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Wyre Forest Clinical Commissioning Group
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Changes to CHC Commissioning Policy

NHS Continuing Healthcare is a package of care arranged and funded solely by the NHS for a person aged 18 or over to meet physical or mental health needs that have arisen because of disability, accident or illness.

For the NHS to fund this care the individual must have a ‘primary health need’, which means that their main or primary need for care must relate to their health (rather than social care) need. Determining the difference between a healthcare need and a social care need is a complex process but over the past seven years the NHS has seen expenditure continually rise in this area with more than £30m being spent on NHS Continuing Healthcare packages last year.

NHS Funded care can be delivered in any setting. If a person receives care in their own home, the NHS funds a care package to meet that person’s assessed health and personal care needs. If that person lives in a care home, the NHS pays for a place in a home that is able to meet their assessed health and personal care needs.

The three Worcestershire CCGs have responsibility for managing and funding this process and for making eligibility decisions for patients registered with Worcestershire GP practices.

The NHS Continuing Healthcare (CHC) Policy for each CCG sets out the principles that are applied in commissioning NHS Continuing Healthcare. The current policies were last approved in April 2014 and they are now due for review.

Our current policy allows patients to choose to receive a package of care in their own home - or a nursing home of their choice - as long as that package of care is no more than 20% more expensive than the cost of the CCG’s proposed option.

We are proposing to reduce that level to 10% for new patients who require a Continuing Healthcare package of care. This means that
  • Patients will still be able to choose to receive a package of care in their own home as long as that package of care is no more than 10% more expensive than the cost of an equivalent nursing home cost
  • Patients will still be able to choose to receive a package of care in a nursing home of their choice as long as that package of care is no more than 10%  above the most competitive cost of nursing homes identified by the CCG

This decision would bring the Worcestershire CCGs’ policies in line with other CCGs including Solihull, Warwickshire, Birmingham Cross City and Birmingham South Central.

It is also proposed that the percentage allowance is applied to the most competitive quote that is sourced.

It is important to highlight that this change will have no impact on a person’s eligibility for NHS Continuing Healthcare which will remain free at the point of delivery for those eligible patients.  

Over the course of the year the CCGs have been engaging with patients and local communities on the proposed changes to the CCGs’ Continuing Healthcare policies, and this engagement has shaped our decisions.

If you have any comments on the proposed change to the CHC policy please email them to ccgcomms@worcestershire.nhs.uk by Monday 14th November at 12:00noon.

These comments, with our other engagement, will be considered before a final decision is taken.