Cost of the DH’s care claims deadline becomes clear

Was the Department of Health wrong to set final deadlines last year for the submission of nearly a decade’s worth of retrospective continuing healthcare claims?

As HSJ reports this week, the financial consequences for the NHS are starting to become clear. Primary care trusts were inundated with claims in the year before their abolition. They had to set aside provisions totalling around £650m for the future costs of meeting those claims.

On top of this, the “contingent liabilities” in PCT accounts rose by a further £605m in 2012-13, driven by the same care claims deluge.

It is the latter figure that will be controversial, because when a clinical commissioning group inherits a contingent liability it does not inherit funds earmarked to cover it.

‘The bigger risk is to people already in receipt of continuing care’

You could argue, though, that if the DH had not set a deadline for retrospective claims CCGs would still have inherited liabilities; it is just that those backdated claims would have trickled in over years, instead of arriving in a massive pile on day one of the reformed NHS.

What about the patients?

But what about the impact on patients? One senior CCG source argues that a worrying aspect of this story is the potential impact on people who have already secured continuing care funding.

Commissioners should regularly review the needs of continuing healthcare recipients, because the amount of funding they need can diminish or increase over time. However, the source told HSJ: “We’re processing so many new claims that we’re unable to do the required review of existing claims…

“The bigger risk is to people already in receipt of continuing care, particularly those people whose needs increase. They are going to get pushed to the back of the queue because we’re trawling through thousands of new claims, many of which are spurious.”

Clearly the counter to this is that many of the claims are not spurious, and the figures suggest vulnerable people have, in the recent past, paid hundreds of millions of pounds for care that should have been NHS funded.

But it would be sad and ironic if the efforts to redress that wrong left those in current need of continuing care without access to funds they need.