AGENDA ITEM: 3.5 FINANCE PLANNING & PERFORMANCE COMMITTEE

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1 AGENDA ITEM: 3.5 FINANCE PLANNING & PERFORMANCE COMMITTEE Subject : Approved and Presented by: Prepared by: Other s and meetings considered at: DATE OF MEETING: 20 AUGUST 2018 CONTINUING HEALTH CARE - QUARTERLY REPORT Interim Director of Nursing Rhiannon Beaumont Wood Katrina Rowlands Assistant Director of Nursing Rhian Price Evans Senior Nurse Continuing Health Care/ Care Home Governance Continuing Healthcare Steering Group PURPOSE: A key requirement of the Continuing Health Care (CHC) Performance Framework implemented by Welsh Government is for a formal quarterly CHC position to be reported to the Board. This requirement has been reinforced by Wales Audit Office (WAO) both in their 2013 report on CHC and the 2014 follow up report. This paper provides the with the required quarterly updates on CHC performance. RECOMMENDATION(S): It is recommended that the DISCUSS and NOTE the requirement for quarterly reporting and observe the latest reported Quarter 1 position Approval/Ratification/Decision 1 Discussion Information 1 Equality Impact Assessment (EiA) must be undertaken to support all organisational decision making at a strategic level Page 1 of 9

2 THE PAPER IS ALIGNED TO THE DELIVERY OF THE FOLLOWING STRATEGIC OBJECTIVE(S) AND HEALTH AND CARE STANDARD(S): Strategic Objectives: 1. Focus on Wellbeing 2. Provide Early Help and Support 3. Tackle the Big Four 4. Enable Joined up Care 5. Develop Workforce Futures 6. Promote Innovative Environments 7. Put Digital First 8. Transforming in Partnership Health and Care Standards: 1. Staying Healthy 2. Safe Care 3. Effective Care 4. Dignified Care 5. Timely Care 6. Individual Care 7. Staff and Resources 8. Governance, Leadership & Accountability EXECUTIVE SUMMARY: A key requirement of the Continuing Health Care (CHC) Performance Framework implemented by Welsh Government is for a formal quarterly CHC position to be reported to the Board. This requirement has been reinforced by Wales Audit Office (WAO) both in their 2013 report on CHC and the 2014 follow up report. This paper outlines the Continuing Care position for Quarter 1 Page 2 of 9

3 BACKGROUND AND ASSESSMENT: Continuing NHS Healthcare (CHC) is a term used to describe a package of care that is fully funded by the NHS where it has been determined that the primary need for care and support is a health need. The existing arrangements for CHC are set out by the Welsh Government in the 2010 National Framework for Implementation. However, Welsh Government along with Health Board CHC leads are currently reviewing and updating the framework, which is likely to be published Autumn The Social Services and Well Being Act Wales (2014) came into force in April 2016, this has necessitated the need for joint working and pooled budgets. PTHB have developed and strengthened their partnership with Powys County Council around care and have initiated several integrated workshops which have highlighted the above challenges. Progress is being made to develop pooled budgets to establish a pooled fund in relation to care home accommodation functions between Powys County Council and Powys Teaching Health Board as required by duties under Part 9 of the Social Services and Wellbeing Act The key driver for this integration work is the commitment of both organisations to ensuring that the health and care needs of the people of Powys are met and provided in the most efficient and effective way. Together with the expectations arising from A Healthier Wales: Our plan for Health and Social care, Health and Social Care will become fully integrated avoiding any duplication. There is a joint operational group for the pooled budgets which will assist the Joint Partnership Board by reporting its activities through oversight of the day to day management of the scheme. Funded Nursing Care (FNC) Work has been underway across all parties over recent months by Health Boards and Local Government regarding FNC. The Supreme Court Judgement in 2017 set out the activities undertaken by the Registered Nurse (RN) within a care home that should be included within the FNC rate. Health Boards and Local Authorities have been working with Welsh Government to ensure compliance with the Judgment and the subsequent financial implications of this on the FNC rate and additional social care funded by the Local Authority. Each Health Board and Local Authority has now formally considered and approved a new FNC rate for 2017/18 will be per patient per week An FNC paper has been submitted to the Board in March 2018; Page 3 of 9

