Continuing NHS Health Care Quarterly Update April 2015

SUMMARY REPORT ABM University Health Board Subject Prepared by Approved by Continuing NHS Health Care Quarterly Update April 2015 Date of Meeting: 30 th July 2015 Agenda item: 7 (ii) Christine Williams Assistant Director of Nursing and Carol Killa Head of Policy & Regulation Christine Williams Assistant Director of Nursing Presented by Rory Farrelly Director of Nursing and Patient Experience Purpose A key requirement of the Continuing NHS Health Care (CHC) Performance Framework implemented by Welsh Government is for each Health Board to receive a formal quarterly Continuing NHS Health Care position report. This requirement has been supported by Wales Audit Office (WAO) both in their 2013 report on Continuing NHS Health Care and the 2014 follow up report, and reinforced in the recent Public Accounts Committee report. This paper provides the Board with the first of these required updates. Decision Approval Information Other Corporate Objectives Excellent Population Health Excellent Population Outcomes Sustainable & Accessible Service Strong Partnerships Excellent People Effective Governance Executive Summary 1

The Public Accounts Committee considered the most recent Welsh Audit Office Report at its 3 rd of February session, taking evidence from the Welsh Government s Director General NHS Wales, the Director of Social Services Wales, and the Deputy Director for Integration and it is likely that the Public Accounts Committee will continue to monitor progress over coming sessions. A key requirement of the Continuing NHS Health Care (CHC) Performance Framework effective from October 2014 is for each Health Board to receive a formal quarterly Continuing NHS Health Care position report; this paper is the first of these regular reports. It informs the Board of developments and current issues relevant to Continuing NHS Health Care, including the establishment of a National Complex Care Board to oversee longer term care related policy implementation. The 2014 Framework contains a number of key revisions made in response to Welsh Audit Office recommendations. Key Recommendations The Board is asked to note the report. Assurance Framework The Continuing NHS Health Care Programme Board will monitor progress Next Steps Collation of data for the 3 rd Performance Report for the Board Implementation of Training Plan Ratification of Operational Policy Develop standard operational processes to support the implementation of the Policy 2

MAIN REPORT ABM University Health Board Meeting held on 30 th July 2015 Agenda item: 7 (ii) Subject Continuing NHS Healthcare Quarterly Update April 2015 Prepared by Carol Killa Head of Policy & Regulation Approved by Christine Williams Assistant Director of Nursing Presented by Rory Farrelly Director of Nursing and Patient Experience 1. PURPOSE A key requirement of the Continuing NHS Health Care Performance Framework implemented by Welsh Government is for each Health Board to receive a formal quarterly Continuing NHS Health Care position report. This requirement has been supported by Wales Audit Office (WAO) both in their 2013 Report on Continuing NHS Health Care and the 2014 follow up Report, and reinforced in the recent Public Accounts Committee report. This paper provides the Board with the first of these required updates. 2. BACKGROUND AND CONTEXT Continuing NHS Health Care (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. A revised Continuing NHS Health Care National Framework was published in June 2014, with the expectation that it would be fully operational from 1 October 2014. In addition to the revised National Framework, the Welsh Government issued a Performance Framework specific to Continuing NHS Health Care. The aim of the performance framework is to support the organisation to meet the key objectives without over-burdening them with data collection. The key monitoring mechanisms will be: Annual organisational self-assessment using the Welsh Audit Office tool; Quarterly reporting using the National Continuing NHS Health Care database and other information which will be readily accessible to local Continuing Health Care leads; Annual external audit; Annual national customer satisfaction questionnaire. Within ABMU the Annual organisational self assessment took place in February 2014, the external annual audit was undertaken in September 2014. The first national baseline quarterly report was completed in December 2014 to test the proposed performance framework and the ability of each Health Board to collate the data using the National Database. The findings of this 3

baseline audit indicated that it was difficult for Health Boards to collate some of the data and that there was huge variation across Health Boards for a number of the performance indicators, for example, relating to Retrospective Reviews, Training and Continuing NHS Health Care Assessments undertaken within timescale. The second organistaional quarterly report was repeated in April 2015 and key findings can be seen in Appendix 1. The Annual National customer satisfaction questionnaire is to be devised by Welsh Government and forwarded to the Health Boards and this will be carried out once it is received. The Welsh Government also required Health Boards to develop and implement a Governance and Accountability Framework key to which was the development of: The establishment of a National Complex Care Board; The establishment of a Stakeholder Reference Group; A Performance and Operations National Group and ABMU continues to support the Welsh Government with this agenda providing representation as requested. Continuing NHS Health Care has been subject to two Welsh Audit Office reviews over recent years: The Wales Audit Office Implementation of the National Framework for Continuing NHS Healthcare published June 2013 and The Auditor General for Wales Continuing NHS Health Care Follow-up Report published January 2015 which sought to establish progress in implementing the recommendations set out in its 2013 Report. The Public Accounts Committee considered the most recent report at its 3 rd February session during which it took evidence from the Welsh Government Director General/Chief Executive Officer NHS Wales, the Director of Social Services Wales, and the Deputy Director for Integration and issued a report with a series of recommendations in late March 2015. The Public Accounts Committee has indicated it will continue to monitor progress in addressing its recommendations over the coming months, with a requirement for an update prior to the summer recess. Based upon the progress reported in that update, it is likely that it will continue to consider this as part of the 2015/16 sessions. The reports also highlighted the growth in numbers of people deemed eligible for both Continuing NHS Health Care and NHS Funded Nursing Care, and it was noted that the number of individuals funded by Health Boards within independent care settings is now higher than the number treated within NHS inpatient beds. A summary of the numbers of individuals placed in non NHS settings across Wales is set out in the table below. 4

