Helping patients settle happily into the right long-term care setting is a key dimension of health and social care. Getting it wrong means needier patients, angry families, and spiralling costs.
Continuing care is becoming ever more important, owing to the ageing population and rising incidence of chronic diseases – but many trusts fail to manage it effectively.
Demographics are not the only trigger for change. The mandatory framework for continuing healthcare and NHS-funded nursing care, introduced across England on October 1, 2007, kick-started many trusts. Others were spurred by financial concerns, as was the case in Hillingdon, west London.
In 2004-5, Hillingdon Hospital used Department of Health project funds to tackle delayed discharges. Finding that staff lacked a comprehensive or informed view of local care homes, or the necessary skills, the hospital called in Carehome Selection to manage the placement process. The company had a good track record - its placement scheme for Worcestershire Royal Hospital was highly commended in the HSJ awards in 2003.
Carehome Selection was established in 1995 by general practitioner Dr Richard Newland, who realized how difficult and stressful it was for patients and families to choose a care home, and how poorly equipped most professionals were to advise them.
The nine-month partnership with Hillingdon Hospital worked well, and encouraged Hillingdon PCT to start work with Carehome Selection. PCT commissioner Kathleen Sadler had found that continuing care costs ran into millions, about 2-3 per cent of turnover.
Money was being wasted, and placements were poorly managed, often arranged by people who knew only their own borough and had limited skill in negotiating contracts.
The PCT recruited independent consultant Sally Gooch to work with its turnaround team. With continuing care lead Sue Maynard, they assessed funded patients and found that many did not meet the existing criteria. The panel that made the eligibility decisions was reformed, and effective processes introduced. Continuing care functions and budgets were consolidated within commissioning to facilitate financial tracking, enabling a wider review of placement costs and contracts.
“A lot of PCTs don’t have the internal capacity or history of employing people with the business and procurement skills for this kind of work,” says Sally Gooch - which is where Carehome Selection came in. It promised to make savings of 10 per cent on all new placements with an agreed tariff, and to handle all placements for the elderly (including the mentally ill) and palliative care. It paid the homes directly and then sent the trust just one monthly bill for everything - saving the trust £3000 a month in transaction costs alone in 2006-2007. Its profits came from a percentage of each client’s fee, paid by the home where they were placed. The same percentage was paid by every home to ensure impartiality.
‘We bring in a level of organizational skills - and the trusts we work with are happy to hand it over to us,’ says director Dr Newland.
In 2006-2007, its first year with Hillingdon PCT, Carehome Selection projected savings of over £446,600. Dr Newland believes this rate of saving is likely to continue and even improve, albeit against the trust’s forecast of increasing demand.
Improving information management was also a key issue. Like all trusts, the PCT needed a complete patient list for controlling its spend, and a tool for filing panel reports. It therefore decided to adopt Caretrack, a tailor-made system for managing all continuing care information.
Hillingdon now has access to an integrated, secure electronic database, web-based so that it is accessible from any computer anywhere. The user can quickly generate financial reports, including future spend projections. Charlene Sables, formerly the PCT’s placement manager for non-acute commissioning, found it a major advance on the previously fragmented range of information stored in different formats across different departments. ‘It leads to greater efficiency, a better service to patients, and greater cost-effectiveness after the start-up phase,’ she says.
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Jane Salvage is an independent healthcare consultant