Your Views on
NHS Continuing
Healthcare
A consultation on proposed policy review for
Mid Essex Clinical Commissioning Group
Monday 11th May - Sunday 5th July 2015
Contents
1. Introduction
2. Who is Mid Essex Clinical Commissioning Group?
3. What is this document about?
4. What are we consulting on?
5. Why does anything need to change?
6. Scope of this document
7. The options
8. Your views count
9. Timetable
Appendices
10. Appendix 1: Reference List
11. Appendix 2: Questions & Answers
12. Appendix 3: Distribution List
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Mid Essex CCG Consultation • [email protected]
1. Introduction
NHS Mid Essex Clinical Commissioning Group (CCG) has commissioned Enable East to
run a consultation on its behalf on proposals regarding how NHS continuing healthcare
(sometimes also known or referred to as CHC) is provided at home.
NHS continuing healthcare is a package of care funded solely by the
NHS that is awarded to eligible adults to meet needs that have arisen as
a result of disability, accident or illness.
It may be provided in any setting including, but not limited to, a care
home, residential/nursing or the person’s own home.
Enable East is an independent NHS team that assists health and social
care organisations to deliver effective projects. We are a not-for-profit
organisation working for and within the public sector.
Mid Essex CCG says it wishes to demonstrate complete transparency,
openness and objectivity in relation to this consultation and has therefore
asked Enable East to run the process on its behalf.
Mid Essex CCG wants
everyone eligible
for NHS continuing
healthcare at home to
have quality, safe care
coupled with fair and
equal access to services
2. Who is Mid Essex Clinical Commissioning
Group?
Clinical Commissioning Groups (or CCGs) are responsible for buying (commissioning)
most healthcare for their populations.
The 211 CCGs across England came into being in 2013 after an NHS reorganisation. CCGs are clinically
led groups, including GPs and other health professionals, who buy NHS services such as emergency
care, elective hospital care, and community and mental health services.
CCGs are responsible for managing the process of NHS continuing healthcare and making decisions
about the eligibility of patients. They are also responsible for funding and arranging healthcare packages,
with a few exceptions.
3. What is this document about?
Mid Essex CCG wants to hear your views on NHS continuing healthcare and the local
policy regarding how care is provided at home. This document sets out:
The current facts about NHS continuing healthcare
Why the CCG is proposing change
Three possible options
How you can have your say
Mid Essex CCG Consultation • [email protected]
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If you are a patient or family member of someone currently receiving NHS continuing healthcare at home,
we want to hear your views and experiences of the process and how we could make changes. However,
the issue affects everyone as it concerns the way the CCG spends public money on healthcare for the
population of mid Essex.
The CCG wants an open and honest conversation about how NHS continuing healthcare is delivered
and how individual care should be allocated. We want patients to be at the heart of this debate, so any
proposed future changes to the policy are guided by the views of the people NHS CHC aims to help.
4. What are we consulting on?
Enable East, on behalf of Mid Essex CCG, wants to engage people in a conversation about
how NHS continuing healthcare is provided at home in the future.
NHS continuing healthcare was established nationally in 2007. It refers
to a package of ongoing care that is arranged and funded solely by the
NHS, where the individual has been found to have a ‘primary health
need’ as set out in the national guidance.
Such care is provided to someone aged 18 or over to meet needs that
have arisen as a result of disability, accident or illness. It is given to
individuals who have complex, intense and unpredictable health needs,
which often depend on the care of highly trained healthcare professionals
on an ongoing basis.
NHS continuing healthcare can be provided in a range of settings
including a care home, residential/nursing or a person’s own home.
This consultation is
about the local policy
of NHS continuing
healthcare and
proposed changes
to how resources are
allocated to supporting
people at home
In meeting the reasonable needs of people who are eligible for NHS
continuing healthcare, CCGs must comply with the relevant national
guidance. However, national guidance is not prescriptive as to the
packages of care services that must be provided by CCGs. Therefore, CCGs have discretion to meet the
needs of each individual and allocate appropriate resources.
