Agenda item

To follow.

Anthony Rafferty, Director for Adult Community Services at Whittington Health, provided an overview of Continuing Healthcare (CHC), explaining that this was a package of ongoing care arranged and funded solely by the NHS where an individual had been assessed and found to have a primary health need as set out in the national framework. The CHC team worked alongside multi-disciplinary team (MDT) colleagues to screen and complete CHC checklists as all patients were entitled to be screened to ascertain if they required a CHC assessment. The CHC/MDT teams and hospitals identified patients who had a rapidly deteriorating condition and were approaching end of life so that they could be fast tracked for CHC assessment automatically.

Anthony Rafferty set out details of the main CHC assessments/tools including:

• CHC Checklist: A screening tool used in a variety of settings to help practitioners identify individuals who may need a referral for a full assessment of eligibility for CHC. This could be used in a variety of settings and the checklist scoring had 11 domains with the threshold set deliberately low in order to screen people in rather than out. Information for this could be gathered from families and patient notes.
• Decision Support Tool (DST): Used by the MDT to assess whether individuals had a primary health need. The DST assessed the individual’s need as low, medium or high under each of the 11 domains and determined what level of care and support they need.
• Fast Track Tool: A means for ensuring that a person’s care was not delayed unnecessarily when an individual had a rapidly deteriorating condition, which may be in a terminal phase. This provided short-term authorisation until a full CHC assessment could take place.

Anthony Rafferty explained that, when the assessment for an eligible person had been completed, the forms were shared with the local authority to check before being sent to the ICB which was responsible for ratification and determining the funding criteria. Reviews for patients took place after 3 months and 12 months to ascertain whether their needs had changed.

Anthony Rafferty then responded to questions from the Panel:

• Cllr Connor highlighted the low figures for CHC patients in Haringey, and in London as a whole, when compared to the national average. Anthony Rafferty acknowledged that this was an area for improvement, noting that most referrals came from local hospitals and so it was important to raise awareness of CHC for clinicians, particularly when there was a high turnover of staff in London. The ICB had recently established ‘in-reach’ nurse roles in each hospital to help identify those who may have increasing care needs and may reach the criteria for CHC. This included patients on Pathway 3 which is discharge to care homes. The ICB also had a piece of work on upscaling awareness of CHC across NCL and it was agreed that further details on this would be provided to the Panel. (ACTION)
• Cllr Connor asked whether the areas of the country with higher CHC rates had variations in their assessment and screening processes which may partially account for this. Cllr O’Donovan referred to differences in demographics between different areas and the complexities in the system that could impact on variations in rates between different areas. Anthony Rafferty said that, as a provider, Whittington Health was limited to conducting assessments and did not make decisions on funding so he would need to refer to the ICB for a response on this question. (ACTION) He added that the recent absolute CHC numbers for Haringey had been around 600 per year.
• Cllr Mason raised concerns about people of disadvantaged or lower economic backgrounds who may find it more difficult to access CHC. Anthony Rafferty responded that the criteria were based on a national framework and there was also an appeal process. He was aware of comments that more affluent people may be better able to navigate the system and, while he did not have figures on health inequalities or ethnicity, he could provide these in writing. (ACTION)
• Helena Kania expressed concerns that CHC was denied to many people with health conditions and queried how the system needed to change. Andrew Rafferty responded that the national framework which determined eligibility was set by the government and that the funding available for CHC was also limited.
• Cllr Brennan noted that CHC was not always well known or understood by patients and needed to be publicised further. Anthony Rafferty agreed that greater awareness of CHC was needed, including for health professionals, and would be working with the ICB and adult social care to improve this.
• Asked by Cllr Connor about the information that residents and families received prior to an assessment, Anthony Rafferty explained that they were contacted beforehand to discuss what the assessment entailed and to provide them with a leaflet. However, he acknowledged that there was always room for improvement and would look to make this a priority to improve accessibility.
• Cllr Iyngkaran queried whether the assessment process could be considered to be truly independent. Anthony Rafferty responded that the CHC team was not based in the hospitals but independently in the community, while the ICB itself was removed from the assessment process.
• Asked by Cllr Iyngkaran about advocacy for people who did not speak English as a first language, Anthony Rafferty said that translators could be provided when required and that advocates could also be provided through the local authority. Vicky Murphy added that the guidance was clear on people requiring advocates for the CHC process if they lacked capacity and that the local authority would help to do this if they were involved with the case, but they were not necessarily involved in all cases. Cllr Connor suggested that further clarification may be required on how advocates were funded. (ACTION)
• Cllr Peacock referred to some local cases involving residents with dementia noting that relatives may not understand how best to begin the process of applying for CHC and that the individuals may not be agreeable to an assessment. Anthony Rafferty said that it would be best to go through a GP to raise a referral as the CHC team did not accept self-referrals. The residents could also be assessed as to whether they had capacity to make decisions and provided with the appropriate support if they did not.
• Cllr O’Donovan asked about the process when a person had been assessed as not meeting the criteria for CHC but then subsequently deteriorated. Anthony Rafferty explained that the assessment letter provided details on how to refer back for a reassessment and that checks could then be made on whether there had been any change in their needs.
• Cllr Connor asked whether assessment meetings were recorded and minuted and whether these recordings and minutes were shared and agreed with the resident/family. Anthony Rafferty said that recordings were not usual, but a resident could request for this to be done. However, each assessment was documented with what was said and what the resident’s needs were using the decision tool. The resident/family and any advocates would be sent these details as an outcome letter which would also set out the next steps of the process. In addition, residents could request access to their electronic patient record. Cllr Brennan suggested that audio recordings of assessments should be carried out by default in order to ensure an accurate record.
• Cllr Connor queried CHC assessments for people in care homes who had been assessed as requiring nursing care but did not receive CHC. Anthony Rafferty said that this would be carried out by nurses as part of the discharge process from the hospital to the care home. However, he acknowledged that figures would be low in NCL due to a lack of care home provision, though some residents may be placed out of borough, and could provide further details on the figures in writing. (ACTION)

Cllr Connor thankedAnthony Rafferty for attending the meeting and summarised the recommendations of the Panel:

• The Panel emphasised that clear written information should be provided to residents/families/carers/advocates prior to any assessment or checklist taking place so that they were clear about the process and the questions that would be asked.
• The information provided to residents should also:

o   Make clear that the recording of assessments can be requested.

o   Make clear how decisions could be challenged and explain the process for this.

o   Provide details on financial assessment/eligibility and ensure that residents are clear about any financial contribution that may be required from them.

• Clarification was requested on the funding for advocacy services for residents undertaking the assessment process.
• Data on health inequalities and ethnicity relating to the recipients of CHC in Haringey was requested.
• Information was requested from the ICB explaining was CHC figures in Haringey/NCL was significantly lower than the national average.
• Information was requested on the work being carried out by the ICB on upscaling awareness of CHC across NCL.
• Data was requested on CHC assessments for people in care homes.