Agenda item

Purpose: To update the Board on the review of Continuing Healthcare payments by the Berkshire West Clinical Commissioning Group.

[The Chairman agreed to bring this item forward on the agenda.]

Niki Cartwright (Director of Joint Commissioning for Berkshire West CCG) presented the Review of Continuing Health Care (CHC) (Agenda Item 10). She explained that CHC was funding made available to people with complex health needs and it resulted in a ‘yes’ or ‘no’ answer regarding eligibility.

In April 2021, the CCG had committed to undertake a review and had agreed to report back in six months’ time about the changes they were making to the CHC processes. The processes were found to be convoluted and time-consuming, so they had been revised and a simplified process map had been created. A dedicated team had been created for the management of new applications, with a 28 day standard for response times, and performance had improved. A dedicated review team had been created to focus on overdue reviews and case management. Interim staff had been recruited with experience of change management and ability to present quality applications within the 28 day expectation.

Local authority dispute meetings had been held with reduced delays and there had been improved relationships with stakeholders, with compliments received from all three local authorities. A provider engagement forum had been established with support from CCG leads, which helped to inform commissioning decisions. There had also been a review of Free Nursing Care, which had resulted in improvements.

Achievement of the 28 day target had gone from 25% in Q1 of 2021/22 to 61% in Q2 of 2021/22.

The Chairman noted that concerns had been expressed previously about where Berkshire West sat within the national league table for CHC payments and that Adult Social Care was having to provide support for patients who they felt should be supported by the NHS.

Councillor Jo Stewart asked if local authorities could engage with the Provider Engagement Forum. Niki Cartwright welcomed this.

Action: Councillor Jo Stewart to identify representatives from West Berkshire Council to attend the Provider Engagement Forum.

Maria Shepherd indicated that she would like to see where Berkshire West sat in the national table for CHC payments and indicated that historically West Berkshire had fared worse than Reading and Wokingham.

Niki Cartwright confirmed that the national average was 7% of applications approved and Berkshire West was at 10% and she offered to provide further detail.

Action Niki Cartwright to provide a breakdown of CHC payments by local authority in terms of percentages and actual numbers.

Andrew Sharp welcomed the simplified process as it would help to relieve the burden on carers and asked if support could also be provided for applicants. He indicated that historically applications were likely to be rejected unless applicants could provide supporting evidence and cited an example of one patient who died four days after their CHC application was rejected. He suggested that the opportunity should be taken to consider whether the service was delivering benefits for the people of West Berkshire where there was a higher proportion of people who would be likely to need support. He also asked about patient representation on Provider Boards.

Niki Cartwright stressed that CHC payments related to the complexity / severity of a patient’s needs rather than their illness and that the national framework was fixed. She suggested that teams putting in the applications could potentially provide support for applicants rather than the CHC Team.

Action: Niki Cartwright and Andrew Sharp to discuss support for applicants outside the meeting.

Dr Abid Irfan welcomed the improvements to processes and highlighted that there was a fast-track process for patients near the end of life.

Niki Cartwright indicated that there was an upcoming meeting with the Berkshire West local authorities to consider how that fast-track process could be improved.

Dr Irfan noted that the review of CHC processes had found that there was effective decision making and processes were being followed correctly, so there was nothing to suggest that Berkshire West was not getting its fair share of funding.

Niki Cartwright agreed. She also highlighted another piece of work looking at a joint funding for services to support people who did not meet CHC criteria, but whose needs could not be met by universal NHS services. This would be piloted between January and March 2022.

Maria Shepherd stated that Adult Social Care employed a CHC specialist to work with social workers / social care practitioners and help families to submit CHC checklists. This person also sat on panels to review checklists and attended Multi-Disciplinary Team meetings. She also noted that if social workers / social care practitioners were supporting families to complete checklists, they first had to undertake appropriate training. She suggested that these courses could be run more regularly.

Action: Niki Cartwright to suggest more frequent CHC courses to the Team  Manager.