Agenda item

Purpose: To assess the effect of the CHC operations policy and procedures in practise 6 months following implementation.

Jan Evans presented information to the Commission in respect of Continuing Healthcare (CHC) arrangements in Berkshire.

Jan Evans advised that the NHS CHC was a package of continuing care arranged and solely funded by the NHS when the individual had a primary health need which met the NHS eligibility criteria. The Council had set its own eligibility for social care criteria at “critical” but this was for a separate purpose and the two were not connected. The CHC assessments considered the complexity of an individual’s presenting needs, if deemed eligible for care then the service would be provided a no cost to the client. Jan Evans explained that in the past care provision was provided in hospitals.

The Commission heard that the CHC assessment process initially involved the use of a checklist following a referral. At the initial stage the threshold was set low and with the use of the Decision Support Tool the NHS would collate evidence to assess whether the individual met the eligibility criteria. If the decision was disputed then the case could be reviewed at a Multi Disciplinary Team (MDT) meeting and a recommendation submitted to the Clinical Commissioning Group (CCG) for a final decision.

Jan Evans explained that following concerns around the application of the CHC process, an independent review took place in 2012. The review provided 52 recommendations, highlighted within five key areas for review by the then PCT and LA Adult Social Care:

·        Policies and procedures 

·        Dispute process

·        Hospital discharge

·        End of life

·        Joint training

Jan Evans explained that the first four items had been addressed. The joint training programme took time to establish but successfully completed training in October 2013 for 600 staff across the two acute trusts and six unitary authorities.

In order to monitor progress of those actions the few areas that were outstanding, representatives from Berkshire West and Berkshire East local authorities met with the Assistant Director for CHC to review the agreed action plan. The group’s purpose was to monitor the implementation of changes, the Management Information (MI) disseminated by the CCGs, the implications of the changes made to polices and procedures and review the dispute policy. The group would formally review all changes one year after implementation.

Jan Evans advised that the three main areas for consideration by the group were;

·        Management Information produced by the CCGs

·        The assessment times and waiting lists associated with initial assessment

·        The number of individuals funded by the CCGs that met the NHS eligibility criteria

The Independent review recommended that NHS Berkshire and the Unitary Authorities met regularly to use benchmarking data to monitor their performance both regionally and national trends. In order to address the recommendation the CCG’s appointed an analyst whose role would be to establish and maintain a database for the seven Berkshire CCG’s and prepare monthly reports.

Jan Evans referred the Commission to the Local Data for 2013/2014. The information showed how many CHC cases were funded by the CCGs across the country (graph 1:1). Further detail suggested that 23 individuals were assessed and their checklist accepted for CHC provision. 12 cases had proceeded to MDT for further review, 2 were held by the MDT and zero assessed as eligible. Jan Evans referred the Commission to the CCGs’ month six expenditure report which suggested that there was a 3% reduction in spend between 2012/13 and 2013/14. The report stated that the CCGs’ forecast outturn for the same period would increase by 13%.

Graph 1:1

Councillor Brian Bedwell thanked Jan Evans for her presentation.

In response to questions asked, Sarah Bellars advised that the budgetary figures and subsequently the percentages referred to within the supplementary report, would be confirmed and reported back to the Commission.

The Commission heard that if an individual was not deemed eligible for CHC funded by the NHS then, due to their presenting needs, it was possible that they may meet the eligibility criteria for LA care. Sarah Bellars advised that the criteria for assessing eligibility was factual and well structured. The Commission collectively expressed their concern that if that was indeed the case, then why did there appear to be a significant variation between the number of CHC cases in Berkshire West to those in other areas.

Councillor Webster highlighted the possibility that whilst residents waited for decisions from the CCGs it was likely that either the Council or the resident would have to pay for interim care. In response, Sarah Bellars stated that the assessment process considered a lot of evidence over a period of time, in order to gain a comprehensive review of the individual’s needs and that if an individual was deemed eligible for care then the CCG would backdate the funding to cover the period prior to the decision being made.

Councillor Bedwell suggested that the public perception of CHC working successfully  was affected by the differing performance statistics compared to other local authority areas. Sarah Bellars stated that the CHC assessment framework was applied consistently across Berkshire with the same team working on all cases.

The Commission acknowledged that the CCGs provided the statistics to compare performance at a national level, however, it was suggested that in order to truly understand the effectiveness of the CHC framework in Berkshire West then the CCGs needed to compare performance directly with neighbouring local authority areas.

Councillor Webb highlighted his concern about the assessment waiting times in Berkshire West and suggested that the CCGs should have had the capability to report on this area in detail. Sarah Bellars advised that the performance reported against by the CCGs was agreed with the Council as part of the review recommendations. Sam Ward advised that the CCGs worked to the national benchmark process which looked at the number of people eligible for CHC via the various routes of referral, costs to CCGs for CHC provisions, number of joint funded cases and the effectiveness of the management tool. The CCGs were expected to report against the number of assessments conducted within the 28 days from the date on which the checklist had been issued, as outlined within the national guidelines. Sam Ward advised that part of the information was made publicly available.

Councillor Webb advised that the Health Scrutiny Panel first reviewed the item in December 2012, at which point they recommended that the CCGs invested in appropriate measures to ensure they had the necessary resource to report on the performance of the service which would be useable at a local level. Sarah Bellars advised that the CCGs appointed an analyst to report on areas as agreed with the LAs.

The Commission highlighted that four residents had waited over a year for an assessment.  It was suggested that by allowing the waiting period to exceed the national framework of 28 days residents expectations were being damaged. The CCG’s were asked to provide information regarding their action plan to address the issue.

The Commission expressed their dissatisfaction with the extended waiting times and the agreements in place for funding. Sam Ward explained that the process for funding interim care was not set at a national level.

Councillor Macro asked how the Berkshire West CCG compared to other CCGs in terms of assessments conducted within 28 days of the checklist being issued. Sam Ward agreed to obtain the figure and report back to the Commission

Councillor Gwen Mason raised her concern that following the review in 2012 many changes had been made to polices and procedures, however, the issue around waiting times remained. Sarah Bellars advised that the CCGs inherited cases from the PCT which they have had to manage.

The Commission requested sight of the action plan the CCG’s had in place to improve waiting time and areas of reporting. Sarah Bellars agreed to respond to questions and provide detailed statistics at the Commission meeting in February 2014.

Resolved that

·        The CCGs would be asked to confirm the total value in which the percentage forecast and overspend had been measured.

·        Sam Ward would ask NHS England to provide the comparative data to show the number of assessments conducted within 28 days of the checklist being issued in Berkshire West and neighbouring local authorities.

·        David Lowe will identify, and then communicate to the Health Service representatives, measures of CHC performance for consideration at the Commission’s February 2014 meeting.