News

Practicality, priorities and pain: What is the way forward for efficient and fair CHC reviews and assessments?

By Dr Gabrielle Silver, CEO

Local authorities and CCGs are beginning to grapple with NHS England and Improvement’s updated guidance on Continuing Healthcare, working through new processes and guidance on how to deal with the numerous deferred assessments on their desks, as well as handling the new cases coming through every day. What are the key considerations and implications for this restart?

To discuss these implications, recently 157 professionals from CCGs and local authorities joined The way forward for efficient and fair CHC reviews and assessments, the second session in our ongoing webinar series. Sydney Hill, Head of Health and Care Strategy at Richmond and Wandsworth Councils and Ben Troke, Partner, Health and Social Care at legal firm Hill Dickinson shared their insights on the implications of the new guidance. As with so many discussions, the webinar appeared to raise more questions than it answered.

And this of course was its purpose: to stimulate thinking about how best to deliver a national programme at a local level. 

Managing expectations

Sydney Hill noted that: “Most important is our commitment to service users – we have to keep them informed and manage expectations. We took the decision during lockdown to complete reviews remotely and to as high a quality as we could.”

Like other local authorities and commissioners, she has started by seeking answers to the fundamental requirements for successful delivery: 

• What is the exact number of citizens in local authority and CCG care, either funded under Covid-19 conditions or who are awaiting an assessment? How do we prioritise these people?
• What is our approach to remote assessments and how do we co-ordinate information between our teams and the CCGs? 
• How can a Trusted Assessor model be introduced as a dynamic tool for both stakeholders and one which maintains the quality of assessment expected?

Ben Troke echoed the sentiment about managing expectations, from both the perspective of patients and families, but noted that as professionals, “we need to manage our own expectations of what we can expect over the next few months.” He emphasised the need for the following 3Ps: Practicality, Priorities and – more ominously – Pain.

Practicality

Now that Coronavirus Act funding (via Treasury) for care has effectively been stopped, the drivers are practical and financial, though the law suspending the legal duties to assess for CHC has not (yet) been reversed. An estimated 55,000 people remain on interim funding and there is a surplus of deferred assessments to be completed. This will take extra resources and funding and must be done “as soon as practicable”, according to government guidance.

Priorities

Prioritising means making decisions about who to assess first – the backlog or the business as usual?  And do we prioritise giving funding to those who should have it but don’t, or removing it from those who have it and should not? Said Ben: “in many ways it can be more difficult to stop or take something away than it is to say ‘no’ in the first place.”

These conversations require a specific and particular skillset, together with a locally agreed, pragmatic approach to decision-making, in line with the 2012 regulations, and the National Framework.

Pain

“The pandemic saw some brilliant working relationships across different organisations in the face of a crisis,” said Ben, “but now that the central funding has ceased, those budgetary tensions may re-emerge.” He expects disputes will increase and notes that there may be difficulties with the expectations of families who have been in receipt of funding which may now stop.

Ben said organisations will need to be open and transparent about their decision-making and will have to be able to defend it. “Avoid litigation and challenge as much as possible; CCGs and local authorities should understand their legal position and understand that guidance is just that – guidance. If you have your own policies, follow them. Take account of the things you are obliged to do and don’t make promises you cannot keep. Remember the law is not only a stick to beat you with, but can also be a shield to protect you.”

Trusted Assessor

The Trusted Assessor model is one area that poses a challenge for CCGs and local authorities. The legislative framework is clear that a multi-disciplinary team (MDT) will need to be involved. Speaking for local authorities Sydney said, “local authorities will feel disengaged if decisions are being made without our input.” The panellists agreed that further clarity from NHS England and Improvement and an understanding how others have done this successfully would be valuable for all concerned. 

But the Trusted Assessor is not just about a single agent trusted by both stakeholders. It is also about how best the information gathered in one arena such as Continuing Healthcare, can be shared with other stakeholders in their own Care Act Assessment. After all, we have been looking at the Single Assessment Model since 2001, and perhaps the new guidance can act as the vehicle upon which to test the principle.

Workforce

In a poll run during the webinar, most delegates said they needed more support with workforce. Sydney agreed that this was her number one priority and was waiting to see what the promised additional funding for staffing comprised. She has been looking at the existing personnel at the local authorities and what skills she needs to create a dedicated recovery team to focus on the deferred assessments. 

CHS Healthcare has been supporting CCGs with CHC reviews and assessments nationally since 2013 and are well-placed to support CCGs and local authorities to tackle their current and ongoing priorities. For more information, contact enquiries@chshealthcare.co.uk to discuss your needs.

You can access a recording of the webinar here: https://chshealthcare.co.uk/events/webinar%3A-the-way-forward-for-efficient-and-fair-chc-reviews-and-assessments/ 

If you are interested in learning more about Ben Troke’s work on the law of medical treatment decisions, you can read more in his new book here (all proceeds go to the Alzheimer’s Society): http://www.lawbriefpublishing.com/product/medicaltreatmentdecisions/