Nottingham City CCG: Clinical Utilisation Review

“It was valuable for the community to have an independent view of both services that was able to reflect back the best practices of both services. “Sometimes we are too close to see how to be objective in a constructive way. It was great to have our work endorsed by someone with as much experience as Monmouth.”

Nottingham City CCG holds contracts with two reablement providers. It needed to understand whether the service was meeting patients’ actual care needs. Specifically, whether they are receiving the right level of support in the right setting. It also needed to better integrate the services together. In particular, the CCG wanted to identify citizens being inappropriately referred, understand the skill and level of clinical input required for the service and the reasons behind delays in care delivery.

Reablement has the potential to save health and social care a significant amount of money by intensively supporting people to be safe and independent at home. Often provided following discharge from hospital or after a crisis, it is designed to avoid the need for an expensive care package or admission into a care home. However, reablement is only cost effective if the service delivers the support patients need efficiently and appropriately.

What we did

Our targeted clinical utilisation review of Nottingham’s reablement providers allowed us to:

• Determine the potential and care needs of patients referred into current services
• Gauge the complexity of referred-patient care needs
• Identify how current services could better reflect these individual patient needs.

Monmouth provided practical recommendations based on review findings. These included service redesign priorities that reduced duplication and improved service flow between care agencies. We prioritised improved outcome measures, referral criteria and new ways of working; including performance monitoring, more comprehensive carer needs assessments and reduced internal referrals.

Outcomes

Adopting our recommendations, Nottingham City CCG introduced single standing operating procedures that crossed health and social care. The CCG used the review to secure funding to improve efficiencies, introducing a single way to capture time and resource. Health and social care adopted our recommendation to use the same outcome measure with regular prompts and checks to embed improved care.