patient flow and pathway solutions across acute and community settings. Acacium Group and CHS Healthcare provide different but complementary services, and this acquisition will enable patient needs to be better served. There will be no changes to our customers’ current service delivery or our contractual terms, and we will continue supporting all our customers to the high standards we have always delivered. Dr. Gabrielle Silver, CEO, says, “CHS Healthcare is excited about joining Acacium Group. Our expert team has strong relationships across health and social care. They make a difference to the wellbeing and outcomes for patients and their families every day. The support of a healthcare solutions partner working with CHS Healthcare will provide a catalyst for delivering innovative patient flow and pathway solutions across acute and community settings. Together Acacium Group and CHS Healthcare can meet the changing needs of customers and the health and social care sectors.”

For more information, contact Ben.Hackwell@chshealthcare.co.uk.

Staffing and community capacity – what’s the real issue?

Dr Gabrielle Silver
CEO CHS Healthcare

Hospital discharge and capacity in the community is becoming an increasingly important issue, with the pressure to keep patient flow moving out of hospital and into the community. Today (7 Jan) on Radio 4 we heard from Chris Hopson, CEO of NHS Providers: ‘Hospitals beds are full, community beds are full and community at home services are also full’. The HSJ also reported on Tuesday (5 Jan):

A spring-style policy intervention to require discharges to be arranged in hours, rather than days, with no dithering over cost, may be required. But where will the staff come from to achieve this? And where can individuals go if they are not ready for home? How do we ensure care homes are not compromised with COVID, and how to enact new policies with the independent care sector setting its own rules?

This highlights how the challenge of staffing has been drawn into sharp focus through this pandemic. I believe we need to think more laterally about how we support aspects of health and care. Hospital discharge is, at its heart, a practical process. Once a patient is medically optimised to leave hospital the clinical job to a large extent ceases. This is why I am not convinced that the issue is staffing per se. I think the issue is how hospital discharge is resourced day-to-day and a lack of effective management tools in the NHS.

Managing the discharge to assess (D2A) pathway is about having strong relationships with local care providers, working closely with families to make sure they are reassured and confident about next steps for their loved one and actively managing each individual’s care timetable to move rehabilitation along.

I see our team’s job as ‘keeping plates spinning’. On a practical level, this is making sure appointments such as occupational therapy take place on time and that any follow-up, like ordering equipment is managed. This detailed hand holding of each patient’s needs means that their care actively continues, and they are able to move quickly back home with support, or into a long-term bed with appropriate funding. And their original bed back goes into circulation for another patient who needs it.

A key element of this is the real-time tracking of patients and their care. We use a digital platform to ensure information about next steps are visible and available at any time to the team involved in their care. These tracking systems are increasingly important within acute trusts to monitor flow across multiple data feeds. We use the same logic but apply it to the discharge and rehabilitation of patients. Gone are the days when care is held up because an excel spreadsheet was not updated or someone forgot to pass a message on or record an appointment.

Technology, deployed correctly, guides staff so they are doing the exact right tasks at the right time to ensure an outcome – in this case patient flow.

As unpredictable as this pandemic has been, we know that pressure on hospital beds will continue for some time to come and that people will need to move promptly from acute services and will require substantial care in the community. The NHS has a huge amount of work to do and where we can provide support and keep things moving, we want to do so.

The workforce solution for many of the current challenges does exist. We must think beyond the NHS for solutions to non-clinical challenges. Where we look to the NHS as the only viable option, we do patients and even people waiting for vaccines a disservice. We need to be proactive and pragmatic – let the NHS get on with the complex and urgent work they need to do and are best placed to do.

When I look ahead past this pandemic and the long-term workforce challenge, I can see that there will be jobs created around health and care which have not even been considered yet. Jobs which we have seen as ‘clinical’ will be broken down and rebuilt as operational support in a whole range of new guises. This will benefit hugely not just the NHS but a completely altered labour market. Data and technology will play a huge role shaping these new job roles. In the meantime lets wrap our support around the NHS at this testing time – we all have a role to play.

