A transformative approach to commissioning Continuing Healthcare

(MLCSU) is one of the largest CSUs in the UK, representing 44 CCGs across the Midlands and North West. As with most of the public sector, budgets within CCGs are being squeezed whilst they are managing an increase in demand and focus on quality.

Martin Pope, Head of Mobilisation at MLCSU says that the CCGs “are becoming increasingly more demanding of the CSU with the need for better quality from services that are more cost effective” To help deliver for their CCGs all CSUs are having to look at different transformation models, and MLCSU are no different.

Traditionally the CSU was seen as a provider of a range of services required by CCGs to commissioning service. The long term objective of MLCSU is somewhat different.

Martin explains “we want to be seen as a true, expert partner to the health economies we serve and this perception has started to work as we become approached for support, advice and guidance more frequently”.

It was this consultative approach that brought about the relationship with adam, which saw us being recommended, and through ongoing dialogue subsequently start implementation of our innovative commissioning model into their 6 Staffordshire CCGs, as part of a plan to phase roll out into further regions. Within Staffordshire, the 6 CCGs had experienced significant growth (13% increase in three years) in the need for Continuing HealthCare (CHC). Procurement of CHC had historically been made by spot purchasing giving limited choice, little contractual management, limited qualitative measurement and no control over cost. Without a significant change of approach, the rapidly increasing cost of servicing CHC risked spiralling out of control.

Why adam?

MLCSU needed, and were looking for, a system that could deliver a transformation to their approach to CHC commissioning, that could support market management and placement of patients in a way that was scalable both by the number of patients it dealt with and the number of CCGs that used it. It needed to do this by improving to whole commissioning process as well, better engaging the providers, improving the quality of information and along with it the efficiency of the process. Importantly it also needed to deliver savings whilst improving the patient experience. The CSU ultimately chose to work with adam.

Because there was no precedence for an approach like this within Healthcare, the implementation needed a bespoke approach which was both detailed and collaborative throughout.

“the team at adam was very responsive and managed the project and stakeholders throughout” says Martin. “CHC is very diverse and complex, especially when compared to Social Care and we now have a system that meets our needs”.

Now we are live

Eight months since launch the turnaround has been clear and the results speak for themselves. Martin highlights that “we’re currently averaging 3 provider offers per requirement which as an average is great across the region and challenges the generic preconception that volume of supply is an issue, but the average doesn’t tell the whole story. Actually, in the north we’re averaging 5 but in the southern areas it can be 1 or 2. Now, that’s not necessarily a reflection of the system, it actually shows that there’s a lack of provision within that specific area, and that’s one of the big benefits of the system. We can now see and be sure where provision is generally lacking and can begin to work with the care home market to address the gaps in specific areas rather than taking a generic perspective on the market.”

One well-publicised issue within the health market is the speed of transferring patients out of hospitals once they are available for discharge (more commonly known as delayed discharge). One of adam’s key drivers as a business is to help organisations improve their process, and these improvements have had noticeable benefit, Martin continues “we have also managed to reduce processing time to move people from a hospital bed into continuing health care setting”. Indications are that average discharge time has been reduced by days which has clear benefits not only for the hospitals by freeing up space, but critically for the patient...

Overall the implementation has delivered against all of the objectives identified at the start of the project, and MLCSU and adam continue to work closely to both continue delivering positive results as well as roll out the system into new areas.

So, the move to adam seems to be paying off already. Martin concludes

“The adam team is very good at change management and has implemented a system and process that is delivering results. We’re doing something that no-one else is. Every CHC team faces the same challenges, but we’re doing something unique it is here and it’s starting to make real a difference.”

Overview of results:

We went live with MLCSU in March and nearly 800 placements have been made via the system.

  • On average there are 3 offers per requirement challenging the perception of lack of supply
  • 200 providers are enrolled on the system - delivering a more sustainable and robust marketplace, previously MLCSU regularly made placements with only 69 homes
  • A contract is created for each patient
  • Enhanced ability to performance manage providers
  • Capability for providers to report on regular, meaningful quality metrics (such as falls, pressure sores)
  • Comprehensive approach to quality management rather than relying purely on Care Quality Commission ratings
  • 1 weekly consolidated invoice per CCG as opposed to 1 invoice per patient
  • This has allowed MLCSU to make their invoice payments team more efficient and remove overpayments
  • Comprehensive data on market activity and details of where MLCSU do have specific capacity issues which they can now use to work with the market to address gaps

Find out more about how we're helping CCG's find residential care for their patients.