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.
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 firstname.lastname@example.org to find out more.
A recording of the webinar is available here.