Recognition from our partners at Maidstone and Tunbridge Wells NHS Trust

We are thrilled to have received special recognition from Maidstone and Tunbridge Wells NHS Trust (MTW) for our ‘exceptional service during the COVID-19 pandemic’.

At CHS Healthcare, we understand the importance of delivering seamless and efficient patient flow in helping our clients maintain a standard of excellent patient care. Whether it’s working to get a patient back home with family, into rehabilitation or a care home, our aim is to ensure patients get the care they need in the best and most appropriate location.

“The team became part of our team” states Stephanie Line, the Discharge Liaison Team Leader at Maidstone Hospital. “We worked as part of a team, alongside each other for the positive outcome of our patients and their family.”

“The current pandemic has been the hardest times we have worked through and one which we are still powering through. I speak on behalf of myself and all colleagues, we could not have survived without the [CHS] team’s support. Their commitment and support to us has been exceptional, they have assisted us to stay afloat.”

“It’s a real honour to be recognised by the MTW team in this way, as we’ve done our best to deliver a high level of enthusiasm and commitment to perfectly align with their operations”, says Debbie Haddow, Team Coordinator at CHS. “Whether it is bringing our extensive industry knowledge to the table, reaching out to homes or agencies to better understand admission policies, or helping to enhance their relationships with hospital discharge teams to increase exposure, we are extremely proud of the work we’ve been doing and are thrilled to be acknowledged like this during such a difficult time.”

Hospital discharge – what really counts for patients and families? 

New guidance in March significantly changed how hospital discharge takes place. But how are those changes going? Not well, according to HealthWatch England and the Red Cross in their new report What happens when people leave hospital and other care settings? which reflected on 590 people’s experiences of hospital discharge at the start of the pandemic when this new guidance was being implemented. 

They found:

  • 82% of respondents did not receive a follow-up visit and assessment at home, one of the key recommendations of the policy. Almost one in five (18%) of those also reported having unmet needs, such as equipment, medication or advice
  • Some people felt their discharge was rushed, with around one in five (19%) feeling unprepared to leave hospital
  • Over a third (35%) of respondents and their carers did not get a contact for further advice, despite this being a recommendation
  • Overall patients and families were very positive about healthcare staff, praising their efforts during such a difficult time.

I was interested to read these findings as earlier this year just before COVID-19 became part of our day-to-day we undertook a survey via the Patients Association of friends and family of people who has recently been discharged. We wanted to understand their experience of finding care and what support was useful.   

When we asked families for their experiences the guidance was focussed on reducing the numbers of ‘super stranded’ patients. Trusts were asked to do a number of things to help older people be ready to leave hospital as soon as they were medically fit. The majority of friends and family we surveyed (72%) were not informed of the risks for older people of staying in hospital when they were ready to leave and 60% of people said that their loved one was not encouraged to stay mobile or active while in hospital. 

We asked families if they had enough support to make decisions about future care and 71% of respondents said there wasn’t enough information. 

Now hospital discharge is a very different process – the high numbers of super stranded patients we used to see are a thing of the past – which is a very good thing. But it was sad to see this report finding the new processes left people “feeling unsafe” when sent home.  With one in five patients feeling “unprepared to leave hospital” which increased to 27 per cent among those who were discharged at night.

COVID or no COVID, we still haven’t got hospital discharge right for patients and their families.

We know from our survey people want more advice and support – either from doctors and nurses (65%) or a dedicated resource who knows the local care options (62%). They also want a better understanding of funding options including social care and benefits (60%). 

Family liaison is key to unlocking the support of families so they can make decisions confidently and quickly, so they feel assured about the next steps for their loved ones, so they know when they can visit them at their care home. In addition, to make new discharge pathways work effectively we need to have the right dedicated support for health and social care teams. This includes coordination of assessments and therapy as well as for meds and equipment, support of commissioned and spot purchased beds as well as overall visibility of the patients care journey.  This all sounds simple but without the right focus a lack of coordination can quickly overwhelm and block patient flow. 

