1. Proposed Review of the National Framework for Continuing Care

2. 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

3. 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

4. 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

5. 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 budgets)

6. 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

7. Content and use of the tools

8. 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?

9. 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?

10. 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?

11. 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?

12. 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

13. 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

14. 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

15. 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.

16. 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?

17. 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?

18. 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?

19. 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

20. Contact details Jeff Featherstone, Review Manager jeff.featherstone@northeast.nhs.uk