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Continuing Health Care
Our ref: FOI 1415 111 Date: 8th December 2014 Email: [email protected] Freedom of Information Request Please find below the response to your recent Freedom of Information request. Request/Response: 1. A copy of all policies and procedures relating to continuing health care. Please see attached. 2. Clarification on what is the responsibility of local CCGs and what would be dealt with by NHS England in terms of continuing health care. The Department of Health National Framework for Continuing Health Care (CHC) dictates what the responsibilities are for both CCG’s and NHS England. Please refer to the national framework: https://www.gov.uk/government/publications/national-framework-fornhs-continuing-healthcare-and-nhs-funded-nursing-care 3. The name of the lead responsible (who would help Sefton residents with a Knowsley GP). Knowsley CHC team 5 Boroughs Partnership Unit 4, Puma Court Kings Business Park Prescot L34 1PJ Tel. 0151 290 1976 4. An example case if that is possible. The CCG does not hold personal identifiable information therefore is unable to provide an example case. 5. Any other information that would help us advise the public about this process. Knowsley GP registered patients can request a CHC assessment from the following teams: Hospital inpatient: Hospital discharge teams Community own home: Community health professional e.g. district nurse Nursing or residential home: CHC team Summary of Knowsley CCG’s CHC process detailed below: Assessment: An initial assessment will be completed (checklist) to determine if the patient triggers for full CHC assessment (decision support tool). The full assessment will be completed within a multidisciplinary setting where a recommendation for eligibility and package of care will be determined. The patient or reprehensive will be invited to attend. Decision: The recommendation and package of care will be quality assured and the final eligibility decision will be made by the commissioning support unit on behalf of the CCG. The patient or reprehensive will receive a written outcome letter. Provision: If the patient is eligible for CHC the CCG will fund the package of care or placement. If the patient isn’t eligible for CHC but is placed in a nursing home the CCG may contribute to the cost of the placement (funded nursing care) Reviews: CHC eligible and funded nursing care patient will be reviewed every 3 months and annually thereafter. Please refer to the following links for national guidance and patient information: https://www.gov.uk/government/publications/national-framework-fornhs-continuing-healthcare-and-nhs-funded-nursing-care or http://www.personalhealthbudgets.england.nhs.uk/ Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Key Contacts Role Name Contact Number Email CSU Locality Lead Chrissy Luff 01744 627684 [email protected] CSU Nurse Coordinator Andrea Weir 01744 621746 [email protected] CSU Specialist Manager Children’s Complex Care CSU Specialist Children’s Complex Care Nurse CSU Specialist Manager Mental Health & Learning Disability CSU Specialist Nurse Mental Health CSU Retrospective, Disputes and Complaints Manager CSU Retrospective, Disputes and Complaints Coordinator CSU Quality, Safeguarding & Performance Coordinator CCG Chief Nurse Tracy Toser 01244 650399 [email protected] Emma Redmond 0151 296 7323 [email protected] Jane Pryce 01244 650399 [email protected] Lorna Warriner 0151 296 7323 [email protected] Sheila Fairclough 01244 650581 [email protected] Jenny Wilson 01744 621746 [email protected] Louise Milner 01744 621746 [email protected] Breeda Worthington 0151 244 3592 Louise Carrington 07717 301333 [email protected] s.uk [email protected] Verity Price 0151 443 4757 [email protected] Head of Commissioning, Health & Community, Knowlsey Council Commissioning Manager for Service Improvements 1 Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Service Continuing Healthcare (CHC) Key Stage Map Eligibility, Clinical Authorisation, Clinical Governance and CHC Eligibility Review Continuing Healthcare (CHC) Key stages Process Patient Group Referral A checklist is completed in line with the framework and the outcome notified to the patient, (and if appropriate their named representative or IMCA). Patients for whom the checklists have been submitted by another party e.g. LA will be validated All community patients 2 Responsible Key Personnel Service 5BP Community 5 BP Nurse Health Teams, LA Assessor Care Management Teams, 5BP CHC Team Review/ Evidence Checklist/ Database Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Patients in an acute setting who are ‘fit for discharge’ Continuing Healthcare (CHC) ELIGIBILITY, CLINICAL AUTHORISATI ON, CLINICAL GOVERNANCE AND CHC ELIGIBILITY REVIEW Key stages Process Patient Group Assessment MDT convened, Decision Support Tool completed, patient and (and if appropriate their named representative or IMCA),, within framework timescales. Of 28 following positive checklist Framework authorisation of the Decisions Support Tool (DST) Notification to patient, validation of Fast track patients paperwork Clinical authorisation; clinical governance, to ensure the care plan needs can be met by the proposed package of care (POC) 1, notification On-going management of individual cases All community patients Decision & Authorisation Care Coordination 1 All patients Acute provider Responsible Service 5BP CHC Team CMCSU – CHC Locality team. All patients All community patients Not financial authorisation 3 Acute Trusts Discharge teams Key Personnel 5BP Nurse Assessor CMCSU Nurse Coordinator or CMCSU Locality lead Review/ Evidence DST/ Database DST/ Decision Forum Minutes/ DST CMCSU Nurse Coordinator or Locality Lead 5BP CHC Team 5 BP Nurse Assessor DST/ Database Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Review Completed according to framework identified timescales. 3 months after initial eligibility, 12 months thereafter or sooner depending on clinical need. All community patients 4 5BP CHC team 5 BP Nurse Assessor Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Key Stage Map CHC Eligibility Disputes. Key Stages Process Referral Receipt, administration and processing of referral, liaison with claimant all in accordance with timescales Initial investigation, liaison with claimant, initial meeting Completion of individual needs portrayal, arrangements and presentation to a local independent review panel, liaison with claimant Administration associated with and presentation to Independent review panel held by NCB 2 Stage 1 Stage 2 IRP 2 Patient Group All patients Responsible Service CMCSU – Customer Support centre / CHC 5BP stage1 Key Personnel Senior Administrator Review/ Evidence Database KIPS Nurse assessor Database Retrospective, Dispute and Complaints Coordinator Needs portrayal, database CMCSU Admin, Dispute Manager, Coordinating Nurse / Locality Lead Panel Minutes CMCSU stage 2 CMCSU Awaiting confirmation of NCB process 5 Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Retrospective CHC Claims (nonclosedown) 3 Key Stage Map Key Stages Process Patient Group Enquiry Receipt, administration and processing of referral, liaison with claimant within timescales Administrative and clinical checks to determine progression, completion of checklist, liaison with claimant, and if appropriate their named representative or IMCA. All patients Request 3 Responsible Service CMCSU – CSC/CHC Key Personnel CMCSU Senior Administrator CMCSU Senior Admin and CMCSU Retrospective, Coordinator Closedown cases will be subject to separate SLA 6 Review/ Evidence Database Database Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Retrospective CHC Claims (nonclosedown) 4 Referral Decision 4 5 Completion of needs portrayal and liaison with claimant, and if appropriate, their named representative or IMCA. Management of the clinical decision making process 5 All patients Closedown cases will be subject to separate SLA Decision making process is a panel unless where unambiguous evidence exists supporting the claim 7 CMCSU CSC CMCSU Retrospective, Coordinator/ Checklist, Database CMCSU Dispute Manager, Locality Lead Needs portrayal, database Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Funded Nursing Care (FNC) Key Stage Map Key Stages Process Patient Group Referral Processing of the FNC referral, ensuring CHC process followed if applicable, liaison with patient, provider and if appropriate their named representative or IMCA. Completion of assessment notifications Ensuring review completed in line with timescales. 