It’s likely this is going to be a dreadful winter.  We can make things easier on patients and families as well as health and care teams by acknowledging simple fixes and release health and care teams to focus on complexity where their unique skills are needed. 

Winter discharge planning and developing your D2A pathways

Dr Gabrielle Silver, CEO

Facing both a second wave of Covid-19 infections as well as the winter period, we know it’s critical that discharge pathways are in place to ensure patient flow and safety. 

We recently held a webinar entitled, “Winter discharge planning and developing your D2A pathways”. The purpose was to gain insight into how people are managing the Government’s Hospital Discharge Service guidance issued at the end of August, which gave clear direction on the purpose of D2A pathways to ensure ongoing and efficient patient flow. 

We had almost 200 professionals from hospitals, CCGs and local authorities join this third session in our ongoing webinar series. Dawn Hallam, Discharge Manager, Maidstone and Tunbridge Wells NHS Trust and Kent Community Health NHS Foundation Trust and David Coyle, Chief Operating Officer, The Countess of Chester Hospital NHS Foundation Trust shared their insights on establishing optimal community pathways. 

Optimising the D2A model 

Ahead of the session we polled registrants to understand whether they felt confident that their D2A pathways would be able to discharge patients within the 6-week funding limit. Interestingly, the results were split, and we wanted to gain insight on what is working well, and the challenges people are facing.

To optimise the D2A model, it is vital to continually think about whether someone is medically fit for discharge, and how an intermediate care bed base can continue to support the care of those patients outside of an acute hospital setting. 

Both David and Dawn agreed that it is important to ask questions daily about why patients can or cannot go home on that day, as well as ensuring close collaboration across all systems, including local authority and community partners. Both also noted that it is important to make sure expectations are managed, which means having a solid and functionally aligned operating team. 

Additionally, among care providers there is a nervousness to accept patients who have had a previous positive Covid-19 swab, which is another reason why transparent communication with care providers is hugely important.

The main D2A challenges

We also asked registrants about their main D2A challenges, with the highest response being coordination across health and social care to enable effective flow, followed by getting assessments to take place at the right time. 

Both Dawn and David noted that when the first wave of Covid-19 hit, there was a rush to clear hospital beds. Patients were quickly moved into the community and there was a decrease in both hospital occupancy and referrals. At present, the number of patients is increasing, and there will have also been a significant number of incomplete assessments over the past several months. Given the discharge of high volumes of patients directly to care homes and the time-limited financial support that currently exists for those patients, there must be close collaboration between hospitals, local authority partners and allied healthcare professionals to ensure assessments are completed as efficiently as possible. 

Additionally, as social service team members were instructed to leave hospital at the onset of the pandemic, teams have had to adjust to online working and different methods of communication than would have previously been the norm.

David noted that: ‘’From a D2A perspective, working closely with local authority and community partners is important – there is a higher level of dependency in the community now because people who didn’t come in during the first wave of Covid-19 have deteriorated. There are more pressures now, as we are dealing with a sicker, more frail population. Importantly, we do not have the same access to the care provider landscape because of the need to ensure we are maintaining infection control, which adds further complexity.’’

Dawn noted that: ‘’In the first wave of Covid-19, too many patients were sent out to a bedded solution, when they could have been sent home. The focus is now to firstly ask why a patient cannot go home. Sending patients home should be the first option, because it is the best place for the patient. That will be the shift in how we will deal with the second wave – making sure we have as many people at home as possible.’’ 

Support for D2A and winter planning

We also asked registrants about the support they need most around D2A and winter planning, with the highest response being support with managing capacity. Other responses included the resource to deliver local plans, support with onward care arrangements and restart of CHC assessments.

Coordinators, occupational therapists and physical therapists are vital for facilitating rehabilitation in the community. ‘’A challenge has been getting acute therapists working in the community and not in the hospital setting. Many assessments happenin hospital rather than the community, and this is something we are trying to change’’ said Dawn. 

Hopes for the future

Looking ahead, it will be important to align on a single version of what ‘good’ looks like to manage expectations throughout the discharge process. It is important to keep flow moving and keep patients safe and out of hospital. Sharing information, and indeed ensuring everyone has the same information is essential for this. 

