• New NHS Continuing Healthcare policy allows for care caps as long as individual need’s taken into account
  • DHSC will not hold a public consultation on the new framework which will be implemented from October 2018
  • CCGs should stop carrying out annual reassements of eligibility for the majority of cases

Commissioners have been allowed to continue applying cost caps to the more than £3bn of NHS Continuing Healthcare claims as long as they follow new new government rules.

The Department of Health and Social Care’s new framework, developed in partnership with NHS England, does not explicitly ban cost caps as long as commissioners take into account an individual’s needs when they do so.

CHC pays for ongoing care for adults, described by the DHSC as ”some of the most vulnerable in our society” and who are assessed as having a primary medical care need in a community setting. It is arranged and funded solely by the NHS and in 2015-16 cost the service approximately £3.1bn.

HSJ has previously reported that 37 CCGs were introducing policies to cap the cost of providing NHS Continuing Healthcare support in a person’s home if the spend would be significantly higher than a residential care placement. Last year the Equality and Human Rights Commission said it was investigating concerns the policies would be “likely to breach individual equality and human rights.”

The new guidance, published yesterday, said a commissioner “must not set arbitrary limits on care at home packages if this does not represent a personalised approach or an accurate appraisal of the cost” of meeting an individual needs.

It went on to say CCGs can take “value for money” into account over an individual’s choice about where they would like to live as long as this is based on the “genuine costs” of care in a home setting versus a residential setting.

It said working out the cost of a home care package should take into account “the willingness of family members to supplement support… but no pressure should be put on them” to do so

The DHSC is not holding a public consultation on the changes. Nor has it made fundamental changes to its assessment tools that have been criticised for being “unfit for purpose” by the CHC Alliance, which represents seven charities.

The document also says that raising awareness of the CHC fund remains the responsibility of local CCGs - a direct rejection of a recommendation by the Commons’ Public Accounts committee from January this year which said both the DHSC and NHS England should improve awareness among patients and families.

Matina Loizou, chair of the NHS Continuing Healthcare Alliance said: “The new framework falls desperately short of the change that was urgently needed. Instead of a crucial overhaul failing assessment tools, used to determine eligibility for life-changing care, have simply been tweaked.

“We are also gravely concerned that raising awareness of this little-known service has been shunted onto CCGs instead of sitting nationally with NHS England. This will lead to further inconsistencies in the system, leaving people to face a postcode lottery of whether they will get the support they are entitled to.

“This, combined with the complete lack of public consultation, means we have been left with window dressing on a framework that falls massively short of addressing the key issues with continuing healthcare.”

It does aim to stop CCGs reassessing a CHC recipient’s needs on an annual basis. The framework said: “These reviews should primarily focus on whether the care plan or arrangements remain appropriate to meet the individual’s needs. It is expected that in the majority of cases there will be no need to reassess for eligibility.”

The new framework is expected to be implemented by CCGs from October 2018.