Ombudsman shines light on NHS Continuing Healthcare

Watchdog calls for new national guidance and more learning for the CHC workforce

The Parliamentary and Health Service Ombudsman (PHSO) has published a report, Continuing Healthcare: getting it right first time based on their findings following a review of 60 CHC cases resolved in the last three years. Ten of these cases are included as case study examples. The PHSO explain that these cases reveal important learning about the way Clinical Commissioning Groups have been applying national CHC guidance.

In his foreward, Rob Behrens, ombudsman and chair says “Our recommendations are rooted in the findings from the casework and point to essential changes that should be made to prevent similar failings for future care users.”

The PHSO acknowledges that the publication of the report comes at a time when the NHS is still dealing with the coronavirus pandemic. The Government paused new assessments for NHS CHC and review of existing care packages between March and the end of August to allow the CHC workforce to support hospital discharge arrangements – and while assessments were restarted from 1 September, it is recognised that a move into stricter lockdown measures may result in further pauses. Currently CCGs and local authorities are now working their way through these deferred assessments and processing new referrals. NHS England and NHS Improvement has rolled out a programme of work to support CCGs with the deferred assessments, including supporting the workforce, and securing additional resources for CCGs to increase capacity as well as providing additional e-learning material.

Analysis of the CHC casework has highlighted two key themes

1. Failings in care and support planning

People being forced into ‘topping up’ care packages either because of errors in care and support planning, or because the CCG did not make them aware of what should be covered by their package or how to review or challenge the package says the PHSO. The report explores two such cases which resulted in significant financial and personal burdens being placed on people using care, their families and carers. The impact of this was so significant that PHSO achieved redress of over £250,000 for each family.

2. Failings in reviews of previously unassessed periods of care

PHSO found CCGs making mistakes when undertaking the reviews of previously unassessed periods of care which has resulted in people living with uncertainty without knowing whether they or a relative were entitled to NHS CHC funding for their care.

The recommendations

Six ‘essential changes’ are set out which the PHSO sees as key to preventing similar failings for future care users

Changes to support the failings in care and support planning

1. Supporting the skills and experience of NHS CHC practitioners locally

This is about CCGs assuring themselves that those involved in assessing care needs and developing care and support plans are appropriately skilled and experienced to perform that role by using the CHC Competency Framework. Reference is also made to regular training for frontline practitioners to ensure best practice is followed – and as a minimum, it says that CCGs should ensure frontline practitioners have undertaken learning from the NHS England and NHS Improvement e-learning tool to increase their knowledge and understanding.

2. Sharing learning nationally

As an immediate action NHS England and NHS Improvement should review the NHS CHC e-learning tool to ensure it takes account of the learning from the case summaries included in the PHSO’s report..

3. Putting learning into practice

In the long-term, NHS England and NHS Improvement should consider what additional support and coaching it can provide to care systems, CCGs and NHS CHC frontline staff to ensure they are appropriately supported and skilled in care and support planning and commissioning.

4. Supporting people and providers through the NHS CHC process

CCGs should ensure all parties to an NHS CHC-funded package of care are aware of the principles of NHS CHC funding and arrangements for additional services. CCGs should clearly explain in care and support plans what is included in the care package to meet the assessed needs, and the process that should be followed if any additional services or charges need to be considered.

Changes to support failings in reviews of previously unassessed periods of care

5. Developing national guidance

The PHSO is clear on what is required: the Department of Health and Social Care and NHS England and NHS Improvement should consider the approach to previously unassessed periods of care dating from after 2012 and develop guidance to clarify CCGs’ obligations. Guidance should set out explicitly how CCGs should respond to requests to retrospectively assess people’s eligibility for NHS CHC-funded care. It further states that this guidance should make clear what CCGs’ obligations are and give clear and specific timeframes for CCGs to meet these obligations. If deadlines for requests are imposed, these should be effectively communicated by CCGs to anyone who may have been affected to ensure no one is disadvantaged.

6. Delivering capability in the NHS CHC system

PHSO says that once national guidance is in place, CCGs should assure themselves, with support from NHS England and NHS Improvement, that they have sufficient capability to successfully meet their obligations as set out in the guidance. Where assessments of previously unassessed periods of care are required by the guidance, CCGs should ensure they can complete timely and quality reviews.

Next steps

PHSO asks the Department of Health and Social Care, and NHS England and NHS Improvement to write to the Public Administration and Constitutional Affairs Committee and the Health and Social Care Select Committee in six months with an update on progress in planning and delivering these recommendations.

Do get in touch with our friendly, expert team if you have any questions arising from the report, or you want to know more following this blog.

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