Safeguarding and reviews in NHS continuing healthcare: keeping people safe

On Friday 25th November, CHS Healthcare held the eighth installation of our continuing healthcare (CHC) webinar series – Safeguarding and reviews in NHS continuing healthcare: keeping people safe. Marking the end of this year’s adult safeguarding week,  we were joined by Kenny Gibson, Deputy Director for NHS Safeguarding at NHS England and Jonathan Senker, Chief Executive of patient advocacy charity VoiceAbility.

The webinar was an important discussion on the role of clinical reviews in safeguarding and why independent advocates need to continuously monitor for risks and prevent issues from arising in the first place. The following discussion points were addressed:

  • The vital role CHC plays in the safeguarding of vulnerable people
  • The importance of empathy and understanding when working with vulnerable people
  • How robust review processes can support effective safeguarding
  • How issues can be prevented by organisations conducting thorough clinical reviews
  • How a focus on patient safety can act as an economic approach to NHS continuing healthcare

You can watch the full webinar here.

Our key takeaways from the discussion:

Looking at the whole person and their journey

The people we see for CHC assessments are a product of their living situation, their neighbourhood and community, the circumstances that led them to needing CHC support, as well as their individual emotions and aspirations.

It is critical to keep in mind that the situation in which we are assessing someone isn’t the full picture. We can get a lot of value from speaking to others, including neighbours, families, pharmacists, GPs, and district nurses. There are so many touchpoints that allow us to paint a complete picture of the individual and understand what the world looks like for them. This is of extreme importance especially in situations where the person lacks mental capacity. By having this holistic view, we can better identify potential safeguarding concerns.

Kenny Gibson shared the methods reviewers can use themselves to keep people safe, including challenging unconscious biases about cognitive impairment, family dynamics and domestic abuse.

Kenny also suggested being mindful of the language we use and the traumatic effects that safeguarding concerns can have – for example ‘cuckooing’ is a commonly used safeguarding term, but from the perspective of the person who experienced it, it’s a home invasion.

Advocacy should become a mainstream part of services

Jonathan Senker highlighted that all examples of safeguarding concerns and abuse are examples of a voice that hasn’t been heard.

Independent advocates can provide a voice for people who may otherwise struggle to express theirs. Jonathan shared how it’s currently unusual for people to have independent advocacy through the CHC process and it isn’t happening as often as it should. We need to highlight the legal right to advocacy in CHC assessments. The new NICE guidelines published on the 9th November this year about providing advocacy to adults with health and social care needs, is a step in the right direction to help prevent safeguarding issues in the first place.

Importance of training

The panel also touched on the importance of cultivating the skills required for effective CHC assessments early on, through ongoing CHC training and shadowing. This will support the future CHC workforce, for which it is currently challenging to recruit in to and instil into future nurses and social workers the complexity of assessments and safeguarding concerns to be aware of.

CHS Healthcare prefer the term ‘CHC education’, rather than training, as it is an ongoing process rather than something that can be taught through a single training course. At CHS Healthcare we pride ourselves on being one of the first organisations to offer a full eight-week placement for students in continuing healthcare.

Looking to the future

The discussion finished by reminding attendees that there is far more excellence than there is incidents, and there is much to learn from examples of best practice. Changes in the organisational culture are necessary to improve safeguarding culture.

Leaders need to demonstrate compassionate leadership, use trauma informed approaches, and build on both their emotional intelligence and data intelligence. We encourage staff to exercise professional curiosity around the situation and feel encouraged to speak out without fear of being wrong – and this begins with the leadership culture.

To learn more about how CHS Healthcare can support your teams with safeguarding and keeping people safe within continuing healthcare, contact Will Johnson, and Tom Morgan-Lee, 

Clinical governance, performance and audit: how data can inform best practice

Sebastian Stewart, CHS Healthcare

In the latest installation of our Continuing Healthcare (CHC) webinar series ‘Clinical governance, performance and audit: how data can inform best practice’, we were joined by Paul Kaye, Director at Quiq Solutions and Dan Harbour, Managing Director at Beacon and NHS Continuing Healthcare Consultant.