5. Why does anything need to change?
Mid Essex CCG is
proposing a local policy
for NHS continuing
healthcare to ensure
all packages of care
are appropriate, safe,
effective and based on
realistic expectations
when delivered at home
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Since 2007, when the policy on NHS continuing healthcare was
established, there have been a lot of changes in the NHS and a
worldwide recession which has affected all public services.
All CCGs, who commission healthcare on behalf of their populations, need
to be accountable for how they spend public money. They need to make
funding go further and find ways of being innovative, fair and sensible
about how money is spent on healthcare.
Last year, Mid Essex CCG launched its five year plan to improve health
and meet the rising demands of a growing population. The CCG wants a
healthcare system which can do more in terms of prevention, target those
who are at greater risk and avoid crises, prevent deterioration and support
recovery – all within a challenging financial envelope.
When the CCG formed in 2013, it inherited responsibility for funding widely
Mid Essex CCG Consultation • [email protected]
diverse packages of NHS continuing healthcare. All care packages will continue to be reviewed, as per
each individual’s care plan, to ensure they are still providing the safest and most effective care based on
individual needs.
The CCG’s role is about responsible commissioning – taking both a strategic and individual approach to
fulfilling its responsibilities. Responsible commissioning is also about looking at how and from where care is
provided, to secure high-quality services that offer value for money.
Why the CCG believes change is needed:
Mid Essex CCG has a budget of around £400 million of public money to provide NHS services and care
from birth to end-of-life. This budget needs to be allocated in a fair and balanced way to meet the needs of
the population.
In 2013/2014, the CCG spent £15 million of this budget on NHS continuing healthcare. That rose to £23
million in 2014/2015.
The CCG knows and understands the demand for NHS continuing healthcare is rising and this is why it
wants to seek a fair solution to a policy that will continue to support all those eligible in the future.
Care at home for existing patients will not be affected under any of the three options.
However, the examples below demonstrate the widely varying packages of NHS continuing
healthcare currently being delivered at home:
1. Out of 300 individuals receiving NHS continuing healthcare, there are currently 47 packages of
care being delivered at home that exceed £1,000 a week
2. The average cost of these is £2,800 a week
3. The most expensive is £6,900 a week
4. Some packages of care at home require 24 hour care
5. Some packages of care require more professional input including 2-to-1 care
This is why the CCG believes a fairer, more equitable and proportionate policy on NHS CHC is needed.
The CCG continues to remain committed to supporting care at home where it is practicable, safe and
effective, and within a realistic NHS funding allocation.
The CCG understands this is a difficult and challenging conversation, as it may affect the most vulnerable
people. Therefore, we invite you to share your views. See how Section 8 for how to do this.
6. Scope of this document
Mid Essex CCG covers the local populations of the following areas:
Chelmsford and surrounding areas
Maldon and surrounding areas
Braintree and surrounding areas
The CCG proposes to make some changes to the local NHS continuing healthcare policy. This would affect:
• New patients who may be eligible for a complex and intensive package of NHS continuing healthcare in
future and want to stay at home
This would not affect:
• Existing or new patients receiving NHS continuing healthcare or NHS-funded healthcare in a
residential or nursing home setting
Mid Essex CCG Consultation • [email protected]
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• New patients receiving NHS continuing healthcare at home whose care package would fall below the
proposed threshold level if the CCG’s preferred option was adopted (see Section 7 – Option 3)
• Existing patients receiving NHS continuing healthcare at home, unless your care needs change*
*Please note. Following this consultation, Mid Essex CCG will be talking to NHS continuing healthcare
providers. Care providers may change for some existing patients who receive NHS continuing healthcare
at home.
