Vacancy -- Appointment of Independent Chairs for Continuing Healthcare Reviews

Background

Continuing NHS healthcare (CHC) describes the situation where, after an assessment someone is found to have a “primary health need” (this term is explained later) and their health and social care needs (including accommodation in some circumstances) are paid for by the NHS. Where someone has health and social care needs, but they are not eligible for CHC, the NHS meets the person’s health needs, but their social care could  either be funded by the local authority (depending on the local authority’s eligibility criteria and the individual’s means) or they would pay the cost of the care themselves . Services provided by the NHS are free but those provided by a local authority may be chargeable. 

 

Whether someone has a “primary health need” depends on the nature, intensity, complexity and unpredictability of their health needs. The process for determining whether someone has a “primary health need” involves a multi-disciplinary assessment and a final decision by the Local Health Board. It is the needs not the diagnosis or condition that determines eligibility.

 

CHC can be provided in any setting including nursing homes, hospices or the person’s own home.

 

In February 2003, the Health Service Ombudsman in England found that a number of people had been wrongly charged for elements of their care which should have been provided free by the NHS.   The Ombudsman recommended that efforts should be made to remedy any financial injustice to patients where the CHC criteria, or the way they were applied, were not clearly appropriate or fair. The recommendation was accepted in England and in Wales.

 

Subsequently arrangements were established which allowed people to claim retrospectively that they (or their deceased relative) were eligible for CHC but were wrongly charged for care between 1996 and 2003.  The arrangements involved an investigation of the case papers and a review by a panel comprising one member each from the local authority and a local health board with an independent chair. The panel’s role was to check that the evidence of eligibility has been properly reviewed and that the Health Board’s decision on eligibility for CHC has been arrived at fairly. An award of financial compensation was made to the applicant if they (or their deceased relative) were eligible for CHC but had to pay for their care for some or all of the period in question.    

 

The new arrangements envisage that only a minority of claims will need to be considered by a full panel, but the independent Chair would still check to see that the new process had been properly followed and the decision on compensation was fair. This independent scrutiny will be essential to reassure the claimants of a fair and open review and to monitor the effective use of public funds. Chairs will therefore be required to review all final reports and recommendations to ensure relevant multi disciplinary evidence has been reviewed and the patient’s needs have been consistently assessed against the appropriate CHC criteria in determining eligibility or refusing funding.   We expect that no more than 30% of claims will need to be considered through a full panel review.

 

The Welsh Government is therefore seeking to appoint five independent chairs to support the health boards to clear outstanding claims.  Currently we expect that each chair will work for a minimum of 30 days per year with time divided between chairing panels and scrutinising reports with recommendations that have been prepared by clinical advisors and negotiated to a settlement with the claimant or their representative. Chairs will be supported at panel by a clinical advisor and a clinician with appropriate knowledge and skills relevant to the medical condition of the subject in the claim but not associated with the organisation who provided care to that person. Local authority input will be provided as required.

To consider reports from clinical advisors on retrospective and current claims to ensure due process has been followed; by reviewing the available evidence, and that the application of appropriate CHC eligibility criteria have been applied consistently.

 

In more difficult or contentious claims to chair properly constituted panels, providing direction and guidance to panel members in order to reach sound conclusions and make recommendations, evidenced by contemporaneous decision documents.

 

Duties and Responsibilities:

 

1.    Provide external, independent scrutiny of reports prepared and submitted by clinical advisors for review, making sure they have followed due process, in reviewing all relevant evidence and applied the appropriate CHC criteria consistently before making their recommendation. Ratify and comment on the final decision document which will be shared with the claimant and/or their legal representative. 

 

2.   Provide advice and guidance both verbal and formal written feedback to the clinical advisors when the chair considers cases need to be reviewed and determined at a full panel hearing with the detailed rational for their recommendation.

 

3.   Act as an Independent Chairperson for Continuing Healthcare Review Panels where eligibility for CHC funding is to be considered. The chairperson will co-ordinate the work of an independent clinical advisor and a clinician with ‘due regard’ experience relevant to the clinical background of the patient who is the subject of the claim.

 

4.    Ensure that claimants or their representatives receive clear information in the form of a detailed decision document that supports the recommendation following an independent review whether through the scrutiny or panel route. This will also require Chairs will produce their own correspondence linked as part of the Review process.

 

5.    Uphold the principles of good communication and engagement, as set out in the National Framework for Implementation of CHC in Wales, with a particular emphasis on ensuring individuals are engaged with in their language of preference.

