Continuing Healthcare (CHC) Alison Kemp Director of People, - - PowerPoint PPT Presentation

‘Corby and Nene CCGs working together for Northamptonshire’

Continuing Healthcare (CHC)

Alison Kemp – Director of People, Partnerships and Integration Caron Williams – Director of Health Strategy and Planning

CHC Transformation

• CHC and CCG statutory duties
• Current position
• LPF Process (Lot 2B)
• Outcomes and local requirements
• Market Management
• Next steps

CCG Statutory Duties

• NHS Continuing Healthcare means a package of ongoing care that is

arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Guidance (DH revised 2012).

• Such care is provided to an individual aged 18 or over, to meet needs that

have arisen as a result of disability, accident or illness.

• The services provided as part of the package should be seen in the wider

context of best practice and service development for each client group.

• Eligibility for NHS Continuing Healthcare places no limits on the settings in

which the package of support can be offered or on the type of service delivery.

• CHC is comprised of the following key components:

– Clinical assessment – Brokerage (market management) – Care pathway redesign (CHC is a point of assessment of need and not a care provision service and therefore informs tactical commissioning requirements: frailty, Learning Disabilities, Mental Health, End of Life Care)

Current provision

National Picture:

• Significant focus on eligibility rate reviews and

quality including public/media scrutiny

• National CHC QIPP ask is £220 million savings by

2020 considering cost removal not cost transfer (notably to LAs)

• Changes to the way CHC services are being

delivered: – Review of options on provision (provider model) – Changing market in relation to providers – STP impact re pathway integration

• Changes to the National Framework from

October, mandatory under Gateway instruction: – Introduction of plans for Personal Health Budgets – Eligibility review / package of care reviews to end requiring improved delivery of initial assessments Local Picture:

• Fluctuating performance in relation to national

requirements notably eligibility assessment

• Integrated model across CHC provider and CCG

supported by external resource

• Risk in relation to the available of ongoing

clinical support to the CCG (workforce)

• Targeted QIPP programme delivering over

2017/18 and 2018/19 above plan. This includes improved assessment, review and the management of the local market for improved value outcomes

• National review of the local system indicates
• pportunity to go further in relation to QIPP.

This was supported by a locally led assessment process.

• PHB model implemented in part but not

universal coverage

LPF process

• In 2016/17 the CCGs undertook a procurement process through the LPF

and CHC provision was included in Lot 2B

• There was only 1 bidder against the specification who later withdrew
• The current local integrated solution is a response to ensuring on-going

provision on an annual NHS contract and MOU arrangement.

• The LPF does not represent a full market test and the market and local

environment has changed in the period since the procurement was suspended

• To ensure the delivery of the: CHC clinical assessment services, enhance

the brokerage model, and opportunity to embed CHC in full pathway redesign, a new commissioned solution is required.

Outcomes based model

• Nationally the traditional CSU model of delivery has been challenged and
• ther options of best practice are being explored
• Across England CCGs continue to implement revised models for CHC

delivery through new and integrated solutions in order to manage the service and its demands, both financial and quality

• Emerging STP models for improved population management with a strong

focus on improving outcomes for individuals with complex needs are developing: place based delivery.

• CHC necessitates a new model approach - a shift from ‘activity’ to
• utcomes; from episodic, fragmented care to a coordinated whole system

approach where outcomes are monitored and measured, where cost is controlled and not controlling.

• The new service model will be required to comply with the CCGs statutory
• bligations and the National CHC Framework, provide additionality to the

arrangements currently in place and offer improved sustainability.

Key Issues

How do we use current levers to deliver improvement:

• Current model not delivering best value
• National review of model and approach
• National requirements to improve process, quality
• utcomes and costs
• Local delivery plan for improvement
• HCP programmes for older adults and learning

disability

Key components of CHC

Clinical Assessment Brokerage/Market solutions Care Pathway redesign (tactical commissioning)

Delivery Model

Clinical Assessment

• Enhanced service

specification

• Engagement of market
• Agreed resource

envelope

Brokerage/Market

• Integrated system

response required – alignment with Urgent Care programme and HCP plans

• Section 75 to pool

budgets and wider resource and reporting

Care Pathway redesign

• Integrated planning

supported by improved information

• Commissioning Board

to review and approve

Next Steps

• The CCGs have commenced the development of the

appropriate outcomes based specification

• A resource model and mobilisation plan has been

reviewed and will be agreed through the existing transition group

• The appropriate market notifications will be issued

(August/September)

• Internal due diligence will commence noting current

contract, national framework and legal requirements (September)

• Mobilisation of new service arrangements to be in

place from April 2019.