NHS Continuing Healthcare Policy on the Commissioning of Care

NHS Continuing Healthcare Policy on the Commissioning of Care NHS South Worcestershire Clinical Commissioning Group Page 1

Groups/Individuals who have overseen the development of the Policy: Groups/Individuals who have been consulted in relation to the content of the Policy: Jo Galloway, Executive Nurse, Quality and Patient Safety, NHS Redditch and Bromsgrove & NHS Wyre Forest Clinical Commissioning Groups. Mari Gay, Director of Quality and Patient Safety/Executive Nurse, NHS South Worcestershire Clinical Commissioning Group Sheila Browning, Associate NHS Continuing Healthcare, NHS Arden Commissioning Support Hilary Green, Lead Commissioner Continuing Healthcare/Funded Nursing Care, NHS Arden Commissioning Support Hannah Willetts, Performance & Process Lead, NHS Arden Commissioning Support Better Together Members In addition the policy has been reviewed by the CCGs legal advisors (Mills & Reeve LLP). Equality Impact Assessment completed: Related documents: Yes The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care November 2012 (Revised). NHS Continuing Healthcare and Patient Choice Patient Information Leaflet Date of Implementation: June 2014 Date of Next Formal Review: April 2015 Document Control Date Version Comment /Update TBC 1.0 Content approved by CCG Governing Body. Page 2

Definitions Care Coordinator A person who coordinates the assessment and care planning process. The Care Coordinator is usually the central point of contact with the individual/patient. The services of a Care Coordinator may be commissioned by the CCGs from NHS Arden Commissioning Support or another commissioning support organisation. care package or package A combination of support and services designed to meet an individual s assessed health and associated social care needs. care plan A document recording the reason why support and services are being provided, what they are and the outcomes that they seek. care planning A process based on assessment of an individual s needs that involves working with the individual to identify the level and type of support to meet his/her assessed health and associated social care needs, and the objectives and potential outcomes that can be achieved. CCGs (Clinical Commissioning Groups) Refers to NHS Redditch and Bromsgrove Clinical Commissioning Group, NHS South Worcestershire Clinical Commissioning Group and NHS Wyre Forest Clinical Commissioning Group. commissioning The means to secure the best care and the best value for local citizens. It is the process of specifying and procuring services for individuals and the local population, and involves translating their aspirations and needs into services that: Deliver the best possible health and well-being outcomes, including promoting equality; Provide the best possible health and social care provision; and Achieve the above with the best use of available resources. Accredited Provider Each CCG s Accredited Providers: Have been assessed and accepted by the CCG as being able to fulfil the NHS Continuing Healthcare requirements of individuals at an agreed cost; and Are registered with the Care Quality Commission (or any successor organisation) as providing the appropriate form of care to meet the individual s needs; and Are not subject to an embargo by the CCG or the relevant Local Authority. home care means care provided in an individual s own home. individual The person who has been assessed for and found to be eligible for NHS Continuing Healthcare. Local Authorities Refers to Worcestershire County Council NHS Continuing Healthcare Means a package of on-going care that is arranged and funded solely by the NHS where the individual has been found to have a primary health need. Such care is provided to an individual aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness. representative Any family member, friend or unpaid carer who is supporting the individual, as well as anyone acting in a more formal capacity (e.g. welfare deputy or power of attorney, or any organisation representing the individual). Where an individual has capacity, s/he must give consent for any representative to act on his/her behalf. Page 3

