Agenda item

5.1

The Committee received a presentation given by Mandy Philbin (Chief Nurse, NHS Sheffield), outlining how the Continuing Health Care (CHC) process was working in Sheffield, ensuring that people were receiving appropriate support for their  needs.

5.2

Also present for the item were Debbie Morton, Deputy Chief Nurse NHS Sheffield CCG), Paul Higginbottom, (Local Authority/NHS Sheffield CCG), Dr Steve Thomas, (NHS Sheffield CCG) and Dr. Eithne Cummins.

5.3

Debbie Morton went through a patient’s story, beginning with his symptoms, through diagnosis and ultimately the care he required to meet his daily needs.  She stated that the four areas to consider when assessing the patient’s needs were the nature of the illness, its intensity, how complex the illness was and the unpredictability of it.  These factors were taken into account when working towards a criteria to establish a primary care need.  Debbie Morton said that she was concerned to hear criticisms of the service, adding that the nurses were highly trained, as were the GPs who attended and the service worked towards NHS England Quality Standards.  She added that the Service had fallen behind with patient reviews, but five extra staff had been employed to help catch up.

5.4

Mandy Philbin stated that following inspection of Sheffield’s whole care system, feedback from such inspection was that there were concerns over quality and accountability of the assessment process, the services were disjointed and needed to be brought into line and there was a need for better use of digital technology, and she stated that, by working more closely with the Local Authority and Healthwatch, these issues could be addressed to improve services.

5.5

Members made various comments and asked a number of questions, to which responses were provided as follows:-

·                     When someone was being assessed for primary health care, eligibility and resources are not considered together.  Checks were made to see if an advocate was present at the initial assessment stage, to try to tease out eligibility.

·                     There are standard packages of care and each person was assessed on their individual needs. Domiciliary care services were provided if deemed necessary, but if someone’s condition worsened, that person would be re-assessed, and should their need intensify, a checklist would be completed by a social worker and the necessary health and social care would be provided.

·                     Continuing Health Care had been around for a number of years, commencing in 2007, and had been reviewed and upgraded since that time.

·                     There was a joint perspective of all the Health agencies and the Local Authority to look at health inequalities and discover ways to better communicate with the public to keep them updated about primary health care.

·                     There was a national framework to adhere to for helping vulnerable people and it was felt that there was a need to do more.

·                     With regard to complaints, it was felt that communication was key, however, all staff throughout South Yorkshire were trained to the same standard to ensure consistency of care.  Due to the extra staff that had been set on, more reviews were taking place.

·                     Work between District Nurses, GPs and care homes was carried out to make sure referrals towards the correct level of care was identified and there was a dashboard to see where such referrals originated from.

·                     Assessments were not carried out in isolation and it was recognised how the need for an advocate to be present was becoming more vital, especially for those persons without close family.

·                     Care package reviews were carried out to see if the same level of care was still required.  In some cases, as a person’s health improved, the level of care was no longer needed and could be reduced.

·                     With regard to making savings, improvement in efficiencies by working together, looking at health and social care tackling the backlog of reviews and making sure that there is fairness for all those in need were key factors. CCG representatives agreed to circulate further information about where the savings come from and the QUIPP programme.

·                     Integrated training had been carried out to have a consistent approach to the process of assessment to make sure it was fair for all.

·                     In comparison to the core cities, Sheffield was about midline with regard to diagnosing dementia.  80% of cases were being diagnosed early and there was evidence to show that level of dementia was now plateauing and a lot of work was being done to prevent the onset of it, particularly involving the voluntary sector and Health UK to produce a dementia strategy.

·                     After visiting a GP, referral to a specialist clinic takes two weeks for diagnostic tests to be carried out.

5.6

RESOLVED: That the Committee:-

(a)       thanks those attending for their contribution to the meeting;

(b)       notes the contents of the presentation and the responses to the questions; and

(c)        requests a report to a future meeting of the Committee detailing progress in improving the CHC process,  where the Committee hopes to see evidence of greater collaboration with the Local Authority and VCF, a commitment to helping people understand the CHC process through improved information giving, and an improved approach to collecting feedback – recognising that some patients and carers fear the formal complaints process.