Your Views on NHS Continuing Healthcare. A consultation on proposed policy review for Mid Essex Clinical Commissioning Group

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1 Your Views on NHS Continuing Healthcare A consultation on proposed policy review for Mid Essex Clinical Commissioning Group Monday 11th May - Sunday 5th July 2015

2 Contents 1. Introduction Who is Mid Essex Clinical Commissioning Group? What is this document about? What are we consulting on? Why does anything need to change? Scope of this document The options Your views count Timetable Appendices 10. Appendix 1: Reference List Appendix 2: Questions & Answers Appendix 3: Distribution List

3 1. Introduction NHS Mid Essex Clinical Commissioning Group (CCG) has commissioned Enable East to run a consultation on its behalf on proposals regarding how NHS continuing healthcare (sometimes also known or referred to as CHC) is provided at home. NHS continuing healthcare is a package of care funded solely by the NHS that is awarded to eligible adults to meet needs that have arisen as a result of disability, accident or illness. It may be provided in any setting including, but not limited to, a care home, residential/nursing or the person s own home. Enable East is an independent NHS team that assists health and social care organisations to deliver effective projects. We are a not-for-profit organisation working for and within the public sector. Mid Essex CCG says it wishes to demonstrate complete transparency, openness and objectivity in relation to this consultation and has therefore asked Enable East to run the process on its behalf. Mid Essex CCG wants everyone eligible for NHS continuing healthcare at home to have quality, safe care coupled with fair and equal access to services 2. Who is Mid Essex Clinical Commissioning Group? Clinical Commissioning Groups (or CCGs) are responsible for buying (commissioning) most healthcare for their populations. The 211 CCGs across England came into being in 2013 after an NHS reorganisation. CCGs are clinically led groups, including GPs and other health professionals, who buy NHS services such as emergency care, elective hospital care, and community and mental health services. CCGs are responsible for managing the process of NHS continuing healthcare and making decisions about the eligibility of patients. They are also responsible for funding and arranging healthcare packages, with a few exceptions. 3. What is this document about? Mid Essex CCG wants to hear your views on NHS continuing healthcare and the local policy regarding how care is provided at home. This document sets out: The current facts about NHS continuing healthcare Why the CCG is proposing change Three possible options How you can have your say 3

4 If you are a patient or family member of someone currently receiving NHS continuing healthcare at home, we want to hear your views and experiences of the process and how we could make changes. However, the issue affects everyone as it concerns the way the CCG spends public money on healthcare for the population of mid Essex. The CCG wants an open and honest conversation about how NHS continuing healthcare is delivered and how individual care should be allocated. We want patients to be at the heart of this debate, so any proposed future changes to the policy are guided by the views of the people NHS CHC aims to help. 4. What are we consulting on? Enable East, on behalf of Mid Essex CCG, wants to engage people in a conversation about how NHS continuing healthcare is provided at home in the future. NHS continuing healthcare was established nationally in It refers to 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. Such care is provided to someone aged 18 or over to meet needs that have arisen as a result of disability, accident or illness. It is given to individuals who have complex, intense and unpredictable health needs, which often depend on the care of highly trained healthcare professionals on an ongoing basis. This consultation is about the local policy of NHS continuing healthcare and proposed changes to how resources are NHS continuing healthcare can be provided in a range of settings allocated to supporting including a care home, residential/nursing or a person s own home. people at home In meeting the reasonable needs of people who are eligible for NHS continuing healthcare, CCGs must comply with the relevant national guidance. However, national guidance is not prescriptive as to the packages of care services that must be provided by CCGs. Therefore, CCGs have discretion to meet the needs of each individual and allocate appropriate resources. 5. Why does anything need to change? 4 Mid Essex CCG is proposing a local policy for NHS continuing healthcare to ensure all packages of care are appropriate, safe, effective and based on realistic expectations when delivered at home Since 2007, when the policy on NHS continuing healthcare was established, there have been a lot of changes in the NHS and a worldwide recession which has affected all public services. All CCGs, who commission healthcare on behalf of their populations, need to be accountable for how they spend public money. They need to make funding go further and find ways of being innovative, fair and sensible about how money is spent on healthcare. Last year, Mid Essex CCG launched its five year plan to improve health and meet the rising demands of a growing population. The CCG wants a healthcare system which can do more in terms of prevention, target those who are at greater risk and avoid crises, prevent deterioration and support recovery all within a challenging financial envelope. When the CCG formed in 2013, it inherited responsibility for funding widely

