Turning Why into How to improve CHC across ICSs

• Why do we have such a wide discrepancy in the numbers of assessments being requested across our region?
• Why does eligibility vary so greatly place by place?
• If management is ‘standardised’, why do we see so much difference in team outputs?
• One of our places does things very differently from the others – how do we make sure we are seen to be impartially reviewing our processes as we capture and embed ‘best practice’ across the region?
• What triggers can we identify to explain why relationships with Local Authority partners vary from ‘very integrated’ to ‘fully at arm’s length’, with the strength of those relationships differing from ‘very warm and close’, to ‘distant and verging on hostile’?
• Why do our fast-track referrals vary so much from Acute to Acute?

Do any of these questions sound familiar?

At Liaison Care, when we talk to individual CCGs and latterly places, we may sometimes discuss the quality of a service with them, and how we can best support them with deliverable-oriented consultancy support. But, more frequently, we find ourselves talking about a lack of supply to meet growing CHC and care demand, which inevitably veers far more towards supporting the organisation with clinically-experienced capacity.

Our discussions with ICS CHC leads are the exact opposite of that, with some debate about resourcing – usually linked to backlogs, budgets, and other risks inherent in those across the region. Far more regularly, we hear a subset of the questions above, many of which have their origins in capability. The drive to better understand WHY things are happening and WHY such differences occur is something that ICSs recognise they need to address partly for financial oversight and control, but primarily to improve decision-making and patient experience.

That is not to suggest that the CHC teams we work with day in and day out are not capable – far from it! We see examples of excellence every day. However, the changing workforce, regularly updating protocols, the introduction of agency and part time staffing solutions, the lack of time for induction and training in best practice, and the real lack of good and insightful management information, means there is a widespread lack of knowledge of HOW things are done at place level, which results in inconsistency.

And with that, the discussion quickly turns to the HOW? How do they ensure that all parties know that their ways of working are being fairly, compassionately, and impartially reviewed? How do they defend and tackle variation whilst identifying best practice? And HOW do they plan for best use of scarce resources?

We took a decision a long time ago as Liaison Care that we would invest, wherever possible, to grow a specialist team of experienced senior clinical nurses and social workers to deliver our capacity; and support them with in-house consultancy when and where that is required.

We take all new team members through a long and intense induction, because we want them to work from their first case as if they have been with us for ever. We also layer Quality Assurance on top of what we do, and hope that our customers notice the difference in the work they receive back from us. Feedback suggests they do – and so we continue to build on this.

In doing this, we have developed a team who are valued by the CHC teams they work with across the country, developing and refining continuing healthcare for the benefit of patients and their families as the NHS’s new structure comes into play. Our team understands the need to move from the WHY to HOW, to enable CHC teams to increase efficiency within their own teams, and consistency across teams covering an ICS.

If Liaison Care can help to answer the questions your CHC team has, please get in touch with us for an initial discussion at [email protected]