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IEG4 have digitised and automated the data collection and processing of CHC & DST, and have been able to demonstrate the potential for significant savings in the CHC assessment procedure.

Productivity gains have been generated for stakeholders across the CHC assessment process from increased speed of completion and submission of checklists and improved data and process transparency. 

This has allowed the CHC2DST User Group to reach faster decisions as to eligibility and to apply the policy to cases more consistently.  

Information below is derived from analysis of NHS England Quarterly Situation Report data from 2017/18 Q1 to Q3.   The CHC2DST User Group, comprising 5 CCGs working together, started using the solution in a live environment from September 2017, beginning with the processing of new assessments.

Improvement In Decision Turnaround

During the period the CHC2DST User Group saw an 18% improvement in their group performance for the turnaround of decisions within 28 days.  

During Q3 the User Group also processed 200 backlog cases which have suppressed the overall attainment figure, indicating a higher percentage of performance against the National Standard.

Previously 2 of the 5 CCGs had received a letter from Matthew Swindells and Prof. Jane Cummings as they were failing to achieve a 50% level against the 80% National Standard.   In Q3 all CCGs in the User Group surpassed that level.

data table for chc2dst 28 day decision

During the same period, NHS England as a whole saw a 9% improvement in decision turnaround.    If the User Group decision turnaround performance had been replicated across NHS England this would have resulted in 2,733 patients receiving a quicker decision regarding their eligibility or otherwise for Continuing Healthcare in the quarter.

Reduction In Unnecessary Full Assessments

CHC2DST offers administrators and clinicians greater transparency, control and communication speeds over the Checklists submitted to them.  As a result, the users have been able to perform admin and clinical checks consistently within a day. 

By applying admin and clinical rules more consistently and quickly against easier to see digital Checklists, significantly more positive checklists have been deemed ineligible for Full Assessment without needing to conduct the actual further assessment.

table for chc2dst submitted checkists

The CHC2DST User Group achieved a 17% improvement in their ability to determine eligibility without the need to conduct the Full Assessment over the period. 

During the same period, NHS England saw a 15% decline in its ability to make decisions without a full assessment, leading to significantly more work, which may not have been necessary.

The User Group was able to determine eligibility at an earlier stage than across NHS England as a whole.  The disparity in performance equates to some 4,600 Full Assessments potentially being conducted during the quarter.   On an annual basis, earlier decision making would offer NHS England a significant productivity boost, by reducing unnecessary work.

For the patients and carers and the support system, a faster decision as to eligibility or ineligibility allows alternative plans to be made without delay.   In the case of the User Group, 41% of the ineligibility decisions could be made within the day and communicated electronically out to stakeholders.

Reduction In Continuing Care Packages Allocated

Better oversight of the process workflow and better insight into the specifics of the assessed cases provided the User Group with increased confidence in the robustness and consistency of their decision making.

Over the period the User Group was able to reduce their Referral Conversion Rate by 15% from 20% to 17%.   During the same period NHS England, as a whole, improved conversion rates by 12%.

table for chc2dst referral rate

Given the scale of CHC assessment requests across NHS England, the difference in Referral conversion rates amounts to some 790 patients receiving NHS funded Continuing Healthcare packages, in the quarter with an annualised saving potential estimated at £37m.

Support For Programmes To Reduce Delayed Transfers Of Care

During the period, the NHS FTs and CCGs took combined actions and implemented a strategy to reduce the number of Full Assessments conducted in Acute Settings in order to meet the National Standard of less than 15%.

table for chc2dst full assessments

CHC2DST supports the completion of assessments in remote locations and was one of a number of measures introduced in tandem which saw the NHS stakeholder organisations within the User Group geography, significantly improve their performance.

IEG4’s ‘Outside In’ Value Assessment

IEG4 has created an ‘Outside In’ Value Assessment for individual CCGs, based on the improvements in performance visible from Q1 to Q3 of 2017/18. 

Using the Outside In Value Assessment Tool, across NHS England the potential for productivity savings, when looked across all the stakeholders involved in contributing to the Continuing Healthcare Assessment process, is estimated to be in the region of £45 -50 million per annum.  

Through better and more consistent application of eligibility criteria the data suggest that CHC Care Package spend could be reduced by around £37 million per annum across NHS England. 

A 5% reduction in the continuation of care packages, as a result of better regularity of review and reassessment of patients, could result in further care package savings of £45 – 50 million per annum for the System.   

Estimated Value Impact On CCGs

IEG4’s CHC2DST has helped its User Group to improve its performance and productivity.  Using benchmark data from the User Group:

  • Productivity gains and cost savings for an CCG on average are around £200,000 for stakeholder process execution and administration time, faxing, paper copying and postage costs. 
  • Productivity improvements will allow CCGs to absorb more work without the need to consume the annual cost budget increase expected in budgets which is set at around 7%. Across a total admin spend of £155m, this equates to a saving of around £10.8m spend or around £50,000 per CCG.
  • CHC2DST usage enables faster processing of decisions and can help CCGs to achieve their Quality Premium for CHC by turning around decisions in under 28 days.
  • Reduction in CHC care package spend, through faster, more transparent, robust and consistently applied eligibility decisions can create savings of around £180,000 per annum for an average CCG.

Given an NHS England commitment to reduce the spend on Continuing Healthcare by £855 million over the next few years, CCG control over the Continuing Healthcare Assessment process itself will play a vital part in working to achieving.