5 diverse packages of NHS continuing healthcare. All care packages will continue to be reviewed, as per each individual s care plan, to ensure they are still providing the safest and most effective care based on individual needs. The CCG s role is about responsible commissioning taking both a strategic and individual approach to fulfilling its responsibilities. Responsible commissioning is also about looking at how and from where care is provided, to secure high-quality services that offer value for money. Why the CCG believes change is needed: Mid Essex CCG has a budget of around 400 million of public money to provide NHS services and care from birth to end-of-life. This budget needs to be allocated in a fair and balanced way to meet the needs of the population. In 2013/2014, the CCG spent 15 million of this budget on NHS continuing healthcare. That rose to 23 million in 2014/2015. The CCG knows and understands the demand for NHS continuing healthcare is rising and this is why it wants to seek a fair solution to a policy that will continue to support all those eligible in the future. Care at home for existing patients will not be affected under any of the three options. However, the examples below demonstrate the widely varying packages of NHS continuing healthcare currently being delivered at home: 1. Out of 300 individuals receiving NHS continuing healthcare, there are currently 47 packages of care being delivered at home that exceed 1,000 a week 2. The average cost of these is 2,800 a week 3. The most expensive is 6,900 a week 4. Some packages of care at home require 24 hour care 5. Some packages of care require more professional input including 2-to-1 care This is why the CCG believes a fairer, more equitable and proportionate policy on NHS CHC is needed. The CCG continues to remain committed to supporting care at home where it is practicable, safe and effective, and within a realistic NHS funding allocation. The CCG understands this is a difficult and challenging conversation, as it may affect the most vulnerable people. Therefore, we invite you to share your views. See how Section 8 for how to do this. 6. Scope of this document Mid Essex CCG covers the local populations of the following areas: Chelmsford and surrounding areas Maldon and surrounding areas Braintree and surrounding areas The CCG proposes to make some changes to the local NHS continuing healthcare policy. This would affect: New patients who may be eligible for a complex and intensive package of NHS continuing healthcare in future and want to stay at home This would not affect: Existing or new patients receiving NHS continuing healthcare or NHS-funded healthcare in a residential or nursing home setting 5

6 New patients receiving NHS continuing healthcare at home whose care package would fall below the proposed threshold level if the CCG s preferred option was adopted (see Section 7 Option 3) Existing patients receiving NHS continuing healthcare at home, unless your care needs change* *Please note. Following this consultation, Mid Essex CCG will be talking to NHS continuing healthcare providers. Care providers may change for some existing patients who receive NHS continuing healthcare at home. The current eligibility criteria for NHS continuing healthcare will not change. The CCG is guided by, and will continue to adhere to, the NHS National Framework for continuing healthcare and any future revisions to it. Existing patients will have their care reviewed annually. Those with the most complex needs and whose care package exceeds the threshold under the CCG s preferred Option 3, will continue to have their care delivered in the setting of their choice. There may potentially, however, be a change in who provides that care, to ensure the best care and value for money. There will be no decision made without first discussing this with each individual and their carer or family. This consultation is about local policy and not about individual aspects of care plans. 7. The options There are three options for NHS continuing healthcare that Mid Essex CCG would like your views on: Option 1: No change to current local policy Would Change Might Not Change Would Change The CCG would need to make savings across other healthcare services No change to the existing NHS continuing healthcare policy Option 2: Change local policy. The option for new patients to receive NHS continuing healthcare at home, but only up to what the same care would cost in a residential or nursing home setting Under Option 2, the CCG would only resource NHS continuing healthcare at home to the cost of the same care delivered in a residential or nursing home setting. A person s choice of care at home may not be agreed if their assessed care needs were above this level. 6 Would Change Might Not Change Would Change A robust and transparent local policy for the fair and equitable allocation of resources to new patients receiving NHS continuing healthcare at home New patients whose clinically assessed needs meant their care package would be above this cost would need to be cared for in a residential or nursing home setting Who provides care to existing patients receiving NHS continuing healthcare at home Who provides care to new patients receiving NHS continuing healthcare at home No change of care for existing patients of NHS continuing healthcare as per their assessed care needs