Regarding treasury funding, Dawn noted: ‘’It is important to remember it is up to 6-weeks, therefore you should be aiming to [complete assessments and confirm placements] in less than 6-weeks. The 6-week timescale means there is more of a focus for speed.’’ 

Having visibility over what is happening in different cohorts and prioritising work is important. Additionally, tracking across different pathways is vital for managing expectations. 

Both Dawn and David concluded by stating that for community pathways to become better established, more communication and joint responsibility is needed to make sure patients are in the right place at the right time. If there is clear communication, and everybody knows what they are expected to do, we can provide a better overall discharge experience for patients.

CHS Healthcare has been supporting CCGs with hospital discharge pathways 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.

You can access a recording of the webinar here: https://chshealthcare.co.uk/chs-webinar-winter-discharge-planning-and-developing-your-d2a-pathways/ 

CEO Dr Gabrielle Silver named in LDC’s Top 50 Most Ambitious Business Leaders for 2020

Our CEO Dr Gabrielle Silver is one of only two healthcare services leaders in the UK’s Top 50 Most Ambitious Business Leaders


We’re pleased to announce that our CEO Dr Gabrielle Silver has been named as one of thirteen women and one of two healthcare services professionals in LDC’s Top 50 Most Ambitious Business Leaders for 2020. Now in its third year and featuring more than 350 individual nominations from across a spectrum of industries, the programme celebrates the inspiring leaders behind some of the UK’s most successful and fast-growing medium-sized firms. 

A doctor by background Gabrielle left clinical practice to work for in the pharmaceutical sector. Since then, she has worked at a series of organisations, all of which help to improve quality of life and outcomes for patients. 

‘The last business I ran was integrated into a large organisation, and I knew I wanted to be part of a smaller company again. I like the small business environment, pulling together a strong team and taking absolute responsibility for outcomes. When I joined CHS, I wanted to wrap my arms around the organisation. I just knew I could help the business evolve’. 

Since joining CHS Healthcare as chief executive in January 2019, Gabrielle has worked to grow and develop CHS Healthcare into the leading provider of hospital discharge services and Continuing Healthcare. 

‘What’s unique about CHS is that we are an independent arbiter: we explain all the options to families and patients and know about each care provider. The reality is nurses aren’t trained to help families choose care providers – that isn’t their job. We get people the right care by working in partnership with the NHS, local authorities, care providers as well as patients and their families. 

2020 and Covid-19 has bought unexpected challenges for the health sector and consequently for CHS. 

“I don’t think any of us could have predicted this pandemic let alone it’s impact on health and care but the way the CHS team has adapted to the challenges over the last months has been beyond impressive. We moved our teams out of hospitals, where we worked alongside discharge teams, and developed a remote methodology for assessments and enabled by our software products. This meant we could effectively support our colleagues and importantly, many patients and families over the initial Covid-19 phase. As we move into winter, new discharge pathways are being developed utilising community-based care in a more effective way. We are developing these intermediate care settings, building stronger relationships across providers and the NHS, as well as continuing to provide dedicated support for patients and their families.

We know winter 2020 is going to be like no other.  I am proud to be leading CHS Healthcare and the amazing team who really do make a difference to wellbeing and outcomes for patients every day.’

To learn more about this year’s Top 50 Most Ambitious Business Leaders programme, visit: https://bit.ly/2HE8SL7 

Practicality, priorities and pain: What is the way forward for efficient and fair CHC reviews and assessments?

Practicality, priorities and pain: What is the way forward for efficient and fair CHC reviews and assessments?

By Dr Gabrielle Silver, CEO

Local authorities and CCGs are beginning to grapple with NHS England and Improvement’s updated guidance on Continuing Healthcare, working through new processes and guidance on how to deal with the numerous deferred assessments on their desks, as well as handling the new cases coming through every day. What are the key considerations and implications for this restart?

