Comment: Digitising continuing healthcare from hospital to home

IEG4ís Simon Williams reveals how digitising paper and automating the workflow around the Continuing Healthcare (CHC) Assessment process will help to improve and enhance NHS services

Digitising paper and automating the workflow around the Continuing Healthcare (CHC) Assessment process promises to help reduce Delayed Transfers of Care (DTOC); improve the quality and reliability of patient service; and, drive-up productivity. An efficient, transparent and reliable approach to assessments will be fundamental to NHS England saving a forecasted £850m from CHC spend by 2021, explains IEG4ís Simon Williams

Itís six months since Matthew Swindells and Professor Jane Cummings from NHS England wrote to around 150 clinical commissioning groups (CCGs) which were failing to achieve the national standards for decision making within the CHC service.

Itís fair to say that, with three quarters of NHS CCGs failing, the CHC assessment process urgently needed some management attention.

A proper look under the bedcovers reveals the major source of delay, inefficiency and process opacity. Paper. Lots and lots of paper

The national standards may not seem overly onerous in this digital age. However, CCGs are evidently struggling.

Most cannot complete the required 80% of eligibility decisions within 28 days.

Over 100 CCGs complete more than the permitted 15% of full assessments in an acute setting. As a result, Swindells and Cummings estimated that as much as 25% of the 2,500 DTOC days they sought to release from the system, could be attributed to inefficiencies in this one process.

A proper look under the bedcovers reveals the major source of delay, inefficiency and process opacity. Paper. Lots and lots of paper.

The lack of transparency makes paper-based processes virtually impossible to manage, particularly when distributed across stakeholders and locations.

In a recent poll of CCGs attending an NHS England CHC event, almost half of the respondents stated they still used the national paper forms.

Some responded they used digital templates of the paper forms, but did not have workflow automation to provide process transparency.

Other than the Cheshire and Wirral CCGs, who had just installed IEG4ís CHC2DST cloud-based solution, none were using a fully-digital assessment tool.

Whereas six months ago, three of Cheshireís five CCGs were recipients of the call to action letter, none of them would be on that list now.

Itís an impressive turnaround and shows what can be done when the NHS works with SMEs to adopt innovation.

Itís not just about technology. Itís about the alignment of processes with people who have the determination to make a difference

Itís not just about technology. Itís about the alignment of processes with people who have the determination to make a difference.

Cheshire & Wirral has driven its own service improvement on top of IEG4ís technology.

The technology supports assessments completion in remote locations Ė so-called Discharge to Assess.

NHS England Q3 statistics show a significant reduction in the percentage of full assessments conducted in an acute setting for the User Group. That has fallen from 26% to 8% in over three months.

The good news for the patients of Cheshire & The Wirral doesnít stop there. Further analysis of NHS Englandís statistics for 2017/18 allows some interesting observations to be drawn.

Greater transparency offered by the digital solution allows more-consistent assessment of the positive referrals received by the CHC team. As a result, many more referrals were found to be ineligible for the CHC assessment.

In the past, this initial screening could have taken many days as validation was sought by phone, fax or mail. Now, its routinely checked and progressed to the next stage in a matter of hours.

CHC rejection itself, is not a bad thing. It points patients more rapidly to alternative services and enables people to develop appropriate plans sooner. It reduces the numbers of patients and their families having to wait for a later Ďineligibleí decision.

Simon Steven has committed NHS England to save £850m from the increasing CHC spend by 2021. Achieving this on the back of a cumbersome paper system will be difficult. CCGs need to grasp the nettle and invest in technology to save

Not only does digital transparency improve service speed, quality and reliability; it has also boosted assessment productivity, and, with it, staff morale.

NHS Englandís data points to the User Group performing at a different level to the rest of NHS England.

Comparison of Q3 data suggests that significant effort is expended on conducting full eligibility assessments which could have been avoided with better screening.

In comparison with levels achieved by the user group, NHS England may have undertaken 4,600 unnecessary full assessments for CHC.

Itís not just the manpower cost of the additional effort, estimated at some 160 FTEs. Each extra full assessment represents a patient for whom a decision regarding their care package is delayed.

Without a transparent system, paper hides this inefficiency, immersing professionals in activity for activities sake.

NHS Englandís data also suggests that the rest of England is finding a higher percentage of referrals eligible for CHC, when compared to the CHC2DST User Group. That may result in more NHS-funded CHC packages than required.

If a decision continues for weeks because paperwork has gone missing, it gets harder to communicate that Ďineligibleí decision, even, if that is the right decision. Itís human nature not to want to disappoint.

ďAll five Cheshire CCGs are collaborating to provide Continuing Healthcare in the region, working in partnership with IEG4,Ē says Tracey Cole, who led the project for the Continuing Healthcare service in Cheshire & Wirral CCGs.

ďThere are efficiencies in doing this to scale and working together to provide services around Continuing Healthcare and Complex Care. It means itís done once - and done well.Ē

CCGs have limited time to address the challenge, but, Cheshire & Wirral CCGs have shown how performance can be turned around.

With supportive technology Ďcontinuous improvementí becomes the management mantra. Freeing up valuable resources from mundane form filling allows those skilled resources to look at other areas of CHC to identify improvement.

Simon Steven has committed NHS England to save £850m from the increasing CHC spend by 2021. Achieving this on the back of a cumbersome paper system will be difficult. CCGs need to grasp the nettle and invest in technology to save.

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