A review of continuing healthcare cases has called for CCGs to ensure staff have the skills and resources to carry out high quality care planning, after it found ‘significant failings’ in this area.
The Parliamentary and Health Service Ombudsman (PHSO) analysed 60 closed complaint cases in a bid to share its learnings with CCGs and NHS England and Improvement (NHSE&I).
The report found that people, in some cases, were forced into ‘topping up’ care packages either because of errors in care and support planning, or because the CCG did not make them aware of their entitlements under their package, or how to launch a review or challenge.
Some patients, families and carers have consequently faced large financial and personal burdens, it found, with two cases resulting in over £250,000 being paid out in compensation.
The PHSO also found that CCGs had made mistakes when carrying out reviews of previously unassessed periods of care, resulting in people being left in limbo for a ‘considerable time’ over whether or not they were entitled to NHS CHC funding for their care.
‘Devastating impact on lives’
The report concluded that these incorrect and delayed decisions had a ‘devastating impact on people’s lives’ and constituted an ‘abrogation of basic rights’.
It said: ‘They have led to people unnecessarily paying out large sums to cover care, or going without care because of incorrect or delayed decisions. Many have faced years of uncertainty about their future finances and experienced stress, anxiety and ill-health as a result.
‘’The NHS should be supporting people in their care needs, not needlessly adding to emotional and financial burdens.’
The PHSO called for CCGs, with the support of NHSE&I, to ensure ‘frontline staff have the skills and resources to deliver high-quality, comprehensive and inclusive care and support planning that meets individuals’ care needs’.
The ombudsman said the complaints it received showed ‘repeated failings’ in the assessment of care packages. It made decisions on 336 complaints about NHS CHC between April 2018 and July 2020, it said, though this constitutes a ‘small proportion’ of the number of people assessed as eligible each year.
CHC assessment backlog
CHC assessments were paused between March and September due to Covid-19, which has created a large backlog of cases. The Government previously urged CCGs to use well-trained non-clinical staff ‘wherever possible’ to help tackle this.
The report said: ‘It remains to be seen what the impact of the second wave of the pandemic will be on NHS CHC over the coming weeks and months. Nonetheless, the findings of the report show how vital it is that CHC assessments are dealt with promptly and effectively.’
Training and guidance
The report recommended that CCG ensure those involved in assessing care needs and developing care and support plans are appropriately skilled and experienced to do so, through ‘regular training’ and the use of the CHC Competency Framework or NHSE&I’s e-learning tool.
It also recommended that CCGs should ‘clearly explain’ care package entitlements to people and any processes that need to be followed.
The Department of Health and Social Care (DHSC) and NHSE&I should consider developing guidance to clarify CCGs’ obligations, which would set out explicitly how CCGs should respond to requests to retrospectively assess people’s eligibility for NHS CHC-funded care, it added.
‘Opportunity to remove burden’
Rob Behrens, parliamentary and health service ombudsman, said: ‘Our casework demonstrates that failing to provide vulnerable people with the care they are entitled to causes huge suffering, as well as financial harm, for them and their families.
‘NHS CCGs must improve communication with patients and families and properly train staff to make sure they get continuing healthcare funding decisions right the first time.
Laura Cockram, co-chair of the Continuing Healthcare Alliance, said: ‘Sadly, this report confirms what our members have been telling us for a long time – that people are being left to struggle through a complicated and unwieldy process. In addition to what is likely to already be a challenging time in their lives, the impact on a person’s physical health and well-being of not receiving the right levels of support cannot be overstated.
‘No one should have to fight this hard for the support they need and are entitled to. By training staff to get continuing healthcare decisions right the first time and making the process easier to understand, CCGs have the opportunity to remove a massive financial and emotional burden for vulnerable people who simply need support, not barriers.’