• Annual recurrent financial savings of £2.235m were identified for the ICB
• 51% of care packages reviewed were found to be either in excess of patient need, resulting in a reduction to an appropriate level of  care or being overcharged against contractual agreements
• There were five  individual care packages where the estimated annual saving for each was greater than £100k
• The largest annual saving on a single care package was £193k

The Challenge

The current demand for continuing healthcare provision has never been greater and there are a number of individuals who, as part of their care package receive enhanced supervision often on a one-to-one basis This is usually due to individuals being exposed to a significant risk of falls and/or presenting challenging behaviours. 

Legally the extent of enhanced observations in place needs be proportionate and commensurate with the degree of risk presented by the citizen and equate to the least restrictive option for the 
individual.
 
In April 2024, the Associate Director of  Quality and Safety Improvement of a  local ICB commissioned MIAA to undertake a  review of enhanced observation care package  arrangements across two places within its system.
 
The objective of the review was to determine whether the enhanced observations in place remained a necessary care requirement for each client and whether the provision was proportionate to the risk presented by the individual in each case.

The Approach

All 70 individuals had a face-to-face review with a clinical CHC nurse assessor. A detailed report was compiled for each individual with a cumulative progress schedule of completed reviews 

maintained for regular ICB progress updates, along with details on savings delivered to support the delivery of its QIPP programme.

MIAA also produced a list of system improvement recommendations based upon observations and findings to support ongoing pathway improvements for this patient group.
 
For several individuals further follow up reviews were recommended to compile additional intelligence to inform future arrangements, and monitor requirements to ensure that any enhanced supervision reduction plans continue to meet the individuals needs and
ensure they are implemented in a safe manner.

The Outcomes 

A reduction or discontinuance of the enhanced supervision arrangements were established for 25 out of the 70 packages reviewed, with an average of £77.6k annual financial saving realised per package. 

For 11 care packages reviewed, 24-hour one to one care was still deemed appropriate, however due to contractual arrangements four hours of care per day was identified as a duplicated charge.  When combined, the corrections to these packages represented annual financial savings of £246k for the ICB. 

In total, annual recurrent financial savings of £2.235m were identified for the ICB, with the largest annual saving on a single care package being £193k. 

Overall this project represented a significant return on investment for the ICB and contributed significantly to the delivery of its CHC QIPP programme.

At the end of the project, all 70 patients are now in receipt of an appropriate package of care which ensured their needs are met, with future reviews at various intervals proposed for the ICB team to take forward.