3 months of initial assessment and 12 monthly thereafter or sooner if change in need. All community patients Assessment Review Responsibl e Service 5BP CHC Team Key Personnel 5BP Nurse Assessor Review/ Evidence Checklists, database Assessment, database Database 8 Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Complex Care Key Stage Map Complex Care Adults Key Stages Process Patient Group Referral Processing of referral, identification if assessment is within specification of patient category, liaison with patient and referrer, notifications, sign posting to appropriate service if required. Statutory assessment under the respective Mental Health Act section, that require detention and treatment Mental health referrals Clinical assessment of the patient needs Assessment and Review 6 Trauma Network specification not defined 9 Responsible Service CMCSU CSC and CMCSU CHC Team Key Personnel CMCSU MH Manager / Locality Lead Review/ Evidence Database, referral Patients who require Mental Health Act section KMBC care management N/A Patients with a physical disability who require rehabilitation 6 Walton NHS Trust – Trauma Network KMBC approved Social Workers. Michelle Montrose Health needs assessment Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Complex Care Adults (continued) Key Stages Process Patient Group Decision Clinical authorisation; to ensure the care plan needs can be met by the proposed package of care (POC), management of decision making forums notifications Patients who require detention under Mental Health Act section Section 117 Aftercare: Joint accountability between CCG and LA to deliver aftercare services. Clinical authorisation; to ensure the care plan needs can be met by the proposed package of care (POC), management of decision making forums notifications. Agreement on the apportionment of the split of Joint funding identified 7 Patients with a physical disability who require rehabilitation 7 Patients with a physical disability (not CHC eligible) 8 Walton NHS Trust – Trauma Network Patients with a learning disability (not CHC eligible) KMBC Patients subject to section 117 aftercare 9 who have identified health needs which cannot be met from commissioned services CMCSU – CHC, KMBC Trauma Network specification not defined Patients who do not require rehabilitation, who do not meet the eligibility for CHC not in SLA 9 Aftercare agreement with Local Authority 8 10 Responsible Service CMCSU KMBC Key Personnel Specialist Mental Health Manager / Locality Lead Walton Neuro Rehab Manager Review/ Evidence Care plan, CHC Database, 1/4rly analysis. N/A Locality Lead in Liaison with CCG Lead Nurse Locality Lead in Liaison with CCG Lead Nurse CMCSU Specialist Mental health manager / Locality Lead, KMBC Care management and Commisionin g N/A N/A Careplan, Joint panel agreement Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Complex Care (Adult) Complex Care (Children) Key Stages Process Patient Group Care Coordination Coordination of all care sector input, if over 50% health funded. Mental Health Responsible Service CSU - CHC Referral, assessment and review Collation and coordination of views and wishes of the child and family, holistic assessment incorporating all MDT assessments. Children 5BP Decision Clinical Authorisation and decision, coordination of the decision making forum, notifications CMCSU Complex Children’s (CC) team Care Coordination Coordination of all care sector input, if over 50% health funded, CMCSU If 50% or less, KMBC CMCSU – CHC / KMBC 11 Key Personnel CMCSU Mental Health Specialist Nurse 5BP Young People’s Health assessor CMCSU Specialist Complex Children’s (CC) Manager / Coordinator CMCSU Specialist CC Coordinator, or 5BP young People’s health assessor. Review/ Evidence CHC database Children’s assessment, CHC database Decision Support Tool Boradcare database / SWIFT Database Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Individual Package Procurement Key Stages Process Patient Group Direct contract for Package of Care Traditionally commissioned packages of care where the contractual arrangements is between KMBC and the provider,on behalf of the CCG issue of the contractual documentation commissioned packages of care where the contractual arrangements is between KMBC and the patient The patient has an agreement directly with the provider and this is managed by a third party on their behalf. Issue of personal health budget agreement.. Non PHB patients 10 To Quality assure, The support plan, assessment and the proposed package of care for Clinical Governance. PHB patients Personal Health Budget Clinical Quality Assurance. 10 Responsible Service Knowsley MBC PHB patients KMBC Care Management Teams and 5BP CHC Team PHB patients can take this route but referred as virtual budgets 12 CMCSU Key Personnel Knowsley MBC info & analysis Team Review/ Evidence Individual Service User placement agreement (ISUPA) KMBC Social Worker and 5BP Nurse assessor Support plan and authorising letter of agreement CMCSU Nurse Coordinator / Locality Lead Support Plan/ DST/Minutes/ database Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Individual Package procurement (cont.) Bespoke Equipment Consumables Clinical and financial authorisation – the ordering of the equipment needs to be clinically assessed as appropriate as well as value for money. CHC Eligible patients CHC and CC Panel CSU Locality Lead, KMBC Commissioning, KMBC Care Management. Panel Minutes Ordering of Bespoke Equipment CHC Eligible Patients 5BP Nurse Assessors, 5BP ICES KMBC Procurement system Ordering of clinical consumables associated with a patients needs Where outside of specification of provider contracts 5BP CHC Team & 5BP Integrated Community Equipment Store (ICES) 5BP Centre for Independent Living Clinical order form 13 Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Finance Key Stage Map Key Stages Process Patient Group Authorisation, 100% Health funded patients in independent hospitals ( Not CHC) Financial authorisation, (i.e. the agreement of annual contract value, notifications) Non CHC patients in independent hospitals POC < £30K Responsible Service CMCSU Non CHC Patients in independent Hospitals with POC >£30K & <£60K CMCSU Non CHC Patients in independent hospitals with POC >£60K CCG 14 Key Personnel CMCSU Nurse Coordinator and CMCSU Mental Health Nurse Specialist CMCSU Locality Lead or CMCSU Head of Service, delegated responsibility Knowsley Lead Nurse Review/ Evidence Authorisation Record, CC1, Database, Authorisation record, CC1, Database Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Finance Key Stages Process Patient Group Authorisation of CHC and Joint Funded cases Financial authorisation, (i.e. the agreement of annual contract value, notifications ) CHC and Jointly funded patients Authorisation Children Complex care and Mental Health Financial Authorisation, Procurement and agreement of annual contract value, notifications Processing Central coordination, scanning and administration of invoicing process Children’s Complex care (CCC)Packages and Mental health (MH) independent Hospital Placements and rehab. FNC, Non CHC Patients with 100% Health Funding, Children’s CC & MH CHC, and Joint funded FNC, Non CHC Patients with 100% Health Funding, Children’s CC & MH. CHC and Joint funded. Validation Checking the details of the invoice against patient data and package details 15 Responsible Service CHC CC Panel CMCSU Key Personnel KMBC Commissioning, KMBC Care Management, CMCSU Locality Lead. CMCSU Mental Health manager / Childrens Complex care manager / CMCSU Locality lead Review/ Evidence CHC CC Panel Notes and SWIFT Complex care Panel Minutes, MH or Children’s CHC Assessment documentation. Knowsley CCG KCCG Finance, SBS Payment Processing. SBS workflow KMBC KMBC Central payments team CMCSU Finance locality lead SWIFT CMCSU – Finance Team KMBC KMBC Central payments team SBS Workflow, CHC database SWIFT Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Query and corrections Invoice Authorisation Finanace (cont.) 11 When invoice does not match data Identified budget holder with appropriate level authorising the individual invoice value 11 Non CHC Patients with 100% Health Funding and FNC. CHC, Joint funded. FNC, Non CHC, Children’s CC and MH CHC, Joint funded CMCSU – Finance & CHC teams Finance locality lead, SBS Workflow, CHC database KMBC KMBC Central payments team KCCG Finance team SWIFT KMBC KMBC Commissioning Team. SWIFT Responsible Service CMCSU Key Personnel Review/ Evidence Database CCG or if during the time of the pool, KMBC CMCSU Dispute Manager, KCCG Finance, KMBC Finance leads Key Stages Process Patient Group FNC Schedules Ensuring schedules are produced, and kept reconciled to ensure providers are paid via relevant payment mechanism All nursing home patients Retrospective Award Payment Financial liaison with the claimant, CCG and Retrospective review payment, calculations and payments All patients awarded as a result of a retrospective claim Consider SFI governance due to Contract value vs. invoice value 16 KCCG CMCSU Finance team SBS workflow Needs portrayal and LRP Outcome Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley CHC and Complex care Contract Management Key Stage Map Key Stages Process Patient Group Mobilisation & Variations Administration and provider liaison Adult Patients in Northwest CHC Framework beds Adult Patients in North Lancs Framework Beds ( Specialist MH) Patients in Bilateral NHS Contracts (when Not on NW framework). 12 Defined as North Lancs framework. 