Introduction of a written continuing healthcare placements policy in BHR
The Joint Committee of Barking and Dagenham, Havering and Redbridge Clinical Commissioning Groups (BHR CCGs) agreed (on 30 January 2020) the final content of our written NHS continuing healthcare (CHC) placements policy.
The policy will come into effect across Barking and Dagenham, Havering and Redbridge from 17 February 2020.
Why have we introduced the policy?
In line with other CCGs across England, we are introducing a written CHC placements policy to support how decisions are made as to where patients receive their individual packages of care (e.g. at home or in a care or nursing home). We do not currently have a uniform and consistent approach about how to fund expensive packages of care, particularly for care at home.
As a result, we have developed a policy that enables us to balance the personal choice of individuals alongside safety, clinical effectiveness and appropriate use of finite resources. We hope that this policy will help support decisions that are consistent and fair for all patients and their families. In addition, the policy explains how patients and their families or carers can appeal decisions made about the location of their care.
We expect the policy will only affect a small number of current patients, and only if their care needs are assessed to have changed considerably following an annual review.
Who does the policy apply to?
The policy applies to all new patients who are eligible for CHC, and in a few cases to existing patients whose care needs have changed considerably since their last CHC review. This could be, for example, if a person’s condition has deteriorated and they require significant extra care.
The eligibility to receive CHC will not change as a result of this policy and all new and existing patients will continue to receive the most clinically appropriate care for their assessed needs. There will be a discussion about where the care is provided, although it may not always be possible for this to be with a person’s preferred provider or at their preferred location.
The policy does not apply to:
- Children under the age of 18 years.
- Individuals who are assessed as needing ‘fast-track’ CHC.
- Individuals receiving CHC who are assessed as having a rapidly deteriorating condition and may be approaching the end of life.
- Individuals receiving Section 117 aftercare following a period in hospital under the Mental Health Act 1983.
Consultation and feedback
In response to feedback received during a 12-week public consultation, our Joint Committee agreed to implement the policy with the following amendments:
- BHR CCGs will generally not fund a CHC package in a person’s home if the cost of doing so is more than 15% higher than providing the same care in a care or nursing home. Please note that we have increased this upper cost limit from the proposed 10% limit.
- Clarification that the policy does not apply to individuals assessed as needing ‘fast-track’ CHC (in other words, care which is provided to people who have a rapidly deteriorating condition and may be approaching the end of life).
- Inclusion of guidance on how individuals can access advocacy services.
During the consultation period, we received feedback from 108 individuals and organisations and an additional 32 representatives from local organisations attended an engagement workshop.
The full policy is available to download from our websites:
Following the Joint Committee meeting, the CCGs have received further information on local advocacy services from Healthwatch Redbridge and VoiceAbility. This information is currently being reviewed by the CCGs’ CHC Team.
In addition, all people currently receiving CHC in their own home will receive a letter to inform them we have introduced the policy. The letter includes information about who to contact if they or their family or carers have any questions or concerns.
Dr Amit Sharma
Dr Raj Kumar
Clinical leads for continuing healthcare, BHR CCGs