WE MUST REMEMBER TO PUT PEOPLE AT THE CENTRE OF CONTINUING HEALTHCARE DECISIONS – HERE'S HOW TO MAKE SURE THAT HAPPENS

Friday, 24 November

By Colin Morrison, Senior Consultant at Inner Circle Consulting

At the interface between social care and health services are a cohort of people with complex needs who are often on the end of difficult decisions about who should be case managing and funding their care packages.  These decisions can have a huge impact on individuals, their quality of life and how their needs are met, managed and funded, and for local councils in terms of their legal, financial and professional accountabilities.

At the core of this is the NHS Continuing Healthcare (CHC) National Framework, which sets out the process for deciding eligibility. But the application of the CHC process can vary widely, particularly now, as it is buffeted by a range of pressures.  These include; rising demand, owing to an ageing population and long-term health conditions; budget constraints; rising care costs associated with home care, nursing care and specialised treatment; complex assessment and eligibility processes; regional differences and disparities in access to care; and increased public pressure as patients and their families better understand how to advocate for themselves.  In addition to this, and as highlighted by the recent Association of Directors of Adult Social Services (ADASS) survey, 70% of Directors reported that their staff are undertaking tasks previously undertaken by NHS staff.

When systems start creaking under pressure, it is all too common to rush to a quick ‘solution’ that can lose sight of the needs and best outcomes for the people at the heart of the process. We need to be able to support staff at all levels to have the right conversations, supported by appropriate knowledge and skills, and with clear and consistent processes in place.  The only way to achieve this is to establish collaborative ways of working that look beyond the boundaries of traditional organisational control.

Balancing individual, operational and financial outcomes, across both social care and health, cannot be underestimated in the context of this legally constituted entitlement.  At Inner Circle Consulting (ICC) we have therefore developed a pragmatic person-centred approach to evaluating the effectiveness of local CHC arrangements.  Our approach covers operational processes, leadership, technology, competence, data and insights, case reviews, management controls and structure and relationships.  We set the following four critical success factors:

1. Outcomes: To understand through every case review what the outcome will be at an individual level, using data to establish the effectiveness of existing arrangements in supporting individuals and meeting their needs.

2. People: To establish how those administering the processes are supported and have the required training to discharge their responsibilities.

3. Structure: To understand how risk is managed, whether quality assurance processes are robust, and to establish the maturity of organisational relationships, with a view to improving dialogue, performance and outcomes.

4. Processes: To establish whether there are jointly agreed processes in place and the extent to which they are supported by technology and effective case management solutions.

Working with one English council we have refined this approach to support individuals to get the help they need by the appropriate organisation.  We assessed and reviewed the effectiveness of its CHC system, implemented more robust processes and shaped the development of more collaborative and productive relationships with health colleagues, to improve outcomes.

Councils and their health partners must work in a collaborative way on these issues if they are to keep ahead of, and be able to respond to, complex need and rising demand.  Co-production and commitment to change is core to our work at ICC, so if your organisation is serious about system change which puts individuals and their needs first, please get in touch.