Paul and Dan gave their expert overview about the current governance landscape and how audit and data can be used to drive improved performance. They also answered questions around clinical governance and performance and how data informs best practice within Continuing Healthcare.

Questions from attendees included: 

  • How can qualitative audit tools support the drive to best practice within NHS Continuing Healthcare?
  • Why is audit important to improve performance within NHS continuing healthcare?
  • At a national level, how are ICBs monitored in the context of CHC performance?
  • What is the shape of NHS continuing healthcare toda,y and where do we want it to be?
  • How can qualitative audit tools support the drive to best practice within NHS continuing healthcare?
  • How can compliance be made front and centre for all commissioners?
  • How can audit be implemented as part of everyday business?

You can watch the full webinar here ‘Clinical governance, performance and audit: how data can inform best practice’

My key takeaways from the discussion:

  • Continuing Healthcare is highly complex which can be open to subjectivity; auditing is crucial to consistent performance and to support informed decision making at all the key touch points of the patient journey. Clinical governance ensures compliance and variation issues are picked up, providing the foundation of a consistent approach across all areas of Continuing Healthcare operations.
  • There are new lines of reporting to monitor ICBs in the context of NHS continuing healthcare – In addition to the core methods of national statistics being reported to NHSD or NHSE for monthly and quarterly analysis, further lines of reporting have been added for this financial year.
  • Following consultation from NHS Digital, reporting methods have been strengthened within NHS Continuing Healthcare. The reporting now includes new patient level data sets with anonymous reporting and subcategories including care package data and review data. Separately to that, ICBs are independent decision-making bodies and will also have their own assurance mechanisms. NHSE and NHSD also have a remit to provide strategic leadership and vocational development to ensure local systems are operating effectively.
  • Audit tools can help drive best practice – CHAT (continuing healthcare assessment tool) is designed as a self-assessment mechanism for ICBs and their sub locations to monitor performance. The tool covers three main themes: assessment decision making, care planning and commissioning, and enablers. Assessments can be peer reviewed by NHS England and systemic issues can then be identified to highlight trends.
  • Education is necessary at every level of an ICS in the context of continuing healthcare – Education about continuing healthcare is necessary at every level of an ICS to ensure clinical governance is accurate across the system.
  • Compliance can be made front and centre for all commissioners – Continuing healthcare is a whole system issue despite statutory responsibility sitting with the ICB. Governance arrangements require a response from additional statutory agencies to make it work. Whilst ICBs are responsible for system leadership within their patch, there is an opportunity to draw partners more closely into delivery and performance monitoring, as part of a whole system approach.

To learn more about how CHS Healthcare can support your teams with clinical governance and auditing within Continuing Healthcare, please contact Will Johnson ( or Jody Collier  (

If you’d like to join us for future webinars and events, please register your interest by emailing

Shining a light on consent in NHS continuing healthcare

Julie Sutton, Director of Operations, CHS Healthcare

On Friday 24th June, we held the fifth installation of our Continuing Healthcare (CHC) webinar series; ‘Shining a light on consent in NHS Continuing Healthcare’.  I had the pleasure of hosting the webinar, and was delighted to be joined by Yvonne Le Brun, National Continuing Healthcare Consultant at Waite Atkins Ltd, Ben Troke, Partner at Hill Dickinson; Mediator; and Author at Law Brief Publishing and Joanna Crichton, Legal Director at Hill Dickinson.

During the course of the webinar, the speakers answered questions around Continuing Healthcare (CHC) Consent, including:

  • When is Consent required for CHC?
  • What further knowledge and support is needed to navigate consent in CHC?
  • Has the newly published guidelines and updated framework provided clarity regarding Consent requirements for CHC?

We also heard from speakers about the statutory responsibilities of stakeholders, as well as their views around CHC Consent in general.

You can watch the full webinar here ’Shining a light on consent in NHS continuing healthcare’ and following are my key takeaways from the discussion:

The law around consent as applied to CHC hasn’t changed – nothing in the updated national framework for CHC changes the substantial guidance around Consent. The only aspect of Consent that has changed is how it is referred to. Rather than Consent in CHC being referred to as a singular decision-making element, there are now three elements to consider:

  • Participation in the CHC process
  • Physical examination for purposes of CHC eligibility assessment
  • Sharing of information

Patient information should only be shared with third parties if it is in the best interest of the patient – this is unless the patient does not have capacity to make that decision and, in this instance, information will need to be shared with the patient’s Lasting Power of Attorney’s (LPA).


