Question to the Department of Health and Social Care:

To ask Her Majesty's Government what recent discussions have taken place between the NHS and the Department of Health and Social Care about the costed breakdown of proposed cuts to the national budget of NHS Continuing Healthcare; whether they intend to provide a detailed rationale to account for the planned reductions in spending; and if so, whether they will publish that rationale.

The Department works closely with NHS England and has regular discussions about NHS Continuing Healthcare.

NHS Continuing Healthcare expenditure is forecast to increase over the period to 2020/21. The identified £855 million efficiency opportunity is not predicated on changes to the National Framework in respect of eligibility or on limiting the care packages available.

There should be no quota or cap on access to NHS Continuing Healthcare funding and NHS England does not aim to reduce spending on NHS Continuing Healthcare, but to reduce the rate of growth of expenditure. NHS England understands that there is variation on how individual clinical commissioning groups (CCGs) are commissioning these services, and the NHS Continuing Healthcare Strategic Improvement Programme will be developing a range of commissioning tools to support CCGs in this role to deliver more efficient services.

The detailed rationale is published in the Treasury Minutes: Government response to the Committee of Public Accounts on the Twelfth to the Nineteenth reports from Session 2017-19. The extract is as follows:

“CHC expenditure (after efficiencies) is forecast to increase over the period to 2020/21, and the identified efficiency opportunity is not predicated on changes to the National Framework in respect of eligibility or on limiting the care packages available.

How any efficiency is delivered in practice will of course be determined by CCGs locally, consistent with their statutory duties and national guidance in respect of access to CHC. National modelling based on variations in CHC expenditure and practice suggests the following notional efficiency opportunities in 2020/21, amounting to circa £855 million, which it is anticipated will inform local commissioning decisions:

• Working with the Department to provide clarity around the National Framework and improving the way CCGs deliver the National Framework. This includes interventions such as improved data and benchmarking information and reducing the number of CHC assessments in an acute hospital setting – (circa £361 million)
• Improving the commissioning of care packages – (circa £122 million)
• Improving CHC processes including the supporting of staff with Training and Development – (circa £79 million)
• CCGs locally delivered improvement initiatives – (circa £293 million).”

A copy of the Treasury Minutes is attached.