COVID: How Will Backlogs Impact on NHS Continuing Healthcare Funding?
Whilst care providers still have restrictions in place to deter visitors and protect their vulnerable residents, it is inevitable that in time, those restrictions will continue to ease slowly. Indeed, some care homes are already allowing non-essential visitors. We know of one company which has been able to arrange for its external nurse assessors (wearing full PPE) to visit a patient at a care home and undertake a preliminary assessment as to their potential eligibility for NHS Continuing Healthcare (CHC).
Clearing the backlog: What is the future for Assessments?
NHS Clinical Commissioning Groups (CCGs) were already behind and flooded with pending assessments (and appeals) before coronavirus. How much more so will the backlog be felt once care homes can reopen their doors to facilitate CHC assessments and MDT hearings can fully resume face-to-face in due course?
CCGs are generally under-resourced and couldn’t cope before COVID, and in all likelihood, they will struggle again, but only to a greater degree. It is, of course, too early to predict the level of that degree until life returns to some sort of ‘normality’. However, we expect that most CCGs will take a long time to regain control and make inroads into clearing their huge backlogs and undertaking new patient assessments (as well as completing appeals).
Those whose CHC assessment is still on hold or else postponed by COVID, may well be feeling the financial strain of paying for their ongoing care. If savings or assets, such as a home, need to be sold to release funds, this is not the right financial market to do so. These are indeed worrying times.
Yet, knowing of the backlogs, some families may be feeling complacent, thinking that their relative’s existing CHC package of NHS fully-funded care (FREE) is ‘safe’ and going to remain in place indefinitely post-COVID.
Those waiting for an assessment or appeal which has been postponed by CCGs, can probably expect lengthy delays unless the NHS put their house in order to address the looming problem. It is expected that CCGs will be inundated and unable to cope as furloughed staff, and other key staff deployed to the frontline to fight COVID, return to their previous CHC duties. We would expect CCGs to recruit more staff to meet the increasing demand of an ageing population and clear the backlogs; but that will have a financial cost, too.
The alternative is for CCGs to outsource its backlog of CHC assessments as a quick fix to catch up, but again, this has a financial implication. Will the quality of the assessments be adversely affected? Does the CCG’s CHC Department have the time to check the quality and standard of assessments undertaken by their appointed outsourced provider? Just because an outsourced resource has been used before, it doesn’t necessarily follow that they are still up to the job, even if they have managed to retain their most experienced staff, post COVID. Will families lose out as a result of shoddy and inadequately prepared assessments?
Will stretched NHS Continuing Healthcare Departments have the time and resources to train new staff to an acceptable standard, such that both they and families can trust their decision-making process and outcome rationale?
Will the mistakes of previous poorly trained assessors and flawed NHS Local Resolution appeal outcomes be perpetuated post-COVID?
Will families be squeezed into rushed assessments merely to clear backlogs, but in doing so, create another long-term problem instead – making wrong decisions due to lack of time and careful consideration, just to tick a box and get the job done? The result may be to knock out lots of assessments quickly, and simply defer those found ineligible for reconsideration at appeal, should the family have the gumption and staying power to fight on.
We shall have to wait and see how all these ‘unknowns’ play out. The Government will have to make huge resources available to CCGs to deal with the backlog of assessments and help patch up a CHC system that some argue has not been fit for purpose for some time.
What is the future for Appeals?
There is no sign of any face-to-face appeals at Local Resolution Meetings, at present.
In the meantime, despite COVID restrictions, some CCGs have been resourceful and have successfully conducted local appeals by telephone hearing, albeit in reduced numbers. From what we hear, this seems to be working well for those families who have tried it. Perhaps it will become the norm in due course, and be offered more widely by all CCGs, as it is efficient and avoids the time and travelling costs of a face-to-face meeting.
Independent Review Panels conducted by NHS England have virtually ground to a complete halt, save for a handful of IRPs who have been proceeding by telephone appointment, again in small numbers. Whilst not ideal, it does have some advantages and appears to be working well.