1 Introduction and Purpose of Policy 1.1 This Policy sets out the principles that the CCGs will apply in commissioning NHS Continuing Healthcare. The content of the Policy is in line with the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care November 2012 (Revised) ( the Framework ) and has been developed to provide a common understanding of the CCGs commitments with respect to individual choice and the funding of packages of care to meet an eligible individual s assessed health and associated social care needs. 1.2 As well as improving quality and consistency of care, this Policy is intended to assist the CCGs to make decisions about clinically appropriate care provision for individuals in a consistent way and to support robust financial management by the CCGs. The Policy recognises that the commissioning of care involves actions at both individual patient and strategic levels and is intended to support each CCG to balance its responsibility to commission services for eligible individuals against its responsibility to provide access to healthcare for the whole of its population, whilst also maintaining financial balance. 1.3 The key aims of the Policy are to: 1.3.1 inform robust and consistent commissioning decision making by the CCGs using a locally developed policy; 1.3.2 ensure that there is consistency across the local area as to the services that individuals are offered; 1.3.3 ensure that the CCGs achieve value for money in the purchasing of services for individuals eligible for NHS Continuing Healthcare; 1.3.4 facilitate effective partnership working between the CCGs and other professions and agencies, including the Local Authorities in the area; 1.3.5 support choice to the greatest extent possible in view of the above factors. 1.4 This Policy is applicable to both new and existing patients eligible for NHS Continuing Healthcare. This Policy applies once an individual has received a comprehensive, multidisciplinary assessment of his/her care and support needs and the outcome shows that s/he has a primary health need and is therefore eligible for NHS Continuing Healthcare funding. 2 Key Principles 2.1 Where an individual is eligible for NHS Continuing Healthcare, the package of care to be provided is that which the relevant CCG assesses is appropriate to meet the individual s assessed health and associated social care needs (see paragraph 167 of the Framework). 2.2 Subject to the factors set out in paragraph 2.4 and within the broader framework of this Policy, the CCG will seek to commission services using models that promote personalisation and individual control and that reflect the individual s preferences. 2.3 An individual s needs may change over time and the person may not always be eligible for NHS Continuing Healthcare. Consequently the CCG may not be responsible for providing NHS Continuing Healthcare services to that person indefinitely. In line with paragraphs 139-144 of the Framework, regular case reviews will be undertaken in order to reassess an individual s current care needs and eligibility for NHS Continuing Healthcare, and to ensure that the person s needs at that time are being met. 2.4 When commissioning care, the CCG will look to balance a range of factors including: Individual safety; Individual choice and preference; The Individual s right to family life; The best use of resources for the population of the CCG Ensuring that services are of sufficient quality; Ensuring services are culturally sensitive; Page 4

Value for money; Ensuring that services are personalised to meet individual need (see section 12 for further information regarding personal health budgets). 2.5 In line with paragraphs 64 and 65 of the Framework, where a person is in a hospital setting, the CCG will consider whether an assessment of eligibility for NHS Continuing Healthcare should be deferred because, with appropriate support, that person has the potential to recover further in the near future. The CCG will in all such cases consider whether the provision of further NHS-funded services is appropriate. 3 Mental Capacity 3.1 In line with paragraphs 48 to 51 of the Framework, if there is concern that a person may not have capacity to make a decision regarding the provision of their care, this will be determined in accordance with the Mental Capacity Act 2005 and the associated Code of Practice. Where it is assessed that a person lacks the relevant capacity, a best interests decision will be taken (and recorded), again in accordance with the Mental Capacity Act 2005 and the associated Code of Practice (a referral to the Court of Protection will be made if necessary). 3.2 In line with paragraph 52 of the Framework, where a person lacks capacity in relation to the relevant decision and has no family or friends that are available (or appropriate) for consultation on their behalf, the CCG will ensure that the Independent Mental Capacity Advocate service is consulted. 4 Care Planning 4.1 The individual s Care Coordinator will discuss care provision with the individual (and/or his/her representative/s - where the individual gives consent for such a discussion or where the individual lacks capacity), including where the care may be provided. 4.2 In many cases there will be a range of options for packages of support and their settings that will be appropriate to meet the individual s needs. 4.3 Subject to the factors set out in paragraph 2.4, in making a decision about care provision, the relevant CCG will take into account any reasonable request/s from the individual (and/or his/her representative/s). 4.4 Care provision is likely to take two main forms: 4.4.1 care provided in a registered care setting (such as a nursing home, a residential home or an independent hospital). 4.4.2 home care. 5 Provision of Care in a Registered Care Setting Choice of Accredited Provider 5.1 In the interests of consistency and equity of provision, the CCG will, wherever possible, place individuals with Accredited Providers (see Definitions). 5.2 The CCG will consult with the individual (and/or his/her representative/s) when arranging the location of care, and will, wherever possible, seek to: (a) offer choice; (b) accommodate reasonable requests; and (c) take into account personal preferences. 5.3 The CCG will, where possible, offer the individual (and/or his/her representative/s) a choice of up to three Accredited Providers who have a current vacancy and are able to provide the care required. In this regard the Page 5

