CHD Living

Navigating the complexities of care

How CHD Living is approaching some of the challenges of providing joined-up care.

Our vision is to support as many people who are in need of care as possible, regardless of funding source or care needs.

Shaleeza Hasham

Director, CHD Living

CHD Living

Family-owned business CHD Living (CHD) started offering older person care in Surrey in 1984. It has evolved organically over the years to meet the wider needs of the local population and now offers a diverse range of services, specialising in four distinct areas of care: residential, nursing, dementia and end of life care for older persons; care for young adults with enduring mental health issues; residential neurological and post-operative rehabilitation and domiciliary care at home including complex care in the community. CHD has 14 centres across Southeast England, and has recently acquired land for two new builds.

We spoke to Director, Shaleeza Hasham, about CHD's relationship with the NHS and its approach to holistic, joined-up care.

CHD Living - Care since 1984

Nurtured relationships

CHD has to navigate a complex set of relationships with other organisations to provide its services to the communities in which it operates. It has different contracts with NHS hospitals and trusts, including some brokered by its local authorities (LAs), as well as some specialist contracts commissioned and funded by Integrated Care Boards (ICBs). The people it looks after are currently 40% self-funded, 20% NHS-funded and 40% LA-funded.

“We’ve worked hard to build strong relationships with the various bodies in different localities over the years, and they’re key to being able to work smarter,” Shaleeza says.

For example, through extensive consultation with the local NHS Trust, CHD has branched into more specialist care, including services for young adults with mental illness, post-surgical rehabilitation and neurorehabilitation. “We worked with the Trust to develop and commission a completely new model to meet the need for brain injury specialist complex care, and we’re now one of only five NHS-approved providers of these services.”

Overcoming challenges

CHD strives to deliver high-quality person-centred care in a friendly environment. Ideally, this requires a joined-up approach, with all the parties involved working to ensure continuity and a clear pathway to support people throughout their care journey.

“However, the sheer size of the NHS – and its ongoing evolution resulting in regular structural changes – can adversely affect our ability to provide this continuity,” explains Shaleeza. CHD has developed several ways to manage these challenges, including the following examples.

Flexibility is key

Dynamic and flexible assessment and admissions processes are key to accommodating the way the NHS works in practice. “To prioritise person-centred care we often have to adapt very quickly to meet the NHS’s needs while managing our risk, particularly in terms of freeing up beds.”

What’s more, the NHS’s size and complexity slows down decision-making, at times resulting in tensions between the NHS and private providers. To alleviate this, CHD has established a single point of contact for triaging referrals.

A different approach to funding

Care funding pathways aren’t always clearly understood and can sometimes be a barrier for people trying to access CHD’s services, particularly over longer periods. As a result, the CHD team often must have difficult conversations with families about the cost of continued care and their funding options.

To ensure it can support as many people as possible, irrespective of funding sources, CHD has changed how it views the funding split internally. It now focuses on average fees, which means managers have the flexibility to choose how they mix their service and fill their beds, provided they achieve the target average fee. “After much work and relationship-building in Surrey, the price they pay plus the NHS-funded nursing care now fits well within our fee structure,” explains Shaleeza.

Staying connected

Surrey used to have social care development coordinators whose job was to know specifically what the various providers offered. Every hospital referral was triaged through this team, and their understanding of what providers could offer meant that people were more likely to get appropriate care.

Shaleeza believes that changes to these roles in 2021 has resulted in a knowledge gap that can negatively affect patients. “As the independent sector can’t solve this, CHD focuses on developing strong relationships within its locality to raise awareness of our services.”

Outsource to survive

Given there are almost half a million people waiting for care in England1, Shaleeza says the NHS needs to outsource to survive: “By teaming up with more independent community services to provide care, including complex and specialist care, the NHS could free up much-needed acute hospital beds. That said, there are simply not enough carers or care beds available to cover demand. Rising costs are further complicating the picture.”

To keep up with the UK’s aging population, Shaleeza suggests that considerable investment and policy change is required to stabilise the care system and rebuild the workforce. More effective communication and a joined-up approach – across government, the NHS, LAs and the independent sector – are key.

We need to reform social care holistically to help people live well, rather than only intervening at crisis point. This requires long-term, sustainable funding that considers the whole cost of care, alongside an effective workforce strategy.

Shaleeza Hasham

Director, CHD Living

Working with Barclays

CHD Living has been a long-standing client of Barclays Corporate Banking. Over the nearly 40 years we’ve worked together, CHD has continually innovated to respond to the evolving needs of the NHS and wider care sector. Its ability to be forward-looking and see the bigger picture has allowed the business to continue to develop new services and opportunities that fulfil the needs of the sector. We’ve been delighted to support CHD Living with its financing needs over the years.

“We value the ‘human’ conversations we can have with the team about our challenges and the possible solutions,” says Shaleeza.

“A good example is where Barclays extended our loan interest-only period to assist us in meeting our energy costs, which increased by over 400% in the summer of 2022. Barclays also reviews our capex spend every few years and offers terms to improve the spend on some of our older stock in order to maintain the fabric of the buildings and keep them future proofed.”

Get in touch for more information about how Barclays can support care providers as they expand to meet growing demand.


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