The National Audit office study into Continuing Health Care in 2017 illustrates some startling figures on the growing cost of CHC to the NHS. There has been a 16% increase in spending from 2013-14 to 2015-16 and this is due to continue rising. The £3.6bn pa spend in 2016-17 is projected to rise to £5.2bn pa by 2020/21 if no action is taken.
In addition, NHS England’s expected savings from reducing administration assessment costs and the overall cost of care is £855m pa. These sizeable figures do beg the question “Why is not more effort being made to control the individual cost of packages of care?”
In a time where Council budgets and provider fee rates are being squeezed it feels like CHC is being used as a release valve, along with self-funders to cover this gap. To address this, commissioners need to better understand the cost of the services and how to consistently achieve value for money in the billions now spent on Continuing Health Care.
With the total spend on CHC across the country reaching the billions every year, and the number of people eligible for CHC funding set to rise (largely due to the UK’s ageing population and greater awareness from the public of CHC funding), there is enormous scope to make processes more efficient, and in tandem drastically reduce the level of spend that this area currently demands.
Better commissioning of care packages is essential to future sustainability, and technology must be recongised as a key enabler.
The costs of CHC placements is a complex area that has remained relatively unchallenged in some areas of the country. Nurses and assessors generally purchase CHC packages over the telephone or via face-to-face meetings without any pricing information to back those transactions. Compare this to other industries where people with purchasing responsibilities often have access to data that helps them secure the best price, and CHC purchasers simply do not have the same level of information available. With some patients who have complex needs requiring funding for many years, and costing thousands of pounds per week, any discussion on buying care with a provider could end up committing the NHS to hundreds of thousands or indeed millions of pounds of spend.
Technology here would enable the entire process to be brought to a level where CHC purchasers can make informed decisions that help to reduce expenditure and achieve value for money. Currently practitioners making placements do not see the line by line costs involved in delivering a service, and can be influenced to believe what the care home provider tells them about how little profit they make: a costing tool will have transparent pricing and therefore start to readdress the balance.
IT must of course be easy to use and seen as a tool for the practitioner; not to be used “as well as” current process but “instead of”. Perhaps therefore IT could be viewed as the easy part, and it is accepting process weakness and an appetite for change that is the barrier.
We must start to buy differently. By grasping the real costs of CHC placements; not only will this bring it in line with the progress of other disciplines across health and social care, it also aids a sustainable, efficient, long-term future.
As NHS England states, the aim of CHC is to achieve the best possible assessment and care pathway, and to ensure these are delivered locally in a fair, efficient and cost effective manner.
Let’s take that final point as the key focus here and make more effort to control increasing CHC costs in healthcare.
