Putting People First: Transforming the CHC experience in Lincolnshire
Earlier this year, Helen Sands, Head of All-age Continuing Healthcare (CHC), set out a clear ambition: to improve the experience and outcomes for individuals, families, and staff navigating the complex CHC process.
With support from the It’s All About People team, this transformation is now well underway, putting compassion, collaboration, and personalisation at the heart of CHC in Lincolnshire.
Why this matters
Continuing Healthcare (CHC) is a fully NHS-funded care package for people with complex, long-term health needs. However, the process is often experienced as bureaucratic and impersonal, especially during moments of vulnerability.
Over the past year, the number of complaints and disputes has risen, leaving staff feeling demoralised and misunderstood - often described as “always feeling like the bad guys.”
This programme aims to change that narrative by focusing on what truly matters: people.
Workstream 1: Understanding what needs to change
Guided by established Quality Improvement (QI) principles, the team built on existing knowledge and identified areas requiring further insight. Using a combination of standard methodologies and tailored tools designed to support personalised and strengths-based approaches, such as the It’s all about People Personalised Care Maturity Assessment Tool, we collaborated with the team to clarify priorities and define necessary changes.
Several activities were undertaken with the team to get a better understanding of how they worked together and with others and how confident they were to work in a personalised way.
Activities included
- A team survey
- It’s All About People Personalisation Survey
- ‘Love Island’ Activity - exploring what your island currently feels like and what your paradise island would feel like.
- It’s all about People Personalised Care Maturity Assessment Tool
What we've learned
- Team Dynamics: Supportive culture, but inconsistent communication and unclear roles.
- Partnerships: Strong desire for better collaboration, especially with Adult Social Care.
- Personalisation: Limited training and understanding, and personalisation is not part of the culture. Barriers include time, communication, and IT systems.
Emerging Priorities
From these insights, the following priorities have emerged:
- Shift the focus from “What’s the matter with you?” to “What matters to you?”
- Explore strengths and support networks to build on what already works.
- Embed shared decision-making to empower individuals and families.
- Strengthen collaboration and communication across teams and with partners.
- Reduce complaints and disputes through empathy, clarity, and consistency.
- Use resources wisely to increase impact and reduce waste.
A shared ambition
The CHC team, supported by the It’s All About People team, developed a high-level plan and identified key workstreams to guide their transformation journey.
Their ambition is clear:
- To embed strengths-based and personalised approaches into CHC and Personal Health Budgets (PHBs), improving outcomes, reducing complaints, and maintaining service costs.
This work is aligned with Our Shared Agreement and the Five Foundations, ensuring a consistent and values-driven approach across the system.
Key Workstreams
- 1. Continuing to understand what needs to change
- 2. Listening to people and partners
- 3. Improving collaboration with stakeholders
- 4. Reviewing current processes and procedures
- 5. Building skills and confidence for personalised care
- 6. Impact and Evaluation
Workstream 2: Listening to People and Partners
Historically, feedback has come mainly through complaints. To change this, we worked with the CHC and NHS Lincolnshire Integrated Care Board Engagement Team to co-produce two surveys - one for the public and one for staff and partners.
These surveys have been designed to help us understand what the CHC journey really feels like, both for the people going through it and for the staff who support that journey every day.
Access each survey via the links below:
Continuing Healthcare Services in Lincolnshire - PUBLIC SURVEY
Continuing Healthcare Services in Lincolnshire - STAFF SURVEY
Both surveys are open until mid-December 2025.
Co-Production and Community Voice
To ensure lived experience is central to this transformation, the team is recruiting members for a Co-Production Group. This group will help shape future improvements and ensure the service reflects the needs and values of the people it serves.
Workstream 3: Improving collaborative working with key partners and stakeholders
The team recognised the need to strengthen relationships with partners, particularly with Adult Care, as these have been strained.
To support this, the It’s all about People team provided independent facilitation, creating a neutral space to explore shared goals and build trust.
Initial conversations with the Lead for Continuing Healthcare (CHC) in Adult Social Care revealed a strong appetite for change, with Adult Care already beginning internal work on their pathways.
This open dialogue quickly led to a shared agreement for Adult Care to actively participate in the programme.
Workstream 4: Reviewing the current processes and procedures
The CHC pathway involves a complex series of assessments and processes, shaped by the NHS Continuing Healthcare framework and the Care Act 2014.
It can often feel transactional, with limited space for the voices of individuals and their carers.
Recognising the need for a more person-centred, whole-system approach, the CHC and Adult Social Care teams have begun mapping the entire CHC journey, from initial referral to review and dispute resolution.
Supported by Health Innovation East Midlands, this 10-week process is helping us identify the current challenges and opportunities for a more integrated and compassionate future pathway.
The mapping sessions have been eye-opening. Staff from CHC, Adult Care, and system partners have shared, challenged, and reflected on current practices.
One pivotal moment came three hours into a session to map the current decision-making process, when the question was asked, “We've not mapped the touch points with people in this process - where are they?”
That question is now guiding the design of a future state that truly centres people.
What's next?
As we look ahead to 2026, we’re energised by the momentum of this work. Our focus now turns to exploring the ‘art of the possible’, drawing on the rich insights, data, and feedback gathered throughout the programme.
We’re also progressing the final two workstreams:
Workstream 5: Building skills, knowledge, and confidence
Targeted training and development will equip staff to embed personalised, strengths-based approaches in everyday practice.
Workstream 6: Impact and evaluation
Robust outcomes and measures are being developed to track progress, demonstrate impact, and ensure accountability.
With a shared commitment to transformation and a clearer understanding of the CHC journey, we’re poised to reimagine how Continuing Healthcare is delivered, placing people and their experiences at the heart of the pathway.
