• CCGs asked to approve and deliver fast-track CHC packages within two days of application
  • But only around one in five meet this standard
  • Projected figures suggest around 6,700 people died last year in hospital rather than their preferred place of death

Terminally-ill patients are “needlessly dying in hospital” because they are waiting too long for specialist care packages, according to a charity’s new report.

A report by Marie Curie suggests only around one in five clinical commissioning groups are meeting a two-day government timescale in which to provide fast-track Continuing Healthcare packages.

CHC is used to pay for the healthcare needs of an adult living in the community. The fast-track process has a speedy assessment and delivery timetable to help people who medics believe are likely to die soon.

The charity collected 2017-18 data from 149 out of 195 CCGs, via freedom of information requests. From this sample, around 10 per cent of approved applications did not result in the patient receiving the care package.

As 67,729 people were found eligible for fast-track CHC in England during the last financial year, a projection of the findings would suggest more than 6,700 could have died in hospital while waiting for community care.

More than a third of approved packages were never provided in 25 CCG areas, while more than 40 per cent were never provided in six areas.

This may have been due to documents being incorrectly completed, the applicant making an unexpected recovery, or the patient dying while waiting.

However, several CCGs told HSJ that delays are not due to decision-making over funding, but are associated with ensuring safe discharge pathways were in place.

They said patients’ preferred place of care is largely dependent on the complexity of their needs and the care that is required to meet them.

CCGs where more than 40 per cent of care packages were not delivered

CCG Fast-track CHC applications Percentage of care packages not delivered
NHS Portsmouth CCG 387 56
NHS West Essex CCG 562 52
NHS Greenwich CCG 201 50
NHS Corby CCG 62 43
NHS South Sefton CCG 290 43
NHS East Staffordshire CCG 156 41

The data also suggested that people who received a care package still faced long waits. Thirty CCGs reported average delays of a week or more, of which eight had delays of more than 12 days.

CCGs with an average wait of more than 12 days for care package provision

CCG Average days to care package provision
NHS Cannock Chase CCG 19
NHS Camden CCG 19
NHS Stafford and Surrounds CCG 17
NHS North Staffordshire CCG 16
NHS East Staffordshire CCG 15
NHS Stoke on Trent CCG 15
NHS South East Staffs and Seisdon and Peninsular CCG 14
NHS Liverpool CCG 13

The charity’s report said: “Until CCGs are made fully accountable for meeting the guidance set out in the [Department of Health and Social Care’s] national framework we will continue to see unacceptable variations between different areas of England.”

Updated national guidelines about NHS CHC eligibility were published by the Department of Health and Social Care in October 2018, which said: “CCGs should have processes in place to enable such care packages to be commissioned quickly. Given the nature of the needs, this time period should not usually exceed 48 hours from receipt of the completed [application].

“CCGs should ensure that they have commissioned sufficient capacity in the care system to ensure that delays in the delivery of care packages are minimal.”

The charity said CCGs should increase the hours during which fast-track CHC applications can be processed so people are not left waiting over the weekend for them to be implemented. But it said “without investment” in community-based health and care services CCGs will not be able to meet the timescales.

The report also suggested the situation “appears to have deteriorated” with fewer CCGs in the last financial year meeting the two-day guidance target and “substantially more” taking up to seven days to deliver funding, compared to 2016-17.

Continuing Healthcare funding has long been a source of controversy as CCGs struggle to meet their overall efficiency targets. NHS England wants CCGs to save £855m from the CHC process by 2021, but it is not clear how commissioners will make these savings.

All the CCGs in the tables were contacted for comment.

Corby said all its packages have been delivered within the required timeframe in the last three months. It added in a statement: “Due to [the] nature of the fast-track pathway a number of individuals may deteriorate rapidly and it may be deemed unsafe to transfer their care to another setting and some individuals may have passed away prior to moving.

“In addition, individual or family choice is a very significant factor in the provision of care to those on the fast-track pathway and this may influence the number who are in receipt of care or who choose to provide family care, remain in a hospice or receive care from commissioned services such as hospice at home.”

Camden said it consistently approves funding applications within two days, and added: “The timescales associated with facilitating a safe discharge to the individuals preferred place of care is largely dependent on the complexity of the patients’ needs and the care that is required to meet those needs.”

Liverpool said a new end of life service has been commissioned from February 2018, overseen by Marie Curie, which has since led to reduced waits.

South Sefton said the data was likely to be inaccurate due to problems the CCG had in recording data during the 2017-18 time period.