CCG reserves the right not to offer the individual the choice of any Accredited Provider whose quote is significantly higher than other quote/s received. 5.4 To support the individual to be able to make an informed choice of care provider from among the choice of Accredited Providers offered, the CCG will, in a timely fashion, provide the individual (and/or his/her representative/s) with relevant information regarding each Accredited Provider. 5.5 It may not always be possible for the CCG to offer to accommodate an individual in their preferred care setting. This may be because that care setting it is not an Accredited Provider or, may be because, although it is an Accredited Provider, there is currently no vacancy at that care setting. In all cases, the CCG will offer to accommodate the individual in a care setting which is appropriate to meet all of his/her assessed health and associated social care needs. Avoiding delayed discharge from hospital 5.6 Where an individual is currently in a hospital setting and is medically fit to be discharged, in order to avoid delays to discharge, the individual (and/or his/her representative/s) will be given 48 hours to make their first choice from among the Accredited Providers offered. This offer may be made in the form of a letter sent by the hospital trust. Where no decision is communicated within this timescale, the relevant CCG, in conjunction with the hospital, will, in order to prevent an undue stay in hospital, arrange to move the individual to an appropriate care setting. This may be a temporary measure until such time as the relevant CCG receives communication from the individual (and/or his/her representative/s) regarding his/her preferred choice from among the Accredited Providers offered. Refusal to accept the CCG s offer of accommodation at an Accredited Provider 5.7 Where an individual declines all of the Accredited Providers offered by the CCG, the individual can propose an alternative care setting. provided that it satisfies the following criteria: 5.7.1 the individual s proposed care setting is available; 5.7.2 the individual s proposed care setting is assessed by the CCG to be capable of meeting all of the individual s assessed health and associated social care needs; 5.7.3 the individual s proposed care setting is able to provide the required care to the individual subject to the CCG s usual contract terms and conditions as appropriate to the nature of the care setting; and 5.7.4 the cost of making arrangements for the individual at his/her proposed care setting does not require the CCG to pay more than it would usually expect to pay having regard to the individual s assessed health and associated social care needs. The CCG will compare the cost of the proposed care setting to the cost of the Accredited Providers offered by the CCG and rejected by the individual. The CCG will not fund any additional cost of more than 20% above the average cost of the Accredited Providers offered by the CCG, except in exceptional circumstances. 5.8 The CCG will not accept an alternative care setting proposed by the individual (and/or his/her representative/s) which is unable to meet his/her assessed health and associated social care needs. 5.9 If the alternative care setting proposed does not satisfy the criteria set out in 5.7 above, the CCG may offer: 5.9.1 a temporary placement of the individual with another Accredited Provider; or 5.9.2 a care package to be provided at the individual s own or a family member s home, provided that it is safe to do so and the cost implications to the CCG will be considered in accordance with paragraph 6.6 of this Policy. Page 6