The current eligibility criteria for NHS continuing healthcare will not change. The CCG is guided
by, and will continue to adhere to, the NHS National Framework for continuing healthcare and any future
revisions to it. Existing patients will have their care reviewed annually. Those with the most complex needs
and whose care package exceeds the threshold under the CCG’s preferred Option 3, will continue to have
their care delivered in the setting of their choice. There may potentially, however, be a change in who
provides that care, to ensure the best care and value for money. There will be no decision made without
first discussing this with each individual and their carer or family.
This consultation is about local policy and not about individual aspects of care plans.
7. The options
There are three options for NHS continuing healthcare that Mid Essex CCG would like your
views on:
Option 1: No change to current local policy
Would Change
Might Not Change
The CCG would need to make
savings across other healthcare
services
Would Change
No change to the existing NHS
continuing healthcare policy
Option 2: Change local policy. The option for new patients to receive NHS
continuing healthcare at home, but only up to what the same care would cost
in a residential or nursing home setting
Under Option 2, the CCG would only resource NHS continuing healthcare at home to the cost of the same
care delivered in a residential or nursing home setting. A person’s choice of care at home may not be
agreed if their assessed care needs were above this level.
Would Change
Might Not Change
Would Change
A robust and transparent local
policy for the fair and equitable
allocation of resources to
new patients receiving NHS
continuing healthcare at home
Who provides care to existing
patients receiving NHS
continuing healthcare at home
No change of care for existing
patients of NHS continuing
healthcare as per their assessed
care needs
New patients whose clinically
assessed needs meant their care
package would be above this cost
would need to be cared for in a
residential or nursing home setting
Who provides care to new
patients receiving NHS
continuing healthcare at home
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Mid Essex CCG Consultation • [email protected]
Option 3: Change local policy. The option for new patients to receive NHS
continuing healthcare care at home, with funding allocated up to 10% above
what it would cost for the same care in a residential or nursing home setting
The CCG recognises that the cost of care at home is generally higher than care delivered in a residential
setting. This is why it is proposing this option.
Would Change
Might Not Change
Would Change
A robust and transparent local
policy for the fair and equitable
allocation of resources to
new patients receiving NHS
continuing healthcare at home
Who provides care to existing
patients receiving NHS
continuing healthcare at home
No financial threshold for
existing patients of NHS
continuing healthcare whose
assessed care needs would
exceed this threshold. The
CCG would continue to allocate
resources above 10% for existing
patients as care needs dictated
This would affect new patients
requiring more intensive,
complex and high cost packages
of care
Under Option 3, the CCG recognises there may be situations where a new patient’s preferred choice of
care at home cannot be agreed. For example, if it was unsafe to provide at home the level or complexity of
care needed or if the cost exceeded the 10% threshold.
The CCG prefers Option 3 as it believes this option would be fairer on new patients choosing NHS
continuing healthcare at home. The CCG wants to achieve the following:
Access to NHS
Packages of NHS
Supporting people in
continuing healthcare
continuing healthcare at
their own home has to
at home should be
home need to be safe,
be balanced against
proportional and
reasonable, realistic,
making the best use of
equitable to everyone
consistent and fair so
finances and resources
living in mid Essex
services are sustainable
available so spending
into the future
on healthcare is fair for
everyone
No decision has been taken.
Mid Essex CCG prefers Option 3 for the reasons given, but they want to hear your views. You may have
other ideas. Your voice is important. The CCG wants this to be an open and transparent debate. You can
respond in a number of ways – see Section 8 for more information.
Mid Essex CCG continues to support care at home and would support someone’s preferred
place of care wherever possible, safe and realistic. The CCG would never withhold care
from someone who met the criteria for NHS continuing healthcare
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Mid Essex CCG Consultation • [email protected]
Please note: It is not the purpose of this consultation, and it would not be appropriate at this stage,
to address individual questions about how individual care may be affected.
We understand you may have questions about your own care or the care of a family member or friend. The
purpose of this consultation is to get your views on the direction of policy for the CCG.