7 Option 3: Change local policy. The option for new patients to receive NHS continuing healthcare care at home, with funding allocated up to 10% above what it would cost for the same care in a residential or nursing home setting The CCG recognises that the cost of care at home is generally higher than care delivered in a residential setting. This is why it is proposing this option. Would Change Might Not Change Would Change A robust and transparent local policy for the fair and equitable allocation of resources to new patients receiving NHS continuing healthcare at home This would affect new patients requiring more intensive, complex and high cost packages of care Who provides care to existing patients receiving NHS continuing healthcare at home No financial threshold for existing patients of NHS continuing healthcare whose assessed care needs would exceed this threshold. The CCG would continue to allocate resources above 10% for existing patients as care needs dictated Under Option 3, the CCG recognises there may be situations where a new patient s preferred choice of care at home cannot be agreed. For example, if it was unsafe to provide at home the level or complexity of care needed or if the cost exceeded the 10% threshold. The CCG prefers Option 3 as it believes this option would be fairer on new patients choosing NHS continuing healthcare at home. The CCG wants to achieve the following: Access to NHS continuing healthcare at home should be proportional and equitable to everyone living in mid Essex Packages of NHS continuing healthcare at home need to be safe, reasonable, realistic, consistent and fair so services are sustainable into the future Supporting people in their own home has to be balanced against making the best use of finances and resources available so spending on healthcare is fair for everyone No decision has been taken. Mid Essex CCG prefers Option 3 for the reasons given, but they want to hear your views. You may have other ideas. Your voice is important. The CCG wants this to be an open and transparent debate. You can respond in a number of ways see Section 8 for more information. Mid Essex CCG continues to support care at home and would support someone s preferred place of care wherever possible, safe and realistic. The CCG would never withhold care from someone who met the criteria for NHS continuing healthcare 7

8 Please note: It is not the purpose of this consultation, and it would not be appropriate at this stage, to address individual questions about how individual care may be affected. We understand you may have questions about your own care or the care of a family member or friend. The purpose of this consultation is to get your views on the direction of policy for the CCG. Taking into account everyone s views, if the CCG did decide to change the NHS continuing healthcare policy, then further conversations would happen with anyone who may be affected. This would be on an individual case-by-case basis as and when care packages were due for review see Section 9 for more information. Exceptional cases: If a change in local policy was adopted: 1. Mid Essex CCG may be prepared to consider funding a package of care where the anticipated cost to the CCG is more than it would usually expect to pay. The CCG would have regard to the individual s assessed health and associated healthcare needs 2. Exceptionality would be determined by Mid Essex CCG on a case-by-case basis and considered in accordance with the CCG s Individual Funding Request Policy 8. Your views count Enable East, on behalf of Mid Essex CCG, wants to hear from anyone who may be affected by this consultation and the local community. The CCG wants to listen to people s views and ensure any change in policy takes account of what people have said during this consultation. Those already receiving CHC at home We want to hear your experiences of your journey into NHS continuing healthcare: What was access like? What prior knowledge did you have? How was the application experience? What improvements would you like to see? Providers of CHC at home We want to hear from providers of NHS continuing healthcare as part of this consultation. Mid Essex CCG also wishes to engage further with providers at the conclusion of this consultation exercise. Wider Stakeholders This consultation is also a matter for wider views as it concerns the way the CCG spends public money on healthcare for the population of mid Essex. 8

