Nottinghamshire CCGs collaboration CHC case study
Difficulties with tracking and managing escalating CHC costs are commonplace within many CCGs. These problems are understandable given the complex nature of the funding, the range of suppliers and the necessary reliance on technology.
Despite extensive efforts to introduce controls, errors and payments can still occur. Liaison has identified that CCGs can require support in reviewing some common areas of CHC spend that may be subject to overpayments and need practical help to recover them. It is also essential to provide support and best practice advice to ensure future errors are prevented.
Liaison’s CHC reviews are performed by a specialist forensic team who are experienced at finding and recovering missed savings. The service has no upfront fee, with charges only made on any funds recovered.
In first year of offering CHC reviews, Liaison has already identified over £3.2m in savings for CCGs.
The NHS Rushcliffe CCG collaboration is comprised of five CCGs covering the Nottinghamshire area. The Continuing Healthcare (CHC) spend for all five CCGs is combined and managed through one ledger. Like many CCGs, the collaboration was facing budgetary constraints and also had concerns about some internal processes needing review. Ultimately, the requirement was to identify savings for reinvestment into patient care.
The Liaison CHC team were asked to undertake a series of forensic reviews of aspects of the CCGs’ collective CHC expenditure. The first objective of the review was to identify any potential financial savings and to then recover them. The second phase of the project was for the team to review the CCGs’ processes and to determine and recommend the most effective processes to ensure future expenditure was correct to prevent further errors. These end to end reviews were to be conducted with minimum disruption to the CCGs and the majority of the analysis was done off-site. As the reviews are purely financial and nonclinical, there is no impact on patient care or funding.
The Liaison team worked with the CCGs to determine the right set of reviews to address the particular pressure points the CCGs had identified and recognised internally. These were:
Before work began, it was important to work with all stakeholders to ensure they understood the purpose of the reviews and how they would be approached and to outline the data requirements. The team also wished to assure the stakeholders about how the data was collected, what format it should be in and, to comply with IG protocols, how the data sent to Liaison would be processed and stored (and later deleted). Liaison’s Controlled Environment for Finance status gives us legal justification to process personal confidential data for financial purposes in a managed, more efficient and accurate way. Importantly this means CCGs are commissioning a CHC service that meets the necessary NHS Information Governance (IG) criteria.
An implementation meeting was held to go through these points and to help understand the CHC processes adopted by the CCGs. It was also important to establish the right way for the Liaison team to work with the local care providers and to understand how things worked within the region, so that their approach could be tailored. This included understanding the payment processes with providers and the terms and agreements in place. Similarly, it was important to have an understanding of how all payments were then processed and reviewed.
On completion of the reviews, the Liaison team presented the CCGs with the findings and an approach to recover the savings from suppliers was agreed. Liaison handled all communications with suppliers and managed the recovery of all the savings. Savings in excess of [£200,000] were identified across the CCG collaboration.