Keywords: Healthcare inequalities, care gap, Continuing Healthcare (CHC)
Background:
CHC funding is provided to eligible patients who have qualifying health and/or mental health issues arising from complex health needs. Individuals must be assessed as having a primary need for health care using a nationally approved toolkit which is delivered via locally commissioned services.
Aim of the case report:
The aim is to analyze the provision of CHC. NHS England (NHSE) is responsible for planning, procuring services, and managing CHC demand. There appears to be a mismatch between requirement and delivery. This is a retrospective review of NHSE-published data and local experience that evaluates the situation of awarding and delivering CHC in a rural area in the east midlands of England.
Case report:
The published data only captures patients who have been assessed as eligible for funding. It excludes cases under dispute and does not provide information on those not receiving care.
Local evidence suggests that even when CHC is awarded care is not always provided. This impacts primary care services which ends up providing non-commissioned services to fill the care gap.
It is recognised that care may be delayed for a variety of reasons including patients waiting for care even when a personalised health budget has been awarded. Other issues can include geography and inefficient care delivery which may be driven by staff shortages.
Conclusions:
Patients and their carers may find that even if CHC has been agreed upon, care cannot be delivered. This can be driven by the higher costs and scarcity of care providers in rural areas. This can cause unnecessary suffering and financial harm driving health care inequalities with unfunded primary care services plugging the care gaps. Factors such as age may exacerbate the situation whilst families may be left without care support having further socio-economic/health impact. The overall system is complex and requires simplification to make it sustainable in an ageing population.
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