9 You can give us your views on this consultation in a number of ways: Drop-in Events You are welcome to come along to any of our drop-in events. They will be one hour long and will be attended by a clinical lead or manager from Mid Essex CCG. It is your chance to understand more about NHS continuing healthcare and the options. You will have the opportunity to ask questions. Please let us know if you are interested: By By phone: Linda Williams Please tell us which drop-in event you would like to attend: Date Venue Time 8th June 2015 Springfield Parish Community Centre, St Augustine s Way, Springfield, Chelmsford, Essex, CM1 6GX 6pm - 7pm 9th June th June th June th June th June 2015 Braintree Town Hall, Fairfield Road, Braintree, Essex, CM7 3YG Combined Military Services Museum, Station Road, Maldon, Essex CM9 4LQ Braintree Community Centre, Hollywood, Bocking End, Braintree, Essex, CM7 9AH Greenacre, Newport House, Sandon, Chelmsford, Essex, CM2 7TL Maldon Community Centre, Sunbury Way, Maldon, Essex, CM9 6YH 11am - 12pm (noon) 11am - 12pm (noon) 6pm - 7pm 11am - 12pm (noon) 6pm - 7pm We are happy to meet patients in their own home if they are unable to attend a drop-in event. Please contact us as below. Similarly, if your group or organisation would like a meeting, please send a request via the address: By By phone: Linda Williams on Survey You can let us know your views in writing by completing our Mid Essex CCG Consultation Survey, which accompanies this document. You can return a completed hard copy to the address below. This survey is also available to complete online via 9

10 In writing or via You can send your views as follows: By By post: Enable East, NHS Continuing Healthcare Consultation, The Laurels, Severalls Hospital, Boxted Road, Colchester, CO4 5HG By phone: Linda Williams on The closing date for feedback is Sunday 5th July A summary report of this consultation and feedback gathered will be presented by Enable East to Mid Essex CCG at its Governing Body meeting on the 29th July Members of the CCG will consider your feedback and may decide to adopt changes to the NHS continuing healthcare policy as a result of the report. 9. Timetable For the consultation process: 11th May 11th May 3rd July 5th July Consultation process begins Drop-in events, group meetings and home visits to patients and their families, where required End of public consultation period Post consultation: July 29th July End of July August - September August onwards Enable East to gather all feedback and draft an outcome report for Mid Essex CCG Governing Body meeting Mid Essex CCG Governing Body meeting: Outcome of the consultation presented and CCG decision on NHS continuing healthcare policy. Any change to NHS continuing healthcare policy will take immediate effect following decision by the Board Inform all stakeholders of decision Engage with providers delivering NHS continuing healthcare at home Engage with those individuals affected by any new policy decision ahead of roll out 10

11 10. Appendix 1: Reference list Reference list Some useful background reading on NHS continuing healthcare can be found as follows: What is NHS continuing healthcare? What is NHS continuing healthcare? easy read read.pdf The National Framework for NHS continuing healthcare and NHS funded nursing care: 11

12 11. Appendix 2: Questions & Answers 12 Here, Mid Essex Clinical Commissioning Group aims to answer some questions you may have about NHS continuing healthcare and this consultation. Q. What is NHS continuing healthcare? NHS continuing healthcare, sometimes commonly known as CHC, is long-term care for people with complex, intensive and unpredictable health needs which often depend on the care of highly trained healthcare professionals. It refers to a package of ongoing care that is arranged and funded solely by the NHS, where an individual has been found to have a primary health need as set out in the national guidance. Services under CHC can include health, personal and social care. NHS continuing healthcare can be provided in a range of settings including residential or nursing homes, or in someone s home. However, your views are important. We particularly want to hear from those who are currently receiving NHS continuing healthcare at home or have in the past. We would like get your feedback so we can further improve how we commission this service and learn from your experiences. Q. So what are you changing? We are not changing anything without first consulting you (a distribution list is in Appendix 3 of this consultation document). The current eligibility criteria for NHS continuing healthcare will not change. This is about local policy change with regards to the allocation of resources for NHS continuing healthcare at home. We have three options for consideration. The options are laid out in Section 7 of this consultation document: Option 1: Make no change in local policy for NHS continuing healthcare Option 2: Change local policy. The option for new patients to receive NHS continuing healthcare at home, but only up to what the same care would cost in a residential or nursing home setting Option 3: Change local policy. The option for new patients to receive NHS continuing healthcare care at home, with funding allocated up to 10% above what it would cost for the same care in a residential or nursing home setting We want to continue supporting care at home and would support someone s preferred place of care wherever possible, safe and realistic. We believe we need a robust local policy for NHS continuing healthcare which ensures all packages of care are appropriate, safe and effective, and based on realistic expectations of what can be delivered at home. We believe access to NHS continuing healthcare at home should be: Proportional and equitable to everyone living in mid Essex Reasonable, consistent and fair, so services are sustainable into the future Balanced against the needs of the population as a whole to ensure spending on healthcare is fair to everyone

