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 is patient 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 [email protected]