Effective commissioning approaches to delivering NHS Continuing Healthcare in new NHSCC publication

NHSCHC_coverNHSCC have launched a new publication which suggests ways in which the provision of NHS Continuing Healthcare (CHC) in local areas can be improved for the benefit of patients and commissioners and shares some of the approaches that have been developed by local CCGs which have proved to be effective in delivering their CHC commitments.

julie-wood_website“Today’s publication identifies a number of ways in which CCGs can take action to improve delivery for patients and commissioners, building upon learning from those areas that have already taken steps to address this issue. As CHC accounts for almost 5% of total NHS spend, this is understandably a priority area for commissioners,” said Julie Wood, Chief Executive NHS Clinical Commissioners, “we recognise that there is considerable variation in how CHC is delivered in local areas and that can result in delays in patients receiving the funding for care that they are entitled to.”

There are several challenges that commissioners have encountered in provision of CHC locally including ensuring the accuracy of assessments due to the complexity of the process, variation in legal advice, a lack of national support for local CHC teams, and significantly the huge workload burden that ineligible applications place on local systems. A recent NAO report found that only 18% of initial screenings led to that person being assessed as eligible for CHC.

Julie Wood went on to say “We believe that there are a number of actions that can be taken nationally to support CHC provision in local areas. Most importantly NHS England must develop a clear narrative and communicate to patients, families and members of the public when CHC funding will be available and when it will not via a national information campaign. This will reduce the burden on local CHC teams, and should result in more timely decisions being made for those who are eligible.”


Lorna Collingwood-Burke, chair of the NHSCC Nurses Forum, that represents commissioning nurses, and chief nursing officer, NHS South Devon & Torbay and NEW Devon CCGs said, “Nurses play a leading role in the provision of quality CHC services in local areas, both as leaders of teams that carry out the assessments and as the assessors themselves. We feel that more must be done nationally to value this key element of the NHS workforce and recognise CHC provision as a distinct career pathway for nurses.”

NHS continuing healthcare: Effective commissioning approaches identifies six national actions that our members believe will support the local delivery of CHC:

  1. Recognise and value the CHC workforce
  2. Develop a clear national CHC narrative
  3. Develop a pre-checklist process to help address workload pressures
  4. Develop national guidance that supports local process
  5. Establish a national process for sharing legal advice where appropriate between CCGs
  6. Establish a policy feedback forum to ensure effective links with the reality of delivery on the ground 

Across the country CCGs are working hard to ensure the CHC assessment process is effective and fair for patients. Our members have shared with us several approaches that have improved the efficiency of CHC provision and most importantly improved patient experience – some examples of these are below and the full list can be found in the document:

  • CCG leadership prioritising CHC –  Those areas that have made most progress in delivering an improved CHC process for patients have benefited from strong sustained local leadership supporting changes, a clear vision and a balanced approach to the underpinning principles.
  • Collaboration with social care – Working collaboratively with local government and social care colleagues ensures a better experience for patients and allows for the release of cost efficiencies through pooling of resources, reducing duplication, and ensuring that the most suitable and cost-effective packages are identified and delivered.
  • Developing positive relationships with families – It is essential to communicate clearly and compassionately with individuals and families, ensuring that there is an understanding of the process and that expectations are clearly established at the outset.
  • Ensuring appropriate skill mix, capacity and capability – The appropriate skill mix within the local CHC team was found to provide opportunities to free up clinical and social care professional time. CHC teams at scale allows for increased competency and consistency in assessments, efficient management, release of cost savings and the development of specialist skill sets.
  • Developing an in-depth understanding of the Framework and quality assurance – Much of the variability in CHC assessment can be prevented or resolved by ensuring that there is a detailed knowledge of the Framework, case law and an in-depth experience of CHC in local teams. Peer support and review is critical to enable ongoing quality assurance and effective learning.

Read the document in full here

Published 25 January 2018

Updated 28 February 2018


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