NHS continuing healthcare funding Contents

2Oversight of NHS continuing healthcare

Oversight arrangements

14.Clinical commissioning groups (CCGs) are legally required to provide funding in all cases where a patient’s healthcare needs are beyond the responsibilities of local authorities, and NHS England is responsible for making sure that they fulfil these duties. However, the National Audit Office found that NHS England had limited assurance processes in place to ensure that eligibility decisions are being made fairly and consistently, both between and within CCGs.21 Data are important for monitoring whether the assessment process for NHS continuing healthcare (CHC) is consistent with the requirements of the national framework, but NHS England acknowledged that there has been a shortage of data on CHC. For example, analysis by the National Audit Office suggests that on average people are receiving funding for a shorter period than they did previously, but NHS England does not have data on why this is happening. Similarly, NHS England does not collect data on the number of local appeals or their outcome.22

15.NHS England told us that, since April 2017, it had expanded the data that CCGs are mandated to provide. For example, it now collects data on the speed of fast-track assessments and how long people wait for an assessment on average. However, it recognised that there are still some gaps, such as how long people receive funding for, and having sufficient data on fast-track assessments.23

16.NHS England told us that it works through its regional teams to gain assurance on CCGs’ delivery and performance. It noted that it is also building local intelligence by carrying out deep dives at CCGs.24 It also plans to undertake sample audits and analyse data for CCGs that are in the top and bottom 5% in terms of access to CHC. The Department noted that the data would not, on its own, identify where there is a problem, but would provide a trigger for carrying out further investigations.25

Efficiency savings

17.NHS England wants CCGs to make £855 million of savings by 2020−21 against its predicted growth in spending on CHC and NHS-funded nursing care. It clarified that it is expecting CHC and NHS-funded nursing care spending to increase over this period, but it wants to slow the rate of growth. It noted that the efficiencies it wants to make on CHC and NHS-funded nursing care are proportionally the same as the efficiencies it expects to make across the NHS as a whole.26

18.The Department told us that it could make the £855 of savings by 2020–21 by tackling variation, adopting best practice, speeding up assessment work, reducing administrative costs and using better case management.27 However, CCGs spent just £149 million on assessment costs in 2015–16 and NHS England has not provided a costed breakdown for how CCGs can achieve the £855 million of savings.28 NHS England noted that CCGs had saved £170 million in the last year against projected spend and are broadly on track to deliver the saving required by 2020−21. NHS England also told us that its assessment of reducing variation and improving consistency indicates these improvements will not increase costs.29

19.The Department and NHS England assured us that there is no quota or cap on access, and that they do not intend to change the eligibility criteria for CHC. However, between 2011−12 and 2015−16, the proportion of people assessed as eligible for standard CHC reduced from 34% to 29%.30 NHS England claimed that the trend suggests assessors are probably becoming better at making accurate judgements early on about whether people are likely to be eligible and need a full assessment. However, if this was the case, then we would expect the proportion of people assessed as eligible to increase, rather than decrease. It told us that the data for 2016−17 showed that the number assessed as eligible for standard CHC reduced by 6%, and the number assessed as eligible for fast-track CHC increased by 5%. NHS England considered that this may show that awareness and use of the fast-track assessment is going up.31

20.NHS England told us that if people are assessed for CHC when they are not lying in a hospital bed, they are less likely to end up with a recommendation that they should go into a care home and be funded in perpetuity by the NHS. NHS England has set a target that fewer than 15% of CHC assessments should take place in an acute hospital bed.32

21.The stakeholders representing patients raised concerns that CCGs are increasingly placing arbitrary financial caps on the cost of care packages and may be forcing people to accept lower cost packages that do not meet their care needs. Specifically, they told us that some CCGs are limiting how much they will spend on someone’s first choice of care package where it costs more than the cheapest possible option. They said that for people that wish to be treated in their home, this may mean that they are forced to accept packages with fewer hours and unsafe levels of care, in order to stay at home.33 NHS England confirmed that it is aiming for people to get the right care for their needs in the right setting. However, it noted that there is variation in the rate that is being paid by CCGs for care in different parts of the country and that there may be differences in the care packages people receive, compared to what they wanted, because CCGs may fund cheaper packages that deliver the same outcomes.34 In written evidence to the Committee, the Equality and Human Rights Commission told us that it has recently written to 44 CCGs because it has concerns that they have policies that restrict funding, which may result in disabled people facing institutional care against their wishes.35

21 C&AG’s Report, paras 4, 1.4, 6.2

22 Qq 48, 57, 65, 75–76; C&AG’s Report, paras 3.3, 6.3

23 Qq 48, 60, 65, 75–76

24 Qq 69, 105

25 Qq 73–74, 89

26 Qq 76–77, 90–93; C&AG’s Report, para 4.5

27 Qq 78–79

28 Q 93; C&AG’s Report, para 4.6

29 Qq 79, 88, 91

30 Qq 53, 70, 79, 109; C&AG’s Report, paras 3.3, 3.7

31 Qq 54–56,

32 Q 72; C&AG’s Report, para 5.3

33 Qq 29, 80, 102

34 Qq 80–81, 102

15 January 2018