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CCGs vary hugely in provision of continuing health care

Some CCGs spend five times as much of their budget on CHC as others do

Louise Prime

Thursday, 25 January 2018

Some clinical commissioning groups spend an almost five times higher share of their budget on continuing healthcare (CHC) as other clinical commissioning groups (CCGs) do, and the number and proportion of people assessed as eligible for CHC also varies significantly between CCGs, NHS Clinical Commissioners (NHSCC) said this morning. In its latest report*, NHSCC called for widespread adoption of best practice approaches from CCG colleagues, and for national organisations to act now to support local delivery of CHC – including the establishment of a national process for sharing legal advice between CCGs, to reduce both cost and inconsistency.

NHSCC pointed out that CHC accounts for 4.9% of total NHS spend (much of this on assessment and screening), which should make it ‘a priority area’ for commissioners. But, it said, commissioners face several challenges in provision of CHC locally, including: ensuring the accuracy of assessments because of the complexity of the process; variation in legal advice; a lack of national support for local CHC teams; and the ‘huge workload burden’ that ineligible applications place on local systems.

NHSCC found reported significant variation between CCGs in both the number and proportion of people assessed as eligible for CHC, which it said cannot be explained by local demographics or core services alone. The estimated proportion of people who were referred and subsequently assessed as eligible, excluding the 5% of CCGs with the lowest and highest percentages, varied from 41-86% –which, said NHSCC, “suggests that there are considerable opportunities to deliver improvements and efficiencies”. It also found that within CCGs, the percentage of the local budget that is spent on CHC varied from 2.1-10.4%.

It argued that because CCGs want to ensure that patients eligible for CHC are appropriately identified in a timely way, thresholds in the checklist are calibrated at a relatively low level, which results in many referrals going through to the CCG that are subsequently unsuccessful. It noted that the National Audit Office estimated that only about 18% of checklist screenings in 2015-16 led to the individual being assessed as eligible for CHC. In NHSCC’s own research, CCGs reported conversion rates from checklist to eligibility as ranging from 13–40%.

NHSCC suggests in its report several ways in which CHC provision in local areas can be improved to benefit patients as well as commissioners, and shares some of the approaches that have been developed by local CCGs which have proved to be effective in delivering their CHC commitments.

It pointed out that, currently, CCGs seek legal advice to clarify elements of the process and for specific individual cases. It said this creates a significant cost pressure for CCGs and has led to inconsistency, as local legal firms can give differing advice and often seek to support the CCGs’ proposed approaches to policies and individual cases rather than offering robust challenge. It called on NHS England to encourage the sharing of legal advice between CCGs, where appropriate, and to establish a central publicly available repository of endorsed approaches.

NHSCC chief executive Julie Wood said: “We believe that there are a number of actions that can be taken nationally to support CHC provision in local areas. Most importantly NHS England must develop a clear narrative and communicate to patients, families and members of the public when CHC funding will be available and when it will not via a national information campaign. This will reduce the burden on local CHC teams, and should result in more timely decisions being made for those who are eligible.”


*NHS continuing healthcare: Effective commissioning approaches. A report prepared by NHS Clinical Commissioners, January 2018.

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