Taking into account everyone’s views, if the CCG did decide to change the NHS continuing healthcare
policy, then further conversations would happen with anyone who may be affected. This would be on an
individual case-by-case basis as and when care packages were due for review – see Section 9 for more
information.
Exceptional cases:
If a change in local policy was adopted:
1. Mid Essex CCG may be prepared to consider funding a package of care where the anticipated cost to
the CCG is more than it would usually expect to pay. The CCG would have regard to the individual’s
assessed health and associated healthcare needs
2. Exceptionality would be determined by Mid Essex CCG on a case-by-case basis and considered in
accordance with the CCG’s Individual Funding Request Policy
8. Your views count
Enable East, on behalf of Mid Essex CCG, wants to hear from anyone who may be affected
by this consultation and the local community.
The CCG wants to listen to people’s views and ensure any change in policy takes account
of what people have said during this consultation.
Those already receiving CHC at home
We want to hear your experiences of your journey into NHS continuing healthcare:
•
•
•
•
What was access like?
What prior knowledge did you have?
How was the application experience?
What improvements would you like to see?
Providers of CHC at home
We want to hear from providers of NHS continuing healthcare as part of this consultation. Mid Essex CCG
also wishes to engage further with providers at the conclusion of this consultation exercise.
Wider Stakeholders
This consultation is also a matter for wider views as it concerns the way the CCG spends public money on
healthcare for the population of mid Essex.
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Mid Essex CCG Consultation • [email protected]
You can give us your views on this consultation in a number of ways:
Drop-in Events
You are welcome to come along to any of our drop-in events. They will be one hour long and will be
attended by a clinical lead or manager from Mid Essex CCG. It is your chance to understand more about
NHS continuing healthcare and the options. You will have the opportunity to ask questions. Please let us
know if you are interested:
By email: [email protected]
By phone: Linda Williams 01206 287501
Please tell us which drop-in event you would like to attend:
Date
Venue
Time
8th June 2015
Springfield Parish Community
Centre, St Augustine’s Way,
Springfield, Chelmsford, Essex,
CM1 6GX
6pm - 7pm
9th June 2015
Braintree Town Hall, Fairfield
Road, Braintree, Essex, CM7
3YG
11am - 12pm (noon)
10th June 2015
Combined Military Services
Museum, Station Road, Maldon,
Essex CM9 4LQ
11am - 12pm (noon)
16th June 2015
Braintree Community Centre,
Hollywood, 19-21 Bocking End,
Braintree, Essex, CM7 9AH
6pm - 7pm
17th June 2015
Greenacre, Newport House,
Sandon, Chelmsford, Essex,
CM2 7TL
11am - 12pm (noon)
17th June 2015
Maldon Community Centre,
Sunbury Way, Maldon, Essex,
CM9 6YH
6pm - 7pm
We are happy to meet patients in their own home if they are unable to attend a drop-in event. Please
contact us as below.
Similarly, if your group or organisation would like a meeting, please send a request via the email address:
By email: [email protected]
By phone: Linda Williams on 01206 287501
Survey
You can let us know your views in writing by completing our Mid Essex CCG Consultation Survey, which
accompanies this document. You can return a completed hard copy to the address below.
This survey is also available to complete online via www.surveymonkey.com/r/midessexCHC
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Mid Essex CCG Consultation • [email protected]
In writing or via email
You can send your views as follows:
By email: [email protected]
By post: Enable East, NHS Continuing Healthcare Consultation, The Laurels, Severalls Hospital,
Boxted Road, Colchester, CO4 5HG
By phone: Linda Williams on 01206 287501
The closing date for feedback is Sunday 5th July 2015.
A summary report of this consultation and feedback gathered will be presented by Enable East to Mid Essex
CCG at its Governing Body meeting on the 29th July 2015. Members of the CCG will consider your feedback
and may decide to adopt changes to the NHS continuing healthcare policy as a result of the report.
