At its meeting on 27 June, 2018, the Adult Care and Health Overview and Scrutiny Committee referred the Scrutiny Review on Continuing Health Care to the Cabinet. The Overview and Scrutiny Committee minute, report to the Committee and Scrutiny Review are attached.

Councillor Chris Jones introduced a report of the Chair and Members of the Adult Care and Health Overview & Scrutiny Committee Task and Finish Group on the Continuing Healthcare Scrutiny Review.  The report set out the findings and recommendations arising from a Scrutiny Review completed in May 2018.  The Review had been commissioned as part of the former People Overview & Scrutiny Committee’s Work Programme – later the Adult Care and Health Overview & Scrutiny Committee.

The report aimed to understand, assess and give consideration to the Continuing Health Care (CHC) framework and how it was applied locally.  A Task & Finish Group had been set up to, amongst other things; evaluate the impact of CHC on clients and their families, focussing on both the process and the funding outcomes.

The Adult Care and Health Overview and Scrutiny Committee had considered the Scrutiny Review on Continuing Health Care report and its recommendations at its meeting on 27 June, 2018 and referred them to the Cabinet.  The Overview and Scrutiny Committee’s Minute was also provided for the Cabinet’s consideration.

The Cabinet noted the Task and Finish Group’s findings and that it had made seven recommendations as follows:

  “Recommendation 1 – Consistency of Application of the CHC Framework by Training

Members recognise that Wirral Clinical Commissioning Group (CCG) is not responsible for the staff training of other organisations. However, the CCG and all relevant health partners are requested to collaborate to ensure that all applicable staff receive the appropriate CHC training, where possible through joint sessions. This will enable frontline staff to pass on correct information to patients and families while operating with confidence to apply both the national CHC framework and local procedures. This should ensure that there is more consistency in the application of the framework. 

Recommendation 2 – Communication

Wirral Clinical Commissioning Group is requested to consider options to improve communication processes between themselves and partner organisations involved in the local delivery of the CHC framework (such as, Wirral Borough Council, Wirral Community Trust, Wirral University Teaching Hospital and GPs). Similarly, it is suggested that communication processes with potential applicants for CHC funding be reviewed and strengthened. 

Recommendation 3 – Dynamic Purchasing System (DPS)

Members note with concern that the introduction of the Dynamic Purchasing System (DPS) has resulted in some reduction of choice for clients while not realising the anticipated level of savings. As a result, Wirral CCG is requested to demonstrate to the Adult Care and Health Overview & Scrutiny Committee that continued use of DPS is providing value for money, is improving the efficiency of staff in identifying appropriate placements and is leading to an improved service for clients, particularly those requiring end of life care.

Recommendation 4 – End of Life Care

Wirral Clinical Commissioning Group is requested to ensure that those clients requesting CHC funding at end of life receive a service which is both compassionate and speedy. The allocation of placements to care homes who have successfully received the ‘Six Steps to Success End of Life Training Programme’  ...  view the full minutes text for item 22

Councillors Moira McLaughlin and Wendy Clements introduced the report and recommendations of the Continuing Healthcare (CHC) Review Task and Finish Group.  The scrutiny review had sought to understand, assess and give consideration to the CHC framework and how it was applied locally, the Task and Finish Group being established to, among other things, evaluate the impact of CHC on clients and their families, focussing on both the process and the funding outcomes. 

In making their presentation, the Councillors thanked former Councillor Alan Brighouse who had contributed much to the work of the Committee and who had chaired the Task and Finish Group; Karen Prior, Wirral Healthwatch, a member of the Group who could not be in attendance at the meeting; and to Alan Veitch, former Scrutiny Officer who had supported the Group.

CHC and NHS Funded Nursing Care (FNC) referred to services funded by the NHS due to an individual’s health related needs.  Under CHC, the NHS funds 100% of care and healthcare outside hospital.  Under FNC, the NHS pays for the nursing element of care, but accommodation costs are met wholly or in part by the service user and / or the local authority.  During 2017, members became aware that Wirral was reported to be third lowest of 32 regional Clinical Commissioning Groups (CCGs) for numbers of people eligible for CHC funding while the Borough, compared to the national average, had a significantly higher number of joint funded care packages.  Anecdotal concerns had also been raised in relation to the service user experience of the CHC process and the time taken to receive a decision.

The review had not looked at the national guidelines which determine eligibility for CHC, but had examined the application of those guidelines on Wirral.  It had become apparent that decisions about eligibility were difficult to make at times, highlighting the importance of training and improved communication channels between the professionals involved.  The pressure to control both the cost of providing CHC and its administration was acknowledged, but regardless of such pressures, there was a clear need to ensure that all changes were adequately scrutinised both before and after implementation.

The report of the Review Task and Finish Group contained the methodology and considerations given during the review leading to the following seven recommendations -   

“Recommendation 1 – Consistency of application of the CHC framework by training

Members recognise that Wirral Clinical Commissioning Group (CCG) is not responsible for the staff training of other organisations. However, the CCG and all relevant health partners are requested to collaborate to ensure that all applicable staff receive the appropriate CHC training, where possible through joint sessions. This will enable frontline staff to pass on correct information to patients and families while operating with confidence to apply both the national CHC framework and local procedures. This should ensure that there is more consistency in the application of the framework. 

Recommendation 2 – Communication

Wirral Clinical Commissioning Group is requested to consider options to improve communication processes between themselves  ...  view the full minutes text for item 9