Continuing concern over continuing care
The funding system known as NHS Continuing Care has long constituted a scandal, of which perhaps the worst element is that so few people, including potential beneficiaries, are even aware of its existence.
Theoretically, Continuing Care looks after all of the costs of care for those individuals who, despite serious long term illness or disability, can effectively live outside hospital. That means in either in a residential care setting – generally one with in-house nursing – or in their own homes with intensive domiciliary care and community nursing services.
The multi-aspect scandal, outlined in January in a scathing report from the usually sober Parliamentary Public Accounts Committee, involves long delays in decision-taking by Clinical Commissioning Groups – many people die before getting the results of their applications – variations in local interpretation of the assessment criteria, the poor quality of some assessments carried out by unqualified staff, and a failure by NHS England to provide any sort of consistent oversight. The result is that many very needy people do not get the services they need or inadvertently themselves pay for services which should be state-funded.
For their part, Clinical Commissioning Groups protest that the costs of providing care for certain individuals can be very high – running in some cases to hundreds of thousand of pounds annually – so that they simply cannot afford to take them on and, given their strained budgets, they do have a point. Some have introduced stringent eligibility tests, adding the further injustice of unfairness between areas. However extenuating these circumstances there can be no justification for statutory bodies failing to carry out statutory duties.
The Public Accounts Committee has now required NHS England to give an assurance that achieving efficiency savings – aka cuts – over the next three years will not involve further restriction on Continuing Care. One possible amendment to the scheme, which the committee did not explore, would be for funding to be centralised. This would by-pass the sometimes crippling burden on local budgets of small numbers of very expensive cases and enable the enforcement of eligibility criteria which, however stringent, would at least be consistent and fair. We are after all supposed to have a National Health Service.
- The CT Blog is written in a personal capacity – comments and opinions expressed are not necessarily endorsed or supported by Caring Times.