Using technology to help address delayed transfer of care

Chris Wilson, managing director of adam, discusses how technology can be used to address delayed transfer of care

Delayed transfers of care (DTOC) cost the NHS and councils – and hence all of us as taxpayers – an increasing amount of money. 780,000 days were attributed to delays in adult social care in 2016/17 according to a recent Care Quality Commission report. This represents a huge cost in unnecessary care, while having a negative impact on patients and preventing others obtaining the care they need.

Local authorities face additional DTOC related costs as a result of the Care Act 2014. This enables NHS trusts and clinical commissioning groups to fine local authorities for not providing the required care services. In a recent survey, 15.5% of local authority respondents reported levying fines and a further 7.7% had expressed an intention to do so.

These ‘divide and conquer’ tactics are stifling the one thing that will solve the problem, namely better collaboration between the NHS and local authorities. Instead, they increase tension, encourage finger pointing and a ‘watch your back’ culture, and reduce any willingness to look for better solutions. Most commissioners know what needs fixing within their environment but their principal concern is usually to address internal issues first. More difficult or longer-term challenges, such as provider market issues or collaboration, or looking at new ways of working, often end up on the ‘too hard, save for later’ pile.


Digital tech reduces the burden

However, we are starting to see local authorities, CCGs and CSUs find innovative ways to address some of these ‘difficult’ issues. Clearly, reducing the rate of growth of the Continuing Healthcare (CHC) budget needs both a different approach and a better use of resources to meet patient needs – and one way to do this is to introduce digital technology to reduce the administrative burden of procuring care.

This may not sound like a great step forward, but many local authorities still rely on a manual commissioning process whereby a broker/commissioner picks up the phone to an individual supplier based on a relationship between them. Due to the high demand and urgency of finding care, many brokerage teams simply place patients in the first available home, rather than finding the right one to meet their needs.

Digital commissioning enables commissioners to find the care they need quickly and efficiently, based on service details, quality and location, not just cost. They can specify an individual’s exact requirements and the system will quickly provide a choice of appropriate suppliers in the right location with details of quality and cost. Staff can spend time saved on value-added activities, including focusing on the most complex cases.

Digital commissioning can also be provided as a cloud-based service, which has security benefits. If there is an issue with their own network, such as the recent WannaCry ransomware attack, staff can continue to commission services with minimum interruption. The service provider also ensures that all staff are running the latest version of applications, with all patches applied and management taken care of.


Effective use

The most effective use of digital commissioning technology is within an open purchasing framework. This replaces the traditional closed model, which can only be entered at certain times and may only allow a fixed number of suppliers, with a ‘live’, flexible market which providers can enter and leave at any time. These open contracts are underpinned by Public Contract Regulations principles such as transparency and fairness, creating a level playing field for providers of all sizes. They must be run through electronic means, providing quicker and less complex interactions than traditional methods. Running the open framework using digital commissioning technology enables a lighter touch and provides a more effective approach to opening up the market, helping buyers identify the provider that is genuinely best suited to a specific need.

To take advantage of the efficiencies and other benefits of digital commissioning, local authorities and commissioners also need to improve their processes – and to have the will to change how things are done. A digital system cannot be laid on top of an outdated process like a sticking plaster; the process must first be reviewed and redesigned to meet the increasingly complex care needs of a growing aging population. This requires a change in culture, ensuring that teams understand the new approach to commissioning and have the skills to use the supporting technology effectively.

This combination of digital technology, open framework commissioning and changed processes enables care provision to be focused on quality and personalisation. Assessing providers on performance using outcomes or feedback from previous users (and/or families) incentivises them to deliver high quality care and to offer genuine value for money. And by having all the information readily to hand, brokers have an immediate picture of their market.

However, the test is whether such systems support market needs. One organisation using digital commissioning is NHS Midlands and Lancashire Commissioning Support Unit (MLCSU), which has seen significant improvements using it to place patients eligible for continuing healthcare in the best possible care home for their health needs. Launched in February 2016, their system involves entering patient needs into the web-based system which sends the information to a list of eligible care homes. These can decide if they are able to meet the patient’s needs and respond within a set period of time, usually 24 hours. The list of providers is then closed and shared with the patient.

Since implementing the system the quality rating on placements has increased, with more offers from more providers, improved contract management and management information that enables them to understand what is happening in their market. System reports also enabled MCSLU to identify gaps in service provision, so they could seek out new providers. Since the launch over 800 placements have been made with providers averaging a quality rating of over 90% whilst saving MLCSU almost £1m.

Technology alone cannot solve the problem of Delayed Transfer of Care. However, by facilitating proactive commissioning of the right care service, it can help providers meet their patients’ needs, which is a major step forward.

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