Agenda item

Purpose: To receive an update on All Age Complex and Continuing Care since attending the HASC in December 2025.

Daphne Barnett (Interim Head of Neuro Transformation and Complex Cases, Thames Valley Integrated Care Board (TV ICB)) presented the report on all-age continuing care and complex care. The presentation set out: the establishment of the new Thames Valley ICB (from 1 April 2026) and its governance arrangements across “places”; work to improve joint working between health and social care (including disputes processes and joint reviews); policy alignment across the new ICB footprint (including further work on a draft healthcare contribution policy); performance and activity data for Continuing Healthcare (CHC) and Fast Track CHC; and key priorities for future delivery including a more centralised operational model, improved consistency and timeliness, and performance reporting to NHS England.

During the debate the following points were discussed:

·         It was discussed that the data being presented had only recently become available at the requested granularity; a caveat was raised by Daphne Barnett that reliability was still improving due to system merging and inconsistent historic recording, and that a new process was being introduced to ensure consistent recording going forward.

·         It was raised by Paul Coe (Executive Director, Adult Social Care and Public Health, West Berkshire Council) that the committee valued receiving local authority-level data and noted that ICB colleagues had done extra work to provide this. It was suggested that embedding this granularity into routine reporting would be beneficial going forward.

·         It was discussed that commentary within the slides about proportionality across Buckinghamshire, Oxfordshire, Berkshire West and the newly-added East Berkshire needed careful interpretation; It was noted that some comparisons were expressed “per 50,000 population” and that would slightly challenge the proportionality point as expressed.

·         It was discussed that, on formation of the new larger Thames Valley ICB, CHC was understood to be an area “protected” within the new organisation, giving some confidence about continuity and focus.

·         It was discussed that quarter-to-quarter data could fluctuate; Paul Coe advised that, for scrutiny purposes, a longer time period (e.g., a full year / four quarters) would provide a more reliable sense of trend and direction of travel than isolated quarterly snapshots.

·         A question was asked about the clarity and internal consistency of the data visualisations and narrative on “slide 3” (standard CHC referrals per 50,000 and eligibility metrics). It was raised that:

·         The narrative referred to specific figures (e.g., 13.6, 16.75, and 9.7 rising to 12.8) that were difficult to reconcile with the charts shown.

·         Some lines/bars appeared not to clearly correspond to the narrative values, making it hard to interpret without confusion.

·         It was suggested that the presentation might be improved by showing data over a longer run (e.g., four quarters), with clearer “before/after” comparisons and/or clearer depiction of means/trends, rather than complex multi-line charts that were hard to map to stated figures.

·         Daphne Barnett responded that she had noted the feedback and would take it back to the data team who produce the figures and slides, with the intention of improving representation and clarity next time. It was also offered that a councillor was willing to make themselves available to discuss the reporting/visualisation issues with the ICB data team.

·         It was raised that a labelling error appeared on “slide 6” where the title referred to “West Berkshire AACCC” but the data were for “Berkshire West”; the point was made that the slide title should reflect “Berkshire West” rather than “West Berkshire”.

·         A question was asked about the conversion rate figure stated in the narrative (21.8% described as the national average / higher end), noting that West Berkshire’s figures shown (2 eligible out of 19) equated to approximately 10.5%, which appeared materially below the national conversion rate. A response was provided by Liz Rushton (Head of Delivery, Neighbourhood Teams / All-Age Continuing Care, Thames Valley ICB) that:

·         CHC reporting to NHS England was done at “Berkshire West” (place/area) level rather than by individual local authority, so the conversion rate quoted related to Berkshire West across West Berkshire, Reading and Wokingham combined.

·         If calculated only for West Berkshire as a local authority area, the conversion rate would indeed be lower, but this was not how performance is routinely reported nationally.

·         A further question was asked specifically why West Berkshire’s local-authority-specific conversion rate might be much lower even if Berkshire West overall aligns with the national range. In response, Liz Rushton discussed possible contributing factors, including:

·         Differences in local care home markets (e.g., areas with more nursing and dementia care homes may see different assessment profiles and volumes).

·         The impact of placements and GP registration: responsibility for CHC assessment is driven by GP registration. If individuals are placed out of area and become registered with GPs across borders (e.g., Wiltshire/Hampshire), they may be assessed by other areas and would not appear in Berkshire West figures, potentially affecting local-authority-level counts.

·         It was noted in the exchange that these factors may explain differences in volumes coming into the assessment process; the questioner indicated that while that might explain lower numbers of assessments, it did not fully explain why the proportion found eligible was lower.

·         It was discussed that West Berkshire repeatedly appeared “at the bottom” of columns in the data tables (e.g., West Berkshire 2 eligible vs Reading 6 vs Wokingham 13), and that it was not clear whether this was solely a function of population size or reflected other systemic factors. It was suggested that the committee may need a clearer “bigger picture” view to interpret whether West Berkshire is improving relative to others.

·         Paul Coe reiterated that:

·         This was an area the committee should continue to monitor regularly.

·         Berkshire West has historically (over a long period) shown disparity in CHC eligibility decisions compared with other areas; it had not always been clear whether that disparity was warranted or unwarranted.

·         Centralising processes should, in principle, help reduce unwarranted variation and improve equity of experience for residents.

·         More granular local authority data, combined with a longer time series, will help scrutiny assess whether the situation is improving, worsening, or static.

·         A question was asked requesting that future data be normalised by population size (e.g., rates per 100,000), so comparisons can be made “like for like” rather than relying on absolute numbers that may simply reflect differing population sizes. Daphne Barnett confirmed that this could be done for future reporting.

·         It was discussed that CHC can feel opaque to residents and potentially even to some professionals; a question was asked about what happened to individuals when CHC was refused (i.e., where the checklist/assessment result was negative / ineligible). Paul Coe responded that:

·         If an individual was not eligible for NHS-funded CHC, responsibility was likely to fall to the local authority to organise care, and the individual may then be financially assessed and charged according to their resources.

·         It was noted that Fast Track CHC related to people who needed end-of-life care (raised by the Chair in clarifying the purpose/intent of the Fast Track route).

·         It was discussed that, while the update was useful, the committee wanted improved comparability and interpretability in future, including (as themes across the questions):

·         Longer trend reporting (e.g., annual/four-quarter views) rather than single-quarter snapshots.

·         Clearer visuals and consistent narrative-statistic alignment.

·         Population-normalised rates to support direct comparison.

Action: Thames Valley ICB to work with its data team to resolve the issues raised about CHC charts/narrative alignment and provide clearer, population-normalised and longer-run (e.g., four-quarter) trend reporting, and to arrange a meeting with Councillor Paul Kander to discuss the data presentation and interpretation issues. To return to the committee in December 2026 with the improved dataset and updated reporting format.