We investigate the worrying trend of some Clinical Commissioning Groups to move patients out of their own homes despite National Framework guidelines to the contrary
NHS continuing healthcare funding (or NHS CHC) is free healthcare to cover care costs provided by the NHS to individuals who have significant and ongoing healthcare needs. This package of care can be received in any setting outside of hospital including care homes, hospices or within your own home. A patient’s health needs, not their location, is the key factor, indeed the NHS National Framework for continuing healthcare states that “eligibility for NHS continuing healthcare places no limits on the settings in which the package of support can be offered or on the type of service delivery.” (page 10, National Framework)
However, in a recent study by Disability United¹, the organisation found that of the 122 replies from 212 Freedom of Information requests sent to clinical commissioning groups (CCGs), 53 admitted using their own continuing healthcare policy rather the NHS National Framework. Further, according to Disability United, 83% of CCGs with their own policy seem to believe they have the right to move people from their own homes.
The Continuing Healthcare Alliance, Disability United and The Guardian are among a growing number of organisations to express their concern over the lack of suitable care packages being put into place once continuing healthcare funding has been granted. There appears to be a growing and deeply concerning move by a number of CCGs to move people out of their homes and into care once they have been awarded continuing healthcare funding.
Richard Vize, writing for The Guardian², suggests that “the revelation that thousands of people could be forced out of their homes into residential care raises serious questions about the judgement of clinical commissioning groups”.
The Guardian further states that
A total of 19 CCGs have said they will not fund care in the person’s own home if it is more than 10% above an alternative – normally going into a care home. The remainder are imposing other restrictions. Up to 13,000 people could be affected among these CCGs; since 87 CCGs did not reply, the national figure could be around 22,000
This trend, which conflicts the National Framework recommendation that “treating individuals and their families with empathy, respect and dignity is at the core of NHS continuing healthcare delivery” was highlighted by the Continuing Healthcare Allianceᶟ in their ‘Continuing to Care?’ report written in association with Parkinson’s UK. The Alliance found that
Almost 20% of survey respondents who were awarded CHC said the cost of care was not met by their NHS funding, resulting in them having to pay top-up fees. Without these top up fees, pre people would end up in increasingly dangerous situations. As an NHS service, CHC should not allow top-ups.
Further, it states that “to maintain positive health and wellbeing, CCGs should prioritise keeping someone at home if that is their preference. The alliance believes that forcing people into residential care could become a huge problem.”
Despite NHS England stating ‘personalised care will only happen when statutory services recognise that patients’ own life goals are what count; that services need to support families, carers and communities; that promoting wellbeing and independence need to be the key outcomes of care” (NHs England (Oct 2014) ‘Five Year Forward View), as mentioned, a total of 19 CCGs have said they won’t fund home if it is more than 10% above an alternative i.e. residential care. Richard Vize (The Guardian) argues that,
To deprive people of the right to live at home on the basis of a 10% limit on additional cost seems arbitrary and callous. It leaves the uneasy feeling that a vulnerable group of patients – many of the recipients of continuing healthcare have brain injuries, significant disabilities or are dying – are being shunted into a care home because it is an easy saving. In their desperation to find cuts, commissioners are in danger of losing sight of the human cost of their decisions. (The Guardian, January 27th 2017)
At Compass CHC, we are deeply concerned at the number of CCGs who are ignoring the NHS National Framework and devising their own set of rules and we have experienced first-hand clients who have encountered CCGs using their own version of the Framework.
Tim Davies, Compass CHC Managing Director comments “In my view, it is troubling from a patient perspective that a National Framework compiled by the Department of Health to be implemented by Clinical Commission Groups under the umbrella of NHS England is being interpreted by some Clinical Commission Groups as merely guidance to be ignored. This creates a clear and obvious risk of a postcode lottery of service and patient experience being received by individuals. Clearly against the backdrop of a National Health service it is inappropriate that certain people receive care that others with equivalent needs in a different area may be denied.”
If you have encountered problems with your CCG or you are at the start of your NHS continuing healthcare funding journey, we, at Compass CHC, can help you obtain NHS continuing healthcare funding. Our team of continuing healthcare experts, comprising lawyers (non-practising) and clinicians (including nurses, tissue viability specialists and pharmacists), review and consider the evidence from a clinical perspective before drafting reasoned arguments which identify an individual’s entitlement to the funding by cross-referring the medical evidence to the National Framework for continuing healthcare criteria
¹: Fleur Perry, Disability United: NHS Staff Can Decide Where Disabled People Live, Even Against Their Choice
²: Richard Vize, The Guardian: NHS commissioners risk losing sight of human cost of their decisions
ᶟ: Continuing Healthcare Alliance: Continuing to care? Is NHS continuing healthcare supporting the people who need it in England?
Author: Tim Davies LLB