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Using recent developments to improve outcomes and patient experience in AACC by delivering consistency of approach and cost-effective quality care

With the establishment of Integrated Care Systems (ICSs) and Integrated Care Boards (ICBs), it is great to see a renewed focus on All-Age Continuing Care (AACC). This should mean that individuals and their representatives will have improved experiences, consistent application of the Framework and transparency across all forms of Continuing Care. All-Age Continuing Care encompasses; Adult’s CHC, Children and Young people’s Continuing Care, related children’s and adult’s joint funded packages of care, and adult’s NHS-funded nursing care. For too long, the focus has been on NHS Continuing Healthcare – this specifically refers to a package of ongoing care which is arranged and funded entirely by the NHS for individuals over the age of 18 who have ongoing health care needs or what is known as a ‘Primary Health Need’.

Integration and Continuing Care

The focus on All-Age Continuing care should enable a smooth transition between services and resource provision, including those who fund their care. It should also allow for more collaborative working and pooled budgets across health and social care services. All-Age Continuing Care funding supports some of the most vulnerable people in society, their families, and their representatives. Those in receipt of these care packages must have their care plan reviewed regularly to ensure they receive the appropriate level of care and support. The eligibility process for Continuing Care is set out in the National Frameworks for NHS Continuing Healthcare and NHS -funded Nursing Care (revised July 2022) & National Framework for Children and Young People’s Continuing Care. However, its application and understanding vary significantly, leading to increased inequalities in outcomes, experience, and access. It is no secret that CHC departments have different policies, processes, and procedures, which is one of the leading causes of the disparity in outcomes, experiences, and access. With the formation of ICBs and the merging of previously independent Continuing Care departments, policies and standard operating procedures must become aligned across the ICB.

Delivering the objectives of the ICS

ICSs are tasked with delivering on four strategic purposes. Improving outcomes in population health and healthcare; tackling inequalities in outcomes, experience, and access; enhancing productivity and value for money; supporting broader social and economic development. Getting AACC right will play a significant role in helping ICSs/ICBs to achieve these outcomes. Ensuring reviews are done on time, focusing on the right care and support for every individual. The emphasis of AACC reviews has often been on eligibility. The focus of these reviews should be on quality. Ensuring timely reviews that focus on providing the right level and quality of care for those in receipt of AACC funding will inevitably lead to enhanced productivity and value for money for the system. After all, this funding is there to support our most vulnerable citizens.

The importance of getting the checklist right

With AACC and complex care departments still dealing with the fallout from the pandemic, many ICBs are now needing to respond to backlogs in framework-mandated 3 and 12-month reviews. They are working incredibly hard to keep up with assessments of new applications (DSTs -Decision Support Tools) for NHS continuing healthcare and NHS-funded nursing care. Evidence suggests that the number of checklists – the initial screening to determine if an individual should be assessed for Continuing Care/CHC – is increasing and leading to more positive checklists for individuals who are likely not eligible for continuing care funding. This is unsurprising given the understandably low threshold for a positive checklist.

However, this increase in referral activity inevitably leads to an increased workload for Continuing Care colleagues. Therefore, the checklist must be completed consistently by professionals with an excellent understanding of the National Framework. We have seen this vital task delegated to ward and discharge teams often with limited time, capacity, and varying degrees of experience and understanding of the Continuing Care/CHC process and relevant Framework leading to an influx of patients unnecessarily requiring a DST (full CHC eligibility assessments). This does not help manage expectations for the individual or their representative and more likely creates unnecessary confusion for those that shouldn’t be recommended for consideration.

Achieving value for money in Continuing Care

The NHS spends a significant proportion of its budget on AACC. It is often one of the first points of call for finance colleagues seeking efficiencies in their efforts to manage their strained budgets. With the move to more collaborative pooled budgets and integration across health and social care, finance colleagues will need to work closely with commissioning colleagues. This should enable better market management and provider engagement to ensure value for money for commissioned packages, particularly complex, high-cost packages and care placements.

Improving patient experience and outcomes through enhancing the quality and appropriateness of care can deliver the required cost efficiencies. Right Care, Right Time, Right Place.

We recognise that Covid 19 has put an incredible strain on the health and care sector. UB Healthcare is ready and available to help the NHS and social care tackle deferred activity and focus attention on more pressing priorities. We can help with the management and assessments of new applications for Continuing Care and NHS-funded nursing care, as well as reviews (CHC, FNC, Section 117, Joint Funded, Fast Track/EoL) of existing patients and more. We can help you take back control.

Mark Shipman

Mark Shipman

Associate Director

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