NHS England’s latest plan to improve delays to NHS Continuing Healthcare assessments – published on August 17th – appears to promote positive progress. In reality, it may be the biggest anti-climax of the summer since Venus Williams and Marin Cilic crashed out of Wimbledon in straight sets.
After the damning, forensic report on NHS CHC assessments by the Government’s own watchdog, the National Audit Office, in July, we expected NHS England to have far more to say about the confusion, delay and inconsistency that those waiting for NHS CHC assessments currently experience.
The NAO put into context what many of us involved in NHS CHC assessments already knew.
- That many people are having to wait far longer than the stipulated 28 days for a decision on whether they are eligible for NHS CHC. In 2015-16 one-third of assessments took longer than that. This causes considerable stress and financial difficulty for patients and their families.
- That CCGs, in general, are cutting approvals for CHC. They are down from 34 percent to less than 30 percent between 2011-12 and 2015-16 (despite an aging population).
- That there is a huge variation in eligibility for NHS CHC between CCGs. Approvals range from 41% in some to 86% in others. These variations cannot only be down to local demographics or other factors. They must mean CCGs are interpreting the national framework on CHC assessments in different ways.
NHS England wants to reduce NHS CHC assessments in acute hospital settings
NHS England’s opinion is that delays in NHS CHC assessments are to blame for around a quarter of all NHS delayed discharges. Also known as, ‘bed blocking’ in the old jargon. Consequently, something must be done to reduce them.
As a result, CCGs are to submit a plan to reduce the number of NHS CHC assessments in an acute hospital setting to 15% by next March. Currently, in over 100 CCG areas it is 30%. Patients who are going on to rehabilitation services or who “do not have long-term care needs” should not have an NHS CHC assessment before discharge.
Furthermore, CCGs must ensure that at least 80% of cases with a positive NHS CHC checklist receive an eligibility decision within 28 days.
The 84 CCGs currently completing less than half of their NHS CHC decisions within that timeframe must submit to an audit “to understand the reasons for lengthy delays” before expecting any help or support.
There are a number of flaws with this plan.
First, it does not address the problems that currently make it impossible for many CCGs to meet the deadline. In our experience, these include holes in resources, disputes between the local authority on the differences between ‘social care needs’ and a ‘primary health need’, and the lack of staffing and training. Our own anecdotal evidence suggests that medical evidence is often incomplete. Misinformation is the norm and there is a lack of understanding of the eligibility criteria. Until this changes, it is unlikely many CCGs will be in a position to meet the NHS England targets.
Second, when patients are considered for discharge from hospital, the first question is supposed to be whether they have been considered for CHC eligibility if they have complex healthcare needs. This is intended to ensure any long term care needs are taken into account BEFORE making major decisions about their next port of call. Refusing to do an NHS CHC assessment before discharging someone because they do not appear to “have any long term care needs” is putting the cart before the horse. Surely, if a more robust and thorough assessment was carried out sooner, delays would be minimised. This should not be yet another block to accessing NHS Continuing Healthcare assessments whilst in hospital.
Third, that large numbers of assessments, most of them resulting in ineligibility, are causing delays in the system is not necessarily an argument for carrying out fewer assessments. It is about assessing whether an individual has a ‘primary health need’. Instead, NHS England should be asking why so few people are officially meeting the criteria, why the delays in decision making are so severe, and why there is so much variation between postcodes.
Faster assessments and greater accountability are welcome.
There are many who believe the answers to these questions have far less to do with inefficiency and time-wasting, and far more to do with a lack of resources and trained CCG assessors. Families with a relative in hospital with complex healthcare needs must always insist that clinicians carry out an NHS CHC Checklist. After all, the recent NHS England letter is for ‘guidance’ only and does not change the eligibility criteria.
Nevertheless, faster assessments and greater insight and accountability are welcome. Delays to NHS CHC assessments can cost families money, as well as cause huge stress. NHS England has said the audits on failing to meet NHS CHC deadlines must be complete by 11 September. Let’s hope NHS England itself is as speedy in formulating a plan at both local and national level. This must ensure sufficient resources for NHS CHC assessments, putting an end to the waiting game for so many families.
Do you think your relative requires an NHS CHC assessment? Have you faced delays in receiving an eligibility decision? Call us today to see if we can help.