CEO Sue Browning comments on NAO report into NHS CHC Funding

Last week’s National Audit Office report into NHS Continuing Healthcare Funding may not be occupying space in the typical beach bag as the summer read of the year. It does though do a good job of shedding much-needed light on the opaque workings of NHS Continuing Healthcare (CHC) – a vital lifeline of support for seriously disabled people. As is often the case, the report invites more questions than it offers answers but is a welcome contribution to efforts across the sector to secure appropriate and high-quality care for all who need it.

NHS CHC is a package of care provided outside hospitals, such as in people’s homes or in a care home, that is arranged and funded solely by the NHS through Clinical Commissioning Groups (CCGs). People must have significant health needs that goes above and beyond usual social care needs, such as help with washing or dressing.

It offers vital support for people with long term and serious health conditions, including those with spinal cord injuries and provides long term planned and funded care, thereby helping people to live independently in their homes, leading fulfilled lives.

Assessments of a person’s healthcare needs are made by the applicant’s local CCG who have a legal responsibility to provide funding to those assessed as eligible.  Meanwhile, NHS England has a responsibility to ensure that CCGs comply with the national framework and to arrange independent reviews if needed.

In the rather dry style beloved of auditors, the report systematically describes the facts relating to NHS CHC funding and access to that funding. It reveals a funding scheme that is increasingly under pressure, full of wide-ranging regional variations, lacking in oversight and failing to meet the needs of the most seriously disabled. It found, for example, that:

• Decisions on whether somebody is eligible for CHC should be made within 28 days, but one in 10 people wait longer than 100 days.
• There is a wide range of eligibility rates between CCGs – from 41% to 86% of those referred and subsequently assessed as being eligible. Between 28 and 356 per 50,000 of population either received or were assessed as eligible for funding.
• NHS England expects to make savings of £855 million by 2020-21 from reducing administration and the overall cost of care.
• Only about 18% of those who apply for CHC are actually granted funding, according to estimates from NHS England.
• Of 124,000 people who were initially screened in 2015/16, 77,000 went on to have a full assessment and 22,000 of those received funding.

The report stops short of describing the human impact of these worrying revelations. That’s something our members and callers to our advice line have consistently shared with us and what living with a flawed process means to their daily lives.

We hear a depressing tale of widespread variation in access and eligibility, delays in assessment and arbitrary caps on what is funded. In practical terms, cuts to the size of CHC funded care packages are reducing care provision to unacceptable and unsafe standards. There are incidents of overnight care being removed and we have started to receive examples of people who have been threatened with a move out of their own home and into residential care, due to budgetary constraints. More widely, the decades-long march toward integration of people with disabilities playing an active role in society, where they can, is being eroded as people are denied packages of care that foster independent and fulfilling lives.

Of great concern is that NHS England expects to save £855 million from reducing both administration assessment costs and the overall costs of care. The report identifies that the administration costs for NHS CHC in 2015/16 were £149 million, so even if all of these administration costs were taken away through “efficiency savings” it would still leave circa £700 million in savings to be found.  It is hard to see how this can be achieved without either reducing the number of people assessed as eligible for NHS CHC, reducing the size of individual care packages or a combination of the two.  As our members are already seeing cuts to their care packages, which leave them with unsafe levels of care provision, this has to be a massive concern.

It’s also worth noting that a person’s care needs do not go away just because there is a reduction in funding. People forced to live with unsafe levels of care who go on to develop unnecessary and preventable complications will be passed to other, no doubt more expensive, parts of the NHS and local authorities for care and treatment. And who thinks that’s a good idea?

So, what’s to be done? Firstly, a partial cheer to the NAO for providing an authoritative, independent and considered – though limited – review of the workings of CHC. But action is urgently needed. We recognise that funding for care at home cannot be limitless, but call for recognition of the value of living at home, independently but supported. The patient’s needs must be at the centre of decision making.

Specifically we are asking for further scrutiny by the Public Accounts Committee of the entire CHC process and the impact the current system has on those seeking support. We’re also asking for a considered response by NHS England into the serious deficiencies uncovered in the report.

There needs to be a reduction in regional variation of assessments and awards – a postcode lottery of care – that the report amply highlights, which does not result in a cost-led race to the bottom, and  greater enforcement by NHS England to ensure lawful decision making that is in the spirit and letter of the national framework used by the CCGs. But above all, we need a system that genuinely engages with people to provide the independence, support and care they deserve and need.

Sue Browning, Chief Executive Officer, SIA