News

June 15, 2015

Measuring patient experience with the “I questions” – what are the new challenges and responsibilities for CCGS?

By Art Calder, Head of Clinical Services, CHS Healthcare

One of the notable features of The Operating Model for NHS Continuing Healthcare is the weight given to measuring patient experience of care. Continuing healthcare guidance has previously tended to focus on how we assess eligibility and the care pathways which follow. While this continues to present a significant challenge for CCGs, the model features a new statutory duty to measure how individuals feel about the services they receive. In other words, there is a new emphasis on what happens after assessments are completed and services commissioned; CCGs have new responsibilities for measuring patient experience of that care.

The principles will be familiar. The Operating Model, published in March 2015, aligns continuing healthcare with the “six Cs”: care, compassion, competence, communication, courage and commitment. These are principles which have been widely applied in other parts of the NHS, particularly inpatient services. The model underlines the fact that although continuing healthcare is normally delivered in an individual’s own home, or in a care home, those same principles must still underline the care.

Developed as it was in close collaboration with stakeholders representing a wide range of service users, the model includes a valuable audit tool, which directly relates core principles to individual experience. Known, as the “I statements”, service users are asked whether they agree or disagree with statements encapsulating the six Cs:
• “I feel valued and respected by my care workers and that they know me and understand me”.
• “I felt listened to, my needs were understood”
• “I have confidence in my care worker to look after me and they have the right knowledge and skills to meet my needs”
• “The people who need to work with me and support me are talking to each other”.
• “I am supported to have choice and control wherever possible over my care and support”

There is a distinct challenge in applying this audit tool in clinical practice within continuing healthcare: the 60,000 people receiving CHC in England are often single service users (if receiving a package of care at home) or will be in very small numbers within a care home. So evaluation will normally need to be taken on a one-to-one basis, whereas in hospitals, there is the advantage of having large numbers of patients based in a single location. Equally, in continuing healthcare, needs can rapidly change and the “I statements” should be reapplied when there is significant change.

At CHS Healthcare, gathering patient experience after care brokerage is a long established practice which works very well. For nearly two decades, we have brokered a wide range of care, including long term care home placements, enablement, fast track and packages of home based care. The same adviser who supported the service user to choose care has always contacted the service user a month after services commence to evaluate experience. This has always been an effective means of monitoring quality, identifying problems and quickly responding to changing needs. As trusted, independent care brokers, we have been able to gather detailed, reliable feedback and meet the challenge of service users being in different locations. Our model of brokerage followed by patient experience gathering can be commissioned by CCGs to achieve compliance with the “I statements” for quality assurance.