9. Timetable
For the consultation process:
11th May
Consultation process begins
11th May – 3rd July
Drop-in events, group meetings and home visits to patients and their families,
where required
5th July
End of public consultation period
Post consultation:
July
Enable East to gather all feedback and draft an outcome report for Mid Essex
CCG Governing Body meeting
29th July
Mid Essex CCG Governing Body meeting: Outcome of the consultation
presented and CCG decision on NHS continuing healthcare policy. Any
change to NHS continuing healthcare policy will take immediate effect
following decision by the Board
End of July
Inform all stakeholders of decision
August - September
Engage with providers delivering NHS continuing healthcare at home
August onwards
Engage with those individuals affected by any new policy decision ahead of
roll out
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Mid Essex CCG Consultation • [email protected]
10. Appendix 1: Reference list
Reference list
Some useful background reading on NHS continuing healthcare can be found as follows:
What is NHS continuing healthcare?
http://www.nhs.uk/chq/Pages/2392.aspx?CategoryID=68
What is NHS continuing healthcare? – easy read
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/328377/NHS_CHC_easy_
read.pdf
The National Framework for NHS continuing healthcare and NHS funded nursing care:
https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhsfunded-nursing-care
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Mid Essex CCG Consultation • [email protected]
11. Appendix 2:
Questions & Answers
Here, Mid Essex Clinical Commissioning Group aims to answer some questions you may
have about NHS continuing healthcare and this consultation.
Q. What is NHS continuing healthcare?
NHS continuing healthcare, sometimes commonly known as CHC, is long-term care for people with
complex, intensive and unpredictable health needs which often depend on the care of highly trained
healthcare professionals.
It refers to a package of ongoing care that is arranged and funded solely by the NHS, where an individual
has been found to have a ‘primary health need’ as set out in the national guidance.
Services under CHC can include health, personal and social care. NHS continuing healthcare can be
provided in a range of settings including residential or nursing homes, or in someone’s home.
However, your views are important. We particularly want to hear from those who are currently receiving
NHS continuing healthcare at home or have in the past. We would like get your feedback so we can further
improve how we commission this service and learn from your experiences.
Q. So what are you changing?
We are not changing anything without first consulting you (a distribution list is in Appendix 3 of this
consultation document).
The current eligibility criteria for NHS continuing healthcare will not change.
This is about local policy change with regards to the allocation of resources for NHS continuing healthcare
at home.
We have three options for consideration. The options are laid out in Section 7 of this consultation document:
Option 1: Make no change in local policy for NHS continuing healthcare
Option 2: Change local policy. The option for new patients to receive NHS continuing healthcare at home,
but only up to what the same care would cost in a residential or nursing home setting
Option 3: Change local policy. The option for new patients to receive NHS continuing healthcare care
at home, with funding allocated up to 10% above what it would cost for the same care in a residential or
nursing home setting
We want to continue supporting care at home and would support someone’s preferred place of care
wherever possible, safe and realistic.
We believe we need a robust local policy for NHS continuing healthcare which ensures all packages of care
are appropriate, safe and effective, and based on realistic expectations of what can be delivered at home.
We believe access to NHS continuing healthcare at home should be:
• Proportional and equitable to everyone living in mid Essex
• Reasonable, consistent and fair, so services are sustainable into the future
• Balanced against the needs of the population as a whole to ensure spending on healthcare is fair to
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everyone
Mid Essex CCG Consultation • [email protected]
If a new policy is adopted, there will be no change to how resources are allocated until we have had
detailed discussions with each individual who may be affected. This will be on a case-by-case basis.
Q. How will this affect me?
It is not the purpose of this consultation to address questions about how individual care might or might not
be affected. This consultation is about the direction of policy. Taking into account everyone’s views, if we did
change local policy, there would be detailed and individual discussions with anyone affected.
The scenario we can give is as follows:
If Option 3 was adopted:
New patients: The new policy might affect those who may be assessed as needing a more complex and
intensive package of NHS continuing healthcare in future and want to stay at home. They would receive
funding of up to 10% above what it would cost for the same care in a residential or nursing home setting.
