The report (which is to follow) seeks to update the Committee on the Continuing Health Care Fund and its management in Wiltshire.
Minutes:
The Chairman welcomed Sarah-Jane Peffers (Associate Director for Patient Safety and Quality and All Age Continuing Care) to the meeting who was present to update the Committee on Continuing Health Care and its management in Wiltshire.
Summarising the more detailed presentation shared at the meeting (attached as Appendix 1 to these minutes), the following was highlighted:
· Continuing HealthCare (CHC) is a package of care provided outside of a hospital setting that is arranged and funded by the NHS. It's provided to individuals who have complex health needs that are primarily healthcare related. To determine eligibility for CHC, individuals undergo an assessment process which considers their overall health and care needs;
· Mandatory quarterly reporting to NHS England monitors Integrated Care Board’s (ICB) performance and activity in all areas of the CHC process and there are 3 set key performance indicators. The quarter 4 2023-24 data shows that 53% of all CHC assessments were completed within 28 days of notification that an eligibility outcome was required and whilst this was a significant increase from the position in quarter 1 it remained below national targets and they wished to improve on making progress in that area;
· The BSW ICB would have to ensure that they respond to the all age continuing care requirements as they were seeing increases in the elderly population who were also having more long term health conditions, therefore needing additional support;
· The intention of the Fast Track Pathway is that it should identify individuals who need to access NHS Continuing Healthcare quickly, with the minimum delay, and with no requirement to complete the Checklist or the Decision Support Tool (DST). Therefore, the completed Fast Track Pathway Tool, which clearly evidences that an individual is both rapidly deteriorating and may be entering terminal phase, is sufficient to establish eligibility;
· For individuals in care homes, registered nurses are usually employed by the care home itself. To fund the provision of such nursing care by a registered nurse the NHS makes a payment direct to the care home. NHS Funded Nursing Care (FNC) is a standard rate contribution towards the cost of providing registered nursing care to individuals who are eligible. Local Authorities are not permitted to provide or fund registered nursing care. Eligibility for NHS Continuing Healthcare (CHC) should always be considered before a decision is reached about eligibility for FNC. The CHC checklist is used to determine the need for a full CHC assessment, if the checklist is negative and nursing needs are identified then FNC is authorised;
· There were a number of transformation activities that were being undertaken to continue to identify those individuals that are eligible for CFC. An improvement in the 28 day assessment target was expected to achieve 80% by the end of quarter 1 2024-25. They had seen an increase in referrals for CHC and would work with colleagues in the South West to further increase referrals. There was now a System CHC Transformation Group chaired the Chief Nursing Officer of the BSW ICB. There was now a joint funding approach for people found not eligible for CHS and since April 2024 joint funding arrangements had been agreed for 9 people in Wiltshire who were found not eligible for CHC but had recognised health needs not met by existing commissioned services; and
· Future opportunities had been identified and they wished to go further with transformation to ensure that all the right processes and procedures were in place to secure funding and they would continue to work on finding the right workforce. There would hope to be able to have a new digital offer with an end to end IT solution by April 2025.
The Chairman thanked Sarah-Jane for attending and welcomed further updates to come back to the committee in due course.
Cllr Jane Davies (Cabinet Member for Adult Social Care, SEND and Inclusion) reported that she felt that the financial aspects of the fund would be of interest to the committee and that they would be interested in clarity around how many assessments result in eligibility for the CHC, specifically for Wiltshire and how they compare to national conversion rates. Also it would be useful if information could be provided on Wiltshire’s ICB spend on CHC and if it was a percentage in comparison to other ICBs. Cllr Davies also reported that she is being told that CHC process is a particular challenge for those with complex needs including those that have learning disabilities and that also affects fast track at the end of life. Further information on what additional steps the ICB are taking to ensure this vulnerable group are able to access support and in timely manner would be welcomed.
The Committee asked questions about how people are referred to CHC for the assessment process to take place, if the process fair for all or are there groups that are not receiving what support they should be, the gap between referrals and unmet need and how this can be improved recognising that this is a challenging area.
The Chairman thanked Sarah-Jane for her presentation.
Resolved:
That the Select Committee
1. Receive a copy of the presentation shared on the Continuing Health Care Funding in Wiltshire (attached as appendix 1 to minutes).
2. Return to this item at a future meeting to allow the Committee time to review the information provided today and consider further financial information for Wiltshire and the additional queries raised at the meeting.
Cllr Clare Cape left the meeting at 12.09pm.