Revealed: 'Ludicrous' CCG variation for care at home

The latest data from NHS England, released in February, showed one clinical commissioning group found no one eligible for continuing healthcare funding if they were not deemed terminally ill, while another deemed more than 87 per cent of applicants eligible, using the same assessment criteria.

The chair of the CHC Alliance, which represents a group of seven charities, called the variation “ludicrous”.

CHC 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 CCGs to save £855m over four years from the continuing healthcare fund. In its recent planning guidance refresh, it said CCGs should “increase standardisation of [CHC] processes and adopt best practice to deliver the targeted reduction in growth”.

The latest data, covering the period from October to December last year, reveals the extent of the variation. It shows:

• 15 CCGs approved 10 per cent or less of applications for funding through the standard CHC assessment process;
• Corby CCG, a very small CCG, did not approve a single case. Harrow CCG only approved 1.4 per cent of assessments;
• By comparison, during the same period 36 CCGs found 50 per cent or more people eligible for CHC funding using the same assessment process;
• Bolton CCG had an approval rate of 77.5 per cent, and Bracknell and Ascot CCG 87.5 per cent;

Variation between CCGs has been eliminated from the fast track process. In quarter three of 2017-18 all CCGs approved 100 per cent of applications from those who were terminally ill.

A spokeswoman for Corby CCG said: “It’s the smallest CCG in the country and a minor variation of cases can therefore appear to indicate a more significant percentage shift. Decisions in relation to eligibility are made in line with the national [CHC] framework.”

A spokeswoman for North West London CCGs, which includes Ealing and Harrow, also said its CCGs ”ensure that decisions are in line with the framework”.

A new NHS CHC 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.

Matina Loizou, senior policy adviser at Parkinson’s UK and chair of the CHC Alliance, said “The variation across areas is ludicrous. Assessors must be knowledgeable about the condition of a person they are assessing, or have an expert present at assessments to inform them.

“Try as they might, NHS bosses must accept that not every person with high-level healthcare needs will fit neatly into this completely inflexible system – the impact of serious conditions cannot be defined with a tick box.”

An NHS England spokesperson told HSJ: “While variation in access to CHC has reduced for both standard and fast-track assessments thanks to recent improvement efforts, the big differences in spending across the country suggests there is potential to make the process more efficient and effective for patients as the majority of people put through a CHC assessment turn out not to need it.”

CCGs with lowest eligibilty rates after a standard CHC assesssment, quarter three 2017-18

CCGs with highest eligibilty rates after a standard CHC assesssment, quarter three 2017-18