Agenda item

The Committee gave consideration to a report which related to an updated Choice and Equity Policy and an outline consultation that would gather views of patients on the new policy.

NHS Continuing Healthcare (CHC) referred to packages of continuing care arranged and funded solely by the NHS where the individual had been found to have ‘primary health need’.  Where a person qualified for CHC, the CCG had a duty to offer to provide a package of health and social care services which met the individual’s assessed health and associated social care needs.

The draft Choice and Equity Policy, which was appended to the report, set out how the CCG would implement CHC in accordance with the National Framework and took into account the legal requirement for the CCG to act efficiently, effectively and fairly.  The policy would be applied to new patients (with exceptions) and, in a few cases, to existing patients whose care needs had changed considerably.  The policy sought to balance the CCG’s duties to the individual and to all the other patients to ensure fairness and best value.

CCG staff would aim to work with patients to identify potential locations and care options.  The CCG would generally use home care providers and care or nursing home providers that it had assessed as being able to meet procurement and contractual requirements.  Under the policy, the CCG would generally not fund a care package in a person’s home if the cost of doing so was more than 10 percent higher than providing the same care in a care or nursing home.  In addition, the CCG would generally not fund a placement at a care or nursing home if its fees were more than 10 percent higher than those of a suitable preferred provider.

The CCG would take account of an individual’s views and wishes regarding where their care package was provided, when determining whether their case was exceptional and justified a higher cost being incurred to provide care.  This would include consideration of an individual’s particular reasons and family circumstances, and whether there were compelling circumstances.  However, in reaching the decision the CCG must be satisfied that the proposed overall cost of the care package was proportionate and a justifiable use of CCG funds in comparison to the cost of commissioning a package of care for the individual in another location.

The policy had been updated to ensure continued compliance with the National Framework, and Article 8 of the European Convention on Human Rights and had taken into account the implications for social care. 

The CCG proposed a small scale, six-week consultation, as appended to the report, of the 232 Oldham patients who were currently in receipt of Continuing Healthcare beginning on 9 September 2019 and ending on 21 October 2019.  It was aimed to finalise the policy at the CCG Governing Body meeting on 7 November 2019.

The Committee received information as to how resources were used efficiently and through a person centred approach and how the policy was applied.  It was planned to put more joined up working in place.  New arrangements were being implemented, quality assurance was being joined up.  Consideration of services which would be funded was outlined and examples were provided.  How the consultation would be undertaken and the timelines was outlined to the members.

Members sought clarification as to whom would be affected by the policy change and the ethnic background to those who were currently receiving funding.  Members were informed that there could be changes to those who currently received CHC when a review was triggered and discussed through a best interest meeting. The ethnicity numbers were not available at the meeting.

Members sought clarification on the budget implications and the breakdown in conditions of those in Continuing Healthcare.  Members needed a better understanding of the budget numbers and the way funding was deployed at the moment and more discussion with the advocates.  Members raised the need for a degree of transition and how this was managed.  Members asked about the outcome of the consultation and engagement with service users.  Members requested a discussion on the outcome of the consultation and requested a workshop be arranged.

Members asked if there was an adequate number of providers.  Members were informed that there was a shortage of mental health nurses and that some providers were looking to expand the services and opportunities to work across localities.  There were general issues around nursing provision.  With regard to care at home, Oldham had several small organisations who were committed to Oldham and were sustainable and ethical.  Members were also informed that services users when they reached the age of 18 fell under different legislative framework.

RESOLVED that:

1.       The updated Draft Choice and Equity Policy and outline consultation be noted.

2.       A workshop be scheduled to receive further information regarding Continuing Health Care (Adults) and the initial findings of the consultation prior to implementation of the Choice and Equity Policy.