Agenda item

The Committee will receive an update on the aims and benefits of Continuing Health Care (CHC) funding and this will address the queries raised when this was last presented to the Committee in June 2024.  The report is to follow.

The Chairman noted that the Committee received an introduction to the Continuing Health Care (CHC) funding in June 2024 and at that time they requested that an update include Wiltshire specific data.  Sarah-Jane Peffers (Associate Director for Patient Safety and Quality and All Age Continuing Care – BSW ICB) was in attendance to provide the update.

Summarising the more detailed presentation included in the agenda pack, the following was highlighted: 

·            ICBs have a statutory responsibility for assessing individuals for eligibility for NHS Continuing Healthcare funding. The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care sets out the principles and processes to be followed by ICBs;

·            CHC funding is a package of care provided to individuals who have been assessed as having a primary health need which is funded by the NHS to support individuals with significant and ongoing healthcare needs and to enable care to be delivered in the most appropriate setting, whether at home or in a care facility;

·            Diagrams within the presentation showed that BSW was within the confidence levels of individuals assessed as eligible for CHC per 50k nationally and the comparative positions with BSW’s nearest neighbours based on demographics;

·            The regional data shows that BSW ICB has the joint highest referral conversion to eligibility rate in the southwest and the second highest assessment conversion to eligibility rate in the southwest with the ICB exceeding the 80% target of assessments being completed within 28 days of notification;

·            The Wiltshire specific data showed that there was a 22% conversion rate to eligibility for Wiltshire residents and there had been a sustained increase in positive checklists over the past year in all three localities;

·            Wiltshire locality CHC patient spend equated to 52.5% of BSW ICB expenditure at £36.76 million from a total of £70.07 million to date and the adult spend in comparison to the nearest neighbour based on demographic similarities reflected the second lowest annual budget; and

·            The transformation work was continuing, and BSW ICS is working to together to empower people to live their best life.  Areas of focus were commissioning, contracting, Personal Health Budgets, digitisation, brokerage, shared polices and workforce development.

The Committee asked the following questions which included but were not  

limited to: 

·            How we convert people into service eligibility is not addressed, how do you ensure fairness for those deemed to be eligible across a cross section so that no particular type of person is left behind and the CHC funding is ethically distributed.  It was noted that BSW ICB have to ensure that there is equity and fairness for all and whilst that information was not shared with the Committee today it could be at a future meeting.   It was important to be able to clearly articulate fairness and equity and BSW ICB worked with all partners across health and care to ensure that the right people have access to CHC funding.  The threshold for a positive CHC checklist is low, so that a CHC assessment can be offered to as many people as possible.

·            What is meant by BSW being within ‘confidence levels’ for receipt of referrals and eligibility for CHC? Confidence Interval is a statistical analysis that offers a range of values that is likely to contain a population parameter with a certain level of confidence. The confidence levels are set by the NHSE, and it is uses both national figures and nearest neighbour data to ensure that they are confident that they are converting the right number of people from referral to assessment and from assessment into eligibility for CHC.

Cllr Jane Davies (Cabinet Member for Adult Social Care, SEND and Inclusion) asked what accounts for the BSW ICB adult CHC spend in comparison to nearest neighbour reflecting the second lowest annual budget.  It was noted that this was multifactorial and should not been seen as a poor indicator for BSW.  BSW ICB want to ensure that they are giving the right care according to their assessment and keep the person at the centre with personalised care and offer the opportunity to deliver that care through the mechanisms of Personal Health Budgets (PHB).  They also work alongside local authority colleagues to use care providers and homes within the framework that Wiltshire has as a local authority to ensure there is the most effective care provision across BSW.

·            What are the expected outcomes of the transformation?  It was noted the aim was to ensure that the right people get referred and assessed for CHC funding and that the people of BSW have a good experience and can live their best lives.  BSW ICB wish to maintain the NHSE Quality standards that patients have a right and timely assessment, they are offered personalisation and choice and increase the numbers of people in receipt of a PHB.  BSW ICB need to ensure they are offering safe and effective services, including financially and do all they can to ensure fairness and equity in service delivery.

The Chairman asked the Committee if they would wish for further scrutiny and receive more Wiltshire specific data.  Sarah-Jane confirmed that as they transfer to a more robust data system from April, they are hoping this would be able to pull through more accurate and reliable information at both a system and locality level.

Resolved: 

That the Health Select Committee: 

1.          Note the update on the Continuing Health Care Funding.

2.          To receive a report annually on Continuing Health Care Funding to include eligibility breakdown.

3.          Carry out a rapid scrutiny exercise to determine the information required around the eligibility and request Wiltshire specific data going forward.