A paper-free assessment process where information never went missing and the scheduling of activities to drive recommendations and verify decisions was transparent.
One where the status of each application could be seen on a single dashboard and time spent updating spreadsheets was removed because audit trails were automatically updated as a result of activity being completed.
We did. And so did five NHS CCGs who helped us bring an award-winning solution to life:
The outcomes: faster decisions about Continuing Healthcare for their patients; increased work transparency and focus; more time available for patients; and, much less time spent on non-value adding admin and progress reporting.
Cheshire and Wirral CCGs save around 13 hours per completed assessment in CCG time alone. Their performance against 28 day decision standards improved dramatically and now exceeds the national KPIs. Case backlogs are a thing of the past.
These CCGs are working smarter, not harder. Redeploying effort to other areas of Continuing Healthcare, they have achieved QIPP savings in excess of £3.4m in nine months of FY2017/18 and £5.3 million in FY 2018/19.
Don’t just take our word for it. We’ve been rigorously evaluated by the NHS National Innovation Accelerator programme which independently confirmed the benefits our solution can deliver.
Roughly half of the CCGs in the England are failing to achieve the national 28 day decision turnaround standard for CHC decisions. A common cause of delay is the handling of paper without an effective automated process to co-ordinate activities from the different stakeholders involved.
In the first year of operation across Cheshire and Wirral CCGs, around 350 authorised users, from different organisations, processed around CHC 2,500 cases, uploaded over 20,000 support documents and made 3,000 case notes, entirely digitally.
As a result of introducing Digital CHC, Cheshire and Wirral CCGs have recorded CCG time-savings equivalent to 13 hours per completed CHC assessment.
Our Digital CHC solution eliminates paper and ends the difficult to manage paper-chase that it causes. It allows users to submit Standard CHC Checklist and Fast Track referrals instantly from any location to a single point of contact.
Methodical checks on completeness and suitability reduce downstream work effort and delays. Across Cheshire and Wirral CHC referrals are quality checked, triaged and, those that should be, are allocated for further full assessment within two to four hours.
Information stored under the patient case is retrievable by authorised stakeholders at the point in the process where their input is required. The elimination of paper and the introduction of effective workflows which mirror the National CHC Framework result in communications across stakeholders which are instant, secure and IG compliant.
QIPP savings in Financial Year 2018/19
Reduction in wait times
Improvement in resource utilisation
Reduction in administration costs
Around 80% of current CHC referrals result in ineligible decisions for CHC. NHS CHC SIP estimated that the full assessment effort on some 30 – 40% of all CHC referrals submitted could be avoided by working smarter.
With Digital CHC, a referrer is reminded when not to submit a Checklist and asked to confirm that submission conditions are met. That focus eliminates unnecessary work from entering the CHC process.
Digital CHC provides a single point of contact to monitor the quality and completeness of referrals coming in. Cheshire and Wirral CCGs normally complete triage of cases for allocation to further full assessment within two to four hours.
Working smarter not harder, Cheshire and Wirral CCGs operations managers expect each clinician to complete between three and four DSTs each week. Digital CHC makes this eminently achievable by providing focus for the work which needs completing.
Staff are both more productive and love the clarity the Digital CHC solution brings.
Working smarter not harder, extends beyond the CCG to all the stakeholders involved in the CHC process. GP practices receive an email link to attach patient summaries and return them securely to the CCG at the click of a button.
Local authority staff are better utilised and able to work more collaboratively. They can access and contribute to specifically allocated cases without delaying progress. An ability to attend MDT (Multi Disciplinary Team) meetings and input views via video-conferencing reduces travel time and expense and enables MDT meetings to be scheduled more frequently.
Where there is a predominance of paper and no purpose-built workflow to drive to decisions or maintain audit-trails, service managers struggle to drive the progress of specific referrals.
With Digital CHC, service managers can track the progress of each case. This transparency means that work effort can be directed to those cases which may be in danger of exceeding 28 days.
Transparency over existing workloads allows service managers to assign cases based on workloads, or, to the appropriate clinician. Individual clinicians see only their cases within their work-queue. Dates for meetings and completion of assessments are clearly visible. Responsibility, accountability and the timetable for progressing the case is clear, not lost in reams of paper or outdated spreadsheets.
An audit trail of all activity makes the verification of process due diligence quick and easy. All documentation supporting the case is digitally presented in one place, easy to read and complete, leading to increased confidence and consistency in decisions made.
