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PCTs call for continuing care help

PCTs call for continuing care help

Strategic health authorities are having to rescue primary care trusts flooded with "continuing care" cases, a year after the government made it easier for service users to claim NHS funding.

Overburdened PCTs have been forced to give SHAs control over all appeals held to decide who is eligible for continuing care.

Continuing care funds services for people who need long-term help with dressing and washing and whose main need is health, rather than social, care.

"SHAs made the decision to align the process we use for reviewing cases because of the expertise we've built up"


The decision represents a further shift of continuing care powers away from PCTs.

Care funding

It comes a year after the national framework for NHS continuing healthcare and NHS funded nursing care in England came into effect. The framework standardised eligibility criteria for continuing care across England, leaving PCTs having to invest more staff and money in providing long-term care.

A deadline for appeals of decisions made before 2004 to be registered by November 2007 created added pressure.

Recent board papers indicate the extent of the burden. North Yorkshire and York PCT minutes reveal "serious concerns" over the workload and uncertainty over the financial risk and the lack of adequate resources.

The increase in cases carried a risk of £3.7m, according to Derbyshire PCT. Lincolnshire PCT said the new criteria could create an overspend "well in excess" of £1m over budget.

The decision of SHAs to take more responsibility for reviews means they will now carry out all current as well as pre-2004 cases. These appeals were previously done by PCTs and should have been completed by this March.

SHA expertise

NHS South Central continuing care project manager Paula Williams said: "SHAs made the decision to align the process we use for reviewing cases because of the expertise we've built up."

South Central PCTs have invested an additional £53m in continuing care - £30m in 2007-08 and £23m in 2008-09 - because of the national framework and demographic changes.

The DH predicted that the framework would cost the health service £219m in its first year.

TIMELINE

July 2000 Government commitment: "We will make nursing care available free under the NHS to everyone in a care home who needs it... in any setting."

December 2004 Criticism of uneven provision of NHS continuing care sparked development of national framework.

June 2007 National framework published. Plans to give primary care trusts total autonomy to set funding policies dropped. SHAs to manage PCTs' performance in implementing framework.

November 2007 Deadline for claims for retrospective (pre-2004) continuing care funding.

March 2008 Deadline for retrospective claims to be reviewed.


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Reader Response

Added: Thursday, 16 October 2008 15:22 BST
Anonymous, London, United Kingdom

Sadly, the change to the National Framework appears to have done little to alleviate the presumption of ineligibility within PCTs and SHAs towards Continuing Care. The lack of transparent guidance for patients and their representatives leaves many feeling that whilst the guidance has moved towards a consistent set of rules, the inconsistent way that they have been implemented gives the public the impression that the issue is more of an institutional one. Until the NHS recognises that many more patients genuinely have a 'primary health need' and grant Continuing Care then the public will continue to be skeptical about the motives behind denial of funding.


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Added: Monday, 13 October 2008 12:49 BST
Anonymous, Derby, United Kingdom

Whilst I understand the concern about NHS staff seeking to avoid Continuing Care costs - we ARE supposed to deliver value for money. Every pound spent inappropriately on Continuing Care is a pound NOT SPENT on appropriate care.

We have to do complete our work promptly and there can be no excuses for delay - but we have to be robust in declining Continuing Care where it should not apply.


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Added: Monday, 13 October 2008 12:49 BST
Anonymous, Derby, United Kingdom

Whilst I understand the concern about NHS staff seeking to avoid Continuing Care costs - we ARE supposed to deliver value for money. Every pound spent inappropriately on Continuing Care is a pound NOT SPENT on appropriate care.

We have to do complete our work promptly and there can be no excuses for delay - but we have to be robust in declining Continuing Care where it should not apply.


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Added: Monday, 13 October 2008 10:42 BST
Anonymous, Norfolk, United Kingdom

I agree entirely with the previous response -- the postcode lottery is alive and thriving. Many PCTs seem to have acted responsibly (well done!) and are doing their best, others seem to have established inefficient and cumbersome systems, effectively 'gatekeeping', and are procrastinating all the way to the bank. This is unfair on patients and their families and clear leadership is needed to enforce the 2007 national framework, which was a good attempt at introducing some clarity and uniformity. It has been let down by allowing each PCT to interpret it in their own often inconsistent way, by not collecting a standard set of comparative data and therefore not being able to show that the greater than expected increase in spending is almost certainly down to an underestimation by the Department of Health, rather than any fault in the system. Perhaps the current review of the framework will result in an improved system (and perhaps not!).


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Added: Friday, 10 October 2008 13:35 BST
Anonymous, nuneaton, United Kingdom

There is still huge dissatisfaction over the ways in which assessments for Continuing Care funding are carried out and over the appeals process. Consistency is still lacking, both between Authorities and within some Authorities, where different staff have differing views of the criteria and the processes. Many patients and their relatives are still left with the impression that NHS staff will do everything possible (or delay do anything possible!) in order to avoid making Continuing Care payments.

Leadership is needed both from the Government and from the NHS. At the moment we have procrastination and evasion.


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