Insights for ICSs from Liaison Group

In our first ICS Update of 2022, we’re looking at how systems can benefit from the launch delay, reporting to quickly identify staff shortages, and the feeling of déjà vu for CHC teams as they again are challenged by funded targets.

We hope you find this month’s update useful and would love to hear your thoughts, feedback, or experiences on any of these subjects. Please share them with us at info@liaisongroup.com.

Andrew Armitage

CEO, Liaison Group

How can ICS leaders benefit from an additional three months until launch?

It was recently announced that the official launch date for ICSs has been shifted by NHS England from 1st April 2022, to three months later, on 1st July 2022. Whether an ICS is already running, or still finding their feet in system working, the additional weeks before formal launch offers some opportunities.

Many senior leaders within ICSs, and particularly those with clinical commitments, are likely to have found themselves again in need of prioritising the treatment and care of Covid-19 patients over the set up of system collaboration. As the most recent wave of the pandemic begins to show signs of easing, the delay provides recovery time to refocus on the needs of the ICS.

The additional time also allows for further collaborative conversations to take place, ensuring that all parties within the system, both hospital- and community-based, are fully aware of processes and requirements. For ICS management teams, the delay also allows extra time for compliance requirements to be put into place where they have not yet been able to do so.

All NHS leaders will be all too familiar with the difficulties of embedding new technology and processes within trusts. It can be expected that processes and platforms will be required to change in at least some partner organisations within a system, and so the delay may be used to ensure that essential programmes, education and support can be put into place to allow for smoother transition to collaborative working and ensure interoperability – a reoccurring pain point for many NHS organisations.

Finally, the delay is an opportunity for NHSEI to continue developing the digital staff passport to allow the workforce to move between organisations, and assist in filling staffing gaps where needed. Across a system, this form of collaboration will be essential in providing support where staff shortages are found, and will support the existing use of collaborative banks where they are already in place.

A delay is never ideal, and not what ICS leaders will want when facing the transition from CCGs to broader system working, and the challenges that the process creates. However, where benefits – or silver linings – can be found, these should be embraced and by acting on them, we would hope to see the transition become advantageous for everyone involved, from management to patient.

– Andrew Armitage, CEO, Liaison Group

Daily staffing report proves invaluable in easing the pressure of understaffed wards

A few weeks ago, a Trust came to us with a common problem… they were finding that they were only able to find out about the staffing shortages within their wards and departments retrospectively, meaning that teams were often left short-staffed for shifts and individuals were faced with the pressure of covering for staff absences whilst also completing their own tasks and providing care.

Using the data they provided, we were able to produce a report, the Daily Staffing and Unavailability Look Forward report, which is proving invaluable in saving staffing teams considerable daily administration time and allowing them to quickly act on upcoming staffing challenges.

The report validates data from existing workforce systems, providing a snapshot of staffing shortages today, tomorrow and the following day. Teams are then able to action the gaps identified at speed, accessing their staff float or collaborative bank to fill shortages before shifts begin.

We all know that staffing pressures have long been an issue across the NHS, and with the current uncertainty around mandatory vaccination meaning that staff may be lost or need redeploying, the strain of ensuring that shifts are filled and care is provided at safe levels for both staff and patients has never been felt more.

The Daily Staffing and Unavailablility Look Forward report is available for use across systems and NHS organisations, and is completely bespoke to their needs of the trust or ICS. It can be adjusted to ensure that we understand which wards and staffing groups you would most like to monitor are prioritised within the data, to ensure it has the most impact on planning and recovery.

At a time when the NHS continues to face staffing issues exacerbated by Covid-19 and its ongoing fallout, the report allows systems and workforce leaders to take a step towards getting on top of workforce shortages and accessing fast information to ease the pressure on staff, and allow the focus to remain on providing high quality patient care.

To view an anonymised version of the Daily Staffing and Unavailability Look Forward report and discuss how it could benefit your organisation or system, please get in touch at info@liaisongroup.com

Déjà vu for CHC across systems

Are Continuing Healthcare (CHC) teams feeling a sense of déjà vu? It wouldn’t surprise us, as they face similar pressures to last year’s year-end with 2021’s Covid-19 backlog now replaced by Discharge to Assess (D2A) and all the challenges that it brings?

