Continuing Healthcare: Getting it right first time

Parliamentary and Health Service Ombudsman

Today I publish an insight report into the complaints PHSO has seen about NHS continuing healthcare (NHS CHC). This is the result of a review of over 300 decisions made on complaints over the past three years, and a detailed analysis of 60 of these cases.

It provides recommendations rooted in our casework to help NHS England and NHS Improvement, the Department for Health and Social Care and Clinical Commissioning Groups (CCGs) improve the system and better support people in need of continuing healthcare.

Complaints about NHS continuing healthcare

NHS continuing healthcare is a complex area of healthcare and one that PHSO has been working to improve for over 25 years. The system has made real improvements over this time, in particular with the National framework for NHS continuing healthcare giving clear, national eligibility criteria.

Despite this, our evidence shows people continue to be seriously let down by failings in the way continuing healthcare is handled by CCGs. The impact of these mistakes can be devastating, as the cases included in the report show.

It is unacceptable that people are going without the NHS care they are entitled to and that their families and carers are left providing care or paying for it themselves.

Findings from our casework

The report focuses on the two main themes we have seen in complaints about NHS continuing healthcare over the past three years.

1. Failings in care and support planning

We found failings in care and support planning for people with care needs. This leads to people who are eligible for NHS-funded continuing healthcare not being provided with plans that sufficiently address their care needs. In some cases, people’s families provided the care themselves or paid for care on top of that which had been provided by the NHS.

2. Failings in reviews of previously unassessed periods of care

Where people’s care needs change over time, CCGs can assess their eligibility for NHS continuing care for previous periods of care. We found failings in CCGs’ handling of retrospective assessments of people’s eligibility for care resulted in people going for long periods of time with uncertainty about their finances.

Our recommendations

Taking a person-centred approach and providing effective communication to people and their families about their entitlement and care package is essential. Based on the findings from our casework, I make the following recommendations.

1. Support the skills and experience of NHS continuing healthcare practitioners locally

CCGs should make sure their NHS continuing healthcare teams receive regular training to equip them with the appropriate skills and knowledge for their roles.

2. Share learning nationally

NHS England and NHS Improvement should review  the NHS continuing healthcare e-learning tool and other learning opportunities to make sure they are updated with the learning outlined in this report.

3. Put learning into practice

NHS England and NHS Improvement should consider what additional support it can provide to care systems, CCGs and NHS staff on the frontline of continuing healthcare.

4. Support people and providers through the NHS process

CCGs should make sure all parties to an NHS-funded continuing healthcare package understand the principles of the funding. They should clearly explain to people receiving care and their families, what is included in the care package and how they go about arranging additional services where necessary.

5. Clarify national guidance

The Department for Health and Social Care and NHS England and NHS Improvement should clarify guidance for CCGs setting out how they should respond to requests to retrospectively assess people’s eligibility for NHS continuing healthcare funding.

6. Deliver capability in the NHS CHC system

With support from NHS England and NHS Improvement, CCGs should ensure they have sufficient capability to meet the obligations set out in this guidance.

As I publish this report, the NHS continues to deal with the unprecedented pressures of COVID-19. As part of the response to COVID-19, there was a pause on new NHS continuing healthcare assessments and eligibility reviews between March and September 2020.

Since 1 September, CCGs have been working through these deferred assessments. It is as important as ever, perhaps more so, that the NHS gets these decisions right first time. This will make sure people do not suffer unnecessary injustice, but crucially will also mean frontline staff do not have to spend time reviewing incorrect past decisions.

Learning from complaints

This report shows that complaints are a vital source of learning. Our public services should encourage and use this feedback to identify and implement improvements.

Next year, and following extensive public consultation, PHSO will publish a Complaint Standards Framework for the NHS. This Framework will provide a consistent approach to complaints management and support to frontline staff, and help senior leaders promote a positive culture embracing learning from complaints.

Read the report here.