Care and Treatment Reviews
Task and Finish Group
Updates for Commissioner Network
7 October 2015
Original scope of Task and Finish Group
• To learn from our experiences of the previous CTRs and explore how
they will become business as usual (BAU)
• To support the development of the pre-admission (or ‘community’)
CTRs and look at how these can be rolled out
• As part of the above, to develop registers of patients at risk of
admission to an inpatient facility (abbreviated to ‘at risk registers’)
• Now revised to ‘To look at how existing patient registers can be
used effectively to identify individuals at risk of admission to
inpatient services, and to support pre-admission CTRs’
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Key aspects related to CTRs
Commissioning Standard
1
All Transforming Care inpatients have a realistic discharge date, agreed at a CPA or CTR
meeting
All Transforming Care inpatients have a Care and Treatment Review (CTR) in line with the
national CTR guidance, and chaired by the CCG.
2
For new patients, a CTR is held within six weeks of their admission to inpatient services
For existing inpatients, a CTR has been either held or scheduled, and further CTRs are
held every twelve months
3
Arrangements are in place between the CCG and Local Authority which allow timely
identification of individuals at risk of admission to inpatient services, and confirmation of
whether this is the most clinically and personally appropriate option for the patient.
This includes the having processes for scheduling and delivering pre-admission
(community) CTRs, managed with CCG oversight.
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The CCG’s contracts with providers allow the CCG to hold the provider to account for
delivery of the recommendations made in patients’ CTRs or CPA reviews. The CCG
commissioner uses regular quality and contract monitoring meetings to ensure these
recommendations are implemented by providers to the quality standard required.
3
Our proposal: identifying individuals who are at risk of
admission to inpatient services
• London CCGs are happy that the existing processes and documentation are
sufficient to identify individuals at risk of admission to inpatient services
• As a region, we do not believe that developing new registers is required or will
provide enhanced outcomes for patients
• Instead, NHSE will require CCG and LA assurance that they have the
processes and documentation in place, including joint CCG-LA registers
4
Our proposal: pre-admission (community) CTRs
• Pre-admission CTRs should take the form of a rigorous CPA/CTR review.
They will be used where a service user is identified as strongly or potentially
at risk of admission to inpatient services
• The CCG will have oversight of this meeting and an external Clinical Expert
and Expert by Experience will be organised
• Where the CCG does not wish to implement these additional elements of a
CTR into the rigorous CPA, it will be for the CCG/LA to justify this position in
discussion with NHSE
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Other actions to be taken to strengthen CTRs
Communication, capability and development
• We need to increase awareness of the market, the services available in the
community, and building services around the individual
• We need to increase understanding of the role of the care coordinator
• We should look at accessing other networks (e.g. psychiatrists) to influence,
educate, engage
Provider role
• CCGs often face issues around compelling providers to deliver CTR
outcomes, given they are not stipulated in current contracts
• Where In order to improve provider performance, NHSE will set up NHSECCG-provider meetings
• NHSE will identify those providers who are slowest to discharge patients
Children
• The next priority is to look at the processes for 16+ and transition
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Collaborative commissioning
Task and Finish Group
Updates for Commissioner Network
7 October 2015
Scope of Task and Finish Group
1. ATU placements – patient numbers, costs and potential collaborative
work
2. Respite and domiciliary care for complex needs – good practice,
how are particular need of people with learning disabilities met,
potential for information sharing and collaboration, development of
care requirements for domiciliary care service
3. Development of specification for enhanced community team – to
support admission avoidance and effective discharges
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ATU placements
• 16 CCGs fed back on their ATU placements
• The current range of costs is shown below
• We will share cost information across all CCGs who have responded
– other CCGs are invited to share their own information
£9,000.00
£8,000.00
£7,000.00
£6,000.00
£5,000.00
£4,000.00
£3,000.00
£2,000.00
£1,000.00
£0.00
Lowest cost (London)
Highest cost (London)
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ATU placements: by provider
Cambian
CNWL
Cygnet
Danshell
Glencare
Herts
PiC
Sequence
SLAM
Enhanced community teams
• Several CCGs have developed (e.g. Enfield, Southwark)
or are developing enhanced community teams
• Across London, different CCGs are at different stages in
terms of integrated community teams
• The opportunity to develop an enhanced team raises the
issue of collecting data/evidence to show potential
benefits and benchmarking the level of service.
Question: How many areas are currently considering
developing this service and are willing to share information?
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Action for CCGs
• Break into five regional areas to discuss opportunities for
information sharing or collaboration around:
1. ATU placement commissioning, improving
quality and costs
2. Respite and domiciliary care for complex needs
3. Development of enhanced community team
specification
• Feed back to the room on your discussion and
opportunities for your sub-region or the Task and Finish
Group
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CCG groups
North and
Central
Enfield
Barnet
Harrow
North
West
Haringey
Hillingdon
Brent
Waltham
Forest
Camden
Islington
Redbridge
Hackney
Ealing
Havering
H&F
Hounslow
Central
London
City
Tower
Hamlets
Barking &
Dagenham
Newham
WL
North East
Lambeth
Southwark
Richmond
Greenwich
Wandsworth
Bexley
Lewisham
Kingston
Merton
South West
South East
Sutton
Croydon
Bromley