THE CHC SCANDAL
What is the scandal?
All members of the campaign team have personal experience of the failings of Clinical Commissioning Groups (CCG) in assessments for Continuing Healthcare (CHC). Whilst there are other accountable bodies to enable reviews and complaints of processes, these have failed, when considering the national picture, to hold the CCGs to account.
Using the published NHS quarterly data showing the number of people eligible at any one time, Rear Admiral Philip Mathias analysed the national picture for eligibility for NHS Continuing Healthcare. His graph shows the dramatic fall in eligibility for CHC since Sir Simon Stevens took over as CEO of NHS England. By statute, CHC is based on needs, not budget. The government, NHS England and CCGs are failing to uphold the law. This is resulting in many thousands of people having to fund their own long term health care. The data shows:
Overall CHC eligibility numbers have significantly reduced since 2015. This is despite claims by the Department of Health and Social Care (DHSC) and the National Health Service England (NHSE) that CHC eligibility numbers have been increasing.
Huge and unexplained variations in Clinical Commissioning Groups (CCGs) CHC award rates continue, which the DHSC and NHSE have not corrected since agreeing to do so after damning criticism from the Parliamentary Public Accounts Committee (PAC) published in January 2018.
Against overall declining CHC eligibility numbers, proportionally Fast Track CHC eligibility numbers have increased (low cost) and Standard CHC eligibility numbers (high cost) have reduced.
A significant proportion of CHC assessments, which have huge financial implications to those being assessed, are being conducted by staff with insufficient training or the required level of specialist knowledge.
Since 2015, in the order of 50,000 people have been unlawfully denied CHC funding, a financial figure totalling between £2.5billon and £5billion.
What is NHS Continuing Healthcare?
The National Framework for NHS Continuing Healthcare describes it as "a package of ongoing care that is arranged and funded solely by the National Health Service (NHS) where the individual has been assessed and found to have a 'primary health need' as set out in this National Framework. Such care is provided to an individual aged 18 or over, to meet health and associated social care needs that have arisen as a result of disability, accident or illness. The actual services provided as part of the package should be seen in the wider context of best practice and service development for each client group. Eligibility for NHS Continuing Healthcare is not determined by the setting in which the package of support can be offered or by the type of service delivery."
What is a Primary Health Need?
The National Framework for NHS Continuing Healthcare describes it as "a concept developed by the Secretary of State for Health to assist in deciding when an individual's primary need is for healthcare (which it is appropriate for the NHS to provide under the 2006 Act) rather than social care (which the Local Authority may provide under the Care Act 2014). To determine whether an individual has a primary health, there is an assessment process, which is detailed in this National Framework. Where an individual has a primary health need and is therefore eligible for NHS Continuing Healthcare, the NHS is responsible for providing for all of that individual's assessed health and associated social care needs, including accommodation, if that is part of the overall need."
It is a legal requirement, under section 21 of The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012), to assess anyone who may be eligible by using the Decision Support Tool.
Eligibility for Continuing Healthcare is dependent on need, not diagnosis, prognosis or age.