Agenda item

5.1

The Chair, Councillor Cate McDonald, stated that the NHS representatives had declined to attend the meeting due to it being held in the pre-election period before the General Election and the sensitivity of the items to be discussed.  Councillor McDonald expressed her dissatisfaction at this, given that the Scrutiny Committee is a statutory body, and the Committee agreed that a letter should be sent to the Clinical Commissioning Group (CCG) expressing their disappointment. The questions asked will be forwarded to the CCG or the appropriate NHS body for their response.

5.2

Question from Rita Brookes

5.2.1

Paragraph 70 of the National Framework for NHS Continuing Healthcare states:

“Assessments of eligibility for NHS Continuing Healthcare and NHS-funded Nursing Care should be organised so that the individual being assessed and their representative understand the process and receive advice and information that will maximise their ability to participate in the process in an informed way. Decisions and rationales that relate to eligibility should be transparent from the outset for individuals, carers, family and staff alike”.

One of our frequent complaints has been that Sheffield CCG does not take any steps to ensure that there is compliance with this requirement.  This results in individuals and their representatives being severely disadvantaged throughout the process.

At present there doesn’t seem to be any improvement to this position. What has Sheffield CCG done specifically to address this problem?

5.3

Questions from Sue Harding

5.3.1

Page 12 of the CCG slide pack (Page 24 of the agenda pack for this meeting) shows that 91% of appeals had the original decision upheld at a local level from April to September 2019. This would seem to be a questionable measure of success to use.

How many people were refused continuing healthcare funding during this period and how many of those refusals turned into an appeal? This is an important indication of the health and accessibility of an appeals system.

The small numbers involved (22) could indicate that the system is not easy for a lay person to navigate. People could be dissuaded from appealing for a whole variety of reasons, some of which we have experienced.

When considering the number of appeals upheld, a high percentage (91%) could be an indication of bias on behalf of those handling the appeals.

There is national concern regularly reported in newspapers about why almost the entire appeals process sits within the NHS. A recent article in a national newspaper stated

“There should be some kind of independent body that regulates or oversees this process because at the moment the NHS is the judge, jury and gatekeeper”.

Is the Scrutiny Committee content to rely on such a flawed procedure as a measure of improvement?

5.3.2

Page 17 of the CCG presentation (page 17 of the agenda pack) refers to the results of the “How did we do” questionnaire.

The satisfaction levels shown on this slide are impressive but there must be some concern about how this survey was conducted.

How many of the 60% plus people shown as satisfied were people who had been refused CHC funding?

When were the questions asked? During the process or afterwards when the result of their assessment was known?

How were the questions asked? In person? By phone?

What questions were asked? Were participants simply asked “were you satisfied?” or were they asked more specific questions like “what was done to prepare you for the DST assessment?” “How helpful was that?”

“Did you understand what was said during the Assessment?” “Was jargon used and if so was it explained?”

I could expand further……

Were the questions asked vetted by any sort of professional who is trained in the science of asking unbiased, non-leading questions in surveys?

Without this sort of detailed explanation, is the Scrutiny Committee content to rely on these satisfaction indicators as any true measure of the quality of the assessment process which affects several hundred people in Sheffield every year?

5.4

The Chair said that she could only answer all three questions in part, and some might form part of the presentation during the meeting. 

5.5

Question asked by Andy Hiles

5.5.1

Mr. Hiles stated that he was addressing the Committee to bring to their attention certain employment practices which have crept into the NHS.  He referred to a lady who was in attendance at the meeting and said that she was “bank” staff and called into question the practices of the NHS and how they treat “employees” and “bank staff”

5.5.2

The Chair said that she would take advice on the role of the Scrutiny Committee on such an issue, and would respond in writing to the question raised.

5.6

Question asked by Joanne Arden

5.6.1

This question relates to the proposal to change the way the Council pays care home fees currently paying the net contribution to care homes changing to gross contribution.

As the owner and operator of Cairn Home at Crosspool we are concerned about the negative cash flow implications of this change.  Currently we collect our fees from the resident by weekly direct debit but the Council pays every four weeks, two weeks in arrears and two weeks in advance.  Whilst this will have a negative impact upon our cash flow, this will be minor compared to what happens when a new resident is admitted, frequently it taking many months before any payment is received from the Council.  In the last year we have had one resident where it was over six months before a payment was received.  Under the current system, at least we have the money from the resident coming in each week.

From the Council’s perspective, you are looking at an annual cost of £715,000 to implement this change at a time when the Council is under severe financial pressure, and if this money is available we would suggest that it could be more effectively spent on increasing the gross care home fees, not making a negative impact on the cash flow of care homes.

Please can this be reconsidered?

5.6.2

The Chair said she would respond in writing to the questions raised.