Commissioning Continuing Care Team

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Commissioning Continuing Care Team

• Sally Forshaw and Elaine Hulmes
• Ashton Leigh Wigan PCT
• 8.12.06

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Background context

• An external review of Continuing Healthcare was
  commissioned by Whole Systems Partnership in Dec
  05
• The diagnostic phase of the review resulted in a
  detailed analysis of the Continuing healthcare
  process across the local health economy
• The outcome of the analysis revealed a need for a
  complete redesign of the CHC process

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Continuing Care Operations Group

• The Continuing Care Operations group was then
  established to agree a process pathway
• System Design model identified key
  responsibilities for providers and commissioners,
  including standards, governance and information

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Ashton Leigh Wigan PCTs Process Pathway for
Continuing Healthcare

• Screening 
• Referral Provider functions
• Decision making Commissioning function
• Procurement of package of care

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Standards
1.2.5 Process Standards
System Design suggested standard
Anytime Provider function
Daily/weekly Commissioner function
Monthly Commissioning function
Annual Contractual
Modernising the
NHS block contracts Modernising the market
through commissioning for quality/difference
Modernising mainstream NHS,social care
and housing services -
intermediate tier (the secondary
prevention agenda)

Geographical footprint/ sites/teams Networks
of trained and aware professionals across health
and social care who provide mainstream clinical
and professional assessments
Local Authority Panel screening and
allocating resources for long term care
Continuing NHS/FNC Healthcare Team Inter-professi
onal mix of knowledge and skills, team based and
singly managed. All care groups covered
Joint Resource Allocation Panel
(LA/PCT) Inter-agency forum for decision making
in respect of individual cases
From local teams to CHC team -50 of all cases
receive a response within 48 hours -95 within 5
days
From CHC team to panel -50 of all cases receive
a response within 5 days -95 within 10
days -Nobody should expect to wait longer than 20
days
From trigger to completion of stationery to
CHC team -Maximum of 5 working days
Standards
Fast-track for end of life or other similarly
urgent cases decisions should be reached within
48 hours of referral
Potential Journey Time Procurement for
fast-track clients (eg end of life) capacity in
service should be such as to ensure immediate (24
hr) input of service for complex cases
managed in local teams core services should
equally be put in place quickly (within 72 hours)
with other package elements secured within 28
days for complex plus cases managed by the CHC
Team procurement can take significantly longer
but with an absolute maximum of 6 months

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Commissioning Continuing Healthcare Team Ashton
Leigh Wigan PCT

• Assistant Director for Commissioning
• PCT Lead Nurse for Continuing Healthcare
• 5 Community Matrons Continuing Healthcare with
  backgrounds in
• - Community Nursing
• - Mental Health Nursing
• - Acute Nursing
• Social Worker
• 2 part time Admin support officers

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Commissioning Continuing Healthcare Team

• Team Functions 1
• Advising practitioners and clinicians of the
  referral process for determining eligibility.
•    Delivering training for the implementation of
  the new continuing healthcare process and
  supporting the training and development processes
  within provider organisations to ensure an
  awareness of the triggers.
•   Receiving the completed stationery from
  practitioners and clinicians and determining the
  completeness of that information for the purposes
  of making a decision on eligibility (i.e. the
  evidence test).

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Team Functions 2

• Referring back to the practitioner or clinician
  to request further evidence of need where
  necessary in order for a decision to be made.
• Making decisions on eligibility, based on
  delegated authority, and informing the referrer
  of outcomes in the agreed way (quorate of 2)
  this should include a recommendation for review.
• Preparing papers for submission to the Joint
  Resource and Allocation Panel (JAP)for individual
  cases where the team (quorate of 2) feels that
  complexity and cost suggest differing options, or
  difficulty in judgement, ensuring that all
  required information is collected and collated
  prior to the JAP in order that it can make an
  informed decision.

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Team Functions 3

• Initiating a programme of audit during the
  course of the first 12 months in order to
• Identify practice competence, issues of policy
  applicability and consistency
• Ensure that the quality of practice and
  assessment is high and applied appropriately
• Identify any changes to the process required in
  the light of its application (NB the audit
  processes could be designed and undertaken
  jointly by the team and providers or developed
  with a peer group partner).

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Team Functions 4

• Undertaking specific thematic training where
  audit suggests issues are arising and where
  practice needs to be enhanced.
• Compiling quarterly summaries of activity and
  caseload across the continuing NHS healthcare
  system whether people are supported in mainstream
  services or by the team itself.
• Reporting quarterly on achievement against key
  performance indicators such as the time taken to
  make decisions, numbers of appeals, rates of
  inappropriate referrals for funding and feeding
  this into appropriate training and development
  programmes.

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Team Functions 5

• Reporting regularly on both current commitments
  against the continuing care budgets and
  projections to alert the Panel as to priorities
  for market development, financial risk management
  and budget setting.
•   Case managing those complex plus cases (high
  cost, complex needs) in both the procurement of
  services to meet agreed needs and reviewing the
  cases at agreed intervals.
• Undertaking all RNCC determinations in line with
  the agreed processes across Greater Manchester
  recording need against determination.
• Providing advice where appropriate as the
  knowledge/policy experts in this area.

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Joint Resource and Allocation Panel

• To make decisions on complex plus cases
• To make commissioning decisions including some
  that may be contentious and difficult to agree. 
• To undertake market management and development
  including planning and linking into commissioning
  (LDP and LA budget cycle) 
• To resolve disagreements/disputes 
• To agree without prejudice interim
  arrangements 
• 1st stage review for declined fully funded NHS
  continuing healthcare applications

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Data base

• Once the process was re-designed the requirement
  for an effective data collation and analysis
  system was essential
• The PCT took the decision to purchase a
  specifically designed software package with the
  functionality to meet the needs of the
  organisation with regard to Continuing Healthcare
  
• The QA CONI system was chosen

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QA CONI Data base

• Functionality
• Manage the Continuing Care and Funded Nursing
  Care Process
• Perform efficient financial processing
• Ease production of reports
• Improve the quality of administrative support for
  the team involved.
• The software was specifically adapted to
  accommodate the PCT process pathway including PCT
  specific stationary

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The Future

• The PCT and the Local Authority are committed
  to undertaking a Critical Friend review of the
  Continuing Health Care process in March 2007

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Thank-you