A report providing the Committee with an update on Continuing Healthcare applications (CHC), steps taken and progress with regard to the application of the CHC Framework and eligibility criteria for residents of the Borough.

Further to Minute 11 of the meeting held on 25 July 2018, the Executive Director of Social Care and Health submitted a report providing the Committee with an update on Continuing Healthcare applications (CHC), steps taken and progress with regard to the application of the CHC Framework and eligibility criteria for residents of Reading Borough Council (RBC). 

The report explained that targeted measures that had been taken by the Council to support staff with CHC applications since October 2018 were as follows:

·         Workshops had been commissioned and delivered by a national expert in Legal and Continuing Healthcare training;

·         The Locality Manager for Reading was the strategic lead for CHC and reviewed and authorised the submission of CHC checklists that had been completed by staff.  They advised on areas to highlight within the decision support tool to evidence the needs of people in the 11 domains of the Framework;

·         A CHC workflow had been created within the Directorate’s Client Record System which output CHC activity in relation to the Council;

·         Meetings at a senior level had taken place with colleagues from the CHC to discuss CHC performance and in particular any issues with regard to the application of protocols and guidance.

The report included a number of tables that illustrated performance in the Borough from April 2018 to December 2019, including the following:

·         The number of CHC checklist being completed had increased significantly in 2019/20 due to increased awareness and understanding of CHC and when an individual could be deemed as having eligible healthcare needs.  There was still work to do to increase this number and make sure that they were being recorded accurately;

·         The cumulative number of CHC applications that were accepted for assessment had remained at a steady number in comparison to previous years.  This reflected that cases did not progress to the Multi-Disciplinary Team due to them not meeting the CHC threshold;

·         There was an improved picture for the number of CHC checklists that had resulted in dispute for 2019/20 compared to 2108/19, reflecting the better joint working and understanding of the CHC framework between Health and Social Care;

·         The total number of cases that had been agreed across an 18 month period between the Council and CCG was 19 since August 2018.  With increased awareness and higher numbers of checklist it was expected that this would rise further through the year but, there was no definitive way of measuring this as the eligibility threshold would ultimately determine the overall numbers;

·         Since Quarter 3 in 2018/19 there had been a slow increase in the number of referrals per 50,000 people in West Berkshire, although this number was still significantly below the national average and managers and practitioners were working to increase this number.  There had also been a significant drop in CHC referrals for both national and regional referrals, this reflected the work that had been done nationally to ensure appropriate checklisting of individuals for CHC assessments;

·         The of people per 50.000 of population across Berkshire West who were eligible for CHC was significantly lower than those across the south east, which in turn were below the average number for England.  This reflected the lower number of checklist that were received by the CHC service for Reading which had continued historically to be low across West of Berkshire.

The report stated that there continued to be a collective drive between the Council and CCG to ensure that greater awareness of CHC and application of eligibility was sustained and the following were areas of practice that had been agreed in partnership and had commenced:

·         Reviews of residents in Nursing Homes had continued, ensuring individuals who had a high level of need would be considered for a checklist at the point of their review if necessary;

·         The CCG had offered CHC training to all nursing home staff across the Borough and West Berkshire and Council officers had ensured that this was taken up through their frequent ‘Care Quality’ and ‘provider liaison’ visits;

·         The Council’s Operations Manager held quarterly sessions with managers and officers to ensure that they were confident in following process and completing checklists;

These practice enhancements would now be reinstated following the continuation of CHC following the pause in assessments during the Covid-19 pandemic.

The Committee discussed the report and a number of points were raised including the following:

·         The only way to change the historic figures was to work in partnership with colleagues in Health;

·         The provision of CHC should be fair and equitable;

·         The Council could not provide Healthcare Services and those that were entitled to free Social Care Service would be entitled to free Healthcare Services;

·         Officers were very clear about what Health Care was and what Social Care was and in protecting the rights to residents in the Borough;

·         Those residents who had healthcare needs would continue to be identified and if it was thought that colleagues in Health were not making the right assessments it was the Council’s responsibility to take this up with Health colleagues and use the appeals process, if necessary;

·         Training had taken place and there were officers in place who felt confident about completing the checklist.

Resolved –

(1)     That the performance in relation to Continuing Healthcare between CCG and RBC staff be noted;

(2)     That the proposed actions to further improve the pathway with regard to ensuring a fair and transparent process for CHC applicants across the Borough be noted.