The University of Sheffield conducted two independent reports on our hospital discharge services. One report focused on the Return on Investment produced by our services, based on the assessment of bed day savings released, accounting for cost of service. Another report is a qualitative evaluation of our hospital discharge services, based on interviews with senior NHS managers commissioning our work, who provide an independent view of benefits and strengths.
Interviews took place with 11 professionals with experience of commissioning CHS Healthcare services and evaluating how they work in practice. The 11 interviewees were all either working at director or head of department level, at CCGs and acute trusts across the country. The interviews took place in September 2016.
The data from these interviews was then analysed by the School of Health and Related Research at the University of Sheffield.
INDEPENDENT INSIGHT FROM NHS COMMISSIONERS WHO USE, KNOW AND EVALUATE OUR SERVICES
CHS Healthcare chief executive Dr Richard Newland commented:
We recognise the importance of independent peer evaluation for NHS decision-makers evaluating whether to commission a service from us.
We can tell you what our services offer. But it is essential for you to know what the actual experience is for trusts and CCGs using our service; their insight and analysis. For this reason, these interviews were undertaken and analysed by the University of Sheffield.
KEY THEMES FROM THE INTERVIEWS AND ANALYSIS:
- The unique strengths of CHS in hospital discharge compared with in-house teams
- The importance of the flexible approach CHS provides with evening and weekend working
- CHS taking ownership of the complex discharge process
- CHS knowledge of the local care sector
- CHS building good relationships with social work teams
Unique strengths of CHS in hospital discharge compared with in-house teams
Interviewees were asked about the strengths of the CHS Healthcare service and how the service differs from the work undertaken by hospital teams.
“… they are there absolutely to support families and patients and their primary focus is on that. Somehow it allows them a level of independence that we would struggle with. [Our] Staff get caught up with some degree of vested interests.”
CHS staff members were reported as being both “a bit sterner or pushy when the situation requires”, balanced with the observation that “[t]hey don’t badger people and have that careful and human approach”. A further respondent noted that a “key strength of CHS is that they are really good at engaging with patients and families who just need that bit of extra support and the elderly partners of patients”
The importance of the flexible approach CHS provides with evening and weekend working
When discussing how the CHS service worked, the flexible approach and evening/weekend working was a strong theme.
…there is something very different about what CHS do and I think they offer a level of responsiveness and flexibility that isn’t bound by a 9-5 Monday to Friday attitude that the NHS would struggle to deliver
A key strength of CHS is the flexibility of the staff and the out of hours service that wouldn’t be replicable in the public sector.
They are much better at chasing people up and doing the out of hours work.
CHS’ key strengths are that they are very flexible and capable of shaping their work in line with what we ask of them
[They] work very flexibly and are doing things the public sector wouldn’t do.
As a private company, they are able to assess those risks in a different way. We wouldn’t be able to establish the same payment structure in the public sector
CHS taking ownership of the complex discharge process
Another theme for several interviewees was the complexity of the discharge process and the importance of having one service taking ownership of the whole process.
Generally speaking it’s a very complex process … It’s about synchronising a lot of different parties and handing somebody over. It’s just difficult not having someone to manage the whole process. It’s difficult synchronising the different parties and integrating everyone.
Before CHS the number of days of stay after medical discharge was close to 20, in some cases above 20
The biggest roadblock that our hospital faces when discharging patients who require continued care is the access to nursing homes in our area and simply finding a bed for someone, which is where CHS comes in
Prior to CHS brokerage we would identify a place but there was nobody working with families to support them in making a decision and progressing the patient so a lot of excess bed days were spent waiting for families and carers to fulfil that part of the pathway
CHS knowledge of the local care sector
A key theme was the way that CHS brings knowledge of the local care sector (both care homes and care agencies) which is much greater than hospital discharge teams would have, because they go out and visit care homes and have the day-to-day contact with care providers.
They look at the area and what they can get, and they go and look around those homes (9)
…we are buying the knowledge of the care homes in [coastal town] that we couldn’t possibly gain otherwise
…they know where the best care homes are and know what they are after … they will find the right care home, for a patient’s particular need rather than showing them all the homes including those that patients are not eligible for
CHS have been really useful with helping us source packages of care. For example, if a family can care for someone in the day but needs someone to come in overnight they have been helping us solve these problems
CHS building positive relationships with social services teams
Hospital discharge is widely acknowledged as an area of potential pressure and conflict between health and social services. However, several interviewees described services where there was a positive relationship between CHS and social services.
At sites where CHS has good working relationships with Social services, this is considered an asset, and is considered to contribute substantially to the success of the CHS service.
It was remarkably successful. CHS were very engaged with social workers and it’s been remarkably successful.
CHS have a very good relationship with social workers and they work together well so the social workers now refer discharge patients to them. The structure of the process hasn’t changed but CHS are more proactive than the previous system with just the social workers.
CHS’ IT is strong and so is their support of patients. Social workers think they are a godsend.
The study, entitled Report of secondary analysis of interview data: strengths, weaknesses, opportunities and threats related to CHS Healthcare hospital discharge services, was produced by the School of Health and Related Research, the University of Sheffield. To request a full copy, please contact Wendy Hawkins, CHS Healthcare communications lead on 0121 362 8844 or by email firstname.lastname@example.org