The new guidelines and updated framework focus on a personalised approach to CHC – there is a clear focus on putting the patient first and helping them to make a decision that is in their best interest.


Patient understanding around CHC Consent is vital – this helps to avoid confusion, future issues and will help patients understand the relationship between Consent and the care they are able to receive.

Collaboration between health and care professionals throughout all stages is vital – this helps to ensure that front-line staff feel confident and well-equipped to have conversations about Consent, that local-authorities and communities are aware of the Consent processes, that Consent checklists are always submitted (even if negative), and that patients receive the care they are eligible for.


There are three elements of Consent that must always be considered:

  • Consent must always be voluntary
  • The patient must have the capacity to make the decision – otherwise their LPA
  • The patient (or LPA) must always be well informed for them to be able to make a decision that is right for them

As Ben said, “Consent is all about respecting an individual’s autonomy… It is important that the law is seen not as a stick to beat you with, but as a shield to protect you and that decision making.”

To learn more about how CHS Healthcare and support your teams in understanding Consent and delivery of Continuing Healthcare contact

The Use of Analytics: Exploring Ways to Enhance CHC Performance

Sebastian Stewart, Growth Director, CHS Healthcare

On 8th April, we held the fourth installation in our CHC webinar series, ‘The use of analytics: exploring ways to enhance CHC performance’. I was joined by Raj Bhatt, Head of Analytics (NHS continuing Healthcare) and Paul Kaye, Director – QuiqSolutions who provide the CHAT assurance tool and AIMS quarterly performance data.

We heard about the huge amount of work going on to prepare CHC data collection and systems for the move from CCGs to ICS. This is creating opportunity to improve how we collect data, what we report on and how that supports improvement for CHC.

You can watch the webinar here The use of analytics: exploring ways to enhance CHC performance | CHS Healthcare but my key takeaways from the discussion are:

Fragmentation of processes and systems will be a challenge. Raj and his team at NHS England are keen to help CCGs where they have issues with pulling together systems and data for the transition to ICS structures.

Mechanism for submitting data: NHS England are working with NHS Digital to make sure there are improvements to how data is provided on the MESH platform, reducing the process to 2 or 3 clicks from uploading, QAing and submitting rather than the current 5-7 clicks.

Reducing the burden of data collection: Raj is keen to hear from CHC data teams about possible improvements for the patient level data set and collection. There is support for utilising existing data sources wherever relevant – with the governance and quality of data being pulled in paramount.

Move from aggregate to patient level data: Aggregate collection has been used to support visibility of compliance against national standards. The limitation of aggregate data is that it doesn’t speak as effectively to patient experience.

While the initial focus for this patient level data, will be on reconciliations, in time patient level data will allow the development of KPIs for topical areas e.g. health inequalities, waiting times, and cost.

Data as a tool for comparison in the move to ICS:  Now data is captured, processed, and reported at CCG level. This is compared amongst peers through clustering indicating unwanted variation and prompting further investigation. As we move to ICBs the level of assurance will take place at sub-ICB location (CCG level) creating consistency with existing methodology.

New CQC inspection methodology places significant emphasis on capturing the experience of people who use services to support understanding of quality. There are many ways to do this including phone surveys and paper surveys. Paul also discussed a number of ‘off the shelf’ solutions.

As Raj stated the key challenges of reporting data will be during the transition to ICSs and the impact it will have on CHC performance. “From a challenge perspective I think it is an obvious statement to say it is going to be a journey for all colleagues to improve data quality and improve a level of reconciliation when we’re comparing both the aggregate and patient level data sets. But data quality is at the heart of what we’re trying to achieve”.

To learn more about CHS Healthcare and our data management systems which support CHC performance, please contact or

Developing Skills and Capacity in the Continuing Healthcare Workforce

Harry Bourton, Client Partner, CHS Healthcare

On 11 February, we held the third installation in our CHC webinar series, ‘Developing Skills and Capacity in the Continuing Healthcare Workforce’, I was pleased to have been joined by both Yvonne Le Brun, CHC Consultant, Waite Atkins Ltd and Adam J. Huszcza, Deputy Head of Continuing Healthcare, West Sussex.

