NHS continuing healthcare: Effective commissioning approaches

NHS continuing healthcare (CHC) is a package of care funded by the NHS for individuals who have a ‘primary health need’. Clinical Commissioning Groups (CCGs) commission and case manage this process, and are statutorily accountable for the delivery of CHC in local areas.

Why is this a priority area for CCGs and the NHS?

Increasing cost and expected savings CHC accounts for 4.9 per cent of the total NHS budget. There was a 16 per cent increase in spending on CHC between 2013–14 and 2015–16 (NAO, 2017). Much of this is spent on delivering an assessment and screening process where only 18 per cent of those assessed are found to be eligible, (NAO, 2017). There is further additional spend on legal advice and support in response to appeals. NHS England expects delivery of £855 million worth of savings by 2020/21 from reducing administration assessment costs and the overall cost of CHC provision.

Variation and opportunity

There is significant variation between CCGs in both the number and proportion of people assessed as eligible for CHC that cannot be explained by local demographics or core services alone. For example, the range in estimated proportion of people that were referred and subsequently assessed as eligible, excluding the 5 per cent of CCGs with the lowest and highest percentages, was 41–86 per cent. This suggests that there are considerable opportunities to deliver improvements and efficiencies. Within CCGs the percentage of the local budget that is spent on CHC varies from 2.1–10.4 per cent.

Meeting the needs of the local population

An ageing population and an increasing number of people living with multiple co-morbidities means that CHC is a priority for the populations that CCGs serve. Improvements in processes ensure that individual patient needs are met and that where individuals are eligible for receipt of CHC they receive this in a timely manner. The Continuing Healthcare Alliance report Continuing to care? Is NHS continuing healthcare supporting the people who need it in England? outlines some of the issues that patients experience in accessing CHC funding.

This document outlines key learning points from those CCGs that have achieved significant efficiency savings and improvements for patients in the provision of CHC in their local area, and the national support that NHS England and others can provide to support local decision-making. The document was informed by a series of interviews with leaders in high performing CCGs and a roundtable with representatives from CCGs, the Association of Directors of Adult Social Services (ADASS), the Continuing Healthcare Alliance and NHS England.