13 If a new policy is adopted, there will be no change to how resources are allocated until we have had detailed discussions with each individual who may be affected. This will be on a case-by-case basis. Q. How will this affect me? It is not the purpose of this consultation to address questions about how individual care might or might not be affected. This consultation is about the direction of policy. Taking into account everyone s views, if we did change local policy, there would be detailed and individual discussions with anyone affected. The scenario we can give is as follows: If Option 3 was adopted: New patients: The new policy might affect those who may be assessed as needing a more complex and intensive package of NHS continuing healthcare in future and want to stay at home. They would receive funding of up to 10% above what it would cost for the same care in a residential or nursing home setting. It would not affect those currently or in future receiving NHS continuing healthcare at home and whose care package falls below the proposed threshold in Option 3. Existing patients: This would not apply to existing patients of NHS continuing healthcare at home whose package of care may continue to exceed the proposed financial threshold after their care has been reviewed. Everyone receiving NHS continuing healthcare at home will be reassessed at their review period to ensure their care package is still relevant to their needs. It may be that existing patients see a change in who provides their care. This will only happen when their care package is reviewed and only after discussions with the individual concerned and their family or carer. This is about NHS continuing healthcare as it is provided at home. Those in residential or nursing home settings are not affected. Q: If this is about more complex and intensive packages of care, then surely these people really need this care, regardless of cost? The question is about proportionality. There needs to be a fair balance in how resources are allocated. We would never withhold funding from someone who is eligible for NHS continuing healthcare and whose assessed needs demonstrate a more complex care package. There may be situations, though, where we have to consider whether the level or sheer complexity of need is appropriate or safe to be delivered at home. We would need to discuss with each individual patient: How and to what level the NHS could fund that care at home Whether it would be more appropriate, taking into account the individual s care needs, to provide that care in a residential or nursing home setting CCGs have a statutory duty to promote a comprehensive health service. They also have a duty to ensure each year their spending does not exceed their financial allocations. Q: Does this mean you are cutting services? This consultation is about proposals to change local policy to ensure the fair and equitable allocation of NHS continuing healthcare in the future. We want to be able to provide the care that people want and need in a place of their choice, but we need to have a fair and equitable approach. The resources available to the NHS are limited and the need is to ensure a proportionate and equitable distribution. 13

14 We want to hear everyone s views, particularly those of existing patients receiving NHS continuing healthcare at home. We want to know what s important to you and hear your experiences. Please complete the consultation survey either online at or send a completed copy in the post to Enable East as indicated at the end of the questionnaire. Q: Why would providers change for existing patients if the policy is only for new patients? As a commissioner of NHS services, we have a duty to ensure the best care which also represents value for money. We have a responsibility to ensure all services we commission are cost effective. Q: Are there exceptions? We may be prepared to consider funding a package of care where the anticipated cost to the CCG is more than we would pay as per the threshold under Option 3 if a change of policy was adopted. We would need to review the individual s assessed health and associated healthcare needs. Exceptionality would be determined on a case-by-case basis and considered in accordance with our Individual Funding Request Policy. 14

15 12. Appendix 3: Distribution list This consultation was initially distributed to the following: Existing patients, families and carers of NHS continuing healthcare at home Community and voluntary organisations in mid Essex Adult and young people s care services District, town and parish councils Essex County Council (including adult social care services and children and young people s care services) Essex Health and Wellbeing Board Essex Health Overview and Scrutiny Committee HealthWatch Essex Hospitals and relevant service providers in mid Essex Local MPs Mid Essex contacts for groups representing older people, mental health, children and people with disabilities Mid Essex CCG Patient Reference Group NHS England (Essex and Midlands and East) Mid Essex GPs Mid Essex Patient Participation Groups (Trusts and GP practices) Essex Clinical Commissioning Groups and Commercial Support Units Press and media contacts Libraries 15

16 Mid Essex CCG Consultation Enable East The Laurels 2 Boxted Road Colchester Essex CO4 5HG

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