The demand for Continuing Healthcare (CHC), packages of care which are arranged and funded solely by the NHS for individuals outside of hospital, is increasing, as is the cost. Staffordshire has been particularly heavily affected, with an average growth rate of 13% over the last three years.
Procurement of CHC has traditionally been made by spot purchasing with limited choice and qualitative measurement, little contractual management and no control over price. A new approach was needed to tackle these problems, along with a culture where patients were able to choose their own care home regardless of cost or suitability.
We implemented a scalable, web-based Dynamic Purchasing System (DPS) called Adam, which enables us to manage the market and place patients effectively in the best possible care homes.
When a patient becomes eligible for CHC, their requirements are entered onto Adam, and then issued to all eligible homes within a set distance, who decide if they are able to meet their needs, and make an offer via the system. After a set period of time, usually 24 hours, offers are closed. They are then ranked based on a 60% quality weighting and a 40% cost weighting. Providers can join the framework at any time, as long as they satisfy the qualitative and financial criteria.
We engaged all care home providers in and around Staffordshire to explain the benefits of Adam, why we were introducing the system, and to train them in using it. We then enrolled almost 200 care homes, and recruited a brokerage team, including a senior clinician, to sit within the CSU’s Continuing Healthcare team and co-ordinate all the details. This has freed up hospital staff, CHC nurses and community teams to spend more time delivering frontline care.
Adam went live in March and we have made nearly 800 placements via the system since. The quality rating on placements to date is 90%. With almost 200 providers enrolled on the system, there is a far more sustainable and robust marketplace than before. On average there are three offers per patient, challenging the perception that there is no capacity.
On a like-for-like basis prices have been reduced by 8% year-on-year, which is worth £600,000 to date. Over the four-year contract we expect to save in excess of £5m.
A contract is created for each patient, which allows us to better manage the performance of providers. The system also enables them to report on regular, meaningful quality metrics, such as falls and pressure sores.
The payment system has been streamlined, with one weekly consolidated invoice per CCG as opposed to one invoice per patient. This has allowed us to reduce our finance invoice payments team and remove overpayments, saving both time and money. Since the start of the project the time taken to place a patient has halved.
“I asked if anything could be done to get my Dad into the home in Tamworth and as far as I am concerned you performed a miracle and told me he was in. I can’t tell you how pleased my Mom is that he is close by and easy to travel too. The nursing staff at Sunningdale care home are just fantastic and my Dad is going to be very comfortable there. So please pass on my thanks and keep up the good work you are doing for people like myself and family.” Son of a patient placed using Adam