Aneurin Bevan Health Board

Transcription

1 Aneurin Bevan Health Board Sustainable Care Planning in Continuing NHS Healthcare: Operational Policy for Health Boards in Wales 1 Introduction The purpose of this report is to: inform the Board of work undertaken by Local Health Board (LHB) nominated representatives, and facilitated by the Continuing NHS Health Care (CHC) National Programme, to develop an all Wales approach on sustainable and affordable approaches to CHC care planning through the development of an Operational Policy for Health Boards in Wales, seek Board approval for the adoption of, and subsequent implementation of, the final Operational Policy. Financial Assessment and link to Financial Recovery Plan Risk Assessment Annual Operating Framework At the current time there are no financial implications for the Board. However, CHC remains a significant risk in respect of financial support and budget management. Policy may carry legal risk and be open to challenge. This risk has been mitigated through application of legal support in development of the policy. This proposal will ensure adherence to the following AOF Targets: 8 To deliver the core efficiency and productivity measures; 9 To operate within their available resources and maintain financial balance. In addition, this Policy links to opportunity 1

2 No 2 of the Welsh Fourteen High Value Opportunities: To improve quality of continuing care through health and social care integration; to reduce continuing healthcare costs through repatriation, development of local services and improved integrated plans with social care. Standards for Health Services Wales Equality Impact Assessment The proposal contributes to compliance with the Standards of Health Services Wales supporting the following Standards 1, 3, 7, 8, 9, 10, 11, 13, 14, 15, 18, 22, 23, 24, 25, 26. An Equality Impact Assessment is currently being undertaken. 2 Background In 2010 the Welsh Assembly Government (WAG) issued a revised CHC Framework for Adults. This describes CHC as a package of care arranged and funded solely by the NHS where it has been assessed that the individual s primary need is a health need. In line with demographic changes and medical advances, LHBs have experienced an increasing demand for CHC services over the past decade, and the rate and variability of growth of CHC have been of concern, with unsustainable pressures being placed on both workforce and funding. LHBs are therefore reviewing approaches, seeking to develop alternative methods of delivering services, to ensure their continuing ability to manage demand, both now and into the future. As part of its 2010/11 work programme, the CHC National Programme has supported LHBs in this work, and has facilitated the development of an Operational Policy for Health Boards in Wales to facilitate sustainable CHC planning. This work has now been undertaken and is attached at Annex 1. 2

3 3 Issues 3.1 The Process Board members will be aware of the general process adopted to deliver this work from a previous report presented at the November Board meeting. Each LHB nominated a representative to form a Task and Finish Group, facilitated by the CHC National Programme, to develop an Operational Policy in support of management of CHC. The timescales for the work were challenging, but benefitted greatly from the preparedness of the Task and Finish Group members to support delivery within a short period of time. Adopting an all Wales approach ensured consistency of response across LHB boundaries, reducing the potential for inconsistencies and different approaches to meet need, dependent on location. Local Authorities linked into the process through representation on the CHC Programme Board, and had the opportunity to comment on the Operational Policy in draft form. This area of policy is complex and the legal position is evolving; the CHC Programme team sought legal advice throughout the process; at key stages, the team obtained legal Counsel s opinion. 3.2 The Operational Policy In addition to setting out the legal, policy and guidance context, the Operational Policy sets out explicitly the key factors to be taken into account when considering appropriate care planning options. This process takes place following determination of eligibility for CHC the operational policy has no role in the determination of eligibility. The key factors identified are set out in the Model for Sustainability in section 7.2 of the attached Operational Policy, and are: Sufficiency Safety Quality Affordability Reliability Exceptionality Collectively, these factors contribute a consistent and comprehensive framework within which to make decisions on care planning options for CHC. 3

4 The Operational Policy also sets out a process (at Section 15) to manage exceptionality this provides an additional process to ensure that exceptional circumstances can be captured and considered as part of the overall response to need. The Operational Policy is transparent in its approach, and reflects all the factors that should be taken into consideration to ensure that service responses are consistent and sustainable in responding to assessed need. 3.3 Benefits and Risks The benefits of an all Wales approach include a consistent and transparent approach on CHC care planning across all LHBs, thus ensuring equality of decision making across Wales. It includes explicit reference to the need to allow for exceptionality and how this should be considered. Whilst the Operational Policy was developed with ongoing access to legal advice, the potential for challenge cannot be removed completely. Recognising this, the Operational Policy includes an appeals process to review the appropriateness of the care options available. The assessment for eligibility and the resulting care planning process rely heavily on the expertise within multidisciplinary teams (MDTs). To ensure the Operational Policy is implemented consistently and effectively LHBs will need to ensure that MDTs are properly supported, and that training and development needs are met. The LHB will also need to consider any workforce requirements necessary to support MDTs in delivering these roles. This will be relevant to MDTs based in both hospital and community settings. 3.4 Next Steps The Operational Policy, as attached at Annex 1, is now provided in final form, with a recommendation that the LHB adopts and implements it as one of its Operational Policies. 4

5 In addition to the actual Operational Policy, an equality impact assessment is underway. Part of this process includes engagement events with members of the public to ensure that the process and the key issues of sufficiency, fairness and affordability are understood. The engagement events will be facilitated by Professor Marcus Longley of the Welsh Institute of Health and Social Care. The outcomes will be used to inform the equality impact assessment and will be shared with LHBs by the end of March 2011, to support local implementation planning. Other work underway as part of the CHC National Programme will develop guidance and training materials aimed at multidisciplinary teams (MDTs). This work is intended to support MDTs, and will, in part, include their role in the CHC care planning process. This work is due to complete by Spring 2011 and the CHC Programme has linked in with Workforce and Organisational Development Directors across Wales to determine the likely training demand and the implications for Health Boards and partners. The LHB will also need to consider and develop a local implementation process, together with any support required from the CHC National Programme to deliver this. 4 Conclusion The CHC National Programme has facilitated work across LHBs in Wales to develop an Operational Policy regarding CHC care planning, and this report introduces the final document for approval and adoption. It sets out the process undertaken to develop this on an all Wales basis, to ensure a consistent response to the consideration of care planning options, irrespective of location. A previous Board report in November 2010 set out the intention to undertake this process, and obtained formal Board approval to participate in its development via a nominated representative. Additional work to support implementation is ongoing, and includes equality impact assessment, engagement events, and training and development aids. 5

6 5 Recommendations Board members are asked to: Note the work undertaken to develop an Operational Policy for Health Boards in Wales. Approve for adoption the Operational Policy. Support the additional work underway to support implementation. Sponsored by: Joanne Absalom Director of Primary, Community and Mental Health Services Prepared by: Joanne Absalom Director of Primary, Community and Mental Health Services Date: 10 th March