New report into NHS Continuing Healthcare raises serious concerns

New report into NHS Continuing Healthcare raises serious concerns

NAO investigation into NHS Continuing HealthcareInvestigation into NHS Continuing Healthcare

The National Audit Office (NAO) has published the results of its investigation into NHS Continuing Healthcare funding.

Thank you to everyone who wrote to the NAO with your personal experience of the Continuing Healthcare process.

The NAO investigation into NHS Continuing Healthcare highlights many issues of concern in the actual funding assessment process, as well as in the way eligibility criteria are applied. These are just some of the issues that the report identifies:

  • huge differences between CCG areas regarding the number of people funded by Continuing Healthcare
  • assessors ignoring case law
  • assessors ignoring the Continuing Healthcare guidelines
  • assessors playing down care needs
  • assessors ignoring or failing to gather relevant evidence
  • unacceptable delays in the process
  • lack of communication and response by CCGs to questions and complaints from families
  • lack of any meaningful data on the number of appeals made against CCG decisions

…and many more.

With this situation as a starting point, and NHS England also looking to make cuts of £855m to NHS Continuing Healthcare by 2020-2, things can surely only get worse for patients.

You can read the full NAO report here.

Many families report feeling powerless when it comes to NHS Continuing Healthcare. ‘Fighting the system’ is rarely easy, and with Continuing Healthcare it seems particularly so. However, two things you can do in response to this report are:

  • write to your MP and demand action to safeguard the right to NHS Continuing Healthcare funding for all those who meet the eligibility criteria
  • write to the press to help further expose what’s going on in NHS Continuing Healthcare.

Are you at your wit’s end with NHS Continuing Healthcare?

How to prepare for an NHS Continuing Healthcare assessment


  1. Sue Hardy 12 months ago

    Can anyone help me understand the structure of the organisation responsible for the Retrospective Review Process? We have been dealing with an NHS Commissioning Support Unit (CSU). They informed us that the Decision Support Tool (DST) would be prepared by the Multidisciplinary Team (MDT). They would make a recommendation as to whether the patient is entitled to NHS Continuing Healthcare. Before the patient, or their representative, is informed of the MDT outcome, their recommendation Is forwarded to the Clinical Commissioning Group (CCG) for FINAL approval. We have received the DST, signed off by the MDT, declining care. However, no where in the document is there a sign off by the CCG. Is this legal? Are the agencies that the NHS hire, – the CSUs, solely responsible for the approvals or rejections of the claims without the approval of the CCGs? Private companies will always work to targets as this is how they make their money. I am to appeal – firstly back to the CSU, which seems a pointless exercise. I have little faith in the whole sorry set up.

  2. nigel johnson 2 years ago

    When is someone going to do something about the maladminstration of the nhs they should go to jail for fraud doing people out of there inheritance. its day light robbery no one cares reading all the coments is sad reading that the nhs has duped so many people it is not fair but who cares. As previously stated i have given up tried everything the nhs has all the answers apparently.

  3. Conrad Jones 2 years ago

    I’ve added my personal esperiences of the CHC processes below to findings of NAO:

    * huge differences between CCG areas regarding the number of people funded by Continuing Healthcare – {Don’t have any figures on that.}
    * assessors ignoring case law – [Totally Ignore and dismiss Coughlan Case as to do with a Promise made by Local Authority – so not just ignoring it but misleading people – Fraud?]
    * assessors ignoring the Continuing Healthcare guidelines {Yes}
    * assessors playing down care needs {At every opportunity}
    * assessors ignoring or failing to gather relevant evidence {Deliberately leaving out previous Hospital Rcords, COPD Diagnosis, History of Falls, etc etc – too much to list here}
    * unacceptable delays in the process {Claim has now taken almost six years, and they make the most of not following up on request for Social Services Records – I had to interven to speed up the process after waiting for several months wondering what the delay was.}
    * lack of communication and response by CCGs to questions and complaints from families {They responded, but always said the delays were due to excissive amounts of claims being made due to the 2012 deadline – which is partly true – more the reposnsibility of Government and the 2012 HSC Act}
    * lack of any meaningful data on the number of appeals made against CCG decisions – {Yes, I don’t know what the percentage is of successful claims – but guess it is quite low }

  4. kevin riley 2 years ago

    The so called, but entirely ineffective , in the context of patient safety and well being”reforms” , introduced by the Health and Social Care Act 2012 did not “reduce accountability ” but removed it completely. We now have a “post code” lottery, so far as care is concerned far worse that it was before the provision of care was removed from democartic control and placed in the hands of non elected and completely unaccountable “independent” CGG’s and NHS Trusts. The Government cannot be more strict with CCG’s – since the Health and Social care Act 2012 removed the NHS (including CCG’s) from democratic control – the Government cannot force either NHS Trusts or CCG’s to behave in a particular way – they can now only “advise and/or recommend” but can do nothing if these now “independent and free from democratic control” organisations refuse to accept that advice or follow that recommendation.