17 Responsible Service CSU - Contracts North Lancs CCG 12 CCG or CMCSU Key Personnel Contract locality lead, Bryan Dexter Review/ Evidence NHS contract, deed of variations Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley KMBC commissioned contracts ( CHC and Joint funded) Patients requiring equipment ( CHC and Joint funded) needing maintenance CHC Contract Management Action PlanSafety Thermometer ver1.docm FINAL Care Home Dashboard 08 2013.xlsx Key Stages Process Patient Group Clinical Monitoring Monitoring of the contracts from a clinical perspective, including safety thermometer and other clinical CQUIN for CHC Clients and CC, including Complex Mental Health. Risk assessment based on all reported qualitative and quantitative data Risk assessment based on all reported qualitative and quantitative data Complex Care and CHC funded Patients Review CHC and Joint Funded Contracts. Review Complex Mental health Contracts CHC and Joint Funded patients. Mental Health independent Hospital Placements 18 KMBC KMBC KMBC Commissionin g KMBC Commissionin g Responsible Service CMCSU Key Personnel KMBC and CMCSU for Clinical assurance CMCSU KMBC Commissioning and CMCSU Locality Lead CMCSU Specialist Nurse, Mental Health/ Mental Health Lead CMCSU Locality Lead / CMCSU Quality,Safe Guarding and Performance Lead Service level agreements Goods and Services contract Review/ Evidence Provider data and analysis reports Provider review report and assessment grading Provider review report and assessment grading Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Contract Management Where action plans or improvement notices are in situ Renegotiations/ decommissioning Non framework Where placements are Pre-placement required, for providers checks outside of agreed frameworks but where circumstances require bespoke placements eg out of area, specialist placements CHC and Joint Funding CHC and Joint Funded Patients. CHC and Joint Funded patients where a nonframework placement is identified 19 KMBC in conjunction with CSU and KCCG Safeguarding Service. KMBC KMBC. With CMCSU for MH/Complex Childrens KMBC Commissioning and CSU Locality Lead. Provider action plans KMBC Commissioning KMBC Case Manager and Specialist Nurse Mental or Children CMCSU KMBC Contracts Pre placement check pro-forma Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley CHC Governance, Support & Other Service Components Key Stages Process FOI Management of process in accordance with guidance and timescales Sourcing data (if CHC FNC related) Management of process in accordance with guidance and timescales Validation of the patient records Access to Records Reporting CHC Framework Governance Data management 13 Patient Group N/A Responsible Service CSU - CSC All known patients CSU – CHC Team 5BP CH AND 5BP CHC Team CMCSU Head of Client Operations (HOCO) Report, in accordance with CCG timetable Quarterly Quality and Performance (QQP) Report, in accordance with CCG timetable and coincident with DoH Returns Department of Health and NHS England returns. 2 Parts, activity report and finance report. All Patients CSU - HOCO All Patients CSU -CHC All Patients Ensuring compliance with all CHC, FNC and relevant Mental Health Act legislation, framework and guidance Ensuring patient related database is maintained, that data is accurate, contemporaneous and that access to is governed in accordance with Data Protection legislation 13 All CHC eligible patients Activity = 5BP, Finance = KCCG & KMBC CMCSU CHC CSU is a Data Processor , NCB is Data Controller 20 All eligible patients KMBC CMCSU Key Personnel CMCSU CSC Admin Review/ Evidence Datix database CMCSU Locality Admin and lead 5BP CHC Team Manager. database CMCSU Admin Coordinating Nurse CMCSU Locality Lead / Head of Client Operations CMCSU Locality lead /Quality, Performance and Safeguarding Lead 5BP and KCCG. Clare Barrow Jo Serridge. CMCSU Finance (support). Locality Lead/ Business and Governance Lead database KMBC Info and analysis, 5BP informatics, CMCSU Locality Admin. Audit reports, QA system checks, Privacy Impact Assessment, IG Toolkit CHC database Patient Files HOCO reports QQP reports DoH Reports Standard Operational Procedures Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Governance, Support & Other Service Components (Cont.) Key Stages Process Patient Group Out of Area register Out of areas notifications are administered. In accrodnace with the NHS NW out of area protocol. All patients in placements out of Responsible Commissioners geographic area Out of area placements for LD as referenced in the Winterbourne recommendations. In area hosted placement register 14 Workforce Development. Safeguarding 14 Oversight of CHC training strategy Delivery of direct CHC training, broken down into relevant components: awareness, checklists, DST, Dispute panels Clinical assessments of patients where a safeguarding plan/ investigation has identified input is required Responsibl e Service CSU – CSC Key Personnel LD patients placed Out of Knowsley CCG Knowsley CCG Lead Nurse All patients in CCG’s geographic area for whom they are not the Responsible Commissioner N/a CCG CSC CSU 5BP 5BP Human Resources. CMCSU CSU - CHC CMCSU CHC Locality team Eligible patients in a provider where safeguarding investigation ongoing for patients not in own home or residential 5BP CHC Team 5 BP Nurse assessor Clarify in hosted placement register 21 CMCSU CSC Team Review/ Evidence CHC database TBC Training strategy, evidence Training pack, attendance register Strategy meeting minutes, Clinical assessment, CHC database Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Governance, Support & Other Service Components Key Stages Process Patient Group Safeguarding Clinical assessments of patients where a safeguarding plan/ investigation has identified input is required Eligible patients in a provider where safeguarding investigation ongoing for patients in own home or residential Providers for eligible patients Clinical input to quality review of provider services following safeguarding and recommendations from the strategy meeting Complaints, against CHC process. Stage 1 – meetings with complainant to address and resolve issue. All relevant patients. Stage 2 – formal investigation into complaint, liaison with complainant. External investigation/Ombudsman; supporting investigators .throughout request 22 Responsible Service 5BP CSU - CHC Key Personnel Nurse Assessor Review/ Evidence Strategy meeting minutes, Clinical assessment, CHC database Quality and Safeguarding coordinator / Specialist Nurse MH or Children where applicable. 5 BP Nurse assessor Provider report, strategy meeting minutes, CHC database KMBC CHC CC Panel Chair. Investigation, report, datix, database. KMBC KMBC Liaison Officer Investigation submission, Datix, database. 5BP CHC and mental health teams. Datix Database, CHC Database Continuing Healthcare & Complex Care Accountability Framework V 1.8 Knowsley Complaints about quality of service. Stage 1. Initial investigation and improvement action. CHC and Joint Funded patients. Stage 2. Formal Investigation and improvement action. Stage 1: initial investigation and improvement action 5bp CHC and Mental health Teams. KMBC NON CHC 100& mental health Funded Patients. CMCSU Stage 2: Formal Investigation and improvement action Legal/Court Clinical representation in legal meetings and court hearings with respect to individuals patients .5BP Nurse assessor and CHC Team manager. KMBC Commissioning. CMCSU CSC, CMCSU Complaints coordinator and CMCSU Mental Health Manager. CMCSU CSC, CMCSU Complaints manager and CMCSU Locality lead All eligible patients involved in legal proceedings 23 CMCSU - CHC CMCSU Locality Lead Court and/or Legal proceeding reports Knowsley Continuing Health Care and Complex Care for Adults Process Guide Version: Approved by: Date formally approved: Document Author: Name of responsible directorate: Review date: Target audience: 1 Verity Price People November 2013 Patients, Providers, CSU, 5 Boroughs, KMBC Page 1 of 35 KMBC DOCUMENT CONTROL PAGE Title: Knowsley Continuing Health Care and Complex Care for Adults Process Guide th TITLE Publication Date: 5 July 2013 Document Type: Procedure Version Number: 1 ORIGINATOR Brief Summary: A description of how patients access continuing healthcare and complex care funding in Knowsley. The process described from referral to commissioning packages of care. Document Author and Job Title: Verity Price, Commissioning Manager Responsible Directorate: People Policy Operational Level: Borough wide Name FORMAL APPROVAL Breeda Worthington Louise Carrington Chrissy Luff Designation Head of Quality and Safety/Lead nurse at Clinical commissioning group Head of Commissioning for Communities and Health Locality Lead for Halton, Knowsley and St. Helens POLICY DEPENDENCIES SUPERSEDES REVIEW Karen Green Organisation Date Knowsley CCG Knowsley MBC Cheshire & Merseyside CSU 5 Boroughs Partnership NHS Trust Review Date: November 2013 Responsibility of: Commissioning Manager for Continuing Health Care and Complex Care in association with Merseyside and Cheshire Commissioning Support Unit and 5 Boroughs Partnership Supersedes: Description of Amendments: Link to other Council documents: Link to Council Primary Objective: Link to Sustainable Communities Strategy Key Driver: Page 2 of 35 1. Table of Contents 1. Table of Contents ................................................................................................................................................... 3 2. Glossary of Terms .................................................................................................................................................. 