5.10 If the individual does not have the mental capacity to make decisions him/herself and, in the reasonable opinion of the relevant CCG, the individual s representative/s are delaying placement in a care setting for any reason, the CCG may exercise its right to apply to the Court of Protection for an Order that it is lawful to move the individual to an appropriate care setting. Temporary placements 5.11 Where no Accredited Providers are available to meet the individual s assessed health and associated social care needs, the CCG may make a specific purchase and place the individual with an alternative provider identified by the CCG who fulfils the criteria outlined in paragraphs 5.7.1 to 5.7.4 above. In this case, the CCG may subsequently make arrangements to relocate the individual should a placement at an Accredited Provider become available. In such cases, and prior to re-locating the individual, the CCG will give consideration to a range of factors, including the possible impact of the re-location on the individual s health and well-being, and will take into account whether re-locating the individual will provide a significant financial advantage (20% or more) to the CCG. The CCG will only take a decision to re-locate an individual if it is safe to do so. 6 Provision of Care in an Individual s Own Home (Home Care) 6.1 The CCGs acknowledge that many individuals will wish to remain in their own homes with a package of care in place to meet their assessed health and associated social care needs. 6.2 Where an individual (and/or his/her representative/s) expresses such a desire, the relevant CCG will consider whether it would be feasible and within the powers of the CCG to provide a clinically safe and sustainable package of NHS Continuing Healthcare services within the individual s home or the home of a family member. 6.3 In considering any request for a package of home care, the CCG will take account of the following nonexhaustive list of factors: 6.3.1 the extent of the individual s needs; 6.3.2 whether care can be delivered safely to the individual without undue risk to him/her, any family member/s and the staff engaged to provide the care. Safety will be determined via a formal risk assessment undertaken by an identified professional. The risk assessment will consider the availability of suitably skilled carers and/or equipment and the appropriateness of the environment. 6.3.3 the acceptance by the individual of any identified risk/s and whether plans to minimise such risk/s can be put in place, which are agreed by the individual, the care provider/s and the relevant CCG; 6.3.4 whether the individual s GP has agreed to provide primary medical support; 6.3.5 the individual s preferences; 6.3.6 the suitability of alternative arrangements; 6.3.7 the willingness and ability of family members/informal carers to provide elements of care and the agreement of those persons that the provision of such care will form an integral part of the Care Plan; 6.3.8 provision of contingency arrangements if any care provider fails or is unable to deliver care to the individual. 6.4 Where the relevant CCG decides to offer a package of home care, the individual s home becomes the place of work of any staff member/s engaged to provide care. Therefore employee safety is a key consideration and the individual s or family member s home must be a reasonably safe environment in which to work and deliver care. 6.5 The CCGs recognise that the affordability of a home care package may be dependent upon family members being willing and able to provide elements of care to the individual without charge. Whilst family members are under no legal obligation to offer such care and no pressure will be placed upon them to do so, the relevant Page 7

CCG will ask family members if they are prepared to do so. If they agree, in designing any home care package, the CCG will be entitled to assume that family members will provide the agreed level of support. In these circumstances, the CCG will ensure that there is a programme of on-going assessments of the individual s needs to ensure that he/she is receiving the appropriate level of care to meet his/her assessed needs. In addition, in line with paragraph 89.1 of the Practice Guidance incorporated within the Framework, the CCG will consider whether there is a need to make a referral for a separate carer s assessment by the relevant Local Authority and/or to meet any training needs that the carer may have to carry out his/her role (this will only be relevant where the involvement of a family member in the provision of care is an integral part of the care plan). 6.6 The relevant CCG may be prepared to support a package of home care where the anticipated cost to the CCG is more than the anticipated cost of the provision of care in a registered care setting capable of meeting the assessed needs of the individual where the additional cost of the home care package is no more than 20% above the average cost of the provision of care in an appropriate registered care setting will not be supported except in exceptional circumstances. In line with paragraph 5.7.4, the cost will be compared by the CCG with the cost of up to three Accredited Providers. In line with the Framework, the cost comparison will be based on the actual cost that would be incurred in supporting a person with the specific needs of the individual in a registered care setting. 6.7 Where a package of home care is agreed to be provided, the CCG will commission such care from domiciliary care agencies suitably qualified to deliver the care that meets the individual s assessed health and associated social care needs. 6.8 The relevant CCG will not fund a package of home care where the CCG determines that it is unable to put in place a package of home care which is both safe and capable of meeting all of the individual s assessed health and associated social care needs. 7 Funding of Holidays 7.1 In the event that any of the CCGs receives a request from an individual (and/or his/her representative/s) to fund a period of respite/holiday, the CCG will review the individual case with the aim of determining whether there are any circumstances which would warrant the approval of additional funding over and above the agreed package of care. The CCG will not in any circumstances fund any direct holiday costs, such as travel or accommodation costs, for the individual or any family member accompanying him/her. 8 Additional Services 8.1 The relevant CCG will only provide and fund those services that are identified in an individual s care plan and for which it has statutory responsibility. Top ups 8.2 The individual (and/or his/her representative/s) has the right to enter into discussions with any care provider to supplement the care package (whether provided in a registered care setting or at home), over and above the package of care that the CCG has agreed to provide and fund. Any costs arising out of any such agreement must be funded by the individual or through third party funding. These costs may, for example, relate to: 8.2.1 additional non-healthcare services provided to the individual. For example, hairdressing, provision of a larger room, provision of an en-suite room or enhanced TV packages. 8.2.2 additional healthcare services to the individual outside of the services that the individual has been assessed as needing as part of the NHS Continuing Healthcare package. These types of services may include, for example, chiropractor appointments or additional physiotherapy sessions. Page 8