4 Key areas for concern
However, when CCGs are able to resume business again on a full basis, there are some key areas for concern which families need to be alert to and need to start thinking about now, so that they are prepared:
1. The initial Checklist
The Checklist screening assessment is the usual starting point to see whether the individual is able to move forward to a full assessment – to determine their eligibility for NHS Continuing Healthcare Funding. However, if the Checklist assessment is delayed, then that will have a direct impact on the rest of the assessment process, and inevitably delay the chance of getting CHC Funding for your relative. When CCGs resume business in due course, we don’t anticipate that they will have a problem undertaking Checklists, as they can be carried out relatively quickly by a wide variety of different skill sets – so resources here shouldn’t be a problem. The bar to passing the Checklist assessment is set deliberately low to ensure all those who merit a full assessment (the next stage) are not deprived of that opportunity. However, this is where the backlog is likely to begin.
Firstly, care homes will also need the administrative skill and resources available to facilitate access to patients for these full assessments, and also to make their records available. Some care homes will undoubtedly fare far better than others, with more available staff and administration to deal with the flood of pending assessments and requests for records.
Secondly, passing the Checklist is only the preliminary stage – to screen out those who aren’t eligible for a full assessment. The full assessment is conducted by a Multi-Disciplinary Team appointed by the CCG. We have raised our concerns above as to how the CCGs will be able to get back on track after months of inactivity. Given the existing backlogs of assessments already in the pipeline, whether pending or postponed, families can expect a lengthy wait. In the meantime, they will have to find alternative means of funding their relative’s care.
2. Interim funding
To encourage prompt discharge from hospital during the COVID-19 crisis period, under the COVID legislation the Government has provided emergency funds to support individuals who may be waiting for an initial Checklist assessment for CHC or other Funding, plus an enhancement to those with existing packages of care, post 19th March 2020. But beware! These interim measures may only be temporary, and you need to be giving thought as to what will happen when Covid Funding is removed, and how your relative will continue to fund their ongoing healthcare needs.
3. Three and twelve monthly reviews post-CHC award
If your relative has an existing package of care in place, you may well be feeling relieved that their CHC Funding is continuing, at least for now. But beware, as many may have their funding reviewed and removed once CHC assessments resume post-COVID. Don’t forget, an individual’s care needs will fluctuate and change over time. Some healthcare needs may become more challenging and complex, whilst others may become better managed and controlled and dissipate. Just because CHC funding is in place now, does not guarantee that it will remain in perpetuity and in certain situations it can justifiably be removed. Please speak to us if you are unsure.
Once CHC Funding is awarded, a CCG is supposed to carry out an initial review at 3 months, and thereafter every 12 months, to check that the current package of care in place remains adequate to meet the individual’s ongoing needs. However, since COVID these assessments have been placed on hold. Great news – if your relative has an existing care package which meets their needs and is continuing. Not so good, however, if that package is out of date and is actually inadequate to meet their increasing healthcare needs, and they are now underfunded.
But how will CCGs manage the review process? What additional resources will be needed to catch-up? Will the work be outsourced, and if so, how reliable are the outsourced providers?
From the CCG’s perspective, we anticipate they will try and make huge strides to play catch up and get as many reviews done as quickly as possible. There are two driving motives:
1) To help patients by ensuring that their care package is still sufficient to meet their needs; and
2) To save money and remove CHC where it is no longer appropriate! There will be many individuals who are in receipt of CHC Funding who are no longer eligible and have been left on CHC unchecked for too long at great expense to the NHS. Others who are legitimately in receipt of CHC Funding may face the worrying risk of having it arbitrarily withdrawn upon review.
Remember, the NHS are mandated to save £855m by 2021. So, it should be a matter of concern for those who already have CHC funding awarded and are expecting a review. If CHC Funding is removed, they will have other means to fund their care.
4. Fast Track Pathway Tool
Fast Track Funding is awarded to an individual who has a “rapidly deteriorating condition that may be entering a terminal phase in their life”. This Funding is typically awarded in an end-of-life scenario. However, to assist with speedy discharge from hospital and to release beds for more COVID patients, many individuals have been given Fast Track Funding. But beware! In many cases, Fast Track Funding has been provided a ‘sweetener’ just to get patients out of hospital quickly and prevent bed-blocking. If the patient survives, a review should ordinarily take place after 3 months. However, post-COVID these reviews have been postponed. Although, some may be fortunate enough to retain the benefit of their CHC package until a review takes place and indeed beyond, others may face the stark reality of having it withdrawn when it is found that their relative didn’t meet the eligibility criteria for CHC in the first place. Their relative may have placed in a more expensive care home based on that Fast Track award, only to find that they have to fund this cost themselves if CHC is subsequently removed. That can create a lot of anxiety both for the patient and their family, especially if they have to relocate their relative to a more affordable care home.
