CCGs have improved the way they assess people needing NHS Continuing Healthcare (CHC), official figures have shown.
NHS England figures on NHS CHC published last week showed that fewer people were assessed in acute hospitals – which are considered inappropriate settings.
CCGs are also completing a bigger number of referrals for NHS CHC since NHS England first started releasing CHC data in 2017.
NHS CHC is a package of care arranged and funded by NHS England. To be able to qualify for it, patients need to be assessed by CCGs.
In Q1 2017/18, 26% of eligible patients received CHC assessment in acute hospital settings. Data published in Q3 2018/19 showed this number is now down to 9%.
According to DHSC guidance published last year, CCGs should make sure the assessment is instead completed in more ‘appropriate settings’ – such as ‘another NHS setting, the individual’s home or some other care setting’.
This is because in an acute hospital setting ‘an individual might feel disoriented or have difficulty sleeping and consequently exhibit more challenging behaviour, but as soon as they are in a care home environment, or their own home, their behaviour may improve’, the DHSC guidance said.
NHS England is also incentivising CCGs to ensure that less than 15% of all full NHS CHC assessments take place in an acute hospital setting through a quality premium (QP) scheme, which was introduced in 2017.
According to a NHS Clinical Commissioners (NHSCC) spokesperson, the QP is a good incentive that may have helped CCGs cut the number of inappropriate settings but it is still down to individual CCGs to actually take action.
CCGs are also assessing patients quicker for NHS CHC, with a greater number of referrals being completed within the 28 days standard. This went from 58% in Q1 2017/18 to 70% in Q3 2018/19.
According to a 2017 NAO report, delays in assessing patients for CHC can cause ‘distress, and in some cases, considerable financial hardship, to patients and their families as they wait for funding decisions. In some cases, people have died while waiting for a decision’.
NHSCC chief executive Julie Wood said: ‘More patients applying for NHS CHC are being assessed by CCGs quicker, in the right location and with the right decisions since April 2017.’
A challenging issue
She added that CHC has ‘historically been a challenging issue’ for CCGs, adding financial pressure to their budgets.
The 2017 NAO report said that CHC spending increased by 16% between 2013/14 and 2015/16 and it accounted for 4% of CCGs’ total spending in 2015/16.
NHS England said they expect spending on CHC, NHS-funded nursing care and assessment costs to increase from £3,607m in 2015/16 to £5,247m in 2020/21 and is asking CCGs to make £855m of savings on CHC and NHS-funded nursing care by 2020/21.
All people found eligible for CHC have a right to access a personal health budget (PHB), which is money allocated to those people with long term conditions to help them have a say on the type of care they should receive.
The Government announced yesterday that wheelchair users and people accessing mental care after leaving hospital will also have a legal right to a personal health budget.
Under the long term plan, PHBs will be made available to up to 200,000 people by 2023/24.