4 3. Introduction .............................................................................................................................................................. 6 4. CHC Standard Route Process Chart................................................................................................................... 7 5. CHC Fast Track Route Process Chart ................................................................................................................ 8 6. CHC Standard Route Process Guide.................................................................................................................. 9 6.1 Assessing Eligibility ............................................................................................................................................. 9 6.2 Agreeing a Suitable Package of Care ............................................................................................................ 11 6.3 Commissioning a Support Package................................................................................................................ 13 6.4 Reviewing Patient’s Needs and CHC Eligibility ............................................................................................ 16 CHC Fast Track Route Process Guide ............................................................................................................. 17 7. 7.1 Assessing Eligibility ........................................................................................................................................... 17 7.2 Agreeing a Suitable Package of Care ............................................................................................................ 18 7.3 Commissioning a Support Package................................................................................................................ 20 7.4 Reviewing Eligibility ........................................................................................................................................... 20 Continuing Care Process Guide ........................................................................................................................ 21 8. 8.1 Jointly Funded Services .............................................................................................................................. 21 8.2 Independent Hospitals ................................................................................................................................. 22 9. Frequently Asked Questions .............................................................................................................................. 24 6. References ............................................................................................................................................................ 26 7. Key Contact Numbers.......................................................................................................................................... 27 8. Appendices 1 - CHC Funding Decision Form .................................................................................................. 28 9. Appendices 2 – MH1 Form ................................................................................................................................. 30 10. Appendices 3 – Joint Funding Application Form ......................................................................................... 32 Page 3 of 35 2. Glossary of Terms CIL Centre for Independent Living is an integrated service which includes the Integrated Equipment Service and Wheelchair service CHC Team The Continuing Health Care Team provided by 5 Boroughs Partnership NHS Trust Complex Care A package of care continuing care that cannot be met by existing commissioned health services. This package of care is specifically commissioned for an individual patient. Continuing Care A package of care provided over an extended period of time to someone aged 18 years or over to meet their physical and / or mental health needs as a result of a disability, accident or illness 1. Continuing Healthcare A package of continuing care that is arranged and funded solely by the NHS1. IMCA Independent Mental Capacity Advocate (IMCA). This person represents the patient’s wishes when the patient does not have a named representative to support them. Information and Analysis The team in Knowsley MBC who inputs CHC services in the client database CMCSU Locality Lead The Cheshire and Merseyside Commissioning Support Unit Halton, Knowsley & St. Helens Locality Lead for Continuing Health Care and Complex Care. Named Representative The patient can choose someone to represent their wishes in how they want to be supported. This person could be a family member or a friend. 1 DOH (2009) The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care July 2009 (revised) Page 4 of 35 Primary Health Need Where a person’s overriding needs are due to their health rather than their social care needs. This is decided through a CHC eligibility assessment. The Co-ordinator The person who knows that patient and will co-ordinate the CHC eligibility assessment and if they are eligible, organise the package of care. Page 5 of 35 3. Introduction Knowsley Clinical Commissioning Group (CCG) is responsible for commissioning Continuing Healthcare (CHC) for patients registered with a Knowsley CCG registered General Practitioner (GP). Knowsley CCG Continuing Health Care funding for patients aged 18 years or older sits within three pooled budgets. These are: • • • Disability Pooled Budget Mental Health Pooled Budget Community Services Pooled Budget (previously known as the Older People’s Pooled Budget) Knowsley CCG is also responsible for commissioning Continuing Care (CC) for patients registered with a Knowsley CCG General Practitioner (GP). Where these needs cannot be met within existing services, packages of care are commissioned from the Complex Care Budget. Some of the Complex Care Budget is sits within the pooled budgets. The pooled budgets are governed by Section 75 of the National Health Service Act 2006 2. They contain funding from Knowsley Metropolitan Borough Council (MBC) and Knowsley CCG. Knowsley MBC manages these budgets on behalf of the partners and the arrangements for the pooled budgets are reviewed on an annual basis and in accordance with the Section 75 agreement. Although Knowsley CCG is responsible for commissioning CHC and CC, elements of the process are outsourced to three different organisations. These are Cheshire and Merseyside Commissioning Support Unit (CMSU), Knowsley MBC and 5 Borough Partnership NHS Trust. This process has been developed to clearly describe the roles and responsibilities of each agency. The process has been developed in consultation with CMCSU, Knowsley MBC and 5 Borough Partnership NHS Trust. The process is based on the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care 3. Sections 4 and 5 are flow charts that describe the process in diagrammatic form. Section 6 describes the process for patients accessing CHC via the standard route and Section 7 describes the process for patients who are accessing CHC via the Fast Track Route. Section 8 describes the process for Continuing Care and the last section in the guide covers some of the frequently asked questions about the processes. There is also an Appendix that includes copies of the forms used in the processes. 2 3 HMSO (2006) National Health Service Act 2006 DOH (2009) The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care July 2009 (revised) Page 6 of 35 4. CHC Standard Route Process Chart New Referral – step 1 CHC Checklist is completed and patient is informed – step 2 & 3 Not assessed as eligible for CHC Decision Support Tool (DST) is completed at a Multidisciplinary Meeting (MDT) – step 5 & 6 MDT recommend if patient is CHC eligible and recommend a package of care. MDT completes a CHC Funding Decision Form – steps 6 & 7 CHC Team completes initial quality assurance on process and sends DST and Funding Decision Form to MCCSU – step 8 CMCSU quality assures eligibility process – step 8. CMCSU decides if the patient is eligible and sets a date to review.