Commissioners 'bombarded' with care cost claims

Some commissioning leaders fear it could lead to deficits being passed on to clinical commissioning groups.

The claims follow a deadline on 30 September for applications to be submitted to be considered for funding for care provided since April 2004.

For patients who are eligible for NHS Continuing Care, the NHS will pay for costs such as home personal care and care home fees. To be eligible, patients’ primary need for care must relate to their health, and they must have a complex medical condition which requires significant levels of care and support, or need highly specialised nursing support.

The Department of Health announced the deadline in March. It said it was “considered timely to introduce these changes” because funding responsibility will transfer to CCGs in April 2013.

Several senior PCT leaders told HSJ their organisation had received thousands of claims – some from individuals and many from lawyers on behalf of large numbers of people. One finance director estimated there would be “hundreds of thousands” across England. The deadline has also brought large numbers of appeals from those previously denied funding.

Finance managers said it was likely many claims were not eligible and would be refused. However, some will be, and sources estimated the additional cost this year as potentially running into millions of pounds for each PCT, and therefore hundreds of millions nationally. Generally, NHS Continuing Care costs each PCT about £20m annually.

Sources said the deadline had also created a huge amount of work reviewing large numbers of claims. PCTs have been told to work quickly to resolve claims ahead of their abolition at the end of March.

One PCT finance director in the north of England said: “There is a lot of work going in to look at what financial risk is coming out. The more quickly it is sorted out the better. CCGs don’t want to be taking on a risk of an unknown quantity.”

A director in the south said: “All PCTs have been absolutely bombarded with claims. There will be hundreds of thousands across the country.” He predicted funds would be found to pay for the claims during 2012-13, for example from contingency funds and regional pools.

Alzheimer’s Society chief executive Jeremy Hughes told HSJ: “Historically, claiming for continuing care has been a minefield. That there was such an influx of applications before the September deadline highlights the desperate need to raise awareness of continuing care and the opportunity to appeal.

“The continuing care debacle is just one example of how vulnerable people are being let down by a flawed social care system. Next year’s social care bill must provide answers on how to ensure that those who need it can access quality care at the right time at the right price.”

The DH declined to give an estimate of the national cost, or say how it would be paid for, but a spokeswoman said: “There has been a considerable response to the introduction of [the] deadlines. PCTs are now working with strategic health authorities and the DH to handle the process. This includes looking at the financial management implications and what happens after the transition to CCGs.”