Third of continuing healthcare assessments take longer than a month

One third of assessments for NHS continuing healthcare (CHC) funding take longer than 28 days, causing distress for patients and their families and in some cases, delaying discharge from hospital, new research reveals.

The National Audit Office (NAO) published a report into the assessment process and found wide variations across the country in both the number and proportion of people deemed ‘eligible’ for the package of care, suggesting that the complexity of the process may be ‘baffling’ commissioners.

Continuing healthcare (CHC) is a package of care provided outside of hospital that is arranged and funded solely by the NHS for individuals who have significant ongoing health care needs.

Care England, the largest representative body for independent providers of adult social care, has welcomed the report. Professor Martin Green, chief executive of Care England said: “The NAO report unpicks some of the complexity behind continuing healthcare. It reinforces what our members are telling us in that assessments for eligibility take too long causing distress to residents and families.”

The report found that the number of people assessed as eligible for CHC funding has been growing by an average of six per cent a year over the past four years. In 2015-16, almost 160,000 people received, or were assessed as eligible for CHC funding, at a cost of £3.1bn. This compares with 125,000 in 2011-12.

However, whilst decisions on whether somebody is eligible for continuing healthcare should be made within 28 days, figures from the report suggest that one in 10 people wait longer than 100 days.

This is having an effect on hospitals, with some patients unable to be discharged until funding is approved or declined.

The report also found that between 2013-14 and 2015-16, spending on CHC increased by 16 per cent and in 2015-16, it accounted for about four per cent of Clinical Commissioning Group’s (CCG) total spending.

NHS England estimates that spending on CHC, NHS-funded nursing care and assessment costs will increase from just over £3m in 2015-16 to £5m in 2020-21.

It wants CCGs to make £855m of savings on CHC and NHS-funded nursing care by 2020-21. It plans to do this by reducing both administrative assessment costs and the overall cost of care through reducing variation in spending.

Care England maintains that the actual commissioning of CHC is “equally as concerning”, with a lack of CCG engagement with care home providers, a lack of understanding of care home costs, and fees that simply do not cover costs all of which ‘exacerbates’ the recruitment and retention of nurses and ‘threatens the stability’ of the care home sector.

He added: “In order for CHC to deliver its objective, namely better care for people, CCGs must engage with the care sector and pay appropriate fees.”

NHS England and the Department of Health have recently started work aimed at providing more consistent access to CHC funding and supporting CCGs to make efficiency savings. From April 2017, NHS England expanded the data it collects on CHC.

The National Audit Office’s report ‘Investigation into NHS continuing healthcare funding’ can be found here: www.nao.org.uk/report/nhs-continuing-healthcare-investigation