“Often our team will get calls coming through asking where referrals are up to. With [Digital CHC], it's so easy to see where the referral is in the process and who it's sitting with. So, there's a bit of ownership. There's no getting around it, if your name is attached to it, this is your job to do it.”
By digitising the CHC assessment process, NHS staff can deliver an improved quality of service to the patients, families and carers who are at the heart of it.
Digital CHC allows standard CHC referrals and Fast Track submissions to be conducted anywhere, on a timely basis, for the benefit of the patient and the system. Full assessments can be conducted anywhere, helping CCGs and hospitals to reduce the number conducted in an acute setting and minimising hospital stays for patients. Digital CHC users conducted less than 3% of their full assessments in an acute setting.
Patients who are ineligible for CHC can be informed quickly of alternative care pathways (e.g. Funded Nursing Care) to help families plan effectively. As a result, more focus can be given to those requiring full assessment, 87% of whom across Cheshire and Wirral CCGs received notification about their CHC eligibility, or otherwise, within 28 days.
Assessment documentation and progress is recorded under the patient case allowing CCGs to respond instantly to inbound patient enquiries. Transparency of scheduling allows patient expectations to be more effectively managed and delivered upon.
Patients of Digital CHC users have seen a drop of 70% in wait days since the introduction of Digital CHC. The longest wait time for patients has shrunk by over 80%.
Cheshire and Wirral CCGs have seen Digital CHC deliver a better patient experience, faster decisions and with less variation in outcomes. The transparency and efficiency generated by the system has improved patient engagement. With better documentation and improved timeliness, they have seen the volume of complaints, local disputes and appeals reduce.
“I rave about it. I think it’s brilliant. I think it’s simple and it’s so much more patient-focused as well.
I would recommend it all the time”
“It’s so much easier to do it on [Digital CHC]. So much quicker and, [the information] it's, just, all there.”
“I've worked on other systems with different companies outside of the NHS, and this is the easiest one that I've been able to pick-up and work [with] straight away”
NHS England confirmed that some £150million was spent on the administration of the CHC process and committed to save £855 million from the increase in spend on CHC by 2020/21. By definition, savings have to come not only from the cost of delivering the service, but also, from honing the spend of the care services provided.
Digital CHC has enabled an increase in CHC staff productivity which has allowed more time for experienced staff to be assigned to other areas within continuing healthcare.
With more time to conduct timely reviews and reassessments and more time to investigate and remove anomalies in care packages and care package spend, Cheshire and Wirral CCGs have achieved total CHC related QIPP savings of £8.7m up to the end of 2018/19, since inception in September 2017.
At the same time, more people served by Cheshire and Wirral CCGs are waiting significantly less time for their CHC decisions.
Cheshire and Wirral CCGs managed to down their CHC case backlog by freeing-up the time of experienced staff to reduce the number from a recorded peak of 229 at Q3 2017/18 to just 23 at Q4 2018/19.
Some CCGs have turned to external agencies to reduce their backlog at calculable expense. Those which have taken this route have invested heavily in people without producing a fundamental change in in-house capability. As CHC volumes are predicted to rise, a return of backlog is likely for those who have not digitised the process. Digital CHC users are confident that their backlog, once removed, will not return to unacceptable levels.
We are delighted that IEG4 and its 'Digital CHC solution' has been backed by the NHS National Innovation Accelerator programme.
The NIA supports the faster take-up of high-impact, evidence-based innovations for patient and NHS benefit.
The NIA’s rigorous, multi-stage assessment called on the expertise of patients, clinicians commercial and improvement leads to confirm the positive impact of each nomination. As a result, IEG4’s Charles Mackinnon was nominated to the fellowship of the NIA to work alongside them in driving the adoption of ‘proven innovation which is absolutely critical to healthcare’.
Digital CHC is the only CHC solution backed by the NIA and the only solution with the independent evidence base and NHS proof of impact gathered over two-years of live operation.
NHS England reports key performance indicators within the NHS Situation Reports for CHC on a quarterly basis. Official NHS England figures show the continuous improvement achieved by Cheshire and Wirral CCGs since they implemented Digital CHC.
The NHS Business Services Authority has produced a best practice case study of transformation in Continuing Healthcare in Cheshire and Wirral CCGs for the NHS CHC Strategic Improvement Programme.