- NHS England letter reveals continuing healthcare improvement plan to “address… reducing growth in CHC expenditure”
- Charities have expressed concern that any aim to cut spending would have “hugely detrimental impact” on people eligible for CHC
- NHS England confirms 10 regional sites to take part in improvement programme
- Analysis by charity shows 18 STPs mention CHC cuts targets
Charities have told NHS England they are “very concerned” that a Continuing Healthcare improvement programme is focused on cutting funding.
HSJ has seen a copy of a letter sent on 7 April by 14 member charities of the Continuing Healthcare Alliance to Professor Jane Cummings, NHS England’s chief nursing officer. It said: “We are very concerned that one of the [programme’s] key aims seems to be to reduce the money spent on NHS CHC. We cannot unreservedly support any project where one of the aims is to reduce the spend on NHS CHC, as we believe this would have a hugely detrimental impact on the highly vulnerable people we support.”
The letter was sent to address concerns about a new national CHC commissioning programme launched by NHS England.
According to board papers from one clinical commissioning group, the programme was launched at the start of December, though NHS England’s website contains no mention of the programme and it did not respond to a request from HSJ for more information.
NHS England did not respond to a request from HSJ prior to publication but has since said the improvement programme will run from 1 April 2017 to 31 March 2019. A spokeswoman said: “The aim is to provide fair access to NHS CHC in a way which ensures better outcomes, better experience and better use of resources”.
The Next Steps on the Five Year Forward View said that, together with the Department of Health, NHS England will be consulting on the CHC national framework in 2017-18 but it did not say if the improvement programme is a precursor to this consultation.
HSJ has also seen a letter dated 5 December 2016 from Ms Cummings and NHS England chief finance officer Paul Bauman, addressed to all CCG accountable officers, chief finance officers, CHC clinical leads and chief nurses.
It said: “It is the first time NHS Continuing Healthcare has become a national improvement priority” and the programme would “share best practice and… identify opportunities for improvement to ensure that we provide access to NHS CHC in a way which is efficient and effective, provides value for money”.
The letter added that one of the issues it will “specifically address” is to meet “the requirements of the spending review which sets a target of reducing growth in CHC expenditure through standardisation and adoption of best practice”.
NHS England did not respond to a request for clarification on what exactly this spending target is but a report by the National Audit Office last year said CHC programmes were expected to deliver 2 per cent efficiency savings each year until 2020-21. Overall this would accrue a £0.5bn saving. The data was attributed to saving programmes by the DH, NHS England and NHS Improvement.
The planning guidance for 2017-19 also mentioned continuing healthcare in the finance “must do” criteria. The document said “demand reduction measures include… improving the management of continuing healthcare processes”.
Rupert Earl, honorary lead on care policy at the Spinal Injuries Association, a member of the CHC Alliance, said that while past CHC concerns on eligibility criteria remained, “the new battleground is on the commissioning of care practices”.
HSJ has previously reported on the growing practice by CCGs to implement a cap on how much they spend on CHC care at home. Mr Earl said: “Our fear is that this [improvement programme] is being used as a backdoor way to give CCGs the green light to cut or restrict care packages”.
The charity shared with HSJ its analysis of how sustainability and transformation plans will manage CHC. It found that 18 of the 44 STPs include proposals to reduce the combined CHC budget of the CCGs in their footprint.
Mr Earl said: “I don’t know how they will achieve those levels of savings without cutting people’s care packages.”
In a similar vein, the letter from CHC Alliance said there is “significant risk that these budget cuts may be achieved by reducing the number of people eligible, and cutting the spend on care packages. Safeguards must be put in place to prevent this outcome.”
The alliance members are: Stroke Association; Age UK; MS Society; Parkinson’s UK; Sue Ryder; Marie Curie; Spinal Injuries Association; Dementia UK; Multiple System Atrophy Trust; Motor Neuron Disease Association; Beacon; Carers’ Trust; Alzheimer’s Society; and the Progressive Supranuclear Palsy Association.
Hilda Hayo, chief executive of Dementia UK, said: “We feel very strongly that families are getting a poor deal [with CHC allocation]. The strategy programme should be aimed at improving things but it doesn’t look like it will improve things for families. It is an awful situation for them.”
The letter from Ms Cummings and Mr Bauman also said NHS England has set up a “development group” to ensure “rapid” progress of its improvement programme, create new commissioning and operating models, and set benchmarks of CHC commissioning practice.
NHS England said 10 regions have now been chosen to take part in its “development group”. They are:
- Nottingham City Collaborative: NHS Nottingham CCG and partners.
- East and West Berkshire Collaborative: NHS East Berkshire Collaborative; Windsor, Ascot and Maidenhead CCG, Slough CCG, Bracknell, Ascot CCG, Wokingham CCG and partners.
- Trafford Collaborative: Trafford CCG and partners.
- Cheshire Collaborative: Eastern Cheshire CCG (covering 5 CCGs: South Cheshire, Vale Royal, West Cheshire, Wirral) and partners.
- Sutton Collaborative: Sutton CCG and partners.
- BNSSG Collaborative: Bristol CCG on behalf of the STP footprint for Bristol, North Somerset and South Gloucestershire CCGs and partners.
- Southampton City Collaborative: Southampton City CCG and partners.
- BSol Collaborative: Solihull CCG and partners.
- Bedfordshire Collaborative: Bedfordshire CCG and partners.
- Cumbria Collaborative: Cumbria CCG and partners.
This article was update at 10.50am on 20 April to include new information from NHS England.