8.3 Any decision to fund additional non-healthcare or healthcare services must be made on an entirely voluntary basis. The provision of the NHS Continuing Healthcare package by any care provider must not be contingent on the individual (and/or his/her representative/s) agreeing to fund any additional services. This means that the registered care setting or home care provider must be able to meet the assessed needs of the individual, without the package being supplemented by other services as described in 8.2. 8.4 Similarly, NHS Continuing Healthcare funding should not in any way be used to subsidise any additional nonhealthcare or healthcare services that an individual chooses to purchase outside of his/her care plan. 8.5 Where an individual is funding additional non-healthcare or healthcare services, the associated costs to the individual must be explicitly stated and set out in a separate agreement. If the individual chooses to hold a contract for the provision of additional non-healthcare or healthcare services, it should be clear that the additional payments are not made in respect of any care provision (relating to the individual s assessed needs) which is funded by the relevant CCG. 8.6 In order to ensure that there is no confusion between the NHS and the privately funded services, the relevant CCG will enter into a legally binding service agreement with the selected care provider which details the provision by that care provider of a defined level of health and social care to the individual. This will expressly be independent of any arrangement between the selected care provider and the individual (and/or his/her representative/s) and will be expressed to continue notwithstanding the termination of any arrangements made between the individual (and/or his/her representative/s) and the care provider. 8.7 Any payments made by the individual (and/or his/her representative/s) under any such separate contract with a care provider for additional services cannot be made under the CCG's contract. 8.8 If the individual (and/or his/her representative/s) decides for any reason that the funding of the additional services is to be terminated, the relevant CCG will not assume responsibility for funding those additional services. 8.9 Where additional services are being provided to the individual under a separate arrangement with the care provider, the CCG will seek to satisfy itself as to whether those services should or should not constitute part of the agreed NHS care package. 9 Acceptance of an Offer of Services/Withdrawal of Services Acceptance of an offer of services 9.1 An individual is not obliged to accept an offer of an NHS Continuing Healthcare care package. Individuals and their representatives should note that if they choose not to accept an NHS package, the Local Authority will not assume responsibility to provide care to the individual. The CCG will work with the individual to help him/her understand his/her available options. 9.2 The NHS discharges its duty to an individual by making an offer of an appropriate package of care to the individual, whether or not s/he subsequently chooses to accept the offer. The following are examples of how this can work in practice: 9.2.1 the relevant CCG offers to discharge its duty by offering to provide a package of services for an individual in one or more appropriate registered care settings, which may not be situated in the individual s preferred location, and that offer is rejected by the individual; Page 9

9.2.2 the relevant CCG offers to discharge its duty to an individual who, to date, has had a package of home care by moving the individual to an appropriate registered care setting but that offer is rejected by the individual; 9.2.3 in line with paragraph 5.6, the relevant CCG or the hospital trust advises the individual (and/or his/her representative/s) in writing of the decision by the CCG of an appropriate care setting. The individual (and/or his/her representative/s) rejects that offer. Withdrawal of services 9.3 Following a review, as described in section 10 below, the individual s needs may have changed to the extent that s/he is no longer eligible for NHS Continuing Healthcare. In these circumstances, subject to the time limits set out below, the relevant CCG will no longer have the statutory power to fund the care package. However, in all such cases, the relevant CCG will carry out a joint review with the Local Authority as follows: 9.3.1 the individual will be notified that s/he is no longer eligible for NHS Continuing Healthcare. At this point the Local Authority will have 28 days to review the individual s requirements. In appropriate cases, the relevant CCG funding for an individual s care may be continued for 28 days while the Local Authority is undertaking such a review. 9.3.2 where there is a dispute between the relevant CCG and the Local Authority as to the funding and/or care management responsibilities, the CCG will follow any Dispute Resolution Protocol agreed with the Local Authority. 9.4 It may be appropriate for the relevant CCG to withdraw NHS Continuing Healthcare services: 9.4.1 where the situation presents a risk of danger or violence to or harassment of staff who are delivering the care package; or 9.4.2 where the CCG considers that the level of clinical risk to the individual has become unacceptable and cannot be safely managed. 9.5 The CCG will not make any decision to withdraw NHS Continuing Healthcare from an individual without consulting with the individual and the Local Authority. 9.6 In such circumstances the CCG will consider whether it is appropriate to offer an alternative care package to the individual. This might be by offering to accommodate him/her in an alternative registered care setting in accordance with section 5 of this Policy (that is by making an offer of up to three suitable Accredited Providers to the individual) or, where the individual is already receiving care in a registering care setting, by offering to put in place a package of home care in accordance with section 6 of this Policy. 10 NHS Continuing Healthcare Review 10.1 The Framework requires that a case review should be undertaken no later than three months after the initial eligibility decision, in order to re-assess the individual s care needs and eligibility for NHS Continuing Healthcare, and to ensure that the individual s needs are being met. Thereafter reviews should take place annually, as a minimum. 10.2 If the case review demonstrates that the individual s needs have changed to the extent that s/he is no longer eligible for NHS Continuing Healthcare, paragraph 9.3 above will apply. 10.3 Alternatively the case review may identify that the individual s needs have changed to an extent that his/her care package requires adjusting. In this case: Page 10

