Agenda Item: 3.7 FINANCE, PLANNING & PERFORMANCE COMMITTEE Subject : Approved and Presented by: Prepared by: Other Committees and meetings considered at: Considered by Executive Team on: Date of Meeting: CONTINUING HEALTH CARE - QUARTERLY REPORT Rhiannon Jones, Director of Nursing Katrina Rowlands, Assistant Director of Nursing Powys Teaching Health Board CHC Steering Group PURPOSE: To provide the Finance, Planning & Performance Committee with the required quarterly updates on Continuing Health Care (CHC) performance. Approval/ Ratification/ Decision Discussion Information THE PAPER IS ALIGNED TO THE DELIVERY OF THE FOLLOWING STRATEGIC OBJECTIVE(S) AND HEALTH AND CARE STANDARD(S): Strategic Objectives: Health and Care Standards: Improving Health & Wellbeing Ensuring the right access Striving for excellence Making Every Pound Count Theme 1: Staying Healthy Theme 2: Safe Care Theme 4: Dignified Care Page 1 of 8 Finance, Planning & Performance Committee
EXECUTIVE SUMMARY: Theme 5: Timely Care Theme 6: Individual Care Theme 7: Staff and Resources 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. DETAILED 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. Committee members may recall, from previous papers and updates, that Welsh Government issued a revised National Framework in June 2014, to be operational from 1 October 2014. This was complimented by a Performance Framework, specific to CHC, against which performance has to be reported to Welsh Government. Each health board has submitted local action plans to Welsh Government in response to the latest Public Accounts Committee recommendations, the most recent submission from PTHB being April 2016. The key policy, performance and implementation issues are summarised in this paper for information. Performance Framework The Framework includes the following requirements: The identification of a lead executive director in each health board with responsibility for CHC; The identification of a named senior officer in each local authority with the lead for CHC and the interface with social care; A national annual self assessment exercise re: compliance to the 2014 National Framework; Annual sample audits; A customer satisfaction survey to be conducted for all individuals undergoing the CHC assessment process; Submission of a CHC quarterly performance report that will be collated and made publically available by Welsh Government. Page 2 of 8 Finance, Planning & Performance Committee
Currently a number of the required performance indicators do not have a single national data source or definition, making comparisons across health boards difficult. Health board lead officers are working with Welsh Government officials and NWIS to try to resolve these issues with pace. Governance and Accountability Framework The WAO report (2014) identified the need for improved governance and accountability arrangements for complex care, with a recommendation that a National Complex Care Board (NCCB) be established to oversee the delivery of national policy. The Board previously considered and approved the Governance and Accountability Framework that included: The establishment of a NCCB, to be chaired jointly by the Director of Social Services Wales and the lead health board CEO; The establishment of an operational delivery group comprising of CHC leads in each health board, to oversee the implementation of CHC and other complex care policy; and A Stakeholder Reference Group to act as a broad expertise base to advise the National Board as necessary. The NCCB held its first meeting in April 2015 and has strategic oversight of complex care related issues, overseeing implementation of policy, ensuring consistent models are in place, and to be the main point of contact with Welsh Government policy officials. This model acknowledges the sovereign nature of Health Boards, whilst driving the need for NCCB recommendations to be formally considered and adopted by individual health boards. 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 review the conclusion is that the person should have been found eligible for CHC then the individual/their estate is reimbursed by the relevant health board. A National Project Team, hosted by Powys Teaching Health Board, has processed the initial cohort of claims received. There are two further phases of retrospective claims that are currently being processed. It has been agreed that, with a small number of exceptions, all these claims will be transferred to the National Project for processing, to be funded by individual Health Boards on a proportional basis. Health boards therefore need to identify resources to both fund the processing of claims and also any reimbursement identified as necessary following review. Page 3 of 8 Finance, Planning & Performance Committee
