The Third Phase of NHS response to COVID-19 has now been published from the chief executive, Sir Simon Stevens and chief operating officer, Amanda Pritchard.
The issues covered relate to what the NHS priorities should be from August, including getting back to near normal levels of non-COVID health services and preparations for winter demand.
Paragraph A3 of the letter deals with restoring service delivery in primary and community services, including discharge from inpatient care and CHC assessments. As we know, the obligation to carry out CHC assessments was suspended in the midst of the pandemic but this letter sets out the plan for this suspension to be lifted. The expectation is that from the 1 September 2020 the usual requirements for CHC assessments will re-start. On top of this, patients discharged from hospital between 19 March 2020 and 31 August 2020 and who have not had a CHC assessment (but whose discharge support package has been paid for by the NHS) will now need an assessment to take place to establish future funding arrangements.
Although not unexpected, this suspension was bound to end at some point, this decision is likely to place an enormous strain on CCGs going into the winter period. Those CCGs must now deal with new assessments from September, and then the backlog of assessments from the past six months. The assessments and resulting decisions may also involve an increasing number of disputes with Local Authorities and individuals and their families, who may need to pick up the ongoing costs of care, and at a time when financial burdens for all (public authorities and individuals) are being stretched. This decision also comes at a time where CCGs have other important challenges to face, including expansion and improvement of mental health services for people with learning difficulties and autism, is just one example.
There is also concern that picking up the CHC assessment process again, at this time, may cause delays in discharges from acute care. The letter seeks to address this by setting out that the Government is committed to continuing to provide funding to support discharge from hospital inpatient care. It has also been announced that there will be new or extended health and care support funded for a period of up to six weeks, following discharge from hospital, with an expectation that a CHC assessment will be carried out within this period.
It remains to be seen if this will be sufficient to avoid extended delays in discharge from acute care during the next few months and whether CCGs will have sufficient resources to cope with the significant challenges ahead.