Morecambe Bay Clinical Commissioning Group (CCG) wanted to review continuing healthcare (CHC) cases to help meet its QIPP target of £1m for 2018/19. With demand on CHC services growing and the priority being patient safety and packages of care for supporting timely discharge from acute trusts, little time was left for step-down reviews.
The CCG required a trained nurse to review high priority CHC cases to ensure:
* quality of care
* safe placement of vulnerable patients
* care packages meet patient needs
* appropriate spending of public funds, in line with National Framework.
Action
* Focus on area of greatest saving opportunity: overdue three-month reviews of patients discharged from hospital with CHC funding in place
* Two experienced CHC nurses recruited from local agencies, employed by MLCSU and integrated with the CHC team
* One nurse covered Lancashire North, the other South Lakes, for six weeks
* Data extracted from the two case management systems to identify patients for review
* Nurses scheduled reviews and tracked patients through the process, with multidisciplinary team (MDT) meetings and decision-making panels as required
* Monitoring arrangements developed for tracking numbers and outcomes i.e. package costs before and after review, along with other benefits for patients and the CCG.
Impact
* Total savings of £425,888 demonstrated a near 12:1 return on the investment of £36,000
* All newly eligible CHC patients recently discharged from hospital were reviewed, ensuring packages of care remained appropriate and necessary
* 24 (45 per cent) of the 53 reviews undertaken resulted in patients stepping off CHC funding or stepping down to funded nursing care (FNC)
* The additional resource provided welcome support to the CHC teams in the two CCG localities
* Findings confirmed that the correct cohort was selected for review to maximise benefits for both patients and the CCG. Patients recently discharged from hospital with CHC funding in place, often do settle or improve and nursing care needs reduce.
Funding enabled targeted resource only for six weeks – additional resource could enable these priority reviews to be delivered on time on an ongoing basis, potentially realising greater savings.