NHS continuing healthcare (CHC) is a package of care that is funded by the NHS for individuals who have a ‘primary health need’.
CHC accounts for 4.9% of the total NHS budget and according to the NHS Clinical Commissioners, there was a 16% increase in spending on CHC between 2013-14 and 2015-16. CHC related appeals and complaints also create a strain on resources, with each assessment reported to take at least 25 hours of nursing time.
The continuing healthcare assessment process is as follows:
- Patients are screened to determine if they should be assessed for CHC through a nationally prescribed checklist, and an equity monitoring form is completed
- A nationally prescribed decision support tool (DST) is completed to determine if an individual is eligible. This is a complex process where the applicant is assessed against 12 domains, each subdivided into up to six statements of needs
- The decision is checked and verified by a commissioner lead and only in exceptional circumstances is the recommendation not followed
- If the individual is eligible for CHC the commissioner arranges and funds the care placement
- Individuals with a rapidly deteriorating condition that may be entering a terminal phase may require a fast track to CHC, so that they can immediately receive CHC
- The commissioner is responsible for ensuring that there is ongoing case management and regular reviews of CHC
- If the individual does not agree with the eligibility decision they can follow a resolution and appeals process which can include an independent review undertaken by NHS England outside of the Clinical Commissioning Group (CCGs)
CCGs are statutorily accountable for the delivery of continuing healthcare in local areas, and it is estimated that 18% of checklist screenings led to the individual being assessed as eligible for continuing healthcare in 2015-16. However, there are significant variations between CCGs in terms of the proportion of applicants assessed as eligible.
Different CCGs vary between 13% and 40%.
A new NHS Clinical Commissioners report, released in January 2018, tackles improving the efficiency of the continuing healthcare system. Using examples of best practice across CCGs, the aim is to deliver £855 million worth of savings by 2020/21.
The report highlights the need for NHS England to communicate more effectively with the public about when continuing healthcare funding will and will not be available, and to develop a consistent national approach to assessing entitlement to funding. It is recognised that “… it can be an incredibly emotive time for the patient and their family – maintaining compassion, empathy and clear communication to manage expectations is critical”
The report contains a recommendation that NHS England should encourage sharing of legal advice where appropriate between CCGs, and establish a central publicly available repository of endorsed approaches.
Slee Blackwell are highly experienced continuing healthcare funding solicitors with a proven track record in successfully assisting families with these cases. We generally support the aims of the NHS Clinical Commissioners Report. A clearer and fairer approach to the decision making process – if this happens – should benefit all those involved. Our concern is that the costs savings, rather than improving the fairness of assessment, will take priority, and our team will continue to keep a close eye on developments in order to give the best advice to our clients.