Government reintroduces NHS Continuing Healthcare after COVID 19 pandemic period

Related Sector: Health & Social Care

The current pandemic has impacted many areas of people’s lives and none more so than the amendments to the NHS Continuing Healthcare assessment process, and relevant linked Government guidance around hospital discharge, brought in by The Coronavirus Act 2020.

During this period the CCG and Trust duties to assess for NHS CHC were suspended. Alongside this, the Government introduced the Rapid Hospital Discharge Guidance to ensure NHS capacity to cope with the pandemic.

In practice how has this affected people?

• If anyone was in hospital and clinically safe for discharge, then they would be rapidly discharged back home or into the community, normally within three hours.
• People and families have not been given a choice over discharge, people have just been discharged to a safe and appropriate place.  
• If this was at home then perhaps with a package of care or if their needs were too great to be supported at home, then to a temporary care home or rehabilitation bed chosen by the discharge service using a bed tracker.
• People who had the capacity to decide where to go would not have been given time to discuss their preferences, and for people who lacked capacity then very little consultation would have taken place to discuss their preferences for care.  
• Care Act 2014 assessments will not have been undertaken for these people due to the emergency funding arrangement. 

How has this been funded?

During the emergency COVID-19 pandemic period the Government agreed that the NHS would fully fund the cost of new or extended out of hospital health and social care support packages agreed on or after 19th March 2020.  However,  discussions should have taken place with people and families about the possibility that they would need to pay for their care once the emergency period had ended if they were not found to be eligible for NHS CHC once assessments were subsequently undertaken.

NHS CHC Assessments

During the emergency period therefore NHS CHC assessments have not taken place.  Most CCG’s should have had a monitoring system in place through the use of the Checklist tool to identify people who may require a full assessment once the emergency period ended,  but clearly there is a huge backlog of people requiring assessments from the 19th March 2020.

Where are we now?

On the 21st August 2020 the Government published guidance instructing Trusts and CCGs to reintroduce the NHS CHC processes from the 1st September 2020 and to introduce a change of process to implement their responsibilities under the discharge to assess approach in line with new Government guidance on Hospital Discharge Service: policy and operating model.

What do you need to do?

From the 1st September CCGs and Local Authorities will have to manage to streams of work, namely

• NHS CHC work deferred between 19th March 2020 and 31st August 2020; and
• Routine NHS CHC referrals from 1st September

The guidance advises that, where appropriate, CCG’s and LA’s should align Care Act and NHS CHC assessments which should be legally compliant to support joint health and social care system recovery.

What implications will this have for CCG’s and LA’s?

CCG’s and LA’s will need to ensure that they have sufficient well-trained staff to deal with both work streams. 

What do CCG’s and LA’s need to do?

The success of delivering these two essential workstreams will not only require an agreement between CCG’s and local authorities to formalise arrangements as to who will undertake the check listing assessments, but ensure a robust training programme is in place to give staff the confidence and competence to complete assessments that are legally compliant and consistent.

Assurance and Governance

It is absolutely essential that local assurance and governance is in place to ensure the delivery of high-quality assessments and robust legally complaint decision making around eligibility.

Author: Sue Inker, Lawyer and Subject Matter Expert in NHS CHC
This article was first published on 2nd October 2020

  

 

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