It was encouraging that over 150 people working in CHC across the NHS and local authorities joined the interactive discussion indicating what an important topic workforce development is for practitioners.

Following are some of my observations and reflections on the discussion. 

How are organisations developing staff skills for CHC?

We all know that the development of skills and capacity within a workforce is crucial for the effective delivery of CHC. But, we want to explore the issues of staff skill development within CCG’s and how this can be improved through better training.

It is known that when pressure and workloads are high within healthcare, training and development are less of a priority. However, we want to delve into how that cycle, which inevitably leads to poor performance, can be broken.

Key findings from our pre-webinar survey showed:

  • 43% of registrants do not feel they have the capacity and skills in their workforce to address referrals via discharge to assess pathways
  • 76% said that they intend to use dedicated training to improve skills and capacity within their workforce
  • 40% said their number one priority for CHC in the coming year is training and skills development

We asked Yvonne ‘In your current CCGs where you are working, are you developing your CHC staff? How are you doing this?’.

‘’The scenarios are different across CCGs but the first thing that is important in developing staff is the commitment to training from people at the top, and this aligns with what respondents from the pre-webinar survey said as their number one priority when developing skills and development in workforce.”

“CCG’s should have a training strategy which shows and outlines the commitment right from the very top of the organisation. And training in CHC should be what I would call a blended approach of face-to-face, e-learning, action learning, and practical case studies, which is ongoing, as learners need more than one training experience in order to embed good theory into practice” said Yvonne.

Adam agreed that dedicating time to development of skills within a workforce is imperative for the growth of staff within CCG’s. “We have been lucky within Sussex CCG, in that seniors have always invested in people, and we’ve got a very supportive organisational development (OD) department.”

“In terms of CHC specifically, we have a transformation board and a series of workstreams that support that transformation board. One of those is called workforce development and digital. There are three strands to the workstream, which include supporting people in terms of training and their wellbeing, the second strand is the development of skills in CHC, and finally, the third strand is digitalisation which focuses on developing technical skills and system use to work more digitally.”

What role can the Associate Continuing Healthcare Practitioner play in the assessment of an individual’s health and social care needs?

Another pressing issue is how the assessment of individuals health and social care needs can be improved. Traditionally, we always believe a CHC assessment requires a registered nurse however, we would like to gather insight from a social work perspective and explore how CHC training could lead to non-clinical staff having the skills to carry out CHC assessments.

In the pre-webinar survey, registrants were asked ‘Thinking about training and workforce development where do you think the most emphasis is required?’

  • 41% of people who answered our survey ahead of the webinar said that most emphasis of training and development needs to on ‘improvement in accuracy of assessments’.

Yvonne gave her opinion on how we can widen our scope and stated that MDT assessment requires a lot of skills, but the national framework is quite clear that it doesn’t have to be a nurse. It requires someone to be competent to actually lead an MDT and make sure process is followed. Therefore, it is about their skills and competency, no matter what their background is.

“I like the concept of apprenticeships as a way to train and upskill people because one of the problems within CHC is there is not a very clear career pathway for people. However, I think the biggest challenge for associate practitioners is the flex of the CCG structures and where they fit within that, as well as what career development opportunities might be there for them.”

Adam was asked if an associate practitioner role could be integrated within the business support side of CCGs. Adam responded “there is more scope for a much more diverse skill mix of people to work within CHC, both on the clinical side and business support side. There is a lot of cross-over between skills needed for both roles”.

He also discussed the possibility of carving out a career path for associate practitioners to work within clinical and non-clinical roles and giving them an opportunity for a path to give an individual experience of both.

To learn more about developing skills and capacity within the CHC please contact Harry Bourton at 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 to discuss your needs.

You can access a recording of the webinar here:  Developing skills and capacity within the CHC workforce | CHS Healthcare



Reflection on “Getting Continuing Healthcare Right”

Harry Bourton, National CHC Operations Manager, CHS Healthcare

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

In the 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. As a result, the PHSO made a series of recommendations to strengthen CHC reviews and assessments moving forward.