To discuss these implications, recently 157 professionals from CCGs and local authorities joined The way forward for efficient and fair CHC reviews and assessments, the second session in our ongoing webinar series. Sydney Hill, Head of Health and Care Strategy at Richmond and Wandsworth Councils and Ben Troke, Partner, Health and Social Care at legal firm Hill Dickinson shared their insights on the implications of the new guidance. As with so many discussions, the webinar appeared to raise more questions than it answered.

And this of course was its purpose: to stimulate thinking about how best to deliver a national programme at a local level. 

Managing expectations

Sydney Hill noted that: “Most important is our commitment to service users – we have to keep them informed and manage expectations. We took the decision during lockdown to complete reviews remotely and to as high a quality as we could.”

Like other local authorities and commissioners, she has started by seeking answers to the fundamental requirements for successful delivery: 

  • What is the exact number of citizens in local authority and CCG care, either funded under Covid-19 conditions or who are awaiting an assessment? How do we prioritise these people?
  • What is our approach to remote assessments and how do we co-ordinate information between our teams and the CCGs? 
  • How can a Trusted Assessor model be introduced as a dynamic tool for both stakeholders and one which maintains the quality of assessment expected?

Ben Troke echoed the sentiment about managing expectations, from both the perspective of patients and families, but noted that as professionals, “we need to manage our own expectations of what we can expect over the next few months.” He emphasised the need for the following 3Ps: Practicality, Priorities and – more ominously – Pain.

Practicality

Now that Coronavirus Act funding (via Treasury) for care has effectively been stopped, the drivers are practical and financial, though the law suspending the legal duties to assess for CHC has not (yet) been reversed. An estimated 55,000 people remain on interim funding and there is a surplus of deferred assessments to be completed. This will take extra resources and funding and must be done “as soon as practicable”, according to government guidance.

Priorities

Prioritising means making decisions about who to assess first – the backlog or the business as usual?  And do we prioritise giving funding to those who should have it but don’t, or removing it from those who have it and should not? Said Ben: “in many ways it can be more difficult to stop or take something away than it is to say ‘no’ in the first place.”

These conversations require a specific and particular skillset, together with a locally agreed, pragmatic approach to decision-making, in line with the 2012 regulations, and the National Framework.

Pain

“The pandemic saw some brilliant working relationships across different organisations in the face of a crisis,” said Ben, “but now that the central funding has ceased, those budgetary tensions may re-emerge.” He expects disputes will increase and notes that there may be difficulties with the expectations of families who have been in receipt of funding which may now stop.

Ben said organisations will need to be open and transparent about their decision-making and will have to be able to defend it. “Avoid litigation and challenge as much as possible; CCGs and local authorities should understand their legal position and understand that guidance is just that – guidance. If you have your own policies, follow them. Take account of the things you are obliged to do and don’t make promises you cannot keep. Remember the law is not only a stick to beat you with, but can also be a shield to protect you.”

Trusted Assessor

The Trusted Assessor model is one area that poses a challenge for CCGs and local authorities. The legislative framework is clear that a multi-disciplinary team (MDT) will need to be involved. Speaking for local authorities Sydney said, “local authorities will feel disengaged if decisions are being made without our input.” The panellists agreed that further clarity from NHS England and Improvement and an understanding how others have done this successfully would be valuable for all concerned. 

But the Trusted Assessor is not just about a single agent trusted by both stakeholders. It is also about how best the information gathered in one arena such as Continuing Healthcare, can be shared with other stakeholders in their own Care Act Assessment. After all, we have been looking at the Single Assessment Model since 2001, and perhaps the new guidance can act as the vehicle upon which to test the principle.

Workforce

In a poll run during the webinar, most delegates said they needed more support with workforce. Sydney agreed that this was her number one priority and was waiting to see what the promised additional funding for staffing comprised. She has been looking at the existing personnel at the local authorities and what skills she needs to create a dedicated recovery team to focus on the deferred assessments. 

CHS Healthcare has been supporting CCGs with CHC reviews and assessments 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.