In conclusion:
There is much uncertainty at present as to how CCGs will be able to manage their inevitable backlogs or how they will possibly cope with existing and new assessments and appeals. What resources will they have at their disposal and how will they be funded? What the state of play will be remains to be seen. However, we fear for families already in receipt of CHC and COVID Funding through different routes, who may be subjected to a curt review of their relative’s care package and potentially be at risk of having it removed and withdrawn.
Preparation is paramount. If you need advice, seek it early on and don’t leave it to the last minute as there could be many people in the same boat, all scrambling for the best advice and help they can get. If you need help, don’t forget to visit our one-to-one page or contact our Advice Line. If you have a query, email to: enquiries@caretobedifferent.co.uk
For additional reading, here’s a selection of helpful blogs. You can visit our website and search for many more related articles:
Beware! Annual Reviews can lead to CHC Funded Care being withdrawn
Are you worried that Continuing Healthcare Funding may be withdrawn?
How To Fast Track The Continuing Healthcare Funding Process
Let’s Talk Fast Track! Vital NHS Funding Withdrawn After 3 Months – The Latest NHS Controversy…
Interesting!
There shouldn’t be “huge back logs” as things begin to return to the “new normal”.
We should never forget that this pandemic killed 32,000 people IN HOSPITAL and 16,000 in CARE HOMES!
More than a thousand people died every day in the UK for 22 consecutive days over the Easter period.
On Easter day 1,445 people died. Incredibly sad for all those families.
Will there be an increasing demand on CHC because of the ageing population? I suggest that the loss of all these mostly elderly patients/residents will lessen the back log! Some have suggested that there will be a saving to the NHS/Government of 200 million a year because of the early deaths of these patients/residents. I welcome others opinions?
I agree that more staff need to be recruited, but of a quality that is desperately needed to improve the service.
Families should continue to demand CHC for their relatives and not be deterred by the thought that there aren’t funds available or that they shouldn’t “trouble the NHS” in times like these.
This Government failed all those elderly patients that were discharged from hospital early into Care Homes without testing for COVID. They hastened the deaths of many by doing this and that in my book is unforgivable!
They need to seek forgiveness from the rest of us by putting CHC/Social Care at the top of the agenda and stop playing with peoples lives!
I urge everyone who is still fighting for CHC, to keep the pressure on!
Hi
I hope everyone is doing ok. This terrible virus and pandemic has obviously made things much more difficult. Which is what none of us need with regards to CHC.
I had a question if anyone could offer their opinion?
If, for example in years to come, a person receiving chc were to become more placid and therefore deemed not to need 1 to 1 or at worse doesn’t meet the need for funding, So , if we wanted to get some NHS fuding and therefore the individual’s financial position is means tested, can the authorities go back eg 10 years to find he had a property and he gave it way?
ie how long can they go back is there a law?
And with continuing healthcare award – is it illegal for a care home to ask a resident or residents family to give financial help if the resident has the full award – maybe in the form of a donation?
Any help is very much appreciated. I feel so lost.
Stay strong everyone
Tom
Are there any looming deadlines or changes to CHC I ought to be aware of please because they might EVEN MORE ADVERSELY affect the processing of my dead Mum’s original, still outstanding claim for CHC?
Mum’s first claim for CHC was never completed by the CCG because of its admin failures; it dates back over 4 years.
Mum’s nursing home, the hospitals with her records, the County Council with her records ,NHS England and (presumably) the CCG will all have been struggling to cope with Covid-19 and weren’t well-organised or procedurally compliant to start with. Her MP was tied up with Brexit. I’ve struggled to get essential information out of most of these parties. It’s possible the extra delay might help as well as hinder if it results in a change of staffing at the top of the CCG???
