Damning Independent Scutiny
Our campaign is not the first to raise issues the NHS Continuing Healthcare. There have been numerous reports into the failings in the system, including by Government funded bodies. Below are excerpts from some of them.
Cross Party Parliamentary Public Accounts Committee - 10 January 2018
"Patients’ likelihood of getting CHC funding depends too much on local interpretation of assessment criteria, due to poor quality assessment tools and inadequate training. There is huge variation between CCGs in access to funding, as well as the amount that they spend on CHC. For example, the number of people that were assessed as eligible for CHC ranged from 28 to 356 people per 50,000 of population in2015−16. The Department’s assessment tools are unclear, so CCGs interpret them differently, which results ininconsistent decisions being made, depending on where a patient lives. Stakeholders told us that some CCGs have introduced arbitrary additional local rules which are not set out in the formal assessment tools, and the Equality and Human Rights Commission is concerned that the way some CCGs are applying CHC policies may be unlawful. Too often assessors in multidisciplinary teams areinadequately trained, have never met the person they are assessing and do not involve the patient or their family in the assessment. Furthermore, a report by the Continuing Healthcare Alliance found that around 60% of healthcare professionals are assessing people without sufficient specialist knowledge of the medical condition that they are looking at".
National Audit Office - 5 July 2017
“There is significant variation between CCGs in both the number and proportion of people assessed as eligible for CHC and there are limited assurance processes in place to ensure that eligibility decisions are consistent, both between and within CCGs.”
Care Quality Commission – extracts from 2017/18 CQC CCG inspection reports:
Wiltshire: "System leaders were unable to describe why the CHC rate was so low but they were aware that CHC processes were not effective."
Stockport: "Significantly less people than comparator areas or the national average were deemed eligible for CHC funding."
Coventry: "The CHC award rate was very low compared to the national average and families were not given the information they needed about CHC funding."
Birmingham: "CHC processes were not working and people were dying in a hospital setting who didn’t need to be there. A person with dementia and affected by multiple strokes had their CHC funding removed following a review."
Hartlepool: "The processes for identifying people for CHC were not working well and a higher proportion of people were entering into the CHC process to subsequently be denied funding."
Northamptonshire: "The number of people eligible for CHC was lower than average for both CCGs and staff were not identifying enough people who needed CHC funding."
Reading: "The decision process forCHC funding was not timely or widely understood by staff and people were dying in hospital before funding was approved."
East Sussex: "CHC award rates were below the England average in each of the three CCGs.’
Plymouth: "Significant improvements were required to ensure staff understood the CHC eligibility criteria. The eligibility rate was half the national average."
CHC Alliance (17 Charities)
"Continuing Healthcare is failing people across England. Due to flawed processes, many people who should be found eligible are being denied this much needed support; the CHC system discriminates against people with dementia, despite it being a medical condition and there is weak enforcement of the National Framework that CCGs must adhere to. 60% of healthcare professionals are assessing people without sufficient specialist knowledge of the medical condition that they are looking at."
Parliamentary and Health Service Ombudsman - 3 November 2020
“NHS Continuing Healthcare is administered by local NHS Clinical Commissioning Groups (CCGs) with oversight from NHS England and NHS Improvement. We have found not only significant failings in care and support planning but also failings in reviews of previously unassessed periods of care. The impact of these mistakes on people cannot be understated. They constitute an abrogation of basic rights. 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.”