Agenda item

Purpose: To assess the effect of the CHC operations policy and procedures in practise

Rachael Wardell introduced the report to the Commission on behalf of Nick Carter. It was stated that the Council had worked in conjunction with the National Health Service (NHS) to address the concerns raised by the Commission during the meeting in November 2013.

Continuing Healthcare (CHC) was a package of continuing care arranged and funded by the NHS where an individual had a primary health need. The eligibility threshold for CHC in West Berkshire was set at critical. The national framework for NHS CHC outlined that an individual’s primary care needs would be assessed as critical if they were unpredictable, complex and intense. If an individual met the eligibility criteria for CHC then the care provided would be covered by the NHS.

The CHC process consisted of five stages:

·         Checklist: The referral stage by which an individual would be considered eligible for CHC and carried forward for assessment

·         Decision Support Tool (DST): The collation of evidence in order to conduct an assessment of the individual’s primary care needs.

·         Multi Disciplinary Team (MDT): Evidence reviewed by the team in order to collate a recommendation/s based upon the eligibility criteria for CHC.

·         Panel (Clinical Commissioning Group): Through which the final decision would be made regarding an individual’s eligibility for care.

·         A dispute resolution process was established in order that the final decision from the panel could be appealed.

Rachael Wardell explained that the staff involved with the CHC decision making process jointly received training in order to ensure consistency. The objective was to provide a clearer explanation to applicants regarding the decisions made throughout the process and ultimately their eligibility for CHC.

The Commission heard that when the issue was considered in January 2014, the total number of completed applications for CHC was 16, of which 3 were deemed eligible for care. 38 cases had been open, of which 29 were over 3 months old (76%).

The current figures were presented as; 38 completed cases of which 13 were deemed eligible. 26 cases remained open of which 18 were over 3 months old. A total of 10 new applications had been received since January 2014. Rachael Wardell stated that significant progress had been made since the meeting in January 2014.

Cathy Winfield directed the Commission to a handout which provided a response to the questions raised in January 2014 regarding CHC budgets. The statistics suggested that the financial expenditure on CHC had risen by 18% year on year.

Historically the Berkshire West Primary Care Trust (PCT) had managed the commission of care services in West Berkshire. Since the changes to the health structure in April 2013 the area was covered by the Newbury District CCG (NDCCG) and the Reading West CCG (RWCCG). Cathy Winfield explained that arrangements between CCG’s were well managed and statistics suggested that local residents were benefiting from the change.

The Commission heard that the budget for CHC in West Berkshire was determined by eligibility and level of demand/need for the service. It was stated that the total spend in NDCCG and RWCCG could differ and that it was likely to be due to the different demographic in each area.

Cathy Winfield directed the Commission through the presentation which explained the key points about the waiting list. It was stated that historically the management of MDT meetings was challenging due to the level of evidential detail required in order to make the decision and agreeing a date for the meeting to take place. Going forward the MDT dates had been set for 10 of the 18 cases over 3 months old and meetings would occur regularly so that the backlog could be managed. New checklists had been created in order to manage the quality of information being submitted.

Fortnightly meetings would take place between the Head of Adult Social Care and the Assistant Director for Berkshire NHS CHC during which case lists would be discussed in order to manage the MDT process. The Council’s CHC specialist attended the majority of MDT meetings and provided generally positive feedback regarding the fairness of the decisions made.

The CCG had outsourced the work required in order to address the backlog of applications. The additional resource would remain in place until the backlog was clear and the ongoing workload could be managed.

The Commission heard that whilst good progress had been made over the past few months, there was still more to do: the Council needed to improve the identification of potential CHC cases at an earlier stage, the quality of submissions needed to be consistent and the CCG needed to ensure that appropriate resources were in place to prevent further backlogs occurring.

Rachael Wardell advised that staff received training in order to support consistency and a focus had been placed on the assessment of an individual’s primary needs at the point of discharge from hospital. Earlier identification of the support required would enable an individual to be discharged from hospital quickly and with a full support package available. It was stated that since the relationship between the Council and CCG’s had improved and the joint training had been delivered, it had become quicker and easier to arrange care packages in preparation for hospital discharge.

Councillor Tony Vickers asked whether every CHC assessment occurred at the point of discharge from hospital or whether there were were alternative avenues through which the authorities could be notified about an individual’s primary care needs. Rachael Wardell explained that it was likely that the majority of the assessment took place before discharging a patient from hospital due to the complexity and severity of an individual’s needs at that point in time. The assessment considered whether the individual could rehabilitate or whether they required regular support for the longer term.

Councillor Quentin Webb was encouraged to hear of the progress jointly made by the Council and the CCG. As the former Chairman of the Health Scrutiny Panel he had been concerned about points raised at the meeting in March 2013 but felt that the improved relationship between the Council and the CCG would contribute significantly towards continued improvements.

Councillor Gwen Mason asked whether resources had been committed to the proposed introduction of discharging patients from hospital seven days a week. It was stated that the process would decrease the overall pressure on the service Monday to Friday. Rachael Wardell explained that only non-complex cases could be discharged at weekends due to the lack of support services available on Saturday and Sunday. Cathy Winfield advised that due to the level of need and complexity of cases, it was unlikely that an individual would be discharged over the weekend.

Councillor Alan Macro asked whether the CCGs which covered West Berkshire shared resources. Cathy Winfield stated that the staff supported each other in order to promote consistency in the allocation of budgets and interpretation of the assessment process.

Councillor Jeff Beck asked whether the CCG planned to maintain the additional support staff. Cathy Winfield advised that work had been outsourced to contracted Nurses who worked alongside permanent staff and it was intended to maintain the additional staff for the foreseeable future.  It was stated that the staff would not be employed on a permanent basis due to the level of investment already committed by the CCG to recruit staff. The CCG had experienced some difficulty maintaining the same members of staff due to unforeseen changes, however, they were confident that the current assessment team had the skill set required.

Rachel Wardell directed the Commission to the report which illustrated the number of applications that had taken over 28 days to determine an outcome. It was stated that the number of cases had increased, and that this was due to the time in which it took the team to receive the application. It was felt that the rise in the figures were explained by and being managed by the points covered during the meeting.

Councillor Bedwell thanked Rachael Wardell and Cathy Winfield for their presentation. Special thanks were given to Balwinder Karr, Interim Head of Adult Social Care, who contributed towards the improvements.

Resolved that

·         The CCG and Head of Adult Social Care should provide an update report in 4 months time.