 

6.    Maintain an effective relationship with the Project Lead for Continuing Healthcare, clinical advisors and other chairs;

 

7.    Liaise with, and provide advice to, panel members on panel procedure;

8.     Liaise with, and take advice from, appropriate clinical advisors;

 
9.     Liaise with the panel to produce a decision document with recommendations on eligibility, where appropriate, to the relevant LHB;

10.   Ensure the panel fulfils its responsibility to:

 

• review the process of decision-making relating to NHS CHC funding for an individual patient and/or

 

• ensure full, fair and impartial consideration of each case is given in accordance with Welsh Government  guidance;

 

• maintain patient confidentiality at all times.

 

11.  Ensure that all panel members have the opportunity to contribute equally and comfortably to the panel discussion, highlighting the key issues to be considered.  To facilitate where differing views are expressed, enabling the panel to reach an overall conclusion regarding whether due process was followed, the eligibility criteria correctly applied and co-ordinate the panel recommendation on eligibility as appropriate.

 

12. Participate in training as and when required as outlined in the paragraph on ‘Induction Training and Continuing Development’ below.

The Welsh Government acknowledges the importance of developing and growing bilingual capabilities in public appointments in Wales, and welcomes applications from candidates who demonstrate their capability to work in both English and Welsh.  The following list of language requirements represents an objective assessment by the recruiting body of the Welsh language skills required to undertake the duties of this particular post.

The Chair for NHS Wales Continuing Healthcare Reviews will be independent of all NHS and local government organisations and commissioners and providers of health and social care services.

 

The Chair may come from any background but will have a genuine interest in healthcare.  Some previous experience of working closely with the NHS, social services, voluntary or independent sector or similar organisations would be advantageous.  Successful candidates will need an understanding of how health and social care services for older people and other vulnerable care groups have developed in recent years.  Knowledge of relevant legislation and policy is helpful but not essential as training in this will be given.

 

To be considered, you must be able to demonstrate that you have the qualities, skills and experience to meet all the essential criteria (divided up in essential and desirable expertise.

 

ESSENTIAL CRITERIA:

Candidates are required to demonstrate that they are able to:

 

• Demonstrate a broad understanding of the underlying health and social care policy issues which underpin CHC;

 

• Exercise good judgement in complex sensitive matters and be an accomplished decision maker.  Remain impartial and to weigh up arguments while remaining sympathetic;

 

• Demonstrate good leadership skills, ideally  with experience of chairing meetings;

 

• Ability to assimilate and summarise information effectively;

 

• Communicate effectively, using both verbal and written skills;

 

• Display a clear understanding and commitment to Nolan’s ‘Seven Principles of Public Life’ and to equality issues and challenging discriminatory practices where appropriate;  

 

 

DESIRABLE CRITERIA:

 

• The ability to speak Welsh is desirable.  

 

The Chair will be required to be flexible with regard to the hours of work and be prepared to travel to various venues across Wales.

04/01/2019, 16:00

Further Information and Queries

 

For further information on the application process, please contact the Public Appointments team at the Welsh Assembly Government on e-mail: publicappointments@gov.wales. 

 

 For further information regarding this role, please contact:

elizabeth.wyatt@wales.nhs.uk   Tel: 07969 921 141

julia.flaherty@wales.nhs.uk       Tel: 07964 117 629

 

To apply for this role, click on the ‘Apply’ button below. The first time you apply for a post, you will need to complete a registration form for the Welsh Government’s online application system.  You will only need to register once, and you will be able to keep yourself updated on the progress of your application, and any other applications you make, via your registered account.

Once you’ve registered, you’ll be able to access the application form.  To apply you will need to submit two supporting documents. The first, a document outlining how your knowledge, skills and experiences meet the criteria for the role as outlined in the information for candidates.  This document should be no more than 2 sides of A4.  Your application may be rejected if you exceed this limit.  The second document is a full, up to date CV.  The two documents should be uploaded to the ‘Reasons for applying’ section of the online application form.

In your application, you will also be asked to provide details of any activities which have helped you to develop skills that would be useful in a public appointment role, and list the organisations for which you undertook these activities.  We also need to know about any political activity that you’ve undertaken over the last 5 years. 

It is recommended that you register for an account and access the application form as soon as possible so that you see how the application form is structured, before starting to prepare your evidence.  You don’t have to complete the application form all in one go.  You can save your responses, and log in and out as required, until you’re ready to submit – just follow the guidance in the application form.

If you’d like to apply for this opportunity in Welsh, please use the ‘Newid Iaith / Change Language’ link at the top of this page, to take you to the Welsh version of this advert, from which you can apply in Welsh.

If you need any further assistance in applying for this role, please contact the Welsh Government’s Public Appointments Unit on 03000 616095 or PublicAppointments@gov.wales.

For further information about Public Appointments in Wales, please visit www.gov.wales/publicappointments