  5. Les Scaife 2 years ago

    We have found from experience that it takes between 18 months to 2.5 years to be successful in obtaining Continuing Healthcare (CHC) in our area; indeed we have had one person die while waiting. All the advertising and enthusiasm by government and CCGs have proved to be nothing more than propaganda. Even when CHC has been achieved the payments for a Personal Health Budget (PHB) take months to arrive and they will not backdate the difference between what social services were paying and the sum of the PHB.
    If government intend this to be a success then they need to be more strict with CCGs who are not delivering.

  6. M.Gibbins 2 years ago

    This complete scenario is clearly an action to be taken on by 38 Degrees. Unfortunately, I am not in England and will not be back for a few years to come but suggest that someone makes contact with this wonderful organisation as this will then be viral and will enable many thousands of signatures to be added- which in turn, can be presented to the Government by 38 Degrees direct.

  7. Meggie 2 years ago

    I scanned the National Audit Office report but haven’t read it and fully taken in all it said. However, I seem to recall that it gave figures for the number of cases that reached the ombudsman (not many) and the number of appeals the ombudsman ultimately upheld (even fewer).
    This surprised me, given the stories I have read on this site and my own experiences. I have wondered for a long time why the ombudsman’s office have not written a report or raised the issue with government – having assumed, obviously wrongly, that many people appeal to the ombudsman in an attempt to get a fair and lawful decision and that the ombudsman would therefore know that eligibility decisions are frequently wrong or based on inadequate or wrong evidence.

    • Ian Grimmett 2 years ago

      Welcome to the strange world of Continuing Healthcare, its associated branches and inadequacies.
      I am guessing you are new to this, I may be wrong.
      Everybody wonders why absolutely nobody holds the people failing to abide to legislation to account.
      Initially, everybody thinks it is a fair and level playing field.
      The painful lesson is, it is not, this can be evidenced by the hundreds of people seeking but not receiving fair treatment and the expectation that the stated leguslation and processes will be followed.
      They are not and NOBODY in government cares or shows any interest in stepping in.
      The recent National Audit Office (NAO) report actually does not appear to support the problems pointed out to it by those who got in touch.
      It just lists what those people told NAO, it quotes figures, percentages and years but little else as far as I can see.
      There does not appear to be any meat on the bone of the report that indicates that the concerns it was told about are going to be followed up and action taken against those not abiding by the Care Act, NF, professional guidances etc. etc. etc., the usual white wash sadly.

  8. nigel johnson 2 years ago

    Hi everyone. I fought the NHS for ten years, tried everything – MPs, ombudsman – its a closed shop. GPs tell the truth, care homes don’t. I have given up as you say even the press won’t help. I paid out £95,000 all lost. Have now sold my house to get equity. The NHS robbed me of my inheritance. I’m now putting it behind me and living my retirement.

  9. Geoffrey Harris 2 years ago

    My wife’s parents had to go into care in 2007 at the behest of their GP he said as he said this had to happen no costs would be incurred how wrong he wasn’t! Until their deaths in 2013 and 2015 some £480000 was spent on care costs most from the sale of their property and pensions. My wife appealed and a company took the cases on on a no win no fee basis – it is interesting to note just how many of these companies have gone out of business. After four and a half years my wife got retrospective funding, but only in part, we are still fighting on behalf of her father now into the sixth year. All we get from our the staff concerned is (can you believe this?) we only have one part time nurse carrying out the final assessments! It really beggars belief. They have omitted errors were made, some previous assessments were wrong and despite promise after promise we still have not had the final results, it is both frustrating and galling. Over the years my wife has spent time with assessor so, she could write a book on how they behave, one example, “erh what box do you think I should tick?” Another instance turning up late looking unkempt and the just got out of bed look the saga goes on. In our county it is known for being one of the worst in the UK, that makes me all the more determined to fight for what is right.