Michelle Wetherall’s comment is interesting and I have thought the same and agree with many of her comments. However, picking up on her point re. the smaller backlog, looking at the enormous amount (and the very sad) loss of people in hospital and care homes due to Covid 19, I was also thinking that a lot of those families may still be claiming retrospectively; if they have already begun the process then this is possible of course. Maybe many families will find themselves in a situation whereby as the care home fees have now stopped and/or they may even have inherited estate from the deceased family member, this could possibly cause them to review and not be so bothered any more with the hassle of the “fight” . However, many will not; therefore the backlog could still be high. I suppose I am just stating the obvious, but to finish off my comment, I was writing to my local MP for the past four years about the care home health care costs for the elderly, feeling that I was getting fobbed off with every reply from the House of Commons; so yes, Michelle, I agree, although a lot of bad stuff has happened this year and everything seems to be a priority, this is one thing that most definitely should be now sorted once and for all, and people should keep the pressure on.
As before you are still stating that reviews are annual, yet this cannot be the case under the rules fully implemented in October 2018. The new rules are crystal clear: a review is not to be made unless there are clear indications of significant change in the patient’s condition. Therefore reviews cannot be done after set intervals of twelve months, can they? Not without beaching the rules.
Hi Jenny,
You made me smile with with your suggestion! My own family have said time and again that I should get a job with CHC! Trouble is, I would be sacked in the first week for spending the budget by overturning ineligible decisions!!!
This Pandemic has laid bare all that is wrong and inadequate with the NHS/Social Care/ Care home Sector, but will Boris keep his promise to keep it at the top of the agenda? I fear not! It will take a massive outcry and demonstrations such as those we have seen with the BLM for the Government to take notice. That’s not going to happen!
Even with Rear Admiral Matthias campaigning, I don’t see change coming quickly. It angers me that we will continue to see families struggling to get CHC. That’s why I still continue to encourage relatives on this platform to keep the pressure on and appeal ,appeal ,appeal.
I stand corrected, CTB. My apologies.
This, then, would explain my CCG’s reference to a “mini review”: this would be the preliminary review ahead of a possible ‘full eligibility’ assessment.
It seems that it is this “mini review” that is used to look for evidence of a sufficient change in condition possibly to warrant looking into CHC eligibility, not (as I had understood it) that there needed to be a priori evidence ahead of initiation of any sort of review.
i am in the nightmare scenario that my dad has had a severe stroke and is in hospital. There is no way that he will be able to come home, he is virtually bed bound, aphasic, dysarthric, doubly incontinent and confused. He is awaiting a fitting of a PEG for feeding. We have been told that due to covid he will be discharged at NHS expense with minimal notice ( regulations say can be 3 hours) with no choice of care home at all. There will be no CHC checklist or assessment until some point in the future. My mum is registered disabled and they had plans to care for her in their own home but his needs are well beyond that they had planned. ( they have stair lift etc but he cant sit ) My mum has her heart set on a specific care home but that is ‘banned’ from the current discharge arrangements as too expensive. They could fund it for while but i can even seem to find a mechanism to request an assessment so payments can be backdated if we win. I am a GP and it is complicated enough for me, so how the lay public are supposed to know what to do is beyond me. Currently i am just documenting everything the therapists say that i can use in our case such as :variable, at risk of , pain, unreliable communication etc.
Really interesting and informative article thank you. One point that really peaked my interest was the following “We know of one company which has been able to arrange for its external nurse assessors (wearing full PPE) to visit a patient at a care home and undertake a preliminary assessment as to their potential eligibility for NHS Continuing Healthcare (CHC).
Do you know which specific CCG was involved in this assessment, or any additional information on this story? Or perhaps you can direct me to where you sourced this information please?
Thanks
It is disheartening to read so many negative comments directed at CCGs and the clinicians that operate in this field. I apprecaite that CCGs and CHC teams don’t always get it right, but the majority of people I know working in CHC are caring individuals. There is no malice, they are not trying to make things difficult, and yes, they make mistakes. Believe me, the idea of a backlog is causing grave concern among the people I know working in this field, especially as we have no direction from HM Government about how this is going to be managed. Inevitably there will be a significant period of retrospective reviews that will inevitably lead to an increase in appeals and further increased work. Unfortunately this almost guarantees a third party provider filling the gap as CCGs do not have the dozens of knowledgeable CHC experts just waiting to leap onto the backlog once they are allowed.
I would reiterate other people who have said Get Advice – but get sensible advice. I have seen too many families dragged through years of appeals by companies professing to assist with an appeal for a case that from the outset would never succeed. This additional burden on a family is cruel to the extreme, raising expectations of a successful outcome when it is highly unlikely there will be one.
