Care assessments return spells ‘total mess’ and years of litigation

Between March and the end of August, as part of the response to coronavirus, the government has provided emergency funding to bypass the CHC assessment process and fund people’s care.

But phase three guidance issued by NHS England last week said government had decided assessments must resume in September, with all those discharged over the last five months needing to be assessed as well. Official estimates suggest the backlog totals around 30,000, although experts believe this is likely to be a significant underestimate.

CHC assessments are carried out to determine who pays for ongoing care needs after a patient receives healthcare, often when they are ready to leave hospital. If there are ongoing medical care needs, this should be funded by the NHS.

The process is recognised to be a major barrier to quick NHS discharge, is highly burdensome for commissioners, and can sometimes result in legal claims.

It is understood government guidance is due out shortly on how systems are expected to tackle the backlog of cases; and the NHS with government is understood to be considering changes to the process to try to make it more straightforward.

But concerns have been raised over the NHS’ ability to deal with the backlog, in addition to new cases.

One well-placed CHC source told HSJ: “The government is not interested in getting involved in the level of detail needed to resolve this. It will likely issue broad brush stroke principles and leave it to clinical commissioning groups to decide how best to implement this. The situation out there is a total mess and this could drag on for years and cost CCGs a fortune.”

Another fear is the approach could add to thepostcode lottery already seen in who receives CHC funding, as well as open up commissioners to multiple independent review panels who can overturn negative decisions.

The source said the government is desperate to avoid the “litigation culture” that arose in 2012-2013, when up to 60,000 people found they hadn’t been assessed for CHC in the previous eight years. At the time it cost CCGs at least £650m to settle.

Another potential issue is claimants who were already paying for their own care prior to March, while waiting for an assessment.

According to the source, the most likely approach the government will take is to base people’s eligibility on their current needs rather than their needs when they were first referred for CHC. This could prove controversial if someone’s health has improved in the intervening period, as they may have paid for care that at the time would have been legitimately covered by the NHS.

NHS England and the Department of Health and Social Care were approached for comment.

Simon Jones, director of policy and public affairs at the charity Marie Curie, which offers advice on CHC assessments, told HSJ: “Returning to the system in place before the pandemic should not and must not mean a return to unacceptable delays in putting packages of care in place, and widely different waiting times across England.”

Analysis by HSJ suggests the backlog could be significantly higher than 30,000, as in previous years there have been an average of around 75,000 referrals for assessment and 70,000 assessments over a similar time period.

Due to the huge administrative burden CHC places on commissioners, there has been growing demand for the process to be reviewed in its entirety. It was reviewed in 2018, although ministers were clear that changing the legislation underpinning the process was not on the table. The government’s position since the 2019 general election has not been clear.

Laura Cockram, co-chair of the Continuing Healthcare Alliance and Parkinson’s UK head of policy and campaigns, said: “We have been meeting with NHS England and NHS Improvement throughout the pandemic to keep continuing healthcare at the top of the agenda, and we are expecting to meet with them and the Department for Health and Social Care to get further clarity as soon as possible.”