‘Continuing healthcare’ money is meant to pay for ongoing specialist treatment – but cash-strapped CCGs are having to claw it back, writes SOFIA LOTTO PERSIO
FINANCIAL mismanagement is putting healthcare for the elderly and vulnerable at risk, a Morning Star investigation into the provision of continuing healthcare (CHC) funding has revealed.
In one of the many shocking cases that see people with serious illness denied the NHS funds dedicated to cover the cost of specialised care, a 72-year-old man’s CHC payments were taken away abruptly, leaving him high and dry.
The man suffers from vascular dementia following a bleed in the brain and he has been looked after in a nursing home, receiving NHS care since 2010.
However, a recent assessment by the clinical commissioning group (CCG) in Cambridgeshire and Peterborough found he no longer qualified and subsequently withdrew the funds.
The man’s son took it upon himself to fight the battle for his funding, alleging misconduct, miscommunication and misinformation from the CCG and the social workers who were supposed to help him.
He said he was notified of a review of his father’s care and he took part — but the assessment to which he contributed was different from the one that was eventually used to cut off his father’s funds.
Despite NHS guidelines requiring the fund suspension to be notified 28 days in advance, and only when alternative funding is in place, the CCG told the son that his father’s funding would be suspended only seven days in advance.
The funding was suspended on August 11 and the man has not received his weekly £150 since. The nursing home where the elderly man has been looked after for the past six years is taking care of him, for now, for free.
A request for a fast-track reassessment was sent but, as yet, no answers have been given.
“My father has had falls and illnesses which are very likely to recur, and in fact have, as his condition has worsened,” he told the Morning Star on condition of anonymity as his appeal process is ongoing.
“After looking into this over the last three months, what I have found really does disgust me. It’s hard-working people’s lives that they are playing with.”
This family’s experience is not unique. Angela Sherman set up the Care To Be Different website in 2010 after her parents were dragged through similar hurdles.
They were made to pay for their own care and, once she found out about their rights and appealed, it took four years to win the case, get a refund and be provided CHC until their death.
“I was so angry at what had happened and I wanted to share what I learned. I had done so much research that I decided to set up the website and I have been researching it and building it ever since,” Sherman said.
The website offers information about NHS continuing healthcare funding and each post attracts an outpouring of experiences from carers who face difficulties and bureaucracy nationwide.
Sherman told the Morning Star: “It’s a nationwide problem but some areas are worse than others. People are having their funds taken away with no proper review. There are thousands of families fighting the battle. Often families are met with obstruction, misinformation and unacceptable delays.
“If someone is receiving CHC, then legally the NHS must pay for their care and, at the moment, people are being pushed into local authority care, for whose funding they will have to pay. And yet many times that is actually illegal because their care needs are as such that they must be funded by the NHS.”
Cambridgeshire and Peterborough CCG insisted it stuck to standards when assessing CHC provision.
A spokesperson stated: “When making a judgement about whether or not a person is eligible for continuing healthcare, we use the national framework for NHS continuing healthcare and NHS-funded nursing care.
“Patients who are eligible for NHS continuing healthcare will have their needs reviewed regularly. If a person’s needs change, their eligibility for NHS continuing healthcare might also change. If someone is judged to be ineligible for continuing healthcare they still have the option of seeing if they are eligible for social care funding or can self-fund their care.”
CCGs were set up by the Health and Social Care Act 2012, replacing primary care trusts in England. They are supposedly led by an area’s GPs and are responsible for commissioning health services in their area — spending two-thirds of the NHS budget — £72 billion this financial year.
Cambridgeshire and Peterborough’s already difficult financial situation was aggravated by the loss of a partnership worth around £800 million for the provision of older people’s and adult community services with private company UnitingCare due to disputes around the contract price.
The National Audit Office’s investigation of the deal dubbed the CCG as “one of the most financially challenged in the country.” Despite recent funding increases, it remained more than 3 per cent below its target funding allocation in 2015-16, with significant financial pressures and an ageing population.
“The termination of this contract indicates that the health sector may not have learned lessons about assessing and managing risk when working with a private provider, despite the earlier failure of the Hinchingbrooke contract and experience in wider government,” the auditors said.
A recent NHS financial assessment rated it “inadequate” and addressing the CCG’s financial deficit will most likely involve cuts to various services, from GP practices to minor injury units and CHC funds.
All are a direct consequence of the financial mess.
The CCG spokesperson said: “In order to address this deficit position, the CCG is going to face a period whereby difficult decisions are going to be required.
“We will involve our member practices, partners and our population as part of this work.
“2015-16 was a very difficult year for the CCG as we have dealt with a number of significant financial and contractual issues.
The CCG has made many changes to the way it works over recent months and is working hard with staff and the governing body to deliver the quality improvements and financial rigour that we need, but there is still a lot more for us to do to address our underlying recurrent deficit.
“However, looking forward, the current and future financial challenges facing the Cambridgeshire and Peterborough health and care system are of an unprecedented scale as we experience an exceptional rise in demand for health services.”
Failure in providing care to older people is a direct consequence of the austerity policies and the government’s continuous cuts to local authorities’ funds.
One way that the government is proposing to deal with the clear financing challenges experienced by public healthcare providers is the merging of health and social care.
Right now the two are administered separately, with the NHS and CCGs providing healthcare and local authorities providing social care.
Whether these plans will provide improved care is unclear, as even NHS England’s chief executive Simon Stevens said in 2014 that “no-one should pretend that just combining two financially leaky buckets will magically create a watertight funding solution.”