NHS Continuing Healthcare

Question

14:51:00

Asked by

To ask His Majesty’s Government what assessment they have made of the effectiveness of NHS Continuing Healthcare in supporting people with long-term complex health needs living in their own homes or in community facilities.

NHS continuing healthcare fulfils a unique function within the health and social care system, providing support for people with the highest levels of need by fully funding their health and social care. To monitor its effectiveness, the department works closely with NHS England, the wider sector, such as the Parliamentary and Health Service Ombudsman, and voluntary organisations which represent people with lived experience. This includes assurance work and projects to promote consistency in implementing this care.

My Lords, I thank the Minister for her very positive response. As she says, NHS continuing healthcare is vital. However, there are problems. Some of those are about finance, but I want to ask her specifically about the criteria for eligibility both nationally and locally, which are obscure and difficult. First, at the national level, can the Minister define precisely the level of nursing or other health services that a local authority can legally provide and which therefore do not have to be provided by the NHS? Secondly, almost 85% of applications other than fast track are refused, yet people have been encouraged to apply by health and care workers locally. Does the Minister agree that more needs to be done to ensure there is a clear understanding of who may or may not be eligible, rather than wasting so much of patients’, relatives’ and professionals’ time on unsuccessful applications?

I do understand the concerns raised by the noble Lord and agree that we need to take a close look at all these areas. I have already raised that with officials and with Minister Kinnock, who is the responsible Minister in this area. On the second question, there is indeed a relatively low conversion rate, and I understand that the decision was originally made to ensure that everyone who might be eligible is actually assessed. The assessment acts as a gateway to other NHS-funded care but, having looked at it, this could perhaps be made somewhat clearer. On the first question, the noble Lord will understand that I cannot give a definitive answer, and he will be aware that legislation does not limit the number of hours or the cost of nursing care that a local authority may provide. However, the Care Act 2014 sets out that local authorities can provide nursing care only in very limited circumstances—for example, where it is a minor part of overall care, such as basic wound care.

What action are the Government taking to hold integrated care boards to account to ensure that the National Framework for Children and Young Persons’ Continuing Care is implemented equitably and consistently across all local areas? I declare my interest as the joint chair of the all-party group for children with short lives.

It is crucial that we provide the right support to children and young people. NHS England’s regional teams are working with local systems to explore the delivery of continuing care to that younger group. It is important to say to your Lordships’ House that we do not currently collect data on, for example, children and young people, but we will be doing so from April next year. That will help us capture evidence, which will enable us to improve things in the way the noble Lord and his all-party group want to do. We continue to welcome views from stakeholders and partners in this regard.

My Lords, I wonder if other noble Lords share my experience of people who should have continuing care never even being told about its existence. As the noble Lord, Lord Crisp, said, the criteria are obscure, but they are even more obscure if nobody tells you that you could be eligible. Would the noble Baroness be sympathetic to the idea of being much more open about the existence of this facility to both patients and their families?

I thank my noble friend for that observation and certainly agree that, in all these areas, it is very important that people understand what might be available and how they might best apply. As I said to the noble Lord, Lord Crisp, the assessment is potentially a gateway to other NHS funding. I feel quite strongly that that needs to be clarified, so that people know what they are going into. I will take my noble friend’s comments on board and discuss this within the department.

My Lords, this issue has been a football between health and social care for many decades. We have never sorted out whose responsibility it is to do assessments and to make sure that those who are assessed know about the local services to which they can apply. How will the Government sort out that fundamental part of the problem?

As the noble Baroness is aware, the responsibility for this lies with integrated care boards and a framework applies to both adults and children and to young people. It is for NHS England to ensure that the framework is properly applied. Certainly, the framework for children and young people has not been revisited since 2016 and we need to look at whether it is doing the job it is intended to do, because we want people to be getting the care they need. Each case is unique and complex and, as a person-centred service, that brings its own complexities. We should therefore ensure that the frameworks are applied correctly and get to the right people at the right time.

My Lords, I take this opportunity to warmly welcome the noble Baroness to her place; I look forward to working with her. During consideration of the Health and Care Act, the last Government committed to moving away from care homes. Are this Government also committed to allowing those needing care to be given support to live at home? What changes do they believe need to be made to the NHS continuing healthcare programme to allow them to stay at home, rather than be in care homes? The noble Baroness and I have exchanged comments about this in private, and I am very happy to discuss it again with her at a later date.

I thank the noble Lord for his welcome, and I welcome him; I hope we have set the standard on this first Question on the first day. What matters is that people are getting the right care in the right place, and that it is provided near to where they want it. We think that continuing healthcare is one means of doing that; of course, care homes are another. It is about getting in place what is right. I will be very pleased to speak to the noble Lord outside the Chamber on this matter.

My Lords, I too welcome the noble Baroness to her post. Does she agree that our society would benefit greatly if we gave more recognition to the load that carers carry in these situations? According to the evidence they gave to our committee, unpaid carers sometimes feel that they are regarded by the health service simply as the chauffeur getting the person to hospital, whereas they are actually providing a huge amount of care. Can the noble Baroness assure the House that recognition will be given to unpaid carers?

I am pleased to take this opportunity to give great recognition to the role that unpaid carers play; they are absolutely crucial to ensuring that people get the care they need, either directly or perhaps by being advocates. I also thank the noble Lord for his kind comments. While unpaid carers are very busy looking after those they care for, they need to be able to look after themselves and their own health needs. We will apply ourselves to this issue.

My Lords, I declare an interest, in that a member of my family gets social care and has been trying to get continuing healthcare, without success. When people live in a local authority area where social care support is inadequate, the temptation is always to apply under the NHS. Is that not the problem? It simply puts more of a burden on those doing the assessments. Can this be resolved?

I hope it can be. When we look at continuing healthcare and the assessment and service it provides, we will certainly take it on board.