Health Board No. of inpatient beds No. funded in independent care sector Abertawe Bro Morgannwg UHB 2374 1817 Aneurin Bevan UHB 1831 2285 Betsi Cadwaladr UHB 2373 2846 Cardiff & Vale UHB 2066 1663 Cwm Taf UHB 1355 1021 Hywel Dda UHB 1207 1325 Powys (t)hb 240 508 TOTAL 11449 11465 3. THE 2014 CONTINUING NHS HEALTH CARE NATIONAL FRAMEWORK Welsh Government initially committed to a review of the 2010 National Framework one year after implementation, but for a number of reasons this review did not commence until 2013. A full consultation process took place during early 2014, with the final Framework issued in June 2014, to be operational from 1 October 2014. Revisions to the Framework The 2014 Framework contains a number of key revisions made in response to: Welsh Audit Office recommendations Feedback from a number of Task Groups established to review the 2010 Framework; and Consultation responses. Key Issues Training Welsh Government facilitated a training programme to support the implementation of the 2014 Framework, but did not resource this as in 2010 instead a cascade model was adopted to ensure as many key staff as possible received training by the implementation date. Two training modules were initially developed: A priority module that focused on what s new and A foundation module that provided back to basics training on core issues such as assessment, roles and responsibilities and care planning. Further modules are planned, but as yet there are no timescales in relation to their availability. While it was a significant challenge to roll out training in time for the October 2014 implementation date, training was provided for key staff across the Health Board and an ongoing training plan has been agreed to provide training for new staff and updating as required. 5

Performance Framework As noted above, the Welsh Government has established a Performance Framework specific to Continuing NHS Health Care. This Framework includes the following requirements: The identification of a lead Executive Director in each Health Board with responsibility for Continuing Care. The identification of a named Senior Officer in each Local Authority with the lead for Continuing Care and the interface with social Care. A National Annual Self Assessment exercise of compliance with the 2014 National Framework; Annual sample audits A customer satisfaction survey to be conducted for all individuals undergoing the Continuing Care assessment process; Compliance with a quarterly performance report specific to Continuing Healthcare that will be collated and made publically available by Welsh Government. In addition, Welsh Government intends to produce an annual report on Continuing NHS Health Care. This model will need to be monitored to ensure the focus on Continuing NHS Health Care as separate from other Health Board performance measures is not counterproductive in that it may indicate Continuing NHS Health Care is somehow separate from other Health Board functions. Another concern in relation to performance data is that a number of the required indicators do not have a single National data source or definition, making comparisons across Health Board boundaries, and conclusions based upon this initial information, potentially flawed. Health Board lead officers are working with Welsh Government officials and NWIS [National Health Service Wales Informatics Services] to try to resolve the issues as soon as possible. The first Performance Report is appended to this paper at Appendix 1 and 2. While the reports are data rich it has been acknowledged by Welsh Government that future reports will need to be more concise. 4. GOVERNANCE AND ACCOUNTABILITY FRAMEWORK The Welsh Audit Office report identified the need for improved governance and accountability arrangements around complex care, with a recommendation that a National Complex Care Board be established to oversee the delivery of National policy. The Board will recall it has previously considered and approved the Governance and Accountability Framework that included: 6

