What did we learn from the suspension of Continuing Healthcare during the pandemic, and what must we do next?

The coronavirus pandemic has had a profound impact on the Continuing Healthcare (CHC) Services across England. Not only was the service suspended for 6 months and its staff repurposed to other priority areas including hospital discharge, care homes or the community, but they were also given the challenge of completing the work that could not be done during the suspension by March 2021.

Now we are at the end of our ‘annus horribilis’, how did we do? And should we return to ‘business as usual’?

Back to Business

On 1^st September 2020, we were pleased to see the long-anticipated return of the CHC processes and how CCGs planned to address their backlog of deferred assessments. While many CCGs were quick off the blocks, some struggled with how they could best utilise their existing workforce and any available agency staff to meet these challenges.

It should be noted that some CCGs were on a better footing at the beginning of the lockdown than others. Blessed with an experienced and complete workforce and good operational relationships with their local authority partners, some CCGs flew out of the traps and did not look back, leaving others to follow with what meagre resources were left.

The suspension and reintroduction of CHC has exposed one of the long-term obstacles that face CCGs – the challenge of recruiting good CHC assessors. The question we need to ask ourselves is: have we done enough to encourage people into CHC to grow our workforce for now and the future?

This issue is likely to be further exacerbated by the UK Government’s decision to award a 1% increase to NHS staff working in England. In my view, this could lead to a mass exodus of nurses leaving the NHS altogether. Everyone understands we need to balance the nation’s books. Having worked so hard to support the country during the pandemic, however, it must be hard for nurses to understand why any politician would think this was a good decision right now.

Variations across the country

The CHC suspension and reintroduction has also shone a light on the fact that there is still a significant variation in how CHC is delivered across England. Despite the efforts of CCGs, NHSEi and the NHS England CHC Strategic Improvement Programme, we still see unwarranted variations in the experience and outcomes of individuals referred to CHC in different parts of the country.

The use of technology to support the CHC process was the thing that I have taken as the most significant learning during this period. Some CCGs have been using technologies like video conferencing for many years, ensuring that people can attend MDT regardless of where they live. Access to MS Teams and Zoom has made this a reality for all, including CCGs, local authorities, individuals and their families.

Using these technologies has allowed CHC teams to restart their processes with confidence that they can complete high quality CHC assessments and reviews while being compliant with the National Framework.

Feedback from families involved in our CHC reviews has confirmed that by completing them on Zoom, we were able to “include all the family in mum’s review” which we would almost never have been able to do before Covid. Using video conferencing has also allowed for a greater level of flexibility. In order to those who work during the day, we have been able to arrange reviews in the evening, again, something that could not have happened pre-COVID.

Necessity is the Mother of Invention

To use an old cliché, ‘Necessity is the Mother of Invention’. During these COVID times, CHC has had to adapt to new and alternative ways of delivering their services through new technologies and remote working.

While we hope these new methods will remain with us post-pandemic, we cannot ignore the reality of the long-standing issues faced by CHC, namely variation in quality and access to a sufficient workforce.

Have Your Say

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