The suspension of the CHC processes during the COVID-19 pandemic which emerged in March 2020 resulted in many CHC teams being redeployed or repurposed to other areas of the NHS, including hospital discharge hubs and community services. The CHC Strategic Improvement Program (SIP) has also seen a change in its role, with many of the team being redeployed to take a significant role in the COVID-19 testing program.
The SIP team was set up in 2017 to support CCGs improve their CHC delivery. The programme was expected to run for two years, but this was extended by an additional two years, with a planned end date being 31st March 2021. During the coronavirus emergency period, many aspects of CHC have been discussed, including what CHC will look like post COVID-19.
With the testing programme continuing and likely to increase over the coming months, many are asking what will happen to the SIP team; and whether the programme will come back together to support CCGs getting back to business as usual. Many are concerned that without their guidance and oversight, they will struggle to pick up their transformation programmes which were suspended during this period.
From 1st September 2020, CHC processes are due to recommence, with many CCGs currently developing recovery and restoration plans ensuring that they can address the requirements outlined in the NHSE Phase 3 letter, issued at the end of July. As well as working on their backlogs, CCGs are working to bring back their CHC teams, many of whom have been dispersed for many months, to be able to deliver CHC in a safe and positive environment.
While it may be the case that CHC can now restart and operate in line with the national framework, there are additional challenges about how assessments, MDTs, etc, can be completed without increasing the risk to staff and individuals.
During the emergency period, technology played an important part in the NHS being able to undertake many tasks. The use of Microsoft Teams, for example, changed the way many NHS, social care and third sector organisations worked and communicated. I would ask why this would not continue – going back to how we used to do things is not always the best direction.
For example, Virtual MDTs are not a new concept, and some CCGs have offered video conferencing for years, enabling individuals and their representatives to be part of the MDT if they are unable to attend in person.
In the current climate, virtual MDTs must be considered as a practical solution, balancing the need to restart the CHC processes while keeping everyone safe. If we are to maintain social distancing and comply with our bubbles then I can see no other option.
Many I have spoken to are sceptical and see them as unethical and not framework compliant. Others, more accustomed to them, disagree. This presents a risk to the CHC programme nationally, if some CCGs are offering this and others are not. This is where leadership from the SIP team would be important.
The CHC digital programme, one of the CHC SIP’s work streams, focused mainly on CHC systems and case management, which was the priority at the time. Maybe this is the opportunity for extending their scope to include other technologies which will support CCGs delivery a framework complaint CHC service?
Standard Operating Procedure (SOP) covering virtual MDTs will become more important and the opportunity to standardise these for all CHC teams is key to ensure consistency. I have been asked by many of the CCGs I work with if I can develop one. All are concerned that without one, they don’t feel confident about getting back to business as usual, and they could be risking doing things differently to other CCGs. This, in my view, is where SIP should be leading and developing one to share across all CHC teams, providing them with clarity on when virtual MDTs should be done and guidance on best practice.
Currently, CCGs are consumed with their recovery plans and how they will restore their CHC processes while managing the backlog of cases due to the emergency period. Many are worrying about the best approach and how they will be able to offer the best service to those who may be eligible for CHC. All of them, however, are concerned about who will pay for this additional work and will there be any financial or workforce resources available.
Prior to the suspension of the CHC processes, the SIP team had developed a number of products and guidance to support CCGs in their delivery of CHC. These included the CHC Delivery Model, the Competency Framework, the Workforce Tool, etc. These were invaluable tools to support CCGs and the SIP’s aims of standardising the delivery of CHC across the country. With the current uncertainty of what ‘good’ looks like in CHC post-COVID, I believe the leadership provided by the CHC SIP programme is needed now more than ever with the risk that its achievements over the last three years will be lost.
With the core SIP team being so small, it is unlikely they could manage both their SIP and testing roles. Consideration of how this should be resourced is key, but I am sure the investment will be worth it.
I would suggest that a well-resourced SIP team, with potentially a broader brief might be appropriate to reflect the lessons learned during COVID-19. This brief could, for example, include supporting CHC teams in their integration with community services and promote better partnerships with local authorities.
It is unlikely that the testing programme will stop anytime soon, but surely it is of equal importance to restart the SIP team to support CCGs during these unusual and uncertain times.
I would urge those of you who agree with this view to make your views known to your CHC regional leads and to Matthew Winn, Director of Community Health at NHSE.
If you would like to discuss the issues above, please get in touch at either email@example.com or firstname.lastname@example.org – we welcome your views, challenges and suggestions for ongoing improvement in the sector.
About Hugh Reynolds, CHC Strategic and Clinical Director, and Paul Taylor, CHC Consultant, Liaison Care
Hugh Reynolds has more than 30 years of combined experience in health and social care, developing products and services to support the increasing challenges faced by the sector.
As Clinical Director of Liaison Care, we have become the Continuing Healthcare partner of choice for over 60% of the CCGs in England and have developed a range of products and services to help them manage their rising CHC costs, through a combination of CHC audits, financial reviews and consultancy.
Paul Taylor’s background is within the NHS England Strategic Improvement Program (SIP), where he was Collaborative Workstream Lead and co-creator of the NHS England/ADASS web-based CHC Delivery Model.
In addition, Paul was a co-creator of the CHC Change Agent Facebook group which is used for such discussions and peer support.