• Commissioning leaders fear funded nursing care price hike could push more CCGs into deficit
  • FOI requests reveal CCGs estimate the rise cost them £152m in 2016-17
  • Price hike from £112 to £156.25 a week was announced by the Department of Health last year and backdated to April 2016
  • DH says the rate will be reduced to £155.05 a week from this month

Commissioning leaders fear more clinical commissioning groups could be plunged into deficit due to the increase in NHS funded nursing at care homes, despite the government agreeing to reduce the rate.

The Department of Health announced last July that the cost of a place in a care home with nursing would rise from £112 to £156.25 a week, which was backdated to April 2016.

The rise, estimated to be worth nearly £200m, followed an independent review by Mazars that recommended the 40 per cent increase.

The DH confirmed in March it will reduce the rate from £156.25 to £155.05 this month, following a further review by Mazars.

A DH spokeswoman said it had increased CCG funding by £2.5bn for 2016-17 with an extra £1.5bn expected in 2017-18.

She added: “NHS funded nursing care is a vital part of supporting vulnerable people and must be funded effectively.

“The current rate is based on the best evidence currently available on the costs of providing high quality nursing care in the sector and the government is increasing funding for CCGs.”

However, NHS Clinical Commissioners chief executive Julie Wood said that even with the reduction, the hike was still an “unfunded” pressure on CCGs’ resources.

An investigation by HSJ has found that nationally, CCGs predicted the rise would cost them an extra £152m in 2016-17 compared to the previous financial year.

The total increase is likely to be higher because only 178 out of 209 CCGs responded to freedom of information requests for data for 2015-16 and 2016-17.

There were 10 CCGs where the increase represented a cost pressure of more than 1 one per cent of their 2016-17 allocation (see table below).

Ms Wood warned that to cover the increase, CCGs will need to make savings from other budgets or risk going into deficit.

She said: “The actual figure [the DH] has confirmed is a slight reduction but nevertheless it’s still adding a significant pressure on CCGs that hasn’t been funded.

“This has somehow got to be mitigated by the CCGs, or if it cannot then it will play through into their bottom line, which is where it links to the wider number of CCGs in deficit.

“If you have to spend £180m [extrapolated] to fund this kind of nursing care increase you have to find £180m from somewhere else or you get into a deficit or bigger deficit position.”

The CCG sector forecast a deficit of £550m for 2016-17, with the position worsening by nearly 50 per cent in the last few months of the financial year.

The DH said it plans to consult on introducing a regional funded nursing care rate.

Its statement added: “These rates are based on the best evidence currently available to the Department of Health on the costs of providing nursing care in the sector.”

An NHS England spokesperson said: “Any unplanned cost pressures resulting from the increase in the funded nursing care rate, announced by the Department of Health in July 2016, have been borne by CCGs, and we have seen these cost pressures reported to us through the 2016-17 reporting process.”

HSJ’s research also found:

  • The total cost of funded nursing care rose from £403.7m in 2013-14 to an estimated £598.5m in 2016-17.
  • The national average cost of funded nursing care dropped from £4,177 per patient in 2013-14 to £4,099 for 2015-16, but was estimated to rise to £7,055 in 2016-17.
  • Sixty-five CCGs expected an increase of more than 40 per cent in costs from 2015-16 to 2016-17.
  • Only six CCGs estimated the cost of nursing funded care to drop from 2015-16 to 2016-17.
  • Out of 118 CCGs reporting a fall patient numbers from 2015-16 to 2016-17, only five reported a drop in costs.

Twenty CCGs with biggest cost pressure due to increase in funded nursing care costs

CCGAllocation 2016-2017Funded nursing care costs 2015-16Funded nursing care cost estimate 2016-17Cost difference 2015-16 to 2016-17% increase as a proportion of 2016-17 allocation
Portsmouth CCG £266,600,000 £11,830,568 £16,822,531 £4,991,963 1.87%
Crawley CCG £154,200,000 £944,561 £3,636,333 £2,691,772 1.75%
West Lancashire CCG £146,600,000 £6,299,504 £8,564,486 £2,264,982 1.55%
Windsor, Ascot and Maidenhead CCG £165,100,000 £7,000,000 £9,400,000 £2,400,000 1.45%
Kingston CCG £217,300,000 £5,986,088 £9,024,000 £3,037,912 1.40%
Darlington CCG £145,200,000 £4,382,041 £6,337,000 £1,954,959 1.35%
Surrey Heath CCG £113,100,000 £4,342,310 £5,833,353 £1,491,043 1.32%
Mansfield and Ashfield CCG £252,400,000 £3,474,449 £6,227,074 £2,752,625 1.09%
Newark and Sherwood CCG £163,900,000 £4,629,268 £6,386,705 £1,757,437 1.07%
Dudley CCG £405,000,000 £7,960,277 £12,066,253 £4,105,976 1.01%
Wokingham CCG £168,700,000 £4,536,474 £6,162,851 £1,626,377 0.96%
Vale Royal CCG £127,900,000 £3,629,027 £4,838,815 £1,209,788 0.95%
Halton CCG £191,300,000 £3,919,659 £5,486,124 £1,566,465 0.82%
Southport and Formby CCG £177,800,000 £5,088,967 £6,379,453 £1,290,486 0.73%
Erewash CCG £125,700,000 £1,900,571 £2,800,000 £899,429 0.72%
West Kent CCG £541,000,000 £10,836,000 £14,624,000 £3,788,000 0.70%
South Kent Coast CCG £273,400,000 £3,026,000 £4,900,000 £1,874,000 0.69%
Isle of Wight CCG £207,000,000 £3,775,153 £5,189,000 £1,413,847 0.68%
South Lincolnshire CCG £198,900,000 £2,353,746 £3,677,300 £1,323,554 0.67%
Great Yarmouth and Waveney CCG £319,300,000 £8,710,000 £10,760,000 £2,050,000 0.64%