To inform the Adults and wellbeing scrutiny committee of a review that has been undertaken in relation to the application of the National Health Service Continuing Healthcare (CHC).

The chairman reminded everyone of the duties placed on local authorities and NHS bodies by the Health and Social Care Act, regarding the provision of information on the planning, provision and operation of health services to enable health scrutiny, and the duty to respond formally to recommendations by a health scrutiny committee.

She recognised that there was a tension between financial sustainability and service delivery, and reminded all present to not lose sight of the vulnerable people in society, and to ensure the checks and balances were in place to support people in need of continuing healthcare.

The assistant director, care operations and commissioning, presented the report, to provide the national context and the local arrangements. He made the following key points:

·         The national framework for continuing healthcare (CHC) was about individuals and their needs, and it was important not to lose sight that application of the framework was for the needs of our residents

·         CHC related to packages of care and support funded by the NHS

·         It was important to recognise that needs were on a spectrum ranging from social care, and as they change and become more intensive, moving into the responsibility of the NHS

·         The decision maker locally was the Clinical Commissioning Group (CCG), but there was a national process to support this.

·         A new framework was due to take effect from the start of October, although the definition for eligibility had not changed.

·         The determination of whether someone has a primary health need is set nationally by the secretary of state. It involved completion of a checklist to determine eligibility, set at low threshold to enable professional to determine, with reference to care domains.

·         There were two outcomes from the checklist – one being a lighter assessment, the other being a move to a full assessment, which is based on a decision support tool using the care domains and looking at complexity of needs. This is carried out by a multi-disciplinary team to determine if needs have gone over the definitions defined by the Social Care Act. From this, a recommendation would go to the CCG, with a requirement to evidence how the decision was reached.

·         The national framework had recourse through disputes resolution. The local authority could challenge the decision through an escalation process based on policy which was a national requirement.

·         The arbiter of social care need was the local authority. The Care Act determined the care that the local authority could discharge and so there were limits to the local authority’s powers to support vulnerable adults.

Looking at the local picture, the assistant director highlighted that:

·         An independent review had been commissioned to look into how CHC was applied. The terms of reference for the reviewer were to analyse national and local data, understand the relationship between staff and the CCG and local authority. The review presented a case for change on how to apply the arrangements locally.  Recommendations were also produced and were summarised in the agenda papers, and these were built  ...  view the full minutes text for item 15