Agenda item

- presentation by Shona McFarlane, Director of Health and Wellbeing

Shona McFarlane, Director of Health and Wellbeing, gave the following powerpoint on Continuing Health Care in Rotherham as follows:-

Context

-        Specific eligibility criteria

-        Assessment/decision making process set out in legislation

-        Single National Framework set out in 2007

Funding

-        Long term health and social care needs with a primary focus on health needs – Continuing Health Care

-        Long term social care needs with needs that should be met in nursing care accommodation – fixed rate NHS contribution plus local authority costs of core placement – Free Nursing Care

-        Long term social care needs with health needs met through primary care – local authority (or self-funded) residential care

National Framework – Best Practice

-        Checklist (initial screening tool)

-        Decision support tool

-        Fast track pathway tool

-        Assessment – undertaken by multi-disciplinary team

-        Recommendations of MDT – should be accepted by PCT, panel in place

-        Consultation with local authority when ending funding

Whole System Issue

-        Assessments

-        Providers

-        Changing needs

-        Customers

Relative Spend

-        2006/7 – 112 people cost £2.15M

-        2007/8 – 215 people cost £2.82M

-        2008/9 – 573 people cost £7.72M

-        2010/11 – 795 people cost £10.86M

-        Spending per head of population improved from 10^th to 8^th of 15

-        Number of people received CHC funding has reduced – down from 7^th best to 11^th

-        Although ranking has improved, Rotherham was below the average spend per head of population

-        Main areas of variation

o       Older people with dementia – less than half the regional average

o       People with physical disability – 1/3 below the regional average

o       People with learning disability – 10% below average but improving

Issues and Challenges

-        Funding levels

-        Delays in assessments

-        Customer experience – timely access

-        Communications on changes in funding decisions

A question and answer session ensued with the following issues highlighted:-

-        Once the issue of delays in assessments had been known, the concerns had been raised in partnership meetings.

-        The national Directions Framework stated that, prior to a decision being made to withdraw funding, the PCT had to consult with the local authority as the burden of responsibility for the social care element of the care package would fall on the local authority.  The Panels were multi-agency.  However, it was felt that a decision made at a Panel meeting to stop funding was not sufficient consultation, so there was dialogue between the partners.  It was acknowledged that the protocol for shared funding for complex care packages could be improved

-        The responsibility for continuing health care would pass to the CCG but it was not known as to how the Group would continue to deliver. It was presumed that there would not be a change given that the national Direction was not going to change

-        There was an Independent Review Panel held by the Strategic Health Authority if a customer felt that the decision made about their continuing health care application was unfair.  Initially a customer would submit an appeal to the PCT who would seek to resolve that in Rotherham.  If a customer was not satisfied with the response it would then pass to the Independent Review Panel.  The Strategic Health Authority sometimes asked a neighbouring health group to hear an initial appeal with further stages going through to the  Strategic Health Authority

-        The End of Life funding had specific criteria.  There were moves at the moment to change the definition of long term conditions and include people with cancer because people were living longer with cancer

-        The Council had built in an expectation that there would be an increase in the amount of Continuing Health Care funding which would be received by customers to fund their care.  Since the implementation of the Framework it had been a simpler process and been successful.  The take up of Continuing Health Care in Rotherham had increased but still did not meet regional average

-        An older person with the definition of “living in residential care” may be eligible for free nursing care but if their needs changed and they needed Continuing Health Care their care would be free to them. If they failed to be defined as legible for continuing health care they would continue to pay care costs and impact on the local authority was that it continued to pay the residential care costs

-        The impact on the local authority was that it continued to pay the residential care costs rather than being paid through the NHS so the burden fell on the customer and local authority.

The Chair suggested that a joint Scrutiny Review be held commencing in January, 2012.

Shona was thanked for her presentation.

Resolved:-  That a joint Scrutiny Review be held consisting of Councillors Beck, Pitchley, Steele, Ann Clough and Russell Wells.