The National Audit Office (NAO) has today published an investigation into NHS Continuing Healthcare (CHC) funding. This was partly prompted by the receipt of more than 100 complaints from members of the public about the CHC process in England since February 2016. We were pleased to be invited to give evidence as part of the investigation.

The key findings

• In 2015-16 almost 160,000 people received, or were assessed as eligible for, CHC funding at a cost of £3.1 billion
• During the year, 77,000 were people referred for a full assessment, with 22,000 (29%) being assessed as eligible. The proportion of people assessed as eligible has fallen from 34% since 2011-12.
• 83,000 were referred for a fast-track assessment, of which 79,000 were assessed as eligible
• Around one third of people had to wait longer than the stated 28-day timescale between referral and an eligibility decision.
• The number of people that received or were eligible to receive CHC funding at any time during 2015-16 increased from 125,000 to 160,000
• But, snapshots from March 2015 and March 2016 shows that the number of people receiving, or eligible to receive, CHC funding fell from 63,000 to 59,000.
• There is a wide range of eligibility rates between CCGs – from 41% to 86% of those referred and subsequently assessed as being eligible
• NHS England expect to make savings of £855 million by 2020-21 from reducing administration (which accounts for £149 million) and the overall cost of care. However, they don’t yet have a costed savings plan.
• In 2015-16, the Parliamentary and Health Service Ombudsman received 1,250 complaints about CHC funding decisions. It investigated 181 of them and partly or fully upheld 36 cases.

Worrying signs

In response to the report, Dan Harbour, Managing Director at Beacon CHC said:

“This report has, for the first time, put on record what we suspected about the worrying state of play in NHS Continuing Healthcare. By bringing together the data so clearly, the NAO has spotlighted trends in this area, which the individual experiences of our callers and clients have been hinting at for some time.

“Notwithstanding the enormous postcode lottery in this area, getting an assessment of eligibility is becoming harder – falling from 34% to 29% in five years – and the year-on-year snapshot data shows a fall of more than 6% in the absolute numbers that were eligible in one month.

“When we unpack these figures alongside the data showing that over the course of a year 35,000 more people were eligible, it indicates that individuals are dropping in and out of eligibility more frequently. This suggests a couple of things:

• that funding is more often being withdrawn from people following the yearly review of eligibility
• that many of those who are eligible, are at the end stages of their life and die shortly after.

“Further alarm bells ring at the first sight of the proposed cost savings of £855 million. Administration costs for CHC can surely be cut but – as they currently stand at £149 million – this is merely a drop in the ocean. Even if admin costs were cut by a quarter, NHS England would still be making more than £800 million in cuts – the equivalent of average annual care fees for over 17,000 people* with severe long-term illness or disability.

“We believe the data on delays in the process is hugely underestimated. We know that CCGs are frequently measuring the timescales incorrectly, and the report identifies that NHS England are aware of this anomaly. It is very common for patients to wait many months for a full assessment, let alone a decision, and such delays place a huge burden on families, causing stress and financial hardship at a time when they are trying to look after a loved one.

“Finally, the NAO data reveals that while the Ombudsman is receiving a large volume of complaints about CHC, only a fraction are investigated and fewer than 3% are upheld. We know from casework that there are widespread problems with CHC procedures, so the figures raise serious questions about the Ombudsman’s performance.

“In summary, this welcome report confirms that anecdotal evidence from our clients reflects the national picture. The scaling back of NHS continuing healthcare – which is a vital service for the most vulnerable in our society – is happening already, and is set to continue. It is inconsistently awarded, regularly delayed and increasingly withdrawn.

“We urge NHS England and the Department of Health to act now, with the Continuing Healthcare Alliance, to ensure the right support is available for everyone who needs it.”

Do you need our help?

Beacon CHC is a social enterprise providing ethical, expert and affordable help to help trying to navigate the maze of NHS Continuing Healthcare. For over 13 years, our team of specialist caseworkers have won over £8million in restitution for our clients, with a success rate of over 70% in cases brought to appeal.

We’re proud that, in addition to our paid-for casework, we provide free and independent help to hundreds of patients and families every week through the Information and Advice Service and free Navigational Toolkit.

If you have questions about any aspect of NHS CHC, call us on 0345 548 0300