It would not affect those currently or in future receiving NHS continuing healthcare at home and whose
care package falls below the proposed threshold in Option 3.
Existing patients: This would not apply to existing patients of NHS continuing healthcare at home
whose package of care may continue to exceed the proposed financial threshold after their care has been
reviewed.
Everyone receiving NHS continuing healthcare at home will be reassessed at their review period to ensure
their care package is still relevant to their needs. It may be that existing patients see a change in who
provides their care. This will only happen when their care package is reviewed and only after discussions
with the individual concerned and their family or carer.
This is about NHS continuing healthcare as it is provided at home. Those in residential or nursing home
settings are not affected.
Q: If this is about more complex and intensive packages of care, then surely these people
really need this care, regardless of cost?
The question is about proportionality. There needs to be a fair balance in how resources are allocated.
We would never withhold funding from someone who is eligible for NHS continuing healthcare and whose
assessed needs demonstrate a more complex care package. There may be situations, though, where we
have to consider whether the level or sheer complexity of need is appropriate or safe to be delivered at
home.
We would need to discuss with each individual patient:
• How and to what level the NHS could fund that care at home
• Whether it would be more appropriate, taking into account the individual’s care needs, to provide that
care in a residential or nursing home setting
CCGs have a statutory duty to promote a comprehensive health service. They also have a duty to ensure
each year their spending does not exceed their financial allocations.
Q: Does this mean you are cutting services?
This consultation is about proposals to change local policy to ensure the fair and equitable allocation of
NHS continuing healthcare in the future.
We want to be able to provide the care that people want and need in a place of their choice, but we need
to have a fair and equitable approach. The resources available to the NHS are limited and the need is to
ensure a proportionate and equitable distribution.
Mid Essex CCG Consultation • [email protected]
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We want to hear everyone’s views, particularly those of existing patients receiving NHS continuing
healthcare at home. We want to know what’s important to you and hear your experiences. Please complete
the consultation survey either online at www.surveymonkey.com/r/midessexCHC or send a completed copy
in the post to Enable East as indicated at the end of the questionnaire.
Q: Why would providers change for existing patients if the policy is only for new patients?
As a commissioner of NHS services, we have a duty to ensure the best care which also represents value
for money. We have a responsibility to ensure all services we commission are cost effective.
Q: Are there exceptions?
We may be prepared to consider funding a package of care where the anticipated cost to the CCG is more
than we would pay as per the threshold under Option 3 if a change of policy was adopted. We would need
to review the individual’s assessed health and associated healthcare needs.
Exceptionality would be determined on a case-by-case basis and considered in accordance with our
Individual Funding Request Policy. http://midessexccg.nhs.uk/about-us/our-key-documents
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Mid Essex CCG Consultation • [email protected]
12. Appendix 3: Distribution list
This consultation was initially distributed to the following:
Existing patients, families and carers of NHS continuing healthcare at home
Community and voluntary organisations in mid Essex
Adult and young people’s care services
District, town and parish councils
Essex County Council (including adult social care services and children and young people’s care services)
Essex Health and Wellbeing Board
Essex Health Overview and Scrutiny Committee
HealthWatch Essex
Hospitals and relevant service providers in mid Essex
Local MPs
Mid Essex contacts for groups representing older people, mental health, children and people with
disabilities
Mid Essex CCG Patient Reference Group
NHS England (Essex and Midlands and East)
Mid Essex GPs
Mid Essex Patient Participation Groups (Trusts and GP practices)
Essex Clinical Commissioning Groups and Commercial Support Units
Press and media contacts
Libraries
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Mid Essex CCG Consultation • [email protected]
Mid Essex CCG Consultation
Enable East
The Laurels
2 Boxted Road
Colchester
Essex
CO4 5HG
01206 287501
[email protected]
Mid Essex CCG Consultation • [email protected]