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Redesigning Council x NHS Continuing Healthcare process

How could we streamline the Continuing Healthcare process followed by Barking and Dagenham and the NHS to improve efficiencies?

Continuing Healthcare To-be Process - Adults - Assessments and decisions - CHC_edited_edit

Project brief

I have recently been brought on by Adult's Social Care in the Council to review and redesign the Continuing Healthcare process. This is the process followed by the local authority and the NHS to identify whether an individual's needs are health related and therefore eligible for support and funding from the NHS.

The current process in B&D is informal and patchy with no agreed process across teams. There is a:

  • lack of documentation, and therefore also monitoring and evaluation

  • lack of clarity of roles and responsibilities and oversight processes

  • communication gap between stakeholders


​The overarching aim of this piece of work is to improve service operations. In order to do that, I drafted a few guiding principles based on my initial chats with the service to scope the project and desk research on best practice:


  • Streamline processes where possible to improve efficiency

  • Reduce unnecessary handovers to increase accountability and ownership of tasks

  • Use formalised channels/paths where possible to reduce drop-offs and improve timeliness

  • Put in place effective communication channels across stakeholders to improve collaboration

  • Ensure a clear audit trail to monitor and evaluate the process

  • Automate tasks where possible to reduce time waste

Discovery process

Since this is a work in progress, I will be talking about what has been done so far and what the next steps are.


  • To kick off the process redesign, I read through statutory guidelines of the Continuing Healthcare process available publicly and multiple internal policy and procedure documents to familiarise myself with the context and the various processes involved in this system. This includes the process of assessment, decisions, appeals and disputes for:

    • continuing healthcare

    • NHS funded nursing care

    • joint package of health and social care

    • hospital discharge

  • As a starting point, I drafted service blueprints of the ideal process (below) from information available in statutory guidelines. I structured it in a way that broke down the end to end service into various front-stage and back-stage processes that seemed most relevant to the redesign of this process. The horizontal axis represents time and the vertical axis represents the various processes involved. The blueprint includes the following categories of information:

    • Phases of the process​

    • Time

    • Actors

    • Primary process steps/actions

    • Support processes

    • Oversight

    • System

    • Gaps

    • Enablers

  • The service blueprints are a working draft and therefore include knowledge gaps and subsequent questions which need input from stakeholders - forming my next steps.

Continuing Healthcare To-be Process - Adults - Assessments and decisions - CHC (1).jpg

Service blueprint - assessment and decision process (click to zoom)

Continuing Healthcare To-be Process - Adults - Appeals_disputes - CHC.jpg

Service blueprint - appeals and dispute process (click to zoom)

Next steps

The next steps include a series of workshops that I would run and facilitate with various different stakeholders as per relevance to the project phase:

  • Initial workshop(s) with stakeholders from Adult's Social Care and NHS North East London (NEL) to validate the process and fill in knowledge gaps in the blueprint across all processes.

  • Workshops with representatives from all aspects of the process, i.e. service operations, NHS NEL, commissioning, brokerage, finance, digital systems to identify gaps in the current process and agree on opportunities for improvement.

  • If no single agreement from the stakeholders, escalate these areas for decision from the directors and leadership team.

  • Separate co-design sessions with stakeholders from different teams to design individual aspects of the to-be process. Facilitate the design work and document business decisions.

  • Work closely with the Project Manager to drive the implementation of the changes.

  • Set up measures to monitor impact and run an evaluation based on those outcome measures 3-6 months after implementation.

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