In Q4 of 2020-21, CHC teams found themselves in a rush to meet funded targets for 3- and 12-month reviews backlogged by the temporary suspension of CHC during the first wave of the global pandemic. As a result, a lot of in-house resource went towards meeting these targets before the 31st March deadline, possibly at the expense of incoming routine reviews. This led to some pretty acute short-term resource issues, with many CCGs and systems turning to external providers, including Liaison Care, to help manage needs and meet expectations.

Jumping forward to this year’s Q4, and the pressures on CHC teams look remarkably similar. Across the NHS, and within individual ICSs, there is a need to rapidly turnover beds to help manage growing waiting lists – again exacerbated by the latest Covid-19 wave – with extra bed capacity needed for both Covid patients and to support higher elective recovery.

To enable the increase in bed spaces, many systems have looked to place some elective procedures with the private sector, as well as utilising collaborative working practices to optimise use of the trusts which have greater capacity within a system. Additionally, trusts have looked to make full use of D2A: sending medically optimised patients out of hospital ahead of completing the usual pre-discharge procedures of establishing care needs, available funding, etc.

D2A is currently funded from central funds for four weeks and is very closely monitored and measured, and is again putting CHC resources under strain. Therefore, teams are again facing similar pressures to the previous year, as a payment regime places an artificial drain on resources, and a necessity to redirect resources to meet D2A requirements and assist in the freeing up of essential bed spaces.

If D2A is not completed within the set four-week timeline, the process could lead to the patient being unable to access ongoing care needs or facilities, which could then lead to further health issues going forward, a negative patient experience and further drains on the system.

Additionally, if a patient leaves hospital with a fully funded package of care, there can be an expectation set with that patient that their care needs will always be funded in that way. If their case is then not managed carefully and with proper communication, any changes to their care package once assessments are complete can lead to further disappointment, and a risk for future complaints and additional reviews as a consequence – again leading to more pressures for the CHC team.

Like last year, this leaves many CHC teams struggling to complete D2A assessments, as well as ‘business as usual’ reviews. The resolution for many teams will mean falling back on agency staff or short-term managed services to assist with the provision of reviews or to look after the day-to-day CHC Decision Support Tools (DSTs) which are again in danger of slipping into arrears, as they were the previous year.

Taking on agency staff to support the additional D2A requirements comes with its own consistency and training risks, and can add to variability in decision making and care management. Variations in quality will also add to the problems, with potential increase in patients funded who are not eligible, complaints and appeals. Therefore, making use of an experienced CHC managed service, such as Liaison Care’s specialist team, who have the skills and expertise to support with either D2A or day-to-day reviews and who can do so quickly and efficiently, will help CHC teams to get back to business as usual and again manage the pressures, hopefully lessening that feeling of déjà vu.

To speak to Liaison Care about support for systems and CHC teams, please get in touch at info@liaisongroup.com

– Phil Church, Managing Director, Liaison Care

News & Views

A brief round-up of recent articles, guides and blog posts covering news and views on ICSs from healthcare experts…

  • The number of patients in hospitals who are ‘medically fit’ to leave has increased in January, despite NHS England targets for trusts to dramatically reduce the numbers. The increasing delayed discharges come amid ongoing high staff absence rates in the NHS and social care, with many care homes closed to new admissions due to covid outbreaks. Read more
  • All ICSs are required to have a System Quality Group, focused on enabling quality improvement across the health and care system. The new guidance published on Friday 21st January replaces the National Quality Board’s previous national guidance on Quality Surveillance Groups.
  • Dr Neil Modha and Hashum Mahmood report on how Cambridgeshire and Peterborough CCG is aligning resource with need, not head count, in NHS Confederation’s latest blog: Resetting human and financial resource in general practice.
  • Louise Patten, director of the NHS Confederation’s ICS Network and chief executive of NHS Clinical Commissioners, publishes a new blog – ICS delay muddies leadership and threatens accountability, which states that poor communication about ICS delays hasn’t helped what can be an already difficult situation.