• Significant drop in people found eligible for standard continuing healthcare funding
  • NHS England attempting to save £855m from CHC budgets
  • Variation eliminated for people applying for CHC funding when terminally ill

The proportion of people with serious long-term conditions being approved to receive NHS-funded care at home has fallen substantially during the past year, the latest official data has revealed.

The rate of approvals for NHS continuing healthcare funding after a standard assessment dropped from 31 per cent in the first quarter of 2017-18 to 26 per cent in quarter three.

Continuing healthcare pays for ongoing care for adults who are assessed as having a primary medical care need. It is arranged and funded solely by the NHS. There are two application routes: “standard” where a person goes through multiple assessments; and a “fast track” process for those who are terminally ill.

NHS England wants clinical commissioning groups to save £855m cumulatively over four years from the CHC budget. NHS England has not said how much CCGs need to save overall, but the National Audit Office reported the 2015-16 budget as being £3.1bn, suggesting a savings target potentially in excess of 6 per cent per year.

In its recent planning guidance refresh, NHS England said CCGs should standardise processes and “adopt best practice” to cut growth in CHC spending.

A Commons public accounts committee report on CHC released in January said: “It is not clear how [NHS England can achieve the savings] without either increasing the threshold of those assessed as eligible, or by limiting the care packages available, both of which will ultimately put patient safety at risk.”

In some areas of the country the decline in those found eligible for CHC was dramatic. Nineteen CCGs recorded a drop of 50 percentage points or greater from quarter one to quarter three in those approved for funding after a standard assessment. Most had seen an increase in the number of people assessed for CHC.

The data also shows that variation between CCGs has been eliminated from the fast track process for terminally ill patients. In quarter three, all CCGs approved 100 per cent of fast track applications. In quarter one, 54 CCGs found between 1 to 20 per cent of these applicants ineligible. However nationwide fast track eligibility has remained relatively stable since April 2017 (99 per cent for quarter one, and 100 per cent for quarters two and three).

Brian O’Shea, CHC advisor at the charity Spinal Injuries Association, told HSJ: ”The clear implication is that assessors consider CHC to only be appropriate for people who are approaching the end of their lives. However eligibility for CHC is a matter of law, as set out in the Care Act 2014, and not NHS or CCG policy.

“We have a changing demographic with people living longer with serious and complex, but not moribund conditions, so it makes no sense that the numbers of people found eligible for CHC through the standard assessment process is decreasing.”

An NHS England spokesman said: “Spending on continuing healthcare is going up as ever more people are being supported but it’s CCGs that undertake eligibility assessments, using the National Framework for Continuing Healthcare, based on needs not diagnosis”.

A new framework was issued by the Department of Health and Social Care last week. It said it would provide “greater clarity to individuals and staff” about CHC eligibility. Prior to this CCGs relied on a framework published in November 2012.

The DHSC declined to comment.

NHS England has been collecting data on CHC funding since April 2017 to monitor the application of the national CHC framework. Prior to that NHS Digital collected data on the service but it was much less comprehensive so a year-on-year comparison is not possible.

More seriously ill people turned down for NHS home care funding