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.
- 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.
- 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/