4 Appendix 1 Powys Performance The demand for CHC packages continue to increase within the Health Board and across Wales. PTHB ensure there is a consistent approach to Quality Assurance utilising core services where needed to meet the need of the population. Finance There continues to be numerous requests for increase in fees from the care homes sector in Powys; this is largely due to the increase in the National Minimum Wage in April PTHB have acknowledged the request and consultations are underway. The Care Home fees within PTHB have been historically agreed and each care home currently has their own agreed rate which differs across Powys. To date, any increase in fee has been based on individual patient need and dealt with through the CHC Quality Assurance process. There was a 2.5% growth expectation and inflation increase of 1.5% for this financial year for Continuing Healthcare. The total spend for Continuing Healthcare has gradually reduced over the last financial year. The current forecast remains to be a reduction in the CHC expenditure. This has been due to the Senior Nurse applying additional scrutiny to the cases submitted to Panel, being independent to the Localities there is no conflict of interest with regard to funding patients discharge from hospital. As a result, an impartial overview of the process and application of the Continuing NHS Health Framework is rigorously implemented in determining whether an individual has a primary health need. The Senior Nurse for Continuing Health Care and Care Home Governance has also developed a streamline process for CHC panel The Continuing Healthcare year end spend for financial year 2017/18 is 11.99m. This is a 0.968m reduction on the previous financial year spend, 0.502m reduction in Locality, MH & LD spend & 0.466m in Children. Tables 1-3 The number of current CHC packages delivered by category and by proportion of total Health Board CHC spend as at are provided in Appendix 2 Page 4 of 9

5 Table 1 Table 2 Page 5 of 9

6 Table 3 Performance of Reviews Powys Teaching Health Board has prioritised completing the reviews of both Continuing NHS Health Care Funded service users and Funded Nursing Care service users to ensure that the patient needs are being appropriately met. The Complex Care Teams have prioritised the CHC reviews and the number of outstanding CHC reviews has reduced from 106 CHC reviews at the beginning of 1 April 2017 to 28 CHC reviews. As of 30 June with 51 Continuing NHS Healthcare reviews being completed within this quarter. This improvement is demonstrated within Table 4 the number of CHC reviews completed in Quarter 4 ( ) was a total of 38 Similarly, as of 30 June 2018 there were only 23 FNC reviews outstanding as with 60 FNC reviews being completed within this quarter. Table 4 Percentage of case reviews undertaken position at 30 June 2018, includes all reviews 3 monthly, and 12 monthly. Period /2019 FNC reviews due at 1/4/ FNC reviews completed 1/4/ /06/ total reviews 86 percentage of reviews undertaken in period in quarter % Page 6 of 9

7 CHC reviews due 1/4/ CHC reviews completed 01/04/ /04/ Total reviews 67 Percentage of reviews undertaken in Quarter % Page 7 of 9

8 Retrospective CHC Claims The retrospective claims process has been established to consider claims from individuals that they should have been eligible for CHC funding for past care needs but, for a number of reasons, they were not identified as eligible and thus were required to contribute financially to their package of care. If following a retrospective review of their needs the conclusion is that the person should have been found eligible for CHC then the individual or their estate is reimbursed by the Health Board. Within the North, South, Mid, Mental Health and Learning Disability teams, there is a total of 9.48 whole time equivalent (WTE) Band 7 Complex Care Specialist Nurses. There are 3 (WTE) Nurse Reviewer Band 6 and 4.8 WTE administrators. WG stipulates that the retrospective review process should not take any longer than 6 months to complete. Reviews which do breach the 6-month time frame are reported to WG on a monthly basis. As there is no dedicated team, the retrospective reviews are undertaken by the Complex Care Specialist Nurses and there is always a potential risk of breached cases. Currently for Quarter 1 there are five retrospective reviews breaching the target review date set by WG. Appendix 3 Of the five there are three near completion, one timeframe has been extended as requested by the solicitor/representative. Consistent progress is made to complete the reviews and inform the relatives and patients of the outcome. The All Wales Project Team, hosted by PTHB will close in December 2018, and there will be 21 cases that will require closing. Completing the outstanding reviews from The All Wales Project Team will be a high priority. However, there is a risk that the Complex Care Team will be unable to complete the 21 cases in a timely manner for completion. The demand for Page 8 of 9

9 completion of this work will have an impact on the team as staff numbers are currently proportionate to the work generated. Powys Complex Care Team will continue to work with the All Wales Team to contribute to the completing the outstanding cases. NEXT STEPS: Strategic Group for the implementation of Pooled Budgets will continue. PTHB Standard Operating procedures to be reviewed on completion of the new CHC Framework. Health Boards and Local Authorities continue to work with Welsh Government to ensure compliance with the Judgment and the subsequent financial implications of this on the FNC rate and additional social care funded by the Local Authority. Appendix 1 Board_Item_2.2_Fu nded Nursing Care C Appendix 2 CHC Packages as at docx Appendix 3 Retrospective Cases position of Page 9 of 9