To discuss the report and its recommendations, we held our sixth session in our ongoing webinar series, “Getting Continuing Healthcare Right”. Facilitated by myself and joined by Jill Mason, Partner and Head of Health & Care, Mills and Reeve, as well as Yvonne Le Brun, CHC Consultant, Waite Atkins Ltd, the webinar aimed to highlight the importance of securing capacity and skill within the workforce to address reviews and enact the PHSO’s recommendations as we move into the next phase of CHC.

Education & Training

Some of the recommendations focussed on ensuring staff have sufficient skills and experience to undertake CHC assessments, as well as sharing learning nationally through a review and further development of current learning opportunities and tools.

There is a clear need for multi-faceted educational programmes. Speaking about the impact of remote online learning for CHC practitioners, Yvonne Le Brun stated that it is excellent in terms of it being a useful starting point, with there being thirteen current e-learning modules available on the NHS England website. However, face-to-face learning, shadowing and mentoring should not be cast to the side.

E-learning can give practitioners a very comprehensive understanding of both CHC and PHBs. It also provides the opportunity to reach a larger audience, which was particularly important with the re-start of CHC when there was quite a big push to upskill as many people as possible. E-learning is also valuable in terms of ‘just in time’ learning, where people can quickly gain access into and knowledge about something they previously were unaware of. 

The PHSO acknowledged the importance of staff training, as increasing knowledge will benefit the NHS and partners, as well as creating a more confident workforce, and in turn support staff retention. A trained workforce will also be more likely to ‘get it right first time’, meaning less stress on capacity, cost savings, and families.

Staff Retention

Another critical aspect explored was how we retain and attract talent in CHC. Yvonne led this avenue of exploration by suggesting that it would be beneficial if as part of pre-registration training, a greater awareness of CHC was incorporated for all clinical staff. This is important because it is not just nurses who complete CHC assessments, but also occupational therapists, physiotherapists and more.

It’s also essential that people understand and are prepared for the breadth of requirements of a CHC role, since assessing and determining entitlement to a funding stream is likely not familiar territory for many incoming staff.

The challenge is not necessarily about attracting staff to CHC – instead it is prioritising retention from the management and board level, with an understanding that the roles of CHC practitioners are extremely demanding and difficult. It’s critical that organisations are supporting staff to the best of their ability. For example, this could include implementing a structured career development path to ensure staff are progressing to levels that they are striving towards.

A national approach to close downs & retrospectives

We heard that a further national CHC close down period would be helpful to assess previously unassessed periods of care, an opinion held by many others working in CHC. The pause of CHC assessments throughout the emergency measures implemented at the start of the pandemic, resulted in many regional organisations approaching CHC referrals differently, and looking ahead a more detailed national approach for retrospective reviews would be of great value.

Still, as Jill Mason pointed out, we should not wait for national guidelines to address current workloads. Organisations must consider and determine how to triage cases, define what administrative support they need, and strive to get as much done as they can before ICSs come into place.

Managing backlogs and the next phase of CHC

Prior to the webinar, we asked participants whether they felt that their organisation had the capacity and skills in place among their workforce to address retrospective reviews. 67% of respondents said yes, with 33% answering no. Furthermore, we asked participants what type of support would be most beneficial to their organisation; 35% answered that workforce training would be the most beneficial, while 24% said workforce capacity and 34% said support in retrospective reviews. 

While there is a promising degree of confidence, there will need to be a degree of proactivity in addressing retrospective reviews ahead of the next phase of CHC.

The large backlog of patients that are due or overdue a review will continue to be a challenge. Among many implications, it will lead to frustrated patients and families, resulting in more complaints. This can drive a disillusioned workforce and is also very costly in terms of time and money. Without action, CHC is in danger of always looking in the rear-view mirror rather than being forward looking and strategic. 

Seven months on from the release of the Ombudsman’s report, we must ensure that review and assessment processes are being undertaken efficiently and effectively. The key to achieving this will lie in effectively implementing the PHSO’s recommended measures, which ultimately comes down to ensuring that CHC practitioners possess the specialist skills required and that organisations have the capacity to manage this process.

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. Please contact Harry Bourton at to find out more.

A recording of the webinar is available here.

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