Briefing Paper on Continuing Health Care (CHC).

Transcription

1 North Norfolk CCG Governing Body Meeting, 21 May 2013 Briefing Paper on Continuing Health Care (CHC). 1. Purpose 1.1 The purpose of this paper is to brief the Governing Body on the background and scale of the CHC challenge facing the CCG. It also sets out the arrangements for the joint CCG Turnaround Programme which has just commenced, and seeks the view of the Governing Body as to how it wishes to receive progress reports on this work. 2. CHC brief background. 2.1 Where an individual s care needs are predominately driven by a health need the NHS becomes liable to fund in effect the social care component of that person s care rather than it being funded, subject to a means test, by the individual or local authority. 2.2 Over the last decade there has been a number of policy documents which have variously moved the boundary about where CHC starts and ends though the latest guidance, the National Framework for NHS Continuing Care and NHS funded nursing care (DOH, updated April 2013), has for the time being provided a stable platform against which claims are assessed. 2.3 The cost of CHC to the NHS has grown significantly in recent years, largely as the public have become more aware of their entitlement to claim such costs from the NHS. 2.4 Last year, in an attempt to flush all historic claims out of the system the Government set a deadline of 30 September for receipt of such claims by the NHS. These are known as Restitution Claims. In reality it is unclear if the NHS will legally be able to resist future historic claims despite this deadline. The PCT received around 1300 claims for CHC restitution following the September deadline. 2.5 This paper considers the 2 issues of Restitution and new claims as separate workstreams, and have different levels of priority accorded to them.

2 3. CHC in Norfolk 3.1 NHS Norfolk and Waveney experienced very high levels of cost increase and overspend on its CHC budget in 2011/12 and 2012/13 despite significant budget increases. NHS Norfolk s overspend on CHC totalled 19.7m in 2012/13, equating to 10.8m for Restitution and 8.9m for new claims. The figures for NNCCG were 2m and 4.6m respectively. 3.2 Despite a number of plans and commitments given during the last year, in practice it was difficult to see any progress being made on arresting this trend, often because of inadequate activity and financial information. 3.3 Though national data is not routinely produced it would appear at least anecdotally that Norfolk, and indeed NNCCG, has a higher exposure to CHC costs than other parts of the country. Some of this inevitably reflects demography, but also perhaps the extent to which people self-fund their social care, as in communities where more of the population access state funding there is no incentive to pursue CHC funding. 3.4 The two comparative charts below suggest that whilst overall numbers of people eligible for CHC in Norfolk are at national average, the spend per head of population is some way above it. It is therefore likely that the most significant savings can be delivered by better procurement and contract management rather than reviewing eligibility criteria

3 4. Accounting for CHC Restitution Costs 4.1 A major accounting problem has arisen over the accounting treatment for CHC restitution which has the effect of significantly impacting the CCG s financial plans in 2013/14. This is because only the known element of CHC restitution costs at 31 March 2013 could be provided for in the PCT s final set of accounts, with the remaining estimated liability of 14.2m only being declared as a contingent liability in the accounts. The NNCCG portion of this estimated contingent liability is 3m. 4.2 Guidance from the Department of Health has determined that CCGs are the successor bodies to PCT s with respect to CHC commissioning, and therefore this liability moves to CCGs. This position does not sit comfortably with the previous Secretary of State s assertion that CCG s would not inherit legacy debt from PCTs. 4.3 The CCG has raised on several occasions with NHS England the need to find a satisfactory funding solution for these costs and it was hoped that central funding would be forthcoming to assist in meeting them. To date this has not happened and it would seem imprudent to assume that it will, though the CCG should continue to raise this with NHS E and politicians. 5. Actions taken to date by CCGs. 5.1 Given the size of the financial challenge presented by CHC, NNCCG in common with West Norfolk, South Norfolk and Norwich CCGs did not believe that sufficient internal management capacity was being directed at CHC either within CCGs or the CSU. An experienced Turnaround Director, Steve Macro of Connect Business Management Services has therefore been engaged to lead and manage a process of CHC Turnaround with the aims of:

