Review on one-to-one care reduces overspending and improves patient outcomes
Oxford CCG found that there was a noticeable increase in additional one-to-one care packages given out in the Oxford area, which led to a review to explore the reasons for and solutions to the sharp rise in provision.
£29,500 per week available to reinvest into care
£1,500,000 per annum reallocated NHS CHC
The Challenge
Oxford CCG found that there was a noticeable increase in additional one-to-one care
packages given out in the Oxford area, which led to a review to explore the reasons for and solutions to the sharp rise in provision.
A number of factors were found to be causing the increased award, including national factors such as the Covid-19 pandemic, high continuing care loads, and elevated staff sickness. Locally, they found that the OCCG and Oxford Health process was also contributing to the over-provision.
Liaison Care was asked to examine the end-to-end process, and make recommendations to improve the clinical and social outcomes for clients. This included ensuring the use of least restrictive practise to support individuals in a nursing home placement currently receiving one-to-one care, and offering insight into the financial situation surrounding additionally funded one-to-one care packages across the region.
As the review commenced, an increased spend from £1million to £4.5million was predicted in the area of one-to-one care alone.
The Solution
Working with the CCG, the Liaison Care team reviewed clinical evidence for each individual case and looked at the current care and support needs before undertaking the one to one review. First, we must consider any adult safeguarding concerns and requirements under Deprivation of Liberty Safeguards (DoLS). Looking at the evidence and care planning to ensure person-centred care and least restrictive practice for each case. The experienced review team worked with providers and the chosen representative to risk assess and reduce when appropriate one to one care, making recommendations to implement assistive technology or activity-based care planning.
Each case was reviewed by Liaison Care for quality and clinical assurance. Finally, each case was considered by the CCG’s panel of health and social care professionals to ensure that the care has been safely and timely reduced. This resulted in a finding of over £4000 a day which could be reinvested into the NHS and other individuals.
The Outcomes
Liaison Care reviewed 34 cases and made recommendations for reduction of one-to-one care in 25 of these, detailing the primary cause for the financial increase and overspend within Oxfordshire CCG. In these cases, one-to-one care was not core to the clients’ needs.
The reviews highlighted no safeguarding concerns highlighted as part of the review.
100% of cases identified an appropriate initial assessment of need for one-to-one care.
The reviews highlighted no safeguarding concerns highlighted as part of the review.
There were 13 cases where assisted technology was recommended to help reduce one-to-one care, suggesting a potential gap in staff awareness of the solutions on offer which could be improved on with training.
Finally, there was a significant difference in expenditure of one-to-one care across the care providers which had been agreed by OCCG. The variation in costs was attributed to a difference in hourly rates, meaning that our recommendation of reviewing and aligning this could save the CCG over £4,000 every day.
Next Steps
In the short term, Liaison Care have recommended a review of the remainder of one-to-one cases across the Oxfordshire locality, to ensure consistency and to confirm the least restrictive practice is present.
In the longer term, Liaison Care has recommended a review of the process for agreement and monitoring of one-to-one care, and potential training needs across the care providers.
We have also recommended the consideration of a standardisation or cap on hourly one-to-one rates to reduce financial variability.
CHC Operations Manager
South West Region
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If you are the individual, a family member or a chosen representative of the individual and would like to enquire about your review please speak to your assessor directly or you can contact us on 08001 30 31 32 or click here to email us.
Business:
Oxford CCG
Challenge
An increase in one-to-one care
Solutions
Bespoke Consultancy (one-to-one reviews)