  10. Ian Grimmett 2 years ago

    Another thing I forgot to point out.

    Under the Care Act it is a criminal offence, punishable by fine or imprisonment, whichever is suitable, yet, proven failures to comply with this Act are never proceeded with.

  11. Ian Grimmett 2 years ago

    We are awaiting an appearance at NHS England and it makes us and surely others, question what is the point if these huge cuts are to be made and the failings highlighted by the report are not going to make any difference to how the system works.

    Time and time again, failures are highlighted but the CCG’s continue on their merry way without complying with the legislation and guidance and absolutely NOBODY brings them to task.

    The whole thing is a joke.

    MP’s and press have been contacted before but it makes absolutely no difference.

    UNTIL such time that the involved organisations are legally accountable and official and legal action is taken against those involved in this disgusting failure to apply legislation and guidelines, those involved will continue to break the law.

    The current legislation is toothless because there is no action taken against those who are failing.

    The National Audit Office may well have published this report pointing out the many, many failures but, what will happen as a result?

    TIme and time again we get official reports into many failures, Continuing Healthcare, Social Services failures regarding children and it is always the same. “WE WILL LEARN FROM THE INVESTIGATION, CHANGES HAVE OR WILL BE MADE ETC. ETC.,” YET IT CONTINUES TO HAPPEN TIME AND TIME AGAIN.

    The CCG answer is always to simply ignore the facts, there will be no punishment and, when push comes to shove and they know they are up against it, all they do is write to you and point you towards NHS England (not a truly independent body) or the Government Ombudsman.

    In Other words they move the problem down the line for somebody else to deal with safe in the knowledge that there will be absolutely NO action taken against them.

    What is the point of the National Framework and the various guidelines for those involved in the process.

    The point is to absolutely and at ANY cost, actively prevent the correct application of the process in order to save as much money as they can.

  12. Stephen 2 years ago

    Cuts have already started. My partner who is on CC has just spent four months in hospital. Whilst she was in hospital her care agency had to let her place go. So when she was due for discharge a new care agency was procured by C.C.
    I found out via a third party that C.C had cut the hours of the package and removed the shopping and domestic hours to boot.
    They got very strong representations from me both to the accountable officer at the CCG and to senior execs at C.C.
    The package was swiftly returned to it’s original format with an apology of “sorry we made a mistake and did not read the package properly.” All you will ever get from these people is lies, deceptions, and cover-ups. In the three years my partner has had C.C. i have only ever met one C.C official who genuinely cared to want to help. I have had to fight tooth and nail using every legal argument i could think of for everything my partner now has. So if you are reading this i tell you to get educated and informed about your situation and fight! fight! fight! using every means at your disposal including involving your MP.
    I have tried to get complaints about C.C and Social Services published in my local newspaper, and in the local BBC tv news but it is always ignored. It seems there is a conspiracy between government and the media to keep the lid on all of this blatant denial of patients rights.

  13. kevin s riley 2 years ago

    Your article appears to have been written without taking into account the effects of the removal of the NHS from democratic control by the Health and Social Care Act 2012.
    As a result of the above the now completely “independent” and “free from democratic control” NHS Trusts and CCG’s are free to make their own decisions and are not accountable to anyone for the decisions they make.
    Writing to MP’s is effectively a waste of time as none of them (including Theresa May or Jeremy Hunt ) can force any of the above to behave in a particular way and that includes, not only the above, but also NHS England, the Department of Health and the Government itself.
    Th only way the above can be changed is by Parliament revoking the Heath and Social Care Act in it’s entirety and return the running of the NHS to Democratic control.

    • Angela Sherman 2 years ago

      Kevin – you’re right that NHS reforms have reduced accountability. At the same time, we still hear from families who do contact their MPs and for for whom doing that has helped. It doesn’t always work – but it can in some instances. We would not have suggested it otherwise. MPs are accountable and MPs effectively make up Parliament – and public pressure can sometimes have surprising results when enough people exert that pressure. The NHS Continuing Healthcare process can be harrowing and it can feel as though no one is on the side of the patient and the family; some MPs are on the side of the family, however, and some have also been able to have a positive influence on NHS Continuing Healthcare cases.

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