CCGs angered by NHS England instruction to set up £250m risk pool

NHS Clinical Commissioners, which represents CCGs, has written to NHS England objecting to a plan to set up a compulsory risk pool to pay for historic claims for continuing healthcare funding.

Last month NHS England wrote to CCGs instructing them to set aside a total of £250m in 2014-15 to contribute to the fund, which it will hold, in the form of a 0.39 per cent claim on each CCG’s allocation.

NHS England’s letter said CCG allocations for 2014-15 were set “on the basis that they will cover the costs of settling legacy continuing health care provisions”, and CCGs were legally liable for the claims. It also indicated the contribution could form part of the 2.5 per cent of CCGs’ funding which is required to be spent non-recurrently in 2014-15.

Individuals can claim continuing healthcare funding – for the full costs of their care such as care homes, community nursing or therapy – if their primary need for it is deemed to be a “health need”.

During 2012-13, a huge number of retrospective claims were submitted to primary care trusts by people who believed they have previously paid for eligible care but not claimed, amounting to significant costs.

NHS England’s plan to fund these retrospective claims in 2014-15 is contrary to promises given by former health secretary Andrew Lansley, before CCGs were established, that they would not inherit debts of predecessor organisations.

The letter from NHS Clinical Commissioners co-chairs Steve Kell and Amanda Doyle says the issue is a “significant concern” for members.

It says the NHS England instruction “runs counter to all that was previously agreed… it is therefore totally unacceptable to CCGs”, and was a “complete surprise” to CCGs’ finance managers.

“Within the context of the very tight financial allocations, there is a very real risk that needing to identify a risk pool will divert resources critical for a number of high level CCG priorities, including service transformation,” it says. “It will also risk CCGs not being able to secure resources to protect and develop high quality care for patients.”

The letter also complains about NHS England’s approach to the issue in instructing CCGs how to use their own funds. It says this behavior doesn’t “sit comfortably” with agreements about the “different roles, responsibilities and accountabilities CCGs and NHS England have for leading the commissioning system”.

They also emphasise that NHS England should be clear and consistent about “the respective decision making powers and processes, and rules for intervening, for both CCGs and NHS England as separate statutory bodies”.

HSJ was awaiting NHS England’s response when this story was published.