10.3.1 where an individual is receiving a package of home care, the relevant CCG will consider whether it is possible and cost effective for the revised care package to continue to be delivered in the individual s home environment in accordance with section 6 of this Policy. 10.3.2 where an individual is accommodated in a registered care setting, the relevant CCG will ensure that the care setting is able to deliver the revised package of care. Where the care setting is unable to deliver the revised package of care, the CCG will offer to accommodate the individual in an alternative registered care setting (that is able to deliver the revised package of care) in accordance with section 5 of this Policy (that is by making an offer of up to 3 suitable Accredited Providers to the individual). 10.3.3 where an individual is accommodated in a registered care setting and the case review has identified a decreased need for services, the relevant CCG will consider whether it is cost effective for the revised package of care to be delivered in the current care setting. The CCG may re-locate the individual to an alternative care setting (that is able to deliver the revised package of care) in accordance with section 5 of this Policy (that is by making an offer of up to 3 suitable Accredited Providers to the individual). 11 Exceptional Circumstances 11.1 In exceptional cases, the relevant CCG may be prepared to consider funding a package of care where the anticipated cost to the CCG is more than it would usually expect to pay having regard to the individual s assessed health and associated social care needs. 11.2 Exceptionality will be determined by the CCG on a case by case basis. 11.3 Exceptionality may include: 11.3.1 the provision of a package of home care to an individual who has an advanced, progressive, incurable illness; 11.3.2 those cases in which consideration must be given to address the particular cultural and/or linguistic needs of the individual; 11.3.3 those cases in which an individual in an existing out of area placement becomes eligible for NHS Continuing Healthcare and wishes to continue to be accommodated out of area. In such cases the CCG will take into account a range of factors including the market rates in the locality of the existing care setting and whether there are particular circumstances (for example, the fact that the individual has resided in the placement for many years) which make it reasonable to fund the placement out of area. If the CCG places the patient out of area, the responsibility for commissioning between different CCGs will be decided in accordance with Department of Health guidance. 11.4 In addition the CCGs recognise that there will be cases in which, as a consequence of the nature of the needs of the individual in that particular case, it may be necessary to fund a higher cost package of care for a limited period of time (for example, in cases where a high/intense level of staffing needs to be put in place to set up the care package). In such cases the CCG may be prepared to consider funding the higher cost package of care for a strictly limited period of time. 12 Complaints 12.1 In compliance with paragraph 99.9 of the Practice Guidance incorporated within the Framework, an individual (and/or his/her representative/s) who wishes to dispute a decision by a CCG as to the package of care to be provided to him/her may make a complaint to the relevant CCG in accordance with the NHS complaints process. Page 11

