Agenda item

In attendance for this item:

Kerry McCrossan, Assistant Director of Adult Social Care

Adrian Hardman, Cabinet Member with Responsibility for Adult Social Care

The Assistant Director of Adult Social Care provided a summary of the review of funding arrangements between the Council and Herefordshire and Worcestershire Clinical Commissioning Group (CCG), as set out in the Agenda report, following an earlier overview to the Panel on 15 March 2021.

The Council had initiated the Review in September 2020, which was carried out by a specialist organisation, Liaison Care.  A series of engagement sessions had been held with managers to understand fully the current position, and use the findings to agree new and effective ways of working with the CCG to ensure there was fair, equitable and transparent approach to funding of Continuing Health Care (a package of care for people who are not in hospital and have been assessed as having a primary health need), joint packages and S117 cases (aftercare funding designed to cover the cost of meeting all a person’s mental health related support needs).   Live sample cases were reviewed for 170 service users across these categories.

The aim was also to ensure people regardless of user group had fair and transparent funding through the correct route, to agree simple methods of apportioning costs for joint funding and to ensure best practice in all areas.

The Review had required some challenging discussions, but the Directorate was very pleased with the progress made, as set out in the report - not purely for the budget implications, but for the individuals and families involved where decisions about funding could not be reached and had often gone on for months and months, therefore delaying decisions around organising care.

As a consequence, there had been a significant reduction in inter-agency disputes, an increase in numbers eligible for CHC funding and an increase in fast track funding eligibility. In terms of finance, the Council’s income related to CHC has increased by £1.1m and an additional £1.6m one-off income has been achieved for backdated claims/recharges, from reducing and resolving disputes.

An agreement had been made with the CCG that all clients under S117 of the mental Health act 1983 (mental Health and Learning Disabilities) would be funded – as a 60:40 split from 2021/22 with the Council picking up 60% and the CCG 40% for all clients, compared with the previous split of 50:50 split for mental Health clients only.

The Chairman invited discussion and the following main points were made:

·      When asked whether the Liaison report had been shared with councillors, the Assistant Director explained that it had been shared with the Directorate Leadership Team and with health colleagues; due to level of detail it was not appropriate to share the full report more widely, however highlights would be provided to the Panel.

·      An independent organisation had been asked to carry out the Review in order to have an independent view on the position and numbers in Worcestershire compared to nationally. The original cost of the review was around £77,000, with a rebate of around £12,000 once it was felt an appropriate point in the Review had been reached. The original contract allowed the Council to receive support on specific aspects in future, if required.

·      Whilst processes were not yet as robust as Officers would like, substantial improvements had been made and there was a S117 working group. Delayed reviews was one area of pressure however the Directorate had robust systems to flag up when reviews were due.

·      In terms of benefit to an individual receiving S117 funding, the agreement reached between the Council and the CCG had no personal benefits however it was vital those involved knew they were receiving what they were entitled to.

·      A Panel member who had previously been involved in CHC appeal panels was aware of the complexity and conflict which had a profound impact on families involved; the Council was to be congratulated for improving this situation.

·      It was confirmed that during the Review there had been direct communications with the families involved in CHC funding, and work was in hand to improve information provided on the website and the integration between health and social care.

·      The original report to the Panel would be shared, which would help with understanding of the types of funding involved, for example S117 funding, which was specifically for those who had been detained under the Mental Health Act (1983).

·      It was confirmed that the S117 Policy would be shared with the Panel and was due to be discussed by Cabinet in February. The S117Working Group was led by the CCG and Officer representative from the Council was part of the Group.

·      Comment was invited from the Healthwatch Worcestershire representative present (Simon Adams, Managing Director), who reiterated the Cabinet Member’s comments in really welcoming the Council’s work to readdress the realities around CHC and the new Policy. Regarding involvement of patients in development of the Policy, the Director explained this was a question for health colleagues.

·      The Healthwatch representative asked whether an equality impact assessment had been done, and the Director advised this would be available from the CCG.

·      The data in the report was for Herefordshire and Worcestershire, although data for each could be separated out.

·      The Cabinet Member was particularly pleased that the funding arrangements between the Council and the CCG had been clarified before the Integrated Care Strategy was fully implemented.

·      A Panel member suggested it would be helpful to review outcomes from the funding review in approximately six months.

·      There were key performance indicators built into the system and reported quarterly to NHS England.

The Chairman thanked everyone for their contribution and asked the Scrutiny Officers present to liaise with the Directorate regarding the information requested.