Agenda item

Purpose: Following a Peer Review in 2022, the Buckinghamshire, Oxfordshire and Berkshire West  Integrated Care Board will present a report on Continuing Healthcare, the Continuing Healthcare transformation programme and progress in West Berkshire.

Niki Cartwright (Director of Vulnerable People’s Services, Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB)) presented the report on the All Age Continuing Care (AACC) Transformation Plan.

During the presentation the following key points were made:

·       The Peer Review at a System level (Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System) illustrated the need for better joint working. An external consultant was commissioned to review how AACC could be improved. That was coming to an end and the Transformation Board had been set up. This was a Partnership Board including local authorities and West Berkshire Council.

·       A set of recommendations were made. The report noted that a lot of new elements had not been properly resourced over the last five years which made the functions fragile. Berkshire West and Buckinghamshire delivery teams would be merging to help with resilience. Assessments and case management would remain with local teams.

·       This would be an eighteen month to two year programme. It would be 2025 before the benefits were seen and afterwards improvements would continue.

·       It was noted that Berkshire West was one of the lowest areas in the UK for eligibility. This had been reviewed a number of times. They had recently requested the NHS South East regional team come in and have another review. They would be continually looking at it.

·       It was highlighted that the impact of the Transformation Plan would be to reduce variation and ensure equity in eligibility across the ICB.

·       The Implementation of the Transformation Plan would provide many benefits including a locally focussed team with more staffing resilience, more flexibility in managing the AACC service and improved relationships.

·       Next, they would be implementing a patient survey which would become regular business as usual.

The following points were noted during the Committee’s discussion:

·       It was noted that there was no strict definition of Continuing Health Care (CHC) or AACC. There was a long and detailed framework and it relied upon professional opinion. CHC was for adults and AACC was an umbrella term which included children and young people.

·       Paul Coe (Interim Executive Director - People) stated that it was agreed that the merging of Berkshire West and Buckinghamshire provided a good opportunity to import good practice. However, Paul Coe noted that the 2025 timescale did not feel urgent, and change was not being recognised on the ground yet. It was suggested that improvements would be needed before the end of the Transformation Plan and that the Health Scrutiny Committee keep the programme in sight.

·       It was noted that the Peer Review was concerning in a number of areas. It was confirmed that the recommendations had been agreed as part of the future delivery of the service.

Action: Niki Cartwright to provide the Committee with the detailed project plan.

·       It was confirmed that Buckinghamshire and Berkshire West were merging due to the size of the teams. They would be continuing to review the new team structure.

·       It was confirmed that Berkshire West was doing very well in carrying out the assessment in the target of 28 days. The rate of conversion from application to eligibility was not available.

Action: Niki Cartwright to send this performance information to the Committee.

·       It was advised that the CHC application was made by a health and social care professional. It was confirmed there were advocacy groups.

·       The patient feedback survey had been agreed recently and would be implemented shortly. This patient experience information would help to drive further improvements more immediately. In terms of staffing, that would take time.

·       There had been some short-term improvements including better oversight of performance, the patient experience group, the gathering of policies and procedures, the joint funding pilot alongside CHC and an oversight of spend across the ICB and quality oversight of funding.

·       It was reiterated that the regional team would be coming in to see if there was anything that could be done to improve the eligibility rates in Berkshire West to ensure that those eligible were receiving the funding.

·       People in receipt of CHC were reviewed as needs changed and some moved out of CHC. There was ongoing case management where people were reviewed for CHC and so it was not necessary to re-review people who had previously been declined for CHC funding. Concern was raised about the gap in Berkshire West which meant that people may have been missing out on funding. There was a process of review and appeal and ongoing work with Berkshire Healthcare to ensure appropriate referrals were received. Very few appeals were made, and the decisions were always upheld.

Action: Niki Cartwright to provide information on reviews and appeals compared to the rest of BOB and England.

·       It was noted that Buckinghamshire was highlighted in the peer review as putting patients and relatives at the forefront of what they did, and that it was not the same in Berkshire West. It was confirmed that these two teams would be merged and the expectation was to keep what was good within the teams. It was also confirmed that clinical staff did not consider the financial impact when making funding decisions.

Action: Niki Cartwright to provide an update in 3 months.