4 Improving the efficiency and effectiveness of the CCGs CHC processes Delivering the QIPP savings identified in CCG financial plans. 5.2 The Steering Group chaired by Ann Donkin, CO of SNCCG has been established and meets fortnightly. It has established a comprehensive project structure with named leads and project teams for 3 workstreams covering: Operational delivery of CHC assessment and reviews Commissioning Strategy Contracting and Procurement 5.3 Some of the key actions for the project include: Better contract management of providers so as to avoid additional costs being claimed for The rationalisation of provider contracts (there are at present in excess of 270 separate providers of CHC) Incentivising NHS providers to continue to support patients within existing resources rather than passing them to new providers Assessing the extent to which personal budgets can help reduce the costs of CHC. 5.4 NNCCG are represented by Mark Taylor (Vice Chair) and Jackie Schneider on the Steering group, and John Everson and Jackie Schneider on the Commissioning Workstream. 5.5 It should be noted that the focus on the Turnaround Plan is solely on the management and costs of new claims, i.e. it will not address issues related to Restitution. This is because to a very large extent there is little the CCG can do to affect the cost of Restitution Claims beyond ensuring that there is a timely, robust but fair process for assessing claims in place. CCGs are currently in discussion with the CSU over the resourcing of this. There is an onus on the NHS to complete claims quickly as an 8% annual interest charge is made on the value of claims. 5.6 The Terms of Reference are attached at Appendix CHC in the CCG Financial Plan 2013/ Assumptions about the costs of CHC and our ability to reduce them are central to the CCGs financial plan in 2013/14. New claims: The CCG plan assumes an increase of 15%, equivalent to 2.5m, over 2012/13 levels in the CCG budget with planned QIPP savings of 2.1m against this. From the data shown in above, it would appear that the primary reason for Norfolk s high CHC costs is the cost of care packages rather than their number per se. Other benchmark data has also suggested that most efforts should be focussed on reducing costs rather than eligibility criteria.

5 Restitution Claims No funding was provided in CCG financial allocations to cover this cost as none had been incurred at the time of the baseline exercise carried out in Summer The only source of funding which could be used to cover this in 2013/14 therefore is the 2% Transformation Reserve. However use of this funding would all but fully utilise it ( 3m of 4.1m) and prevent the CCG for using it for other purposes, which predominately would be to act as a mitigation of risk around the non-delivery of planned QIPP savings. 7. Risk Share Arrangements 7.1 CCG CFO s have recently concluded a detailed risk share agreement for 2013/14 which seeks to reduce individual CCG exposure to unnecessary risk, predominately from volatile, low volume high cost episodes of care. CHC claims fall into this category and it is proposed therefore to risk share CHC restitution costs in their entirety and risk share any new claims with an annual cost equivalent to 100,000, or 8,333 per month. 8. Settlement of Restitution Claims 8.1 The volume of claims received across Norfolk is too great to be handled within the current resources available at the CSU. The CSU has provided a business case to the CCGs for settling the claims, which indicates the cost of the service over 2 years to be around 2m. The business case is being considered at the moment in terms of procurement rules, value for money and deliverability. 9. Conclusions and Recommendations a. CHC is a major commissioning issue for the CHC both in terms of ensuring a timely, robust but fair process of assessment but also reducing costs in the procurement of care packages. This represents the largest single QIPP scheme in the CCG s financial plans and it is therefore imperative that the Governing Body retains careful oversight of progress. b. The Governing Body therefore is requested to: Note the background and context to CHC set above To continue to lobby NHS England and other decision makers regarding the funding of restitution costs Approve the CHC Turnaround Project arrangements set out above Consider how it would like to receive progress reports on CHC through the year. Mark Taylor Helen Stratton

6 Chief Officer Chief Financial Officer