– steps 9 & 10 CMCSU writes to the patient to inform them of the CHC eligibility decision – step 10 CMCSU Agree Package of Care below thresholds & sets a date for Review – steps 13 to 15 Patient Accept Decision Panel Agrees Package of Care above thresholds & set a date for review – steps 16 to 19 Patient Disputes Decision Accept Decision Not assessed as eligible for CHC Appeal Decision CMCSU Appeals Process – step 11 KMBC Complaints Process – step 20 The Co-ordinator supports the patient to pick a provider. The Funding Decision Form is updated and sent to CHC Team– steps 22 to 25 CHC Team send Funding Decision Form to MCCSU – step 26 CMCSU Agree Package of Care below thresholds & sets a date for Review – steps 13 to 15 Patient Accept Decision Panel Agrees Package of Care above thresholds & set a date for review – steps 16 to 19 Patient Disagree with Decision CMCSU send the Funding Decision Form to Information & Analysis to set contract and pay provider – step 28 to 31 CHC Eligibility and Package of Care is Reviewed – steps 35 and 36 Page 7 of 35 5. CHC Fast Track Route Process Chart New Referral – step 1 CHC Fast Track Pathway Tool, Supporting Evidence, CHC Funding Decision Form is completed and sent to the CHC Team– step 2 Weekends and Bank Hols co-ordinator decides eligibility for CHC – step 6 Mon to Fri (excluding bank hols) CHC Team quality assures process and sends to CMCSU– step 3 CHC Team complete preliminary quality checks and sends to MCCSU– step 9 Mon to Fri (excluding bank hols) CMCSU decide eligibility and agree a package of care. CMCSU set a review date – step 4 & 5 CMCSU quality assures process – step 9 MCCSU Disagree with Eligibility Decision MCCSU Agree with Eligibility Decision Patient is eligible CMCSU notify the patient in writing of the outcome of the CHC Fast Track Assessment – step 7 Packages of Care are reviewed in line with the Review Date – step 13 Patient is not eligible CHC Standard Process Page 8 of 35 6. CHC Standard Route Process Guide 6.1 Assessing Eligibility 1. A new patient is identified as potentially being eligible for CHC funding because their health needs are significant enough to potentially be a ‘primary health need’. This person could be in his or her own home, in a residential setting (such as registered residential home or nursing care home) or in hospital. 2. A Co-ordinator is identified to co-ordinate the CHC assessment and, if required, organise their care. This person is a professional who is trained to complete the CHC checklist. The CHC checklist is a national tool that screens people who may potentially be eligible for CHC funding. The co-ordinator completes the CHC checklist. 3. At the end of the checklist assessment the patient (and, if appropriate, their named representative or IMCA) is given a copy of the completed checklist. 4. The thresholds for eligibility in the CHC checklist tool have deliberately been set low to reduce the chances of people who might be eligible for CHC from being excluded unintentionally. If the patient is screened as being unlikely to be eligible for CHC then no further action is taken at this time with regard to CHC funding. If, in the future, the person’s needs change then they can go back to step 1 and follow the process again. 5. If the person is screened as potentially being eligible for CHC then a multidisciplinary meeting (MDT) is arranged. This must be with the consent of the patient and, if appropriate, their named representative or IMCA. Representations from the following areas are present at the meeting and each representative has a specific role to fulfil. Page 9 of 35 Who Role Attendance at the Meeting Optional. CHC Team provided by 5 Partnership Boroughs NHS Trust Social Care Registered Nurse The Co-ordinator Patient / Named Representative / IMCA Other people who know the patient Quality Assure the MDT Provide advice on patients social care needs. Provide advice on care planning. To provide professional opinion of the patient’s health needs To provide professional opinion of the patient’s health needs. To provide insight into the patient’s health needs and advocate for the patient’s wishes To provide insight on the patients health needs Dependent on the experience of the Co-ordinator’s expertise. Essential Essential Essential Desirable. Optional 6. An assessment of the patient’s health and social care needs is completed by the MDT with the support of the decision support tool (DST). The assessment process supports the MDT to recommend if the patient is eligible for CHC. The assessment and recommendation is recorded in the DST. The MDT sends a copy of the DST and supporting documents to the CHC Team. 7. If the MDT makes an eligibility recommendation. Separate to this, the MDT also recommends a package of care that will meet the patient’s needs and reflects the patient’s wishes with regard to how they want to be supported. The MDT completes a CHC Funding Decision Form to record their recommendation and describe how the recommended package of care will meet the person’s assessed need. The MDT sends a copy of the CHC Funding Decision Form to the CHC Team. 8. If the CHC team have not attended the MDT, the eligibility decision and, the proposed package of care is referred to the CHC Team for preliminary quality assurance checks. The CHC team then refer the eligibility recommendation to Cheshire and Merseyside Commissioning Support Unit , Nurse Coordinator for approval. This referral sent to [email protected] and [email protected]. Referrals can be made Monday to Friday (excluding bank holidays) 9am to 5pm. 9. CMCSU will make the final decision with regards to the patient’s eligibility for CHC based on the evidence presented in the DST. This will be done within 7 days. If there is not enough information for MCCSU Nurse Coordinator to decide eligibility then they will request additional information from the MDT. CHC team will liaise with The Co-ordinator to organize the collection of the additional information. 10. If the CMCSU Nurse Coordinator agrees with the MDT eligibility recommendation, this decision is communicated in writing to the patient (and, if appropriate, their named representative or IMCA). This is done by the MCCSU. The Co-ordinator is also informed. Page 10 of 35 The CMCSU Nurse Coordinator also sets a date to review the patient’s needs and eligibility for CHC. For patients who have just been assessed as CHC eligible this must be no longer than 3 months from the date of the initial MDT but may be sooner depending on the patient’s individual clinical needs. For patients who are already CHC eligible and their needs are being reviewed, this can be up to 1 year from the date of the MDT review. 11. If the decision was that, the patient is not eligible for CHC funding then the patient (and, if appropriate, their named representative or IMCA) has the right to appeal this decision. Information on how to dispute the decision is given to patients as of part of the written decision on eligibility. All such disputes are coordinated by CMCSU as per their service specification with Knowsley CCG. 6.2 Agreeing a Suitable Package of Care 12. A series of thresholds have been set which delegates authority to for CMCSU to agree certain packages of care. Any other service must be considered and formally agreed by the CHC Scrutiny Panel. Package of Care Below the Threshold 13. The following packages can be agreed by CMCSU: Type of Service Provider Standard Residential or Nursing Care (i.e. no 1:1 support) On the NW CHC Framework for Nursing and Residential Care Domiciliary Care at the standard rate Standard Equipment in a Nursing or Residential Home Standard Equipment On the Knowsley MBC Framework for Community Service Framework On the NW CHC Framework for Nursing and Residential Care Integrated Equipment Store Threshold Cost must reflect the NW CHC Framework for Nursing and Residential Care Rate Less than 62 hours a week No cost as it is included in the base rate for Nursing and Residential Care Standard equipment stocked by the CIL 14. If MCCSU agree with the recommended package of care, they notify the MDT verbally. If the package of care is below the threshold, the CMCSU will agree a date for reviewing the suitability of the package of care. For patients who have just been assessed as CHC eligible this must be no longer than 3 months from the date of the initial MDT but may be sooner depending on the patient’s individual clinical needs. For patients who are already Page 11 of 35 CHC eligible and their needs are being reviewed this can be up to 1 year from the date of the MDT review. 15. If CMCSU do not agree with the package of care, CMCSU notify the MDT and explaining the reasons why. The CHC Team then work with the MDT to agree a suitable package of care. 16. A list of services agreed by CMSCU are presented to the weekly Scrutiny Panel. Package of Care Above the Threshold 17. The CHC Scrutiny Panel meets once a week. The following people attend the panel and have the following roles: Who Role Attendance at the Meeting Head of Care Management Chair Essential or appropriate deputy Head of Integrated Commissioning, Health and Communities Deputy Chair Essential or appropriate deputy Commissioning Manager, Knowsley MBC Locality Lead, CMCSU Care Management Service Manager, Knowsley MBC Budget management and commissioner of eligible packages of care Representing Health and to advise on Clinical appropriateness of the proposed package Representing Social Care Essential or appropriate deputy Essential or appropriate deputy Where appropriate and assuming representation at MDT. 18. The following packages must be agreed by the CHC Scrutiny Panel. Type of Service Standard Residential or Nursing Care (i.e. no 1:1 support) Enhanced Residential or Nursing Care (i.e. with 1:1 support) Domiciliary Care at the standard rate Domiciliary Care at the complex care rate Provider Any provider not on NW CHC Framework for Nursing and Residential Care Threshold All Services Any provider Any cost that does not reflect the NW CHC Framework for Nursing and Residential Care Any provider All Services Any Provider More than 62 hours Any Provider All Services Page 12 of 35 Specialist Equipment Any provider All equipment 19. The CMCSU provides a copy of the CHC Funding decision form to the CHC Scrutiny Panel. This is password protected and sent electronically to the panel members at least 3 working days before the panel meeting. The CHC Scrutiny Panel will decide on the most appropriate package of care to meet the patient’s needs. The panel will take into account the patient (and, if appropriate, their named representative or IMCA) wishes. 