13 Personal Health Budgets 13.1 The CCGs are committed to using personal health budgets where appropriate and recognise that the use of a personal health budget can enable an individual to have greater choice, flexibility and control over the care and support s/he receives. 13.2 Personal health budgets can operate in a number of different ways, including: 13.2.1 a notional budget held by a CCG commissioner; 13.2.2 via a cash payment to the individual (a healthcare direct payment); 13.2.3 through a budget managed by a third party on the individual s behalf. 13.3 From April 2014 any individual in receipt of NHS Continuing Healthcare will have the right to ask the CCG for a personal health budget, including a direct payment. All such individuals will have the right to receive a personal health budget by October 2014. Work is currently on-going to ensure that the CCGs will have the capability and capacity to deliver personal health budgets to individuals who are eligible for NHS Continuing Healthcare. 13.4 A separate policy with regard to the operation of personal health budgets will be in place by April 2014. The principles of this Policy (in relation to the allocation of resources) will be applicable to personal health budgets. 14 Transition from Child to Adult services 14.1 In relation to transition planning, the CCG will pay regard to the various requirements outlined in paragraphs 124-138 of the Framework. In line with paragraph 131, at the age of 17 any relevant young person s eligibility for adult NHS Continuing Healthcare will be determined in principle by the relevant CCG, so that, wherever applicable, effective packages of care can be commissioned in time for the individual s 18th birthday. In commissioning care packages under such circumstances the principles of this Policy (in relation to the allocation of resources) will be applicable. 15 Compensation Awards 15.1 The CCG recognises that there are cases in which an individual may previously have received an award of damages for future care as part of a claim for compensation. Where the CCG becomes aware that such circumstances exist, it will request full details of the award and may seek its own legal advice regarding the nature of the award and its impact in relation to the consideration of eligibility for NHS Continuing Healthcare or the package of care to be commissioned. Page 12

Equality Impact Assessment Organisation South Worcestershire CCG NHS Arden Commissioning Support Unit Department NHS Continuing Healthcare & Funded Nursing Care. Name of Lead Person Mari Gay Sheila Browning Piece of work being assessed NHS Continuing Healthcare Policy on the Commissioning of Care Aims of this piece of work This Policy aims to detail the legal requirements and agreed course of action in identifying care settings which meet an individual s assessed health and associated social care needs and the CCGs requirement to ensure value for money and to accommodate individual requests as far as reasonably possible. Date of EIA 21.04.2014 Other partners/stakeholders involved NHS Arden Commissioning Support Who will be affected by this piece of work? Patients in Worcestershire eligible for NHS Continuing Healthcare. Page 13

Protected characteristic All Gender Race Baseline data and research on the population that this piece of work will affect. What is available? Eg population data, service user data. What does it show? Are there any gaps? Use both quantitative data and qualitative data where possible. Include consultation with service users wherever possible If a CCG identifies any issues for particular groups or communities, it should take steps to address these. This is in line with the NHS Continuing Healthcare Practice Guidance. As part of the eligibility assessment process, the NHS Continuing Healthcare Checklist and Decision Support Tool incorporate an equality monitoring form and this is for completion by the individual being assessed, although staff should offer to help them complete it where support is required. The purpose of the equality monitoring form is to help CCGs identify whether individuals from different groups (in terms of disability, ethnicity, etc.) are accessing NHS Continuing Healthcare on an equitable basis, including whether they are being properly identified for potential eligibility at the Checklist stage and are being identified for the Fast Track process where appropriate. The equality form will enable the CCG to monitor whether the Framework is being applied equitably in its area. DoH, Equality Analysis. National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care 2012 Men and women, including transgender men and women, may require NHS Continuing Healthcare. Women outnumber men as the population ages. The population of Worcestershire is as follows: Is there likely to be a differential impact? Yes, no, unknown Yes Yes Yes Bromsgrove Redditch Wyre Forest Malvern Hills Worcester Wychavon All categories: Ethnic group % White: English/ Welsh/ Scottish/ Northern Irish/ British 94 87 95 95 89 94 White: Irish 1 1 0 0 1 0 White: Gypsy or Irish Traveller 0 0 0 0 0 0 White: Other White 1 4 2 2 4 3 Mixed/ multiple ethnic group: White and Black Caribbean 1 1 0 0 0 0 Page 14

