Agenda item

To receive an update on NHS Continuing Healthcare (CHC).

Sarah Webster, ICB Executive Place Director, Berkshire Wets, provided an update on Continuing Healthcare (CHC).  She focused on the Transformation Programme All Age NHS Continuing Healthcare which was taking place across BOB, local work in Berkshire West to address particular areas, and joint funding arrangements.

During the discussion of this item, the following points were made:

·       The ICB was formed in July 2022 through the merger of the three CCGs in the BOB area.  The ICB had wanted to quickly progress the transformation programme around CHC.

·       The aims of the Transformation Programme were as follows –

Ø  Ensure that assessments occurred at the right time and place, meeting all nationally mandated KPIs

Ø  Reduce variation in patient/carer experience of CHC assessments and eligibility across BOB in terms of the assessment process and

Ø  Establish appropriate ICB oversight of CHC and related services performance, developing locally appropriate and the application of the national eligibility criteria.

Ø  Standardise and enhance corporate support services for CHC and related services, improve service resilience and efficiency.

Ø  Review commissioning arrangements to drive economies of scale where appropriate whilst retaining local flexibility and responsiveness.

·       A CHC Transformation Board had been established which was overseen by the ICB Chief Nursing Officer.  It met monthly.  The Board had a broad representation across the ICB, including representatives from the five local authorities and patient representative organisations. 

·       There were three phases to the Transformation Programme –

Ø  Phase 1 - Comprehensive review of CHC service across BOB and seeing what variations existed and what operating model may be put in place.  This was underway (October – January 2023)

Ø  Phase 2 - Produce a strategic development plan for implementation of the recommendations from phase 1 ensuring high quality efficient, fair, and equitable AACC services across BOB ICS.  This was underway. (February - March 2023).

Ø  Phase 3 - Underpin the delivery of the Transformation Programme Plan using an inclusive and supportive approach, providing leadership and mentorship to the clinical and non-clinical teams responsible for service provision. (April – September 2023).

·       At present in Berkshire West the CHC team was an arm of the ICB.

·       Joint funding was where an individual may not meet the eligibility criteria for NHS Continuing Healthcare, but a contribution could made towards an element of their care in partnership with the Local Authority.

·       There were also specific actions for Berkshire West.  The LGA review across BOB in July 2022 had identified many areas for improvement particularly in Berkshire West.  The review had highlighted some inequity in access and potential inconsistencies across the three areas.

·       Members were informed that discussions between the Directors Adult Services in Berkshire West and the ICB (including the external Transformation Consultants), were ongoing about what could be done differently.

·       A local action plan was being developed with a focus on:

Ø  Reviewing the CHC standard operating procedures to align with best practice;

Ø  Agreeing a Disputes Policy with a target date by end of March 2023.  There was currently not a Policy in place so it was not always clear how disputes should be resolved;

Ø  Jointly developing a business case for the implementation of a Joint Funding / Shared Care policy and pathway, which would make it clearer what should be covered as a health cost or a local authority cost for those who required care from multiple agencies.  The business case was due by March 2023.  The Policy would ideally line with existing policies within BOB;

Ø  Further work would be undertaken on improving relationships and mutual trust between teams as part of the rollout of the new policies.

·       A new post, the BOB Head of CHC, had been agreed and was being seconded from NHS England from February so as to provide additional capacity and support.

·       A partnership approach was being taken to the review.

·       In response to a Member question, Sarah Webster explained that NHS CHC was where an individual had ongoing care needs, predominantly relating to a health issue.  Care could be provided in the individual’s house or in a residential care home.  An assessment of an individual’s care needs and if they were eligible for CHC was undertaken by the ICB team who would then commission packages of care from independent care agencies.  In Berkshire West there was not a single commissioning team arrangement in place currently, although this was being reviewed.

·       Members asked what was being done to make improvements in the Berkshire West area.  Sarah Webster referred to the findings of the LGA Peer Review, which related predominantly to relationships between health and social care, and also highlighted a level of discrepancy in the level of provision of CHC per 50,000 population in comparison to other areas.  Berkshire West had a lower level of provision, and it was being determined if the appropriate level of CHC was being provided, and if not how to improve on this.

·       Members questioned how far away the current position was from best practice.  Sarah Webster indicated that she could not comment on the specific findings of the review whilst it was in progress.  There was a lot of good practice in place but more consistency was required.  She would be able to provide more specific detail once the review had concluded. 

·       A Member went on to ask what was currently being done well in Berkshire West.  Sarah Webster responded that there was a good level of knowledge amongst the team.  However, capacity, working relations and trust could be improved.

·       It was noted that a number of the target dates within the Transformation Programme were March 2023.  A Member questioned how the ICB would report back to the Committee and demonstrate the progress made.  Sarah Webster indicated that she would be happy to come back to a future meeting.

·       Members sought clarification on relationships between the ICB and local authorities and questioned whether there were issues because the ICB was new, and trust took time to develop.  Sarah Webster responded that there were criteria to meet to decide if an individual was funded by health or not.  There had been some difficult discussions around which organisation should be funding care, which could create difficulties in relationships.  The work being undertaken would help to rebuild that trust.  She and Matt Pope, and other key senior officers were providing a united front.

·       In response to a Member question regarding funding disparity, Sarah Webster commented that there was a legal obligation to provide CHC if someone met the criteria.  National statistics showed that the amount spent on CHC in Berkshire West was lower.  Consideration was being given to whether there a lower level of need or if all the checklist was being captured.  This would be looked at as part of the review of the operating model.

·       Members asked whether there was a disparity in funding levels across Berkshire West.  Sarah Webster indicated that it was monitored on a Berkshire West level and was based on the old CCG footprint.  The national statistics monitored it by 50,000 population.  There was variation between the funding levels in Buckinghamshire, Oxfordshire, and Berkshire West per 50,000 population, but work was being undertaken to determine what was driving this.  A consistent approach was needed.

·       A Member asked about the eligibility levels for Wokingham Borough and was informed that eligibility was monitored at a Berkshire West level.  Sarah Webster agreed to provide more Wokingham specific information regarding those receiving CHC at the Committee’s next meeting.

·       A Member queried if there were any delays in the delivery of care whilst assessments took place, and if so, which organisation paid in the interim.  The Committee was informed that there was a national standard around completing assessments for CHC within 28 days, and Berkshire West performed well against this standard.  There were varying criterion regarding who paid in the interim, which was set out in a national framework, but individuals were not left without care.

·       Members sought assurance that the geographic size of the different areas in BOB did not impact funding levels and were informed that geographic lines did not impact this.

·       Members questioned when residents would begin to see the benefits of the Transformation programme, and how progress could be monitored.  Sarah Webster stated that a greater clarity around processes would assist staff.  It was expected that staff feedback would be more positive.  In addition, if funding streams changed, a difference would be seen in the national reporting of CHC per 50,000 population.  A Member added that improvements to the process would help to reduce the stress on individuals and their families, going through the process.

·       In response to a question regarding potential backdating following reviews of assessments and disputes, Sarah Webster indicated that if there were any changes in care needs there was an opportunity for review.

RESOLVED:  That

1)    Sarah Webster be thanked for her presentation;

2)    A further progress update be sought at the Committee’s March meeting.