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                                                          Cluster Board meeting 5 October 2011
                                                                       Agenda item number 7.1.3

                     5th October 2011

Report Title:     Complex Case Panel Proposal                                  Item No: 7.1.3

1.   Background and context
     The cluster board has responsibility to seek the greatest health advantage possible for the
     local population using the resources allocated. This needs to reflect both a population
     approach and, increasingly, an individual approach through Individual Funding Request
     Panel or Complex Case Panels.

     Complex case panels provide a mechanism for assessing and planning the needs of
     individual clients with longer term needs of a complex and/or specialised nature.
     Derbyshire Cluster has a number of these panels – Continuing Care, Mental Health,
     Children’s and Acute Hospital Panel cases all of which identify the best way to manage and
     finance individual long term care.

     These panels work completely separately, with no common experience except that which is
     incidentally provided by a common member. This risks decisions being made at one panel
     which would not have been made at another e.g. the decision making process for IFRs is
     driven by a rigorous policy, a cost-benefit analysis, and an ethically based discussion about
     opportunity costs and affordability for the whole community. The decisions in the fields of
     Mental Health and Learning Disabilities are more focussed around ‘the art of the possible’.
     In addition, there are some cases which fall between stools, not being IFR cases within the
     strict meaning of the policy, but also not easily fitting anywhere else.

2.   Matters for consideration
     We propose the creation of a single Complex Case Panel to deal with all cases which
       1. Are not covered by an existing PCT policy
       2. Do not fulfil the criteria for an IFR
       3. Represent either a high cost or a high risk to the PCT.

     The proposed creation of one Complex Case Panel will give a more effective, integrated
     and co-ordinated approach to complex case management, especially where co-morbidities
     are present for example: mental illness and other diagnosis. It will also encourage a
     consistency of approach across all sectors.

     Expected Outcomes:

     Improvement in quality and consistency of approach
     Provision of a coordinated approach to meeting the needs of individuals with complex needs
     Improvement in overall health outcomes for the individual
     Greater rigour in making decisions, thus reducing the likelihood of challenge

     Complex Case Panel Representation:

     A core group of multi disciplinary people able to assess evidence and make difficult
     decisions each making a commitment to attend the panel meetings so developing

                                                            Cluster Board meeting 5 October 2011
                                                                         Agenda item number 7.1.3

        organisational memory and consistency of approach.
        Suggested members being:

           1.   Director of Finance, or his representative
           2.   Director of Public Health, or his representative
           3.   Clinical Lead,
           4.   Non – Executive Director, who would normally chair the panel
           5.   General Practitioner, representative of CCGs.
           6.   Representative of Social Services for MH/LD cases
           7.   Head of Continuing Care
           8.   Member of the Quality Team

        Each case would be presented by the main case worker/ presenter with additional expertise
        who would attend the Panel for this purpose. It is envisaged that the Panel would meet once
        a month and that decisions would be made there similar to those made at the current
        Continuing Care Panel, but covering a wider range of patients.

3.      Actions and recommendations
            The Board is asked to note the content of the paper
            To support and agree the development of one Derbyshire County Complex
              Case Panel.
            To agree the composition and authority of the Panel
            To decide directorate responsibility

Name:           Corinne Camilleri Ferante – Consultant in Public Health Medicine
                Judy Derricott – Clinical Lead
Sponsor:        Bruce Laurence – Acting Director of Public Health
Date:           September 2011


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