20. CHC Scrutiny panel will agree a date to review the suitability of the package. For patients who have just been assessed as CHC eligible this must be no longer than 3 months from the date of the initial MDT but may be sooner depending on the patient’s individual circumstances. For patients who are already CHC eligible and their needs are being reviewed this can be up to 1 year from the date of the MDT review. 21. Minutes are kept of the scrutiny panel meetings. These are password protected and distributed to Knowsley MBC, CMCSU and the CHC Team. The CHC Team will inform the MDT of the decision. The nominated care coordinator will communicate this decision to the patient. Making a complaint about a Decision on a Package of Care 22. If the patient (and, if appropriate, their named representative or IMCA) or provider disagrees with the package of care approved to meet their needs they can make a complaint to Knowsley MBC. This done via: CHC Complaint Head of Commissioning – Health and Communities Knowsley MBC 6th Floor Huyton Municipal Building Archway Road Huyton, L36 9YU Tel: 0151 443 3231 6.3 Commissioning a Support Package Choosing a Residential or Nursing Care Provider 23. If residential or nursing care has been agreed as the most suitable way to meet the patient’s needs then the Co-ordinator will liaise with the patient (and, if appropriate, their named representative or IMCA) to choose a residential or nursing home. The patient may already be in a residential or nursing home and may wish to stay there. If not, the patient (and, if appropriate, their named representative or IMCA) will be given details of residential or nursing homes on the NW CHC Framework for Nursing and Residential Care by the coPage 13 of 35 ordinator. The Co-ordinator will support the patient (and, if appropriate, their named representative or IMCA) to pick a home of their choice. 24. Once a home has been chosen by the patient (or, if appropriate, the Named Representative or IMCA), the Co-ordinator will update CHC funding decision form and send it to the CHC team. This can be faxed via 0151 290 1969 or emailed via to [email protected] . The CHC team quality assures the content of the form and send it to CMCSU via [email protected] and [email protected] Choosing a Domiciliary Care Provider 25. If domiciliary care has been agreed as the most suitable support to meet the patient’s needs and they are already supported at home by a domiciliary care provider then the Coordinator contacts the provider to agree the change in funding stream and if appropriate any changes to the package that have been agreed. Details of this provider and support are inserted into the CHC funding decision form by the Co-ordinator. The Co-ordinator will send this information to the CHC Team. 26. If the patient does not already have a provider then the co-ordinator will share details of providers who are on the KMBC Community Services Framework. The Co-ordinator will support the patient (and, if appropriate, their named representative or IMCA) to pick a provider on the list. The Co-ordinator then contacts the provider to agree the package of care. The co-ordinator will insert this information into the CHC funding decision form. The co-ordinator will send this information to the CHC Team. 27. The CHC team quality assures the content of the CHC funding decision form and send it to CMCSU via [email protected] and [email protected] Approving a Provider 28. CMCSU can agree providers below the thresholds described in step 13. Providers above thresholds as described in step 17 must be approved by the CHC Scrutiny Panel. Once provider has been approved, CMCSU sends the form the Information and Analysis Team in Knowsley MBC and the KMBC Commissioning Team. This information must be password protected to secure the data held in it and it must be sent by email to [email protected] and [email protected] 29. Information and Analysis Team input the service details into Knowsley MBC Social Care Client Database (SWIFT) and arranges the Individual Service User Placement Agreement (ISUPA). KMBC Commissioning Team authorises the payments in SWIFT. Making Payments Page 14 of 35 30. Residential and Nursing Care providers are paid on a four weekly basis by Knowsley MBC in accordance with SWIFT and the ISUPA. The provider does not need to invoice to receive payment as this happens automatically via the Independent Service Provider (ISP) run. 31. Domiciliary Care providers are paid based on invoices sent to the Knowsley MBC. The invoices are sent to the Central Payments Team, 2nd Floor Nutgrove Villa, Westmoreland Road, Huyton, L36 6GA. A payment run is completed every week. 32. Payment queries are investigated by the Central Payments Team. There email address is [email protected]. Reconciling SWIFT and Broadcare Systems 33. Information and Analysis Team will run a monthly report from SWIFT and share this with the CMCSU Locality Lead. The report will contain: • • • • • • • • • Patient’s name Date of Birth NHS Number Eligibility Date Service Provision Provider Start date of the service End date of the service Weekly cost 34. CMCSU Locality Lead will use this information to update Broadcare so that CMCSU can report on the performance of CHC. 35. The CMCSU Locality team, will send Information and Analysis team a fortnightly report from Broadcare so the Knowsley MBC can reconcile the information in Broadcare with SWIFT. The aim of this to ensure effective payments to providers and reduce payment queries received by the Council. The report will contain: • • • • • • • • • Patient’s name Date of Birth NHS Number Eligibility Date Service Provision Provider Start date of the service End date of the service Weekly cost Page 15 of 35 6.4 Reviewing Patient’s Needs and CHC Eligibility 36. Patient’s needs and eligibility for CHC is reviewed in line with the review date. The process returns to step 5 for an MDT to be arranged and the process is followed again. 37. If the patient’s needs change or how they wish to be supported changes, the process returns to step 5. Page 16 of 35 7. CHC Fast Track Route Process Guide 7.1 Assessing Eligibility 1. A new patient is identified as potentially being eligible for CHC funding because their health needs are significant enough to potentially be a ‘primary health need’. This person’s condition is rapidly deteriorating and they may be entering a terminal phase of their condition. Their level of dependency may be increasing and there is a need for a package of care urgently 4. 2. A Co-ordinator is identified to co-ordinate the CHC fast track assessment and, if required, organise their care. This person is someone who is trained to complete the CHC Fast Track Pathway Tool. The CHC Fast Track Pathway Tool is a national tool that screens people who may potentially be eligible for CHC funding and may need to go through the Fast Track Route. The Co-ordinator completes the CHC Fast Track Pathway Tool, Supporting Evidence (such as health assessments, care plan) and CHC funding decision form. The Co-ordinator makes a recommendation for the type of support that will meet the patient’s needs and reflect their wishes on how they would like to supported. This information is recorded in the CHC funding decision form. 3. The information from step 2 is sent to the CHC team by the Co-ordinator. This information can be sent Monday’s to Friday’s (excluding bank holidays) 9am to 5pm by either fax or email. The fax number is 0151 290 1969 and the email address is [email protected] . The CHC team complete initial quality assurance checks. If the CHC Team disagree with the Co-ordinator’s assessment they will ask the Co-ordinator to reassess the patient’s needs and quality assure the process. 4. The CHC Team send the CHC Fast Track Pathway Tool, Supporting Evidence (such as health assessments, care plan) and CHC funding decision form electronically to CMCSU via secure email to [email protected] and [email protected]. Alternatively the information can be faxed to CMCSU CHC team office on 01744 624356. This information can be sent Monday’s to Friday’s (excluding bank holidays) 9am to 5pm. CMCSU quality assure the fast track application in lines with the NHS framework for CHC and decide if the patient is eligible for CHC Fast Track. If the Fast Track application is agreed as eligible, CMCSU agree a suitable package of care to meet their needs. A decision is made within 24 hours of referral. 5. CMCSU set a date to review the patient’s needs and eligibility for CHC. This person will then be reviewed in line with the CHC Standard Route Process. This starts with the MDT in step 5 of the CHC Standard Process. 