As a solicitor who specialises in advising and assisting people who are assessed for NHS Continuing Healthcare funding (CHC), I observe the inherent problems in the system on a depressingly regular basis.
It is therefore heartening to read irrefutable proof of the systemic flaws in the system in the Parliamentary Public Accounts Committee’s report, NHS Continuing Healthcare funding. It can only be hoped that shining such a high profile spotlight on the problems will result in urgently needed improvements.
What is NHS Continuing Healthcare funding and how does it work?
NHS Continuing Healthcare funding is a package of healthcare which is provided outside of a hospital environment for individuals with high levels of health need. This is generally the most vulnerable disabled and elderly people in our society. If an individual is eligible for CHC, their local NHS Clinical Commissioning Group (CCG) will arrange and fund a package of care to meet their needs whether in their own home or in a residential care setting. In 2015-16 almost 160,000 people received this funding.
What problems has the report highlighted?
The process of assessing whether an individual meets the eligibility criteria for CHC has been reviewed by the Public Accounts Committee and in their report they have identified the following concerns:
- Delays in assessments with knock on delays in receipt of funding and care.
The Department of Health’s National Framework states that people should not have to wait more than 28 days after assessment to receive an eligibility decision, however, one-third of decisions take longer than this. There are many examples of individuals dying whilst waiting for an eligibility decision and not receiving the care package which they are entitled to.
- There is a significant lack of awareness of CHC funding, meaning many individuals simply do not know that they may be entitled to this funding.
78% of health professionals believe that the system is difficult to navigate (this is certainly my own experience when advising clients) and around two-thirds of people with increasing health and social care needs do not find out anything about CHC until very late in the day.
- Poor quality assessment tools and inadequate training leads to huge variation between CCGs – a veritable postcode lottery.
The CHC assessment process is extremely subjective, depending heavily on the skills of the assessor, and utilising unclear assessment criteria which results in huge inconsistencies in decision making. It is estimated that around 60% of healthcare professionals are inadequately trained in assessment and all too often assessors have insufficient knowledge of the person they are assessing. Worryingly there are also incidences of individual CCGs introducing their own unlawful and arbitrary local rules.
- NHS England is responsible for ensuring that CCGs comply with Department of Health guidance however, it is not adequately carrying out this responsibility in supporting CCGs to act in a lawful manner.
Whilst NHS England has been collecting data, there is insufficient meaningful data to identify common areas of concern and in turn provide timely improvements.
- NHS England has announced that it wants CCGs to make £855 million in efficiency savings by 2020-21 without clearly stating how this can be achieved without simply cutting funding for eligible recipients of CHC.
As only £149 million was spent on CHC administrative costs in 2015-16 it is hard to see that the level of savings required can be achieved by economies of scale or better IT systems, rather than reducing the money spent on care itself. There are already reports of CCGs starting to impose arbitrary financial caps on care packages or more insidiously starting to move young, severely disabled people out of the family home and into institutional nursing homes – an appalling breach of human rights which need to be immediately judicially challenged.
The Public Accounts Committee has clearly identified the above pressing concerns and asked the Department of Health and NHS England to respond to their recommendations by April 2018, so it is hoped that improvements can be identified at the earliest possibility.
For more information on the funding of care including NHS Continuing Healthcare funding, please contact our Elderly, Care & Mental Capacity team on 0161 475 7676.
The report can be viewed on the Parliament’s website, click here.