Mixed/ multiple ethnic group: White and Black African 0 0 0 0 0 0 Mixed/ multiple ethnic group: White and Asian 0 0 0 0 0 0 Mixed/ multiple ethnic group: Other Mixed 0 0 0 0 0 0 Asian/ Asian British: Indian 1 1 0 0 1 0 Asian/ Asian British: Pakistani 0 3 0 0 2 0 Asian/ Asian British: Bangladeshi 0 0 1 0 0 0 Asian/ Asian British: Chinese 0 0 0 0 0 0 Asian/ Asian British: Other Asian 0 0 0 0 1 0 Black/ African/ Caribbean/ Black British: African 0 0 0 0 0 0 Black/ African/ Caribbean/ Black British: Caribbean 0 1 0 0 0 0 Black/ African/ Caribbean/ Black British: Other Black 0 0 0 0 0 0 Other ethnic group: Arab 0 0 0 0 0 0 Other ethnic group: Any other ethnic group 0 0 0 0 0 0 Disability At least 7,000 households have at least one person who does not speak any English. In Redditch and Worcester, 3% of households have no one who speaks English. This figure is 2% for Wynchavon Some individuals will have impairments such as a learning difficulty, visual or hearing impairment, mobility difficulty or mental health related issues, in addition to the clinical diagnosis which has brought them to need NHS Continuing Healthcare. Yes % reporting claiming DLA Day-today activities limited a lot Day-today activities limited a little Bad health Very bad health Page 15

Bromsgrove 4 8 9 4 1 Redditch 5 8 9 4 1 Wyre Forest 5 9 11 5 1 Malvern Hills 4 9 11 4 1 Worcester 5 7 9 4 1 Wychavon 4 8 10 4 1 Religion/ belief There are strong links between religion/belief and health. Yes Sexual orientation Age The government estimates that about 5% of the population is lesbian, gay or bisexual. 27% of the Bromwich population, 29% of the Wyre Forest population, 21% of the Redditch population, 32 % of the Malvern Hills population, 20% of the Worcester population and 30% of the Wychavon population is over 60 Yes Yes Social deprivation Carers 30% of households in Redditch and Bromsgrove have no adults in employment. In South Worcestershire it is about 20%. In Wyre Forest this is less than 1% of households. In South Worcestershire in particular, issues of rurality, including access to services and transport for patients, carers and relatives are an issue. % Provides 1 to 19 hours unpaid care a week Provides 20 to 49 hours unpaid care a week Provides 50 or more hours unpaid care a week Bromsgrove 8 1 2 Redditch 7 1 3 Wyre Forest 7 1 3 Malvern Hills 9 1 2 Worcester 6 1 2 Yes Yes Page 16

Human rights Wychavon 8 1 2 Will this piece of work adversely impact on anyone s human rights? Right to a fair trial Right to respect for private and family life Right not to be discriminated against Right to freedom and security Possibly ** All data is taken from the 2011 census results on the ONS website. Page 17

Equality Impact Assessment Action Plan Strand Issue Action required How will you measure the outcome/impact Timescale Lead All All The CCG has a duty to Advance equality of opportunity between people who share a protected characteristic and those who do not by treating people differently in order to ensure that they have equality of access, treatment and outcomes. Part of the decision making has to consider their needs relating to their protected characteristics. These should already be picked up under 4: communication, 6: nutrition and 12: other significant care needs. The policy is written as a one size fits all and needs to be amended to accommodate the different needs of patients covered by the protected characteristics where the costs of meeting these differences are considered reasonable. For instance; The Policy needs to be re-worded regarding the distance from home to accommodate home being the home of their next of kin; care at home vs. care in a residential establishment if language, cultural or nutritional needs can be more easily met by care at home. Consideration in regards to threshold levels may need to be more flexible to take into account any individual cultural needs i.e. sexual orientation, diet, language Revised policy See wording at paragraph 5.4 broader statement included regarding consideration of location requests. Also note paragraph 11.2.2. Customer satisfaction Also note paragraph 11.2.2. Completed October 13 July 2014 Sheila Browning Hilary Green Additionally, an equality monitoring form should highlight any issues related to the protected characteristics. All No monitoring or reporting has taken place on the protected characteristics of patients receiving CHC. Consider the data to date of who have been in receipt of a care package Equality Data. Partial data available via National Benchmarking process. October 2013 Sheila Browning Page 18