House of Commons Public Accounts Committee report on NHS Continuing Healthcare

Having taken evidence from a variety of witnesses, including Simon Stevens, back in November the Committee produced its report on 10 January 2018. That evidence is summarised in chapters one and two.

The report sets the scene by explaining that the number of people eligible for CHC funding has grown by an average of 6.4 per cent over the last four years – for the period 2015-16, almost 160,000 people received or were assessed as eligible for CHC funding.

The report contains five conclusions and recommendations:

1. Too many people are waiting too long to find out if they are eligible for CHC and to receive the essential care they need – the national framework provides that most people should not wait more than 28 days for a decision. But in 2015-16 almost 25,000 assessments (one third of assessments) took longer.

PAC recommendation: NHS England needs to hold CCGs to account for delays in assessments and needs to find out the extent of further delays by CCGs in providing care packages once funding is agreed, and taking remedial action where needed.

2. Some patients are not receiving the care that they are entitled to because they are not made aware of the funding available or because the system is too difficult for them to navigate.

PAC recommendation: NHS England and the Department of Health and Social Care need to improve awareness of CHC amongst patients, their families and health and social care professionals. The Committee request that the Department and NHS England report back by April 2018 on how awareness has been raised.

3. Patient's likelihood of getting CHC funding depends too much on local interpretation of assessment criteria, due to poor quality assessment tools and inadequate training. The number of people assessed as eligible for CHC ranged from 28 to 356 people per 50,000 population in 2015-16.

PAC recommendation: the Department and NHS England to report back by April 2018 on:

    - what action they have taken to improve the quality of assessment tools and training for staff carrying out assessments; and

    - how it plans to monitor the impact of these changes on reducing variation between CCGs.

4. NHS England is not adequately carrying out its responsibility to ensure that CCGs are complying with the legal requirement to provide CHC to those that are eligible.

PAC recommendation: NHS England need to establish a consistent oversight process, using the new data available, to ensure eligibility decisions are being made consistently both within and across CCGs, including by setting out what criteria they will use to identify and investigate outliers and undertake an annual sample audit.

5. CCGs are required to make £855 million of efficiency savings in CHC and NHS Funded Nursing Care spending by 2020-21, but the committee are unclear how commissioning groups can do this without either increasing the threshold of those assessed as eligible, or by limiting the care packages available.

PAC recommendation: NHS England to provide, by April 2018, a costed breakdown of how these savings will be achieved and an assurance that they will not be achieved by restricting access to care for vulnerable patients.

Do get in touch if your CCG would like support with CHC funding applications.

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