NOTES OF EVIDENCE

Meeting	Policy Commission for Care, Health and Housing
Ref	He.PC.28/03/07
Date	28 March 2007
Time	18.00hrs
Place	Committee Room 1, County Hall, Newport, Isle of Wight
Purpose of meeting	Formal public meeting
Attendance	Commission	Colin West (Chairman), Geoff Lumley, Win McRobert, Margaret Webster and David Whittaker Co-opted Members: Mr Robert Jones
	Cabinet	Cllr Dawn Cousins
	Secretariat
	Other Councillors
	Officers	Ms Louise Biggs - Overview and Scrutiny (O&S) Team Mrs Sarah Mitchell – Director of Community Services Ms Claire Foreman – Head of Older Persons and people with a physical disability
	Stakeholders	Mrs Nancy Ellacott
	Apologies	Cllrs Erica Oulton and Cllr Roger Mazillius
Agenda Items
1. To agree the notes of evidence arising at the meeting held on 22 February 2007	In the absence of Cllr Oulton a chair was elected a chair for the meeting. Cllr West was voted in unopposed (4 in favour, 1 abstention) The notes of the previous meeting were agreed, with one amendment: Cllr Cousins wished her apologies to be noted at the previous meeting.
2. Declarations of Interest.	Cllr David Whittaker as a Member of the Development Control Committee Cllr Margaret Webster declared an interest as a board member of Medina Housing Mr Robert Jones also declared an interest as shareholder in Medina Housing
3. Directors Update	3.1 The Director advised that the free homecare package for all people aged over 80 on the Island had been well received, and would be implemented on 1 April 2007. There had been training and development with staff and the council would be working with providers to develop services on island in order to provide 24 wrap-around care to keep people in their own home. 3.2 There will be an inspection later in the year of the Supporting People initiative. In preparation for this Members will be offered briefings to explain what the Council are doing, where the Council are targeting the support and how we’re evaluating the programme. This initiative enabled people with mental health and learning disabilities to live in supported tenancies. 3.3 The Housing Strategy was being finalised and a user-friendly accessible version was also being produced. The final version would be going to Cabinet in May. 3.4 The Council now have weekly meetings with the PCT to look at how we can better manage patient care. There was a high level of demand for acute beds over January and February of 2007 was experienced from older people with respiratory problems. The Council would be working with primary care staff to keep people out of hospital, as people were sometimes admitted for social care rather than health reasons. 3.5 As part of the joint work ‘Help and Care’, a national charity, will be providing in-hospital advice to patients on how to cope after being discharged. They will offer advice, information and a screening service (to assess need after discharge) to all older people in hospital. 3.6 A conference had been scheduled for 19 April to discuss the implications of the white paper ‘our care, our health, our say’ to identify what we are currently doing and any gaps that might exist. 3.7 The Council were doing some work with the Voluntary and Community Sector (VCS). Contracts with VCS would run for three years rather than one or two. The Council had spoken with smaller organisations to look at the provision of some smaller services e.g. sports. The ‘Future Builders’ initiative can assist the VCS to help develop capacity and expertise.
4. Continuing Care	4.1 Continuing Care was a general term that describes the care which people need over an extended period of time, a as result of disability, accident or illness, to address both physical and mental health needs. 4.2 Continuing Care had been a key issue for the past few years and continued to be, in terms of whose responsibility it is. 4.3 NHS Continuing Care referred to ongoing care needs fully funded by the NHS. In a person’s own home this meant that the NHS paid for both medical and personal care, as it would in hospital. In a care home the NHS paid all the care home fees. 4.4 A person would qualify for NHS Continuing Care if their main need was for health care, as opposed to personal care. This meant that a patient’s needs would be above that which social services would be able to provide. 4.5 NHS responsibility should begin where the local authority responsibility ends: there should be no gap in services. 4.6 Whether or not a person’s main requirement was for healthcare was determined by looking at the nature, complexity, intensity and unpredictability of their need. 4.7 NHS Funding was not dependant upon type of illness, age of the patient, location, condition or diagnosis. Instead it is about the totality of needs. Eligibility is not dependant upon finances. 4.8 NHS Continuing Care can be provided at home, in a nursing home, at hospital or in sheltered accommodation. 4.9 Care services provided by the NHS are free at the point of delivery; care services provided by the local authority are subject to a charge. 4.10 What determined eligibility for NHS Continuing Care? · Type of need, e.g. is supervision needed? Are they complex? · Unstable (either physical or mental) health · Amount of care needed over and above what the local authority can provide. · If a person was in the final stages of terminal illness then care is NHS funded. 4.11 There was also a separate registered nurse care assessment, previously referred to as ‘Registered Nurses’ Contribution to Care’ (RNCC), as the NHS is responsible for any care provided by a registered nurse, even if a client did not qualify for NHS Continuing Care. For people in care homes the nurse would usually be employed by the home, so the NHS would pay the care home for those eligible. The NHS funded nursing care was covered by a separate framework than the Continuing Care. These systems were complex and have been misunderstood in the past. 4.12 Nursing services can be provided by the local authority under section 21 of the National Assistance Act, where they are Incidental or ancillary to the provision of the accommodation which the local authority is under a duty to provide Of a nature which it can be expected that an authority whose primary responsibility is it to provide social services can be expected to provide. 4.13 Several cases have brought changes to Continuing Care: · The Coughlan case highlighted that the level of general (as opposed to registered) nursing care that could be provided by local authorities was limited. · The Pointon case reinforced the fact that NHS Continuing Care could be provided at home and by a carer who was not a qualified nurse. · The Grogan case underlined the fact that local authorities do not have a duty to fund care not provided by the NHS. · Continuing Care eligibility differed between each of the 28 strategic Health Authorities (SHAs) in England. Each SHA had independent tools to assist their decision-making and the criteria used were also differed. This created a ‘postcode lottery’ and led to a recent decision to review the arrangements for Continuing Care. · A new national framework for Continuing Care was currently under development, expected in October 2007. This meant that all SHA areas will have the same criteria for assessing continuing care. The new framework will also incorporate eligibility for NHS funded Nursing Care, rather than this being a separate process. There will also be a standard process for assessment for NHS funding, including tools to support decision-making. · The joint working already being carried out between the Council and NHS will be helpful when the new framework comes into being.
5. Annual Healthcheck comments	5.1 Members agreed the comments within the letter, with one amendment to paragraph 4 to read: “The Chair of the Policy Commission has regular meetings with the Chief Executive of the PCT. In addition, NHS colleagues have been helpful and willing to attend meetings when invited to give evidence”.
Actions	1. To amend the healthcheck letter and forward to the NHS Trust 2. To write to the NHS requesting that they send a representative to all meetings of the Policy Commission for Care, Health and Housing.		LB LB / EO