Making continuing healthcare work better for all

Anyone that is involved with the administration and delivery of NHS Continuing Healthcare (CHC) will recognise that the scheme has supported more and more people over the years.

CHC is a package of ongoing social care that is arranged and funded solely by the NHS, where the individual meets specific criteria laid down by the Department of Health and Social Care.

For adults, this funding is offered to meet health and associated social care needs that have arisen as a result of disability, accident, or illness. I want to share a few headlines from our recent research.

Gaps between assessment and eligibility criteria

Patients are initially assessed by a trained health professional using an agreed government checklist. However, data shows that there is a huge gap between the number of patients initially assessed to go forward for full eligibility assessment, and those who are then assessed as eligible.

Currently, the system only awards funding for essential care to 17 per cent of those families who pass the initial criteria in the checklist.

We’re asking the government to give patients and their families more clarity about what to expect

Nurse leaders told us that, when families who have passed the checklist criteria are then found not eligible for funding at the full assessment, this creates very difficult experiences for patients and their families and has led to abuse of the health and care staff supporting them.

Calling for more clarity

That’s why in our new report on CHC, published today, we’re asking the government to give patients and their families more clarity about what to expect, by changing the initial checklist process to make it clearer and closer to the care people can expect to receive.

Our report – NHS Continuing Healthcare: Delivering Excellence – makes it clear that frontline staff see updating the checklist as a priority to improve patient experience.

In quarter four of 2021-22, 14,415 completed referrals were made for standard CHC, but only 2,447 were assessed as eligible and approved for funding – just 17 per cent.

This week, the Department of Health and Social Care has acknowledged the problem in an updated checklist.

It now asks practitioners to remind patients and their families that a positive checklist does not automatically lead to eligibility for CHC. But this only highlights the problem, it does not fundamentally address the chasm between the checklist and assessments at the core of the issue.

False hope leads to anger and abuse

We recognise that this is a highly sensitive issue. The current process raises false hope for both patients and families who assume that a positive checklist guarantees that they will be eligible to receive care, only to then be turned down further down the line.

What is often not recognised, however, is the anger and abuse that the CHC professionals sometimes sadly receive as a result.

Our report reflects on the lessons learned from the pandemic and how the CHC model needs to change as we move into integrated care systems.

Recommendations for improvement

We suggest eight recommendations to improve CHC going forward, some of which reflect the issue of staff abuse, workforce pressures and the impact this has had on delivering CHC services.

There are other positive learnings from the report, which describes how clinical commissioning groups (CCGs) and local authorities have worked hard to overcome barriers and achieved a more collaborative approach, and the positive impact this has had on people needing ongoing care.

Experiences from leaders shared within our report also highlight some of the good joint working practices identified

Following the accelerated integration that took place during the COVID-19 pandemic, our report provides a shared vision of good practice through some agreed principles and calls for changes to ensure a clear legacy of best practice is handed on from CCGs to integrated care systems.

Experiences from leaders shared within our report also highlight some of the good joint working practices identified and the lessons learned about good discharge planning and ongoing support, particularly lessons from the last 18 months of COVID-19 with its different funding and process implications.

We know that CHC remains a critical component of NHS care, which can make a huge difference to the wellbeing of patients.

We hope that the learnings set out in our report will be considered by national policy makers so that health and care staff can be supported to offer improved services to patients and their families.

This article first appeared in the Nursing Times on 1 June 2022.

Lou Patten, is director of the NHS Confederation ICS Network. You can follow Lou on Twitter @LouisePatten1