The establishment of a National Complex Care Board, to be chaired jointly by the Welsh Government Director of Social Services Wales and the lead Health Board Chief Executive Officer. The establishment of an Operational Delivery Group comprising of Continuing NHS Health Care leads in each Health Board, to oversee the implementation of Continuing NHS Health Care and other complex care policy through to delivery via robust service models; Welsh Government establishing a Stakeholder Reference Group to act as a broad expertise base to advise the National Board as necessary; The National Complex Care Board held its first meeting in April 2015. Its role will be to have strategic oversight of complex care related issues, oversee the implementation of policy, seek to ensure consistent models are in place, and be the main point of contact with Welsh Government policy officials. This model reflects the sovereign nature of Boards, and the need for National Complex Care Board recommendations to be formally considered and adopted by Health Boards. 5. RETROSPECTIVE CONTINUING HEALTHCARE CLAIMS The Retrospective claims process has been established to consider claims from individuals or their family/representative that they should have been eligible for Continuing NHS Health Care 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 an agreed National retrospective review process the conclusion is that the person should have been found eligible for Continuing Health Care then the individual or if deceased, their estate is reimbursed by the Health Board. A National Project team, based in Powys Health Board has processed the initial cohort of claims received. There are two further phases of claims that are currently being processed that refer to different claim periods. Following discussions with Welsh Government Health Board Chief Executives have agreed that, with a small number of exceptions, all these claims will be transferred to the National Project for processing, to be funded by Health Boards on a proportional basis. Health Boards therefore need to identify resources to both funds the processing of claims and also any reimbursement identified as necessary following review. There are clearly financial implications for the Health Board in that it is difficult to accurately project the likely resource impacts, leading to challenging financial planning. 6. CONCLUSION AND RECOMMENDATIONS The Welsh Government issued a revised Continuing NHS Health Care National Framework in 2014. This Framework reflected recommendations made by both the Wales Audit Office and the Public Accounts Committee, who continue to monitor implementation, with the most recent report, issued by the committee in March 2015. 7

As part of the separate Performance Framework required by the Welsh Government, Health Boards are required to receive an organisational quarterly report on Continuing NHS Health Care, and this paper provides the first of these regular reports. It informs the Performance Committee of developments and current issues relevant to Continuing NHS Health Care, including the establishment of a National Complex Care Board to oversee longer term care related policy implementation. RECOMMENDATION: The Board is asked to note the report. 8

Quarterly Executive Report January to March 2015 Measure Swansea NPT Bridgend Mental Health LD ABMU Total Process 1 Place of assessment: numbers by location Acute Hosp 72 Acute Hosp 52 Acute Hosp 22 Own Home Hospital 183 Community Hosp 8 Community Hosp 4 Community Hosp 3 There were no CHC Assessment Community Home Own Home 37 s carried Mental Health 20 Mental 2 Mental 0 Res Unit Nursing/ 82 out over Hosp Health Hosp Health Res Hosp the last Care quarter Care Home 43 Care Home 30 Care Home 9 Hospital Patients Own Home 24 Patients Own Home 11 Patients Own Home 2 TOTAL 167 TOTAL 99 TOTAL 36 TOTAL 302 2 % Complex Cases where the screening tool was used We are not currently using the screening tool across ABMU, but are reviewing processes to commence using it in a fair equitable and consistent way. 3 % cases requiring scrutiny by lead manager Swansea NPT Bridgend MH LD As above

4 % cases requiring scrutiny by full QA panel As above Service Delivery Putting 5 Number of individuals who have declined assessment for CHC and the reasons they have given e.g. don t wish to lose DP or other benefits. 6 Number of current CHC and FNC packages delivered by category and by proportion of total health board CHC spend. 7 Total numbers of CHC numbers and spend for CHC packages delivered: a. In a registered setting b. In the community 8 % case reviews undertaken at a. 3 3 months b. 112 months 9 Number of cases initially assessed as not being eligible for CHC funding, but found eligible by Independent Review None 1 - DP issue None None Included in the data collated from the National Complex Care Database Included in the data collated from the National Complex Care Database Swansea NPT Bridgend MH LD 88% 0 0 0 0 0

things right 10 Panel following appeal Performance re completion of retrospective reviews (Phases 2 & 3) 15 Reviews Completed by the ABMU Team Equalities 11 Performance re new claims submitted post October 2014 (annual rolling cut-off arrangements for which individual LHBs are responsible) 12 Assurance from each LHB that there is no discrimination in CHC assessment & provision. Supported by more detailed information if requested. ABMU have received 8 claims since 01/10/14 to date and have completed 3 Additional Measures/Information All assessments are completed as per framework guidance, where language / communication support is required this is provided. The Health Board ensure patients with disabilities are able to access the meetings and engage with the full process should they so wish Compliance with process timescales Transition 14 13 Rate of exceptions to the timescales in the Framework and an understanding of why these are not being achieved. % of young people in transition allocated a named transition co-ordinator All assessments contain an equalities monitoring assessment Systems are currently being considered to collate this information All Swansea cases, total of 5 young people. % cases where transition planning has commenced at age 14 These young people are under 17 years of age Service 15 % cases where eligibility for adult CHC is determined at age 17 % of contract mechanisms that have N / A All areas place only with approved providers list for the relevant local authority. All of which are part of the annual monitoring frameworks.

provision appropriate governance arrangements in place either through pre-placement questionnaire process or via other auditable arrangements. The exception to this would be out of HB area, where the HB reviews quality standards via the relevant regulatory reports, and the local pct is contacted to ensure there are no escalating safeguarding concerns in relation to the provider Complaints 16 Number of upheld complaints (NHS process) Swansea NPT Bridgend MH LD 0 0 0 0 0 Disputes Training 17 Number of interagency disputes and the outcomes 0 2 0 Family disputes x 3 going to Independent Review Panel in the next quarter 18 Number of staff who have completed training this quarter 0 0 0 16 0 0 0