Making continuing health care funding work for stroke

1. NHS
NHS Improvement
Stroke
SPOTLIGHT ON:
CONTINUING HEALTH
CARE IN STROKE
MAKING CONTINUING HEALTH CARE
FUNDING WORK FOR STROKE
‘People with a primary need are eligible for NHS continuing health care (CHC),
where the NHS funds all of the individuals assessed needs including
accommodation.’
The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care, DH, 2009
Stroke patients make up a significant proportion of the number of people eligible for CHC due to often
complex impairments and subsequently multifaceted, unpredictable and intensive care needs.
A Stroke Improvement Programme survey of stroke staff in 2011 showed that 54% of respondents found the
CHC process time consuming and added to delays of transfer of care. An additional 30% felt CHC was the cause
of major delay, with the main causes being staff availability, PCT validation of the decision, availability or timing of
care packages and frequency of panel meetings.
Recommendations to improve the CHC process • Stroke specific information should be
• Processes should be streamlined to ensure developed and provided to support patients
information isn't duplicated; ideally a and their families through the process.
designated coordinator/key worker would co-
ordinate the process (see Portsmouth example of “ CHC was a difficult process to
good practice).
• Commissioners should consider joint funding understand, especially at the time
agreements to avoid delays in discharge and care when nothing is sinking in”
provision. Discharge to a community setting or use
of intermediate care beds during of the CHC Carer, Winchester
application process provides a more appropriate
environment than an acute ward.
• Social workers should be integrated members
of the MDT to enable timely engagement, avoid ‘Stroke patients may have impairments and
delays and ensure a joint health and social care care needs which don't readily fit the DH
approach to CHC applications. defined descriptors. The 'intentionally low’ set
• Stroke specialist professionals should be threshold may result in a positive checklist for
involved in application and review of eligibility people assessed soon after stroke; which then
for CHC in the community so that complex or triggers the full application, although the
hidden post stroke deficits which may be missed by person’s care needs may not be complex,
generic staff can be considered. This could be intense or unpredictable in the longer term.
included in the six week, six month and annual Ideally stroke specialists with a good working
stroke reviews, and form part of the joint health and knowledge of the CHC process would assess
social care plan. people with stroke at the right stage in their
• The CHC process should be carried out in a recovery.’
post-acute setting to avoid inappropriate use of
staff time, duplication of information and delays in (The National Framework for NHS Continuing
Healthcare and NHS-funded Nursing Care, DH,
discharge. (The National Framework for NHS Continuing
Healthcare and NHS-funded Nursing Care, DH, 2009, 2009, p19)
Clause 56 &57)

2. SPOTLIGHT ON: NHS
CONTINUING HEALTH NHS Improvement
CARE IN STROKE Stroke
EXAMPLES OF GOOD PRACTICE
Discharge coordinator role - Poole General Hospital
A typical District General Hospital (DGH) admitted 172 stroke patients in 10 weeks, the staff were trained
in CHC and integrated processes. 172 MDT hours were spent on CHC paperwork which resulted in only
seven patients ultimately granted CHC funding. The average delay in discharge from hospital was 45.2
days per patient. Poole Hospital, a similar sized DGH, used a band 6 nurse as a discharge coordinator,
taking responsibility for organisation, coordination and completion of documentation and processes
related to CHC. Time spent on CHC was reduced by 19%.
Contact: Susan White - Email: susan.white@poole.nhs.uk
Computerised systems to reduce duplication and improve efficiency- Royal Bournemouth
Hospital
Devised a software package which is electronically linked to the patients admission; populating data from
existing infrastructure and completing the CHC checklist is as part of the electronic MDT documentation.
On completion of the checklist the discharge team are automatically emailed. The checklist is embedded
on the social services system and is electronically visible by relevant community services including the GP.
The software also cross populates data from the problem list and MDT notes to the discharge summary/
joint health and social care plan, and directly onto social services assessment proformas. This avoids
duplication and increases the time available for the MDT to write reports and for social care to complete
assessments. The software package can be altered for use in other organisations.
Contact: Louise Clark - Email: louise.clark@wessexdeanery.nhs.uk
Intermediate care beds to complete CHC out of the acute setting - Portsmouth Local Authority,
Jubilee House
Patients within Portsmouth City Local Authority, who 'trigger' at checklist stage for further assessment
are able to be discharged from the acute hospital to nearby Jubilee House, enabling MDT assessment for
CHC (including the completion of the decision support tool) to take place when appropriate in a more
settled care environment. Hospital delays have been reduced by weeks for patients from this locality in
comparison with the other localities where the whole CHC process takes place in hospital.
In other areas, acute providers and local authorities have agreed criteria to jointly fund patients out of
hospital, with the decision support tool being completed at approximately 12 weeks. Money is then
reimbursed and back paid to the relevant organisation once CHC eligibility is determined.
'In an acute hospital setting, the Checklist
should not be completed until the individual’s
needs on discharge are clear.’ It should always
be borne in mind that assessment of eligibility
that takes place in an acute hospital may not
always reflect an individual’s capacity to
maximise their potential. This could be
because, with appropriate support, that
individual has the potential to recover further
in the near future.'
(The National Framework for NHS Continuing
Further resources, case studies and
Healthcare and NHS-funded Nursing Care, DH,
publications are available at:
2009, p19)
www.improvement.nhs.uk/stroke