Personal Health Budget Panel

Transcription

1 Personal Health Budget Panel Document Version Version 1.00 Last Review Date N/A Next Review Date Document to be reviewed November 2021 Approval Policy Owner Policy Author Partnership Management Group Service Manager Continuing Healthcare Team Location Related Documents Nil Introduction A Personal Health Budget (PHB) is an amount of money to support individuals identified healthcare and wellbeing needs, planned and agreed between the individual, or their representative, and the local NHS team. PHBs offer the opportunity for individuals to work in equal partnership with the NHS about how health and wellbeing needs can best be met. They are one way to provide choice and control over healthcare and support. A Personal Healthcare panel has been established in Portsmouth to enable professionals and practitioners to make fully accountable decisions about the use and risks associated with Personal Health Budgets. These Terms of Reference describe the arrangements that the Portsmouth CCG/LA have put in place to manage what are deemed to be high risk, high cost or complex situations. Portsmouth CCG/LA recognise that risk can be a consequence of people taking decisions about their lives and using a direct payment to pay directly for the healthcare that they need. To make good choices, we all need to understand the consequences of the decisions we make and to take proportionate responsibility for them. Portsmouth CCG/LA aims to promote a culture of choice that entails responsible, reasonable, supported and shared decision-making.

2 Reasonable risk is striking a balance between empowering people to make choices, while supporting them to take informed everyday risks. Decision making should take into account PCC/CCG's choice and equality policy The PHB Panel shares decision-making in order to be the most effective, transparent way to reach the best decision based on the information available. PURPOSE The panel provides a forum to consider identified risks and mitigating actions where these cannot be resolved during the normal process of assessment, support planning or review. The purpose of the PHB Panel is to support the management of risks associated with setting up and running Personal Health Budgets, to provide consistent decision making about appropriate use of a PHB and to review disagreement about the content of the support plan budget Project Title Accountable to: Time Period: Governance Requirements Background Personal Health Budgets PHB Panel Partnership Management Group The PHB panel will meet on an as required basis Operational level via multi-agency PHB Panel, The Department of Health expects all CCGs to be in a position to offer Personal Health Budgets as a default option from April 2019 Current legislation allows for those in receipt of CHC funding to have a Direct Payment from August The Continuing Care /117 Team will offer PHBs to everyone in receipt of Continuing Healthcare from April A PHB should help people get the services they need to achieve their health outcomes, by letting them take as much control over how money is spent on their care/support as is appropriate for them. It does not necessarily mean giving them the money to purchase care directly. PHB could work in a number of ways: A notional budget held by the PCT commissioner A budget managed on the individual s behalf by a third party, and A cash payment to the individual (a healthcare direct payment ) It will be necessary to establish a way of validating and approving decisions about what it is appropriate for PHBs to be used for as part of the decision making process, and ensure consistent

3 decisions are being made. The Department of Health have provided guidance that PHBs are not to be used in the following circumstances: Anything that is illegal, Emergency Care, Services that the GP already provides, Alcohol, Tobacco, Gambling or Debt repayment. There will be circumstances where the CCG will need to review whether it is appropriate a PHB can be used in a particular way. The formal decision making responsibility will rest with Portsmouth CCG/LA Scope of Responsibility: The PHB panel will support all risks associated with the implementation of personal health budget. The PHB Panel will review all support plans that have been highlighted as high risk or requiring reviews by the CHC Team/Manager or where the support plan contains items that have been deemed by Portsmouth CCG/LA needing to be individually risk managed through the PHB Panel. The Panel will act as a decision maker and offer advice and guidance on complex or high risk/cost cases. It is the responsibility of the relevant senior/service manager, the CHC team and Solent staff who are supporting the individual with their personal health budget to agree how they will put this advice into action any agreed actions arising from the case discussion must be recorded in PHB Panel minutes. The PHB Panel will report to the Partnership Management Group regarding issues arising out of the management of complex/high cost risk cases. This will take the form of a short summary of PHB panel decisions prepared by the chair of the panel. The panel may be used to support consistent decision making and to publish details of decisions to managers in the continuing health care team as well as to the wider members of the Partnership Management Group. This could include considering the following: Proposed PHBs which are not recommended (for audit and transparency in decision making); Cases where the individual or his/her representative is disputing the content of the support plan or budget. A case where an individual has requested a service that is out of the ordinary and the healthcare manager is seeking approval; The risks to the service user that cannot be resolved through support planning or normal safeguarding /ISA

4 processes; Could the risk cause endangerment to other people (third parties); Could the risk expose Portsmouth CCG/LA to political or reputational risk; Legal and regulatory issues including the status of measures in a support plan or compliance issues; Suspected fraud and/or duplication; Risks arising from the availability of services or facilities; All cases where family carers living in the same household as the client have requested a direct payment to pay themselves for providing care; Financial or budgetary risks that cannot be resolved through the validation process. (High cost) A care plan should be referred if: Client Groups Covered: A care plan should be referred to the PHB risk panel where there is: Uncertainty about the suitability of the individual or representatives to manage a PHB; Where the individual is requesting funding for a service that is out of the ordinary or does not follow guidance about what is appropriate to be included/excluded in a PHB; Uncertainty about the risks of going ahead with a PHB; Where there is disagreement between the care manager and individual or representatives (e.g. broker) about the PHB; Where family carers living in the same household as the client have requested a direct payment to pay themselves for providing care; Where family carers have already previously been named on other care plans for providing care; Where more than one PHB has been submitted for a single address. This will be all adults eligible for NHS Continuing Health care and in receipt of joint CHC Health and Social Care funding. Membership Service Manager/Accountable Officer CHC Financial Representative (PCC and CCG) Team Manager/Clinical Lead (CHC Team) Clinical Representative Appropriate Specialist Representation as required e.g. LD, AMH Therapy Representation as required Dr Jonathan Price -GP as required

5 Case Manager to present Each case is to be presented by the Care Manager and /or Broker. Chair of Service Manager/Accountable Officer CHC Group: Admin Support CHC Team Quorum: A quorum shall be 3 members; this must include the chair, a representative from Governance and Commissioning and appropriate Care Group. Where a member cannot attend they should nominate an appropriate deputy or submit written comments. Reports to: Frequency and format of meetings: Partnership Management Group Each meeting will have a designated Chair to ensure that there is accountability, continuity and commitment. The PHB Panel will meet as required Panels will meet as appropriate to the needs of the individual circumstances. Thus, a meeting will be called when a risk assessment is completed or where a PHB is being considered where there is a complex high cost or high risk situation. An agenda that clearly sets out the cases for discussion is to be circulated at least one week in advance of a meeting being held. It is essential that the meeting is well documented, with outcomes and actions demonstrably followed up. Therefore all panel meetings will be accurately recorded and distributed to panel members. Panel members will endeavour to facilitate the meeting in an informative, supportive and sensitive manner. Consideration will be given to any access and support needs of the service user. The Case Manager/Broker will present the case at the panel meeting. The chair will set a review date for each assessment as agreed or as appropriate. Secretariat: Papers relating to each case, including support plans and risk assessments will be prepared in advance of each meeting of the PHB Panel. Each panel will be minuted with detailed

6 action points being circulated to the panel members, Partnership Management Group. Escalation Procedure: For cases where the decision of the panel cannot be agreed all decisions will be escalated to The Deputy Director Adult Services, the Chief Operating Office/ The Director of Adult Services NHS Portsmouth