Continuing healthcare (CHC) assessments will resume next week following an almost six-month suspension designed to speed up hospital discharges and free up NHS capacity to fight the coronavirus.
Local authorities and NHS commissioners face a backlog of an estimated 25,000 assessments not carried out since the suspension on 19 March, and will likely need more assessors to clear this – something which the Department of Health and Social Care (DHSC) has promised to fund.
Three-month and 12-month reviews of CHC packages and individual requests to review eligibility decisions for the NHS-funded system of health and social care will also be reinstated, with backlogs also needing to be cleared.
In guidance issued at the end of last week, the DHSC said councils and clinical commissioning groups should secure sufficient staff to deal with the backlog and resumed assessments and reviews, which may require bringing in extra temporary staff.
It said that CCG staff from CHC teams who were redeployed to deal with pressures elsewhere in the system should be brought back. The guidance also suggested using “well-trained non-clinical staff” to release professionals to carry out assessments and make eligibility decisions for CHC.
Where additional staff are needed, the DHSC will provide funding from its hospital discharge programme for Covid-19, introduced in March.
Six-week limit placed on post-discharge care
At the same time, the DHSC will end its indefinite funding of social care, free at the point of need, for people discharged from hospital. This was instituted on 19 March, funded by £1.3bn in Covid-19 funding for the NHS. From 1 September until 31 March 2020, this will now be limited to six weeks’ post-discharge care and will only cover costs additional to pre-existing social care packages.
The six-week packages will also be funded through the NHS, with £588m allocated from a £3bn settlement announced last month by government to cover winter pressures on the health and social care system.
Guidance on the new hospital discharge policy, also released last week, said the support was designed to help people return to the quality of life they had prior to their most recent admission. Under the Care Act 2014, local authorities must already provide six weeks’ free intermediate care or reablement for those who need it, to help them regain independence, and this is often used for people discharged from hospital.
It is unclear how far the funding will enable councils to subsidise the cost of free reablement as the hospital discharge guidance says that the £588m “should only be used to fund activity arising from this guidance that is over and above the activity normally commissioned by CCGs and local authorities”.
‘Essential and welcome’ funding
Welcoming the funding announcement, Association of Directors of Adult Social Services president James Bullion said: “Additional funding until the end of March and arrangements for the challenging winter months to come are essential and welcome, and we are looking forward to a confirmation that additional staffing costs will be equally covered.
“Whilst welcome, this funding is one piece of the adult social care puzzle. Recognition of the brilliant contributions, courage and commitment of the adult social care workforce during the pandemic, long term funding and reform of the sector are equally pivotal to ensure we can shape the care that we all want for ourselves and our families for years to come.”
The new guidance on hospital discharge replaces advice that had been in place since 19 March.
Martin Green, chief executive of independent care provider umbrella body Care England, said: “Care England welcomes this guidance, although tardy, and the £588 million funding being made available until the end of March 2021. CHC assessments were deferred as a result of Covid-19 and with winter around the corner this guidance comes at a critical time.
“We hope that individuals, providers and families will be kept informed thereby ensuring that both funding and the provision of care is not interrupted for those living in care homes, an essential part of the continuum of care.”
Challenge of resuming CHC assessments
Lou Patten, chief executive of NHS Clinical Commissioners, which represents CCGs, said: “Despite national criteria, there are significant variations in numbers of CHC assessments & reassessments requested and many CCGs have difficulty in managing this workload (or buying an effective service) due to the numbers of highly skilled nurses required.
“The different expectations of professionals and potential service users creates a very challenging environment for assessments; we need comprehensive, consistent communication about the process and we need to support these nurses to enable them to do their job effectively.
“We have heard a lot of concern from CCG members about the challenges of restarting CHC assessments and the related guidance and have already raised these with NHSEI [NHS England and NHS Improvement] colleagues. We will work through our NHSCC Nurses Forum with NHSEI to understand the implications, to strive to improve the experience for the patient.”