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Funding of NHS Continuing Healthcare

The House of Commons Committee of Public Accounts has published a damning assessment of the funding of NHS Continuing Healthcare (CHC).  CHC is a package of care provided outside of hospital to individuals who have significant ongoing healthcare needs.  But as always with UK healthcare provision the commissioning and funding arrangements are unnecessarily complex. The DfH is responsible for the legal framework for CHC, including setting criteria for assessing eligibility for CHC through a national framework. Clinical commissioning groups (CCGs) are responsible for using the national framework to determine individuals’ eligibility for CHC and then for commissioning the care required. NHS England is responsible for making sure CCGs comply with the national framework. People can access CHC funding through two processes: a standard CHC process and a fast-track process for people with rapidly deteriorating conditions who may be nearing the end of their life.  The Committee’s Report, published on 17th January, makes for very troubling reading.   Key issues include (i) serious delays in assessment and, even where funding is agreed, in getting the agreed package in place; (ii) a widespread lack of awareness as to the availability of CHC and how it can be accessed (one survey suggesting that most people found out about CHC by chance); and (iii) widespread discrepancies in terms of the approach taken by CCGs across the country.  The Committee has made a series of recommendations as to how the system should be improved, but this all sits in the context of NHS England wanting CCGs to make £855 million of savings by 2020−21 against its predicted growth in spending on CHC and NHS-funded nursing care.  The prognosis is not good.

Landmark members regularly advise NHS bodies and individuals in relation to CHC issues.