So – my advice – get advice from more than one source. Speak to people who know the system and the framework in both the letter and the application. Speak to a clinician in CHC if you can and ask them for a no nonsense answer – “does my relative reach the threshold?” – and don’t be blinded by promises of success.
Interesting fact, only around 1 in 10 appeals at IRP (the final stage of NHSE appeal before Parliamentary review) are successful, and of those 1 in 10, less than 1 in 10 are successful for the whole period being claimed. Usually, ‘success’ is the last few weeks of the claim. And if you are not successful at IRP the Parliamentary Ombudsman does not always ask for the case to be looked at again.
I don’t think people should have to sell their homes to pay for their care, but that is the law of the land. I also don’t think that the NHS should pay for all care either – which leaves home owners in a difficult situation, I get that, but that is the law. CHC workers and CCGs are not just trying to make life difficult, they are trying to operate lawfully in a complex system that does disadvantage home owners and people with savings – but that disadvantage is not a fault of the NHS, the CCGs nor the workers themselves.
Replying to On The Coast – my Mother was one of the rare cases, successful at IRP and received a full refund of nursing costs exceeding a mere few weeks. Throughout the completely flawed process the CCG clearly had an eye on Financial Gatekeeping. Even to the extent of over hearing senior CHC staff at a public meeting concerning CHC muttering ‘there is no money in the pot for CHC’. That particular CCG’s processes were so far removed from the National Framework Guidance that following my complaint to senior Management CHC, the CCG self referred to an external auditor to scrutinise their processes, so that going forward patients and families would have a positive experience. If the CCG’s did their jobs properly in the first place, didn’t treat families as adversaries and conducted fair and professional assessments , relatives would not feel the need to engage professional organisations to assist them. I find it disheartening to hear accounts of so many individuals suffering ill health due to the avoidable stress placed on them by a process clearly lacking accountability and transparency. Maybe NHSE should provide HMG with a feasible solution to the backlog issue? And not one that wastes more public money paying recently retired CCG staff in a consultancy capacity…….
Replying to On the Coast – I have evidenced the maladministration of the ‘caring individuals’ you defend and the misery they cause to extremely vulnerable people and their families. I have witnessed the misuse of the framework by CHC assessor’s to suit their agenda, leaving vulnerable people without the care they need. The CHC are playing financial gate keeper for the CCG’s because they are not adequately trained to the standard needed for such a delicate process nor have they any understanding of laws that underpin the Mandatory Framework they are supposed to pay heed to. Intended Malice or not these individuals should not be making mistakes when dealing with vulnerable people. It’s not an acceptable excuse, especially as the ratio of ‘mistakes’ drastically outweigh due process. They should be stripped of their NHS badge because they go against everything the NHS stands for.
The backlog hasn’t just appeared due to the Covid pandemic these backlogs have been there for years. Why the concern all of a sudden. A More public accountability perhaps?
You berate the Advocates and legal professionals who are now having to defend the atrocities of the CHC process and suggest they give people false hope which is cruel. yet you defend and promote the clinicians responsible for the situation. You advise individuals to “Speak to a CHC clinician and get a no nonsense answer” the very clinicians who unlawfully deny many the funding they are entitled to and use their own interpretation of the Mandatory Framework to perform unlawful assessments. That is the REAL cruelty. Vulnerable people left without care because the CHC/CCG’s cannot or do not follow the correct process.
Let’s be clear if the CHC teams understood the Framework, law and responsibilities of their role and followed it, then there would be no need for such Legal companies or advocates. But until the unlawful assessments stop they will be ready to act.
“You don’t think people should have to sell their homes to pay for care – but that’s the law of the land” – Where exactly ‘In law’ does it say that you MUST sell your home? The rules around property disregard are incredibly complex. If the CHC/CCG’s can’t grasp the rules of the Framework the odds are they won’t grasp this. I agree that the NHS shouldn’t pay for all care, however the CCG’s are unlawfully pushing health needs into the social care bracket, and that’s the battle. I disagree “that the CHC/CCG’s are trying to operate lawful” You have to understand the law to operate within it, and you have to respect it enough to follow it. Their actions contradict your statement.