Now that the dust has settled somewhat on Lord Darzi’s independent Investigation of the NHS in England, it’s been telling how many picked up on his admission that even though the social care system was outside of the formal scope of his report, Darzi thought it vital to the overall picture of the NHS.
That wasn’t a surprise to us. How care delivered outside hospital settings is commissioned and paid for, and by whom, has always been labyrinthine. Indeed, some of the packages of support we manage at Alocura, using our Rostrata software, are a complex combination of NHS and local authority funding that require quite a lot of unpicking in order to achieve the best outcomes for individuals.
But it is this very labyrinthine system which is causing so much waste and inefficiency. As Darzi noted, the statutory integrated care systems have the makings of a sensible management structure, but he has concerns.
“Across ICBs, there are differing understanding of their roles and responsibilities, including how far they are responsible for the performance management of providers,” he said.
This has always been the problem inherent in funding care outside hospital settings. No-one really takes full responsibility for managing or understanding what is being spent on care packages. Far too much money is spent on trust, with ad hoc and largely manual audits on just a small number of the packages commissioned.
Bank statements and online bank accounts don’t tell you nearly enough. On higher value and more complex packages it’s critical that the commissioner understands all of the information that is available from the care process itself; charge rates, pay rates, margins, competencies, locations and most importantly, whether the care delivered matches the care plan that was agreed.
Bank statements cannot tell you that.
It is within this management information – and by working in an open book manner – that operational and financial efficiencies can be identified and realised, before the money is spent.
The NHS Confederation’s response to the Lord Darzi report wasn’t just broadly in agreement with his findings, it confirmed some of their own suggestions to government which had been made earlier in the year. Here were just three:
- Health and care leaders needed to ensure every pound was spent as effectively as possible
- Capital expenditure wasn’t just about buildings but developing IT and digital tools.
- Longer term funding cycles aligned between the Department of Health and Social Care,Housing
and Communities and NHS England would empower ICS leaders in England to make the best
possible use of their allocated funds, to plan ahead and to innovate.
Innovation is at the heart of what we do at Alocura, and it’s why we’re able to say that Rostrata is the solution to many of Lord Darzi’s misgivings – and the NHS Confederation’s suggestions. Our pioneering cloud-based care management system offers the kind of digital tool they’re talking about to operate and interrogate every element of the care process in out-of-hospital settings.
The market as it is currently shaped is not configured to deliver digital transformation. So this has to be led by NHS and Local Authority commissioners; they have to determine the common systems that the care and third party providers will use.
They will need to align this approach with their frameworks and contractual arrangements too; layering a system on top of existing frameworks and processes may not work.
The market is evolving and quickly, the tools to assist this transformation are emerging. Rostrata is one solution, designed from the outset to capture all of the management information collected during the care process and to present it in a way which will drive efficiency and quality, for both care providers and commissioners… a rare ‘win-win’.
From care planning to rostering staff, care delivery to automated payroll, invoicing, reporting and audit, implementing Rostrata across frameworks will allow commissioners to operate in open book manner with providers and have immediate access to everything required to ensure that packages of care run efficiently and productively.
In that sense, Rostrata really does ensure that every pound is spent as effectively as possible. Of course, we would say it’s a no-brainer for commissioners to have such oversight on what they’re spending – so they can make best possible use of their allocated funds and have that responsibility for the performance management of providers.
But ask the providers who use Rostrata too – such as My Life in the North West. They have welcomed with open arms the ability to fully understand the financial and operational performance of individual care packages. Installing Rostrata has actually deepened the relationships they have with funders when it comes to planning, reviews and outcomes. They’ve even proactively returned unused funds to commissioners – such a unique set of circumstances that it took the commissioners in question by surprise; they had no idea that the monies were due.
We now feel that the time for talking is over. Lord Darzi’s report is out there. The NHS Confederation has made its recommendations. It’s now incumbent on commissioners to pursue this transformational digital agenda, and by using Rostrata, they will be leading from the front.