6. If a Fast Track Assessment is required at the weekend or on a bank holiday then this is completed by the Co-ordinator. If they assess that, the patient is eligible for CHC then 4 DOH (2009) The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care July 2009 (revised) Page 17 of 35 they refer this patient to the CHC team on the next available working day providing them with CHC Fast Track Pathway Tool, Supporting Evidence (such as health assessments) and CHC funding decision form. To ensure that there is no delay in the provision of support for the patient the Co-ordinator can move to step 14 of the Fast Track Route Process. 7. If a CHC Fast Track Application has been agreed by CMCSU, the patient (and, if appropriate, their named representative or IMCA) is informed of the decision in writing, by CMCSU. 8. If the patient is not assessed as meeting the criteria for the CHC Fast Track Route (either by CMCSU in step 4 or by the Co-ordinator in step 6) then the case will be referred to the CHC Standard Route Process (Section 4) for consideration via the CHC Checklist and MDT (if required). 9. Quality assurance is completed on eligibility assessments for the CHC Fast Track Process. Eligibility decisions made by Co-ordinators in Step 6 are quality assured by CMCSU. The CHC Team will send the CHC Fast Track Pathway Tool, Supporting Evidence (such as health assessments) and CHC funding decision form to CMCSU on the next available working day (Monday to Friday 9am to 5pm excluding bank holidays). 10. If CMCSU disagrees with the eligibility decision for someone who has been assessed as eligible the patient must go through the CHC Standard Route Process from Multidisciplinary Team Meeting onwards. This means they will have the right to an eligibility review completed by a multidisciplinary meeting using the Decision Support Tool. The patient’s needs can be reviewed after 1 month. 11. If CMCSU disagree with the eligibility decision for someone who is has been assessed as not eligible by the co-ordinator in step 6 the patient can go through the CHC Fast Track Route Process from step 3 onwards. This is so that there is not unnecessary delay in eligibility decision. 7.2 Agreeing a Suitable Package of Care 12. If the person is assessed as meeting the criteria for the CHC Fast Track Route CMCSU will assess the suitability of the proposed package of care based on the information in the CHC Fast Track Pathway Tool, Supporting Evidence (such as health assessments) and CHC funding decision form. CMCSU will take into account the patient’s (and, if appropriate, their named representative or IMCA) wishes on how they want to be supported. 13. CMCSU has delegated authority to agree packages of care that are agreed via the CHC Fast Track Route. The table below describes the typical type of services requested and the duration before which the package must be presented to the CHC Scrutiny Panel. Page 18 of 35 Type of Service Provider Threshold Reviewed within All providers Up to 3 months On the NW CHC Framework for Nursing and Residential Care Standard Residential or Nursing Care (i.e. no 1:1 support) Cost must reflect the NW CHC Framework for Nursing and Residential Care Rate Standard Residential or Nursing Care (i.e. no 1:1 support) Any provider not on NW CHC Framework for Nursing and Residential Care Enhanced Residential or Nursing Care (i.e. with 1:1 support) Any provider Domiciliary Care at the standard rate Domiciliary Care at the standard rate Domiciliary Care at the complex rate On the Knowsley MBC Framework for Community Service Framework On the Knowsley MBC Framework for Community Service Framework Any Provider Any cost that does not reflect the NW CHC Framework for Up to 1 week Nursing and Residential Care All Rates (Standard, Enhanced, RGN, Up to 1 weeks RMN) Up to 62 hours Up to 3 months More than 62 hours Up to 1 week All Services Up to 1 week 14. If a new care home placement or change of care home is needed at the weekend or on a bank holiday then the Co-ordinator can agree a temporary arrangement until the next working day. If a new or revised domiciliary care package is needed at the weekend or bank holiday then the District Nurses will meet this need on a temporary basis until the next working day. Step 3 of the Fast Track Process will then apply. Page 19 of 35 7.3 Commissioning a Support Package 15. CHC Fast Track Services are commissioned in the same way as CHC Standard Route Services. This is detailed in steps 22 to 34 of the Standard Route Process. 7.4 Reviewing Eligibility 16. Patient’s needs and eligibility for CHC is reviewed in line with the review date set by the CMCSU. The patient will then enter the CHC Standard Route Process at Multidisciplinary meeting in step 5 of the standard route process. 17. If the patient’s needs change or how they wish to be supported changes, the patient will then enter CHC Standard Route Process at Multidisciplinary meeting in step 5 of the standard route process. Page 20 of 35 8. Complex Care Process Guide 1. Patients who have long-term health care needs but are not assessed as eligible for CHC may still be eligible for health funding through Continuing Care (CC). These needs may be met through existing community health services such as community therapy and district nursing. Sometimes patient’s health needs cannot be met by these services, so specific packages of care need to be arranged. When this happens, it is funded out the Complex Care budget. Some elements of the Complex Care Budget sit with pooled budgets that are administered by Knowsley MBC. Other elements of the Complex Care Budget such as administered by CMCSU. This section describes these relationships. 8.1 Jointly Funded Services 2. Patients who have continuing care needs may also have social care needs that are the responsibility of the Local Authority to fund. In these circumstances, a joint package of Continuing Care may be arranged with funding from both Knowsley CCG and the Local Authority. 3. Patient’s are eligible for Joint Packages of Continuing Care funding in Knowsley if they: • Are aged 18 years or over • Have long-term health needs. • Are subject to section 117 of the Mental Health Act 1983 5 • Are registered with a Knowsley GP and is the responsibility of Knowsley MBC. If the patient is not the responsibility of Knowsley MBC then the panel can decide if the patient is eligible for health funding and what percentage. They have no authority to agree funding for social care from other boroughs. • Have been through the CHC pathway and although a primary health need was not identified, health needs that were over and above what the Local Authority would meet were still present. These health needs cannot be met by commissioned services. • Have been assessed as requiring services to meet social needs which are eligible under Knowsley MBC Eligibility Criteria for Social Care. 4. The Complex Care Scrutiny Panel assesses eligibility for Joint Packages of Continuing Care. This is health contribution to the package of care. The panel meets on a weekly basis and each member of the panel has a specific role. 5 HMSO (1983) Mental Health Act 1983 Page 21 of 35 Who Role Attendance at the Meeting Head of Care Management Chair Essential or appropriate deputy Head of Integrated Commissioning, Health and Communities Deputy Care Essential or appropriate deputy Commissioning Manager, Knowsley MBC Budget management and commissioner of eligible packages of care Essential or appropriate deputy Locality Lead, CMCSU Representing Health Care Management Service Manager, Knowsley MBC Representing Social Care Care Coordinator To provide additional information to supplement application for joint funding. Essential or appropriate deputy Essential or appropriate deputy As required 5. Applications must be made by a health or social care professional. Prior to applying for joint funding for continuing care, the application must already been approved by social care. For Knowsley residents this is done the weekly Community Care Panel that is chaired by Knowsley MBC. Applications are sent to [email protected]. Appendices 3 has a copy of the form used to apply for social care from Knowsley MBC. If the patient is not a Knowsley patient then the borough that has responsibility to fund that patient must agree the funding. 6. Applications for continuing care must be made using the MH1 form (appendices 2) and supplying supporting evidence, such as a copy of the application to social care, as appropriate. The panel application must also provide details of what support is proposed to meet the needs of the individual. Applications must be made at least 3 days prior to the panel meeting. The documents must be password protected and made electronically to [email protected]. 7. The panel will consider the needs of the patient and decide on the clinical appropriateness of the recommended package of care and the level of health funding. Moving forward the panel will work with adult social care colleagues to harmonise the panel arrangements for those individuals jointly commissioned to ensure that decisions are made in a timely manner. 8. If the package and funding is agreed, the Co-ordinator will arrange the package of care and commission the services. 8.2 Independent Hospitals 9. Knowsley CCG are responsible for funding independent hospital. This is administered on their behalf by CMCSU. Applications for funding are made to the CMCSU via CMCSU Specialist Nurse for Mental Health. Applications are made via secure fax on the following number 01744 624356. CMCSU Specialist Nurse for Mental Health completes quality Page 22 of 35 assurance checks to make sure that the proposed service meets the patient’s needs and prepares applications for funding. 