Phase 1- complete except for a small number of residual claims. This covered the claim period 01 April 1996-15 August 2010. Phase 2 - covers the claim period 01 April 2003 - Present Phase 3- covers the claim period 01 April 2003-31 July 2013 Phase 4 covers the claim period 01 August 2014 to 31 October 2015 In addition: Phase 5-01 November 2015 to 30 September 2016 Phase 6-01 October 2016 to 30 September 2017 The exceptions refer to those claims that have already been actioned by the responsible health board. The rationale for this is that transfer to the National Project may disadvantage the claimants, as it risks extending the time taken to process the claim through to an outcome. Powys Performance The demand for CHC packages continue to increase within the health board and across Wales. There has been numerous requests for an increase in fees made by Care Homes across Powys Teaching Health Board, this is due to the rise in the living wage. A 1% increase has been agreed by the Health Board with individual costed care plans being reviewed for increases exceeding the 1%. An overarching Continuing Health Care Financial Plan is in place which incorporates the individual localities plans to monitor and reduce the CHC spend. The individual locality plans are monitored at the local finance meetings to ensure planned efficiencies are actioned. The over arching financial plan is monitored at the newly formed Continuing Health Care Steering Group which is multi professional. Although the numbers within PTHB are low compared to the large health boards the delay in the reviews are evident in the performance graphs (Appendix 1) The delays are mainly due to capacity issues within the CCSN Team for the localities. Recent successful appointments have been made for two Band 6 Nurses North and South to focus on the outstanding reviews, so we are anticipating a reduction. There has also been success in appointing a Senior Nurse for Continuing Health Care and Care Home Governance, who will be in post Mid November. Page 4 of 8 Finance, Planning & Performance Committee
CHC Training is being undertaken by the Complex Care Specialist Nurses and a training plan is now in place to ensure staff within hospitals are fully briefed on the CHC process and documentation requirements, which should expedite the process and allow a more seamless approach for patients. The Health Board has been successful in maintaining the Independent Review Panel review process for retrospective claims. Two appeals have been successfully upheld, with challenges and interagency disputes numbers minimal in relation to number of assessments being completed. The mandatory annual self assessment process is currently being undertaken which will generate an updated Action Plan for the health board. The key performance indicators can be seen in Appendix 1 and is the basis of the statutory quarterly reporting, as requested by the PAC and the CHC Framework. RECOMMENDATION(S): The Committee are asked to note the quarterly update report. NEXT STEPS: To submit the next quarterly update in due course. Impact Assessments Equality Act 2010: Quality and Safety: Welsh Language (Wales) Measure 2011: Financial Implications: Legal Implications: Well-being of Future Generations (Wales)Act 2015: Page 5 of 8 Finance, Planning & Performance Committee
Appendix 1 Performance overview Number of current CHC packages delivered by category and by proportion of total health board CHC spend as at 30 th September 2016 Category No of Active Packages Total Cost of active packages Active packages apportioned by Annual HB Forecast Spend % Adult Mental Health 50 3,910,997 31% Adult Palliative Care 34 684,782 5% Children 7 856,070 7% Community Based/Home Care Support 37 1,079,701 8% Elderly Mentally Ill Nursing Home 50 2,143,517 17% General Nursing 53 2,545,955 20% Learning Disability 28 1,069,613 8% Respite 1 3,918 0% Grand Total 260 12,294,552 96% Total number of CHC cases and spend for CHC packages delivered in a care home and in the community as at 30 September 2016. Position as at 30th Sept 2016 CHC Placements (as at P06-17) No of Packages Annual Forecast cost of packages In a registered setting 209 9,433,960 In the Community 154 3,320,911 Grand Total 363 12,754,871 Page 6 of 8 Finance, Planning & Performance Committee
Percentage of case reviews undertaken as at 30/9/2016 Above includes all reviews 3 monthly, and 12 monthly. Position at 30/09/2016 Position at 30/9/2016 CHC overdue reviews as of 30/9/2016 158 CHC reviews completed in quarter 2 as of 30/09/2016 33 total reviews 191 percentage of reviews undertaken in quarter 2 17.27% FNC reviews as of 30/9/2016 128 fink reviews completed in quarter 2 39 total reviews 167 percentage of reviews undertaken in quarter 2 23.35% Retrospective cases Position of 30 September 2016 there are 7 phase 3 cases to complete, in addition 7 phase 4 cases to complete, and 1 phase 5 recently received. The timescales to complete for the above numbered cases are For Claim Applications Limits of Claim Periods to be Reviewed Phase Submitted Powys HBs Phase 2 01/04/2003 to 01/04/2003 16/08/2010 to 31/07/2014 onwards 30/04/2014 Phase 3 Phase 4 Phase 5 Phase 6 01/05/2014 to 31/07/2014 01/08/2014 to 31/10/2015 01/11/2015 to 30/09/2016 01/10/2016 to 30/09/2017 01/04/2003 to 31/07/2014 N/A N/A N/A 01/04/2003 onwards 01/08/2013 onwards 01/10/2014 onwards 01/10/2015 onwards Target Review Timescale 30/06/2014 2 Years 1 Year 6 Months 6 Months Continuing Health Care - Page 7 of 8 Finance, Planning & Performance Committee Agenda Item 3.8
The Welsh Assembly Government has recently undertaken a widespread advertising campaign informing the public on the cut off date of 31 October 2016 for registering an interest in making a claim for care given between 1 October 2014 and 30 October 2015 (Phase 5 claims). Posters and information leaflets have been widely distributed throughout Powys. Summary The corporate Continuing NHS Healthcare Steering Group, which is multi disciplinary, has recently been formed to bring together key staff within the localities to improve the efficiency and delivery of Continuing NHS Healthcare across PTHB. The Group will monitor progress against the Financial CHC Saving plan, to include: Commissioning KPI s Retrospective reviews Self Assessment CHC Action Plan Continuing Health Care - Page 8 of 8 Finance, Planning & Performance Committee Agenda Item 3.8