Transcript Proposals for a Common Assessment Framework for Adults

Proposed Review of the National
Framework for Continuing Care
Background to
the proposed review
• Commitment to review made during development of National
Framework (introduced October 2007).
• Review is focussed key issues that have emerged during first
year of National Framework that would support consistency
and practice
• Purpose of today’s event is to gain views on key issues that
will help inform proposed review
• A chance to give views on any improvements that could be
made to the three Tools after a year of their use
• Improved practice and greater consistency during first year
Structure of
proposed review
• Process for review developed in partnership with
national Continuing Health Care Stakeholder Group
• Group includes SHAs, ADASS, LGA, ECCA, Mind.
Foundation for People with Learning Disabilities,
Alzheimer’s Society and Age Concern,
• Events/processes in each SHA, gaining views of key
stakeholders using template of questions
• National stakeholders also invited to respond to template
• Other key data considered
What happens next?
Outcomes from today to DH by 3 October
Then,
• October-DH and National Continuing Health Care
Stakeholder Group looks at messages from the events
plus other data
• November-National meeting of 50-60 key stakeholders
to finalise all the messages from the review
• November onwards-develop detailed proposals as a
result of the outcomes from the review
Key issues for
the proposed review
Three key issues
•
•
•
Content and use of the tools
Monitoring the implementation of the
framework
Equality impact
Other related issues
• The responsibilities of key organisations.
• Links between NHS Continuing Healthcare
and wider policies (such as personal health
Content and use
of the tools
•
•
•
•
The Decision-Support Tool in relation
to;
the wording of individual domain levels
the interaction of domains
the ‘system rules’ guiding its operation
the operation of the Fast-Track Tool and
the Checklist Tool
Content and use
of the tools
P
S
S
H
H
H
M
M
L
N
P
P
S
S
S
P
S
S
H
H
H
H
H
H
H
H
M
M
M
M
M
M
M
M
M
L
L
L
L
L
L
L
L
L
L
N
N
N
N
N
N
N
N
N
N
Cognition
Communication
Nutrition –
Food &
Drink
Behaviour
Psychological &
Emotional
Needs
Mobility
Continence
Skin &
Tissue
Viability
Drug
Therapies &
Medication:
Symptom Control
Altered
Breathing
states of
Consciousness
Content and use
of the tools
What have been the key challenges in using the
national framework tools?
Have the challenges been related to;
• the wording of the tools
• the rules on how the tools should be used
• the degree to which MDT members, service users
or carers understand the tools?
What would you suggest needs to change?
Content and use
of the tools
How helpful is the Decision Support Tool in
informing a decision about whether a person has a
Primary Health Need?
What changes would make the Decision Support
Tool more helpful in supporting making this
decision?
Monitoring the
implementation of the Framework
•
Though still early days for the new framework, there seems to
have been some improved consistency between regions.
•
What could be done to accelerate greater consistency in NHS
Continuing Healthcare assessments and decision-making?
•
What is the key data (up to five items only) to be collected and
monitored to help understand whether the national framework is
being applied consistently?
•
or how can we improve the current data that is collected
•
Should this be collected and monitored locally, regionally or
nationally and why?
Equality Impact
Equality Impact Assessment issued with National
Framework
What do you know about whether the national
framework is being implemented equally amongst
people from
• different ethnic groups
• genders
• ages or
• with varying types or disability?
• What would help you know more about whether the
framework is being applied equally?
Other issues-1
Organisational Responsibilities
PCTs are responsible for
• ensuring consistency in eligibility for CHC, in line with Framework
•
promoting awareness of NHS Continuing Health Care
•
implementing and maintaining good practice and quality standards
•
providing training opportunities for practitioners
•
identifying and acting on issues arising in Continuing Health Care
•
Informing strategic and individual commissioning arrangements
•
ensuring co-ordinator (post-checklist to decision-making/care plan)
•
ensuring case management and reviews
•
consulting with relevant local authority (as far as reasonably
practicable) before making eligibility decision
Other issues-1
Organisational Responsibilities
Joint duty on ‘NHS bodies’ (PCTs and NHS Trusts):
•
Ensure that an assessment for Continuing Health Care is carried out
where it appears there is a need for such care
•
Carry out assessment in consultation with local authority whenever
appropriate
•
Must consult with patient and, where appropriate, carers when carrying
out the assessment
•
If screening process is used, ensure that the Checklist is used for this
•
Ensure that MDT carries out (or makes use of) appropriate assessment
•
Ensure that DST is completed
•
Use DST to make decision on whether the person has a primary health
need
Other issues-1
Organisational Responsibilities
Local authorities:
• Duty to provide advice and assistance (as far as reasonably
practicable) to PCTs when they are consulted on eligibility
• Use information from community care assessment to fulfil
above duty wherever practicable
• Advice and assistance duty links to expectation in National
Framework that MDTs completing DSTs will usually have both
health and social care representation
• Duty to nominate IRP representatives
PCTs and local authorities should agree and use a joint disputes
process
Other issues-1
Organisational Responsibilities
SHAs are responsible for:
• strategic leadership, organisational and
workforce development
• ensuring local systems operate effectively and
deliver improved performance
• holding PCTs accountable
• responsibility for co-ordinating the Independent
Review Panel process.
Other issues-1
Organisational Responsibilities
• What are the key actions that have been taken
to address these responsibilities locally over the
past year?
• What are the most important actions that still
need to be addressed?
Other issues-1
Organisational Responsibilities
Are health and social care organisations
participating appropriately in the operation of the
National Framework?
If any are not, is this due to;
• lack of clarity over their responsibilities or
• local relationships or other local issues?
What would be of most help in supporting
appropriate participation?
Other issues-2
Links with wider policies
What are the key existing and emerging wider policies
that are relevant to people who receive Continuing
Health Care?
How clear are the links between the national framework
and these policies, both locally and nationally?
What should be done to create better links with these
policies?
Does this require local or national action and why?
Examples of
good practice
Can you identify any examples of good practice
of the commissioning and provision of NHS
Continuing Care?
Examples could be:
• giving patients a strong voice in the process
• outcome focussed assessment and care
planning
• supporting choice and flexibility in the
services offered
Contact details
Jeff Featherstone, Review Manager
[email protected]