You can access a recording of the webinar here: https://chshealthcare.co.uk/events/webinar%3A-the-way-forward-for-efficient-and-fair-chc-reviews-and-assessments/ 

If you are interested in learning more about Ben Troke’s work on the law of medical treatment decisions, you can read more in his new book here (all proceeds go to the Alzheimer’s Society): http://www.lawbriefpublishing.com/product/medicaltreatmentdecisions/ 

Reflecting on Continuing Healthcare COVID-19 Recovery Planning

Dr Gabrielle Silver, CEO

The Coronavirus Act 2020 helped to support hard-pressed health and care services throughout the acute Covid-19 phase but created uncertainty around implications for recovery. This is an issue we have been working with CCGs on over the last months as we consider how the system is to manage the significant backlog of reviews and assessments for Continuing Healthcare (CHC) that has built up, and how the relationship between stakeholders involved in these assessments has changed.

We knew many others across health and care were grappling with these challenges so to bring everyone together with some expert commentary, we recently held a webinar with speakers Jan-Denise Wood, Head of Complex Care, Milton Keynes CCG Covid-19 Tactical Lead Commissioning, Contracting & Flow Cell, and Jill Mason, Partner and Head of Health & Care, Mills and Reeve. We had over 160 attendees from across the NHS, social care, local authorities, and private providers.

These are some of the key points that emerged from our discussion, which usefully reflect the evolving policy landscape and NHSE/I’s phase three letter issued 31 July 2020.

  1. When do CHC reviews and assessments need to start?

Everyone involved in Continuing Healthcare ultimately has the same goal of moving people into the right funding stream to provide security around their long-term care. With an estimated 55,000 patients placed under interim Covid funding, organisations wanted clarity on when these assessments would need to restart. Furthermore, confusion around the legal implications of the Coronavirus Act 2020 meant that many were hesitant to pursue reviews through this period, resulting in a backlog of assessments building up – not to mention the BAU reviews on those already receiving CHC-funded care.

The good news is that the recent letter from NHSE/I clarifies that by 1 September, assessments for CHC must be underway.

We asked attendees to vote on what their biggest challenges are moving into the recovery phase and the results were:

  • workforce capacity
  • the impact of a second peak
  • funding for additional work

These responses force us to reconsider how reviews and assessments are delivered. Our panellists pre-empted the NHSE/I phase 3 response by advocating the use of a trusted assessor model. Using an independent assessor who presents an expert assessment to an MDT panel is an efficient way of working through the backlog, and in some locations this model is in place already.

As swathes of work have been moved online across health and social care, many organisations, including ourselves, have been successfully conducting assessments via video and/or telephone, particularly in the trusted assessor role. While remote (and especially video) assessments and reviews will not be appropriate in all cases, being able to shift even 50% of the current workload to these models will alleviate workforce capacity. We have seen huge steps forward in digital services being used to treat and diagnose patients, so the ability to conduct reviews and assessments in the same way is also promising.

  1. Planning for the future – data is key

Planning for the future is challenging, but necessary, especially in the mid-term. We must prepare with the assumption that there will be a second wave which is likely to preclude any return to ‘normal’ ways. Now may not be the time for total system change, but it is a time to think about what is coming and ensure that local policies and systems are in place to address it.

As part of this it’s critical to ensure that proper data management processes are in place. At the moment this will vary between organisations, but we need to be prepared to assess against data collected through the COVID-19 period. This means ensuring that existing data is cleaned, and that a credible baseline is established ahead of the second wave. Where data collection can be improved right now that is clearly a good thing to do.

We know that everyone involved in CHC and phase 3 wants what’s best for patients, and one of the most heartening things to come out of the difficult last months was the way the system pulled together and put in place what was needed to provide care and keep people safe. Phase 3 will be a huge challenge, but I am optimistic that with the right systems and a clear focus we can provide the clarity patients and their families will want and ensure their long-term care. CHS is perfectly placed to support our NHS partners with the increased assessment activity over the next few months.

You can find a recording of the webinar here: https://chshealthcare.co.uk/events/webinar-what-next-continuing-healthcare-covid-19-recovery-planning/

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.

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