10. Applications for funding are made to the CMCSU Locality Lead at the weekly Scrutiny Panel. Applications must provide at least three potential placements options to meet the patient’s needs that have been sourced via tender process. CMCSU Locality Lead (or deputy) will make a decision, with regard to the most appropriate service to meet the patient’s need. Applications are made using the MH1 Form. A copy of this is in Appendices 3. Page 23 of 35 9. Frequently Asked Questions 1. Where can I get a copy of the CHC Checklist? The CHC checklist is a national tool. A copy of the checklist and guidance are available from the link below: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/127200/N HS-CHC-Checklist-FINAL.pdf.pdf [Accessed 2nd July 2013] 2. Where can I get a copy of the Decision Support Tool (DST)? The CHC checklist is a national tool. A copy of the checklist and guidance are available from the link below: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/127201/D ecision-Support-Tool-for-NHS-Continuing-Healthcare.pdf.pdf [Accessed 2nd July 2013] 3. Where can I get a copy of the CHC Fast Track Tool? The CHC Fast Track Tool is a national tool. A copy of the checklist and guidance are available from the link below: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/127202/N HS-CHC-Fast-Track-Pathway-tool.pdf.pdf [Accessed 2nd July 2013] 4. Who can complete a CHC Checklist or complete an assessment using the DST? Any professional, who has been trained to do so; CMCSU provide training on how to use the CHC checklist and DST. 5. What if the patient / service user is not resident in Knowsley but has a Knowsley GP? We think that this currently applies to approximately 10% of health funded packages. In these situations the process would be followed as usual. However, where there is joint funding with the local authority, the care coordinator is required to work with the relevant authority. The care coordinator is required to ensure that the scrutiny panel is updated on the outcome of any such funding request. Page 24 of 35 6. Does a Social Worker need to be involved in the completion of the Decision Support Tool / Fast Track Tool where we are seeking to Fast Track a package of care and support? The key area of concern in these instances should be to support the person home or to an alternative care setting of their choice as expediently as possible. In the spirit of this it may not always be possible to have a social worker involved in the decision making tool, it is still appropriate to proceed without social work input providing that the tool has been completed by an appropriate clinician. Page 25 of 35 7. References DEPARTMENT OF HEALTH (2009) ‘The National Service Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. July 2009 (revised)’. Department of Health. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGui dance/DH_103162 [Accessed 15th February 2013] HER MAJESTY’S STATIONERY OFFICE (1983) ‘The Mental Health Act 1983’ The National Archives. Available at: http://www.legislation.gov.uk/ukpga/1983/20/contents [Accessed 2nd July 2013] HER MAJESTY’S STATIONERY OFFICE (2006) ‘National Health Service Act 2006 (Part 3).’ The National Archives. Available at: http://www.legislation.gov.uk/ukpga/2006/41/contents [Accessed 19th February 2013] Page 26 of 35 8. Key Contact Numbers Organisation Telephone Number 5 Boroughs CHC Team 0151 290 1976 KMBC Central Payments Team 0151 443 3145 KMBC Commissioning Team 0151 443 4772 Merseyside & Cheshire CSU CHC Team 01744 627685 Page 27 of 35 9. Appendices 1 - CHC Funding Decision Form Knowsley CHC Funding Decision Form v1 Address & postcode: NHS number: CCG: SWIFT ID Current location: Client Category: GP: Name: DOB: Under 65 Physical Disability Mental Health Learning Disability Substance Misuse Over 65 Physical Disability Mental Health /EMI Dementia Legal Status Section 117 Section 3 Social Worker: Diagnosis: Summary of Care needs: (Please include any potential hazards or risks to inform provider of) Referrer details (name, post, service) Referral type Date completed Fast Track DST Recommended Package of Care to meet Assessed Need: FT / MDT CHC Recommendation Eligible Not Eligible Weekly Cost (£): (NB Complete individual support hours for Home Care Packages or 1:1 requests) Date received by CSU for authorisation: CHC Eligibility Decision “I have reviewed the recommendations of the Multi-disciplinary team, and would / would not concur with the recommendation that…………………………………………………………….is / is not currently eligible for NHS Continuing Healthcare”. (Note – any exceptionality statements to be expanded on a separate sheet) Name: Designation Signed: Date: Initial Review Date 3 months >> 6 months >> 9 months >> Other – Specify Date >> Page 28 of 35 Eligibility Dates Start End Full CHC Agreed % Health % Social Care 100% Which LA? 0% Recommendation for Joint Funding Not recommended for Joint Funding If service has an end date please state reason for end: Details of Agreed Package of Care: Authorised by: CSU Name/s & Designation Signed Date Scrutiny Panel Page 29 of 35 Version 4 01.02.2013 11. Appendices 2 – MH1 Form APPLICATION FOR NHS FUNDED CARE Please be aware that all applications will be screened as complete prior to being submitted to panel for consideration. At point of screening, should any supporting information be incomplete the case manager will be contacted to re-submit the application when all complete. Patient Details Name ………………………………………….. ……………………... DOB …………………………….. Current address / existing placement : ………………………………………………………………………… ……………………………………………………………………………………….……………………………… ………………………………………………………………………………………………………………………. Case Management Details Please complete all fields clearly as these details will be used to inform the outcome of the panel decision Case Manager Name Role Team Organisation Correspondence Address What are you asking the NHS to fund? Contact Tel No Intensive Rehabilitation Email Address Section 117 Aftercare Change in Need (existing client) One-off Treatment Other Confirm your line manager is in agreement with this application Y / N Please include placement details, costing, details of all other options explored including responses and why this is the only suitable placement, if a one off or recurrent, and any other relevant detail. If this placement is urgent or is required by a specific date please document the reasons why. Page 30 of 35 Application Checklist (The following documents should be included with your application as a minimum*) *Recent Assessment of Health Needs *Current Risk Assessment *Proposed Care Plan Continuing Healthcare feedback (if applicable) Specialist Assessment enclosed ( if applicable, SALT) Send completed request and supporting documentseg forPsychiatrist, the attentionOT, of NHS Funded Care by email to: [email protected] NB: Please ensure address is exact as above Social Care assessment (if applicable) Confirm Carers Assessment complete (if identified on care plan) OR by Safe Haven fax for the attention of NHS Funded Care to the following: For Liverpool / Sefton applications FAO Lorraine Norfolk on 0151 296 7300 NHS Decision For Halton /St Helens/Knowsley applications FAO of Chrissy Luff on 01744 624356 Chair ………………………………………. Panel date …………………………………… Panel Members: …………………………………………………………………………………………… …………………………………………………………………………………………… …………………………………………………………………………………………… Outcome of Panel Agreed Deferred Declined Rationale: Governance (for office use only) Added to Database by Recommendations: …………………………………….. Date………………… Date Outcome of Panel letter sent ………………………… Page 31 of 35 12. Appendices 3 – Social Care Funding Application Form Care Managers Name Date of Request Please provide the following:Budget Calculator Assessment CHC Checklist Name of the Person Swift Number Home Address Date of Birth GP name GP Telephone Number Next of Kin Name SWIFT Number if known/applicable Home Address & telephone number Date of Birth Does the person have an Yes Appointee, Power of Attorney, No Lasting Power Attorney or subject to the Court of Protection? If so, please provide the financial representatives name, address and telephone number Is the person eligible for Continuing Health Care? Yes If yes, please specify % 100% Is the person eligible for Section 117 funding? Yes No 50% 25% Page 32 of 35 Does SU receive ILF No If yes, – contribution Cost of Current Budget (weekly) Cost of Budget requested (weekly) Increase (weekly) Potential for re-hab: date referral made to CIT or RAS ? Will this budget assist in meeting carer needs? Any ideas, or alternative services that would have been useful, but do not exist or are unavailable? Has Assistive Technology been considered, and what was the outcome? Page 33 of 35 Have Direct Payments been discussed? Endorsed by Manager (to verify risks cannot be managed in any other way) Details of the budget request and any other Information? Decision Page 34 of 35 When is the care detailed required? Monday Tuesday Wednesday Thursday Friday Saturday Sunday Morning Midday Afternoon Teatime Evening Night Page 35 of 35
