- Ward nurses concerned West Norfolk CCG’s screening process blocks eligible patients from receiving funding
- CCG’s “5Q test” sprung out of pilot project supported by NHS England
- Other CCGs have scrapped plans to introduce the test, with one advised to do so by NHS Improvement officials
A clinical commissioning group has been accused of blocking potentially eligible patients from receiving continuing healthcare funding under a programme supported by NHS England.
West Norfolk CCG has been using a locally-devised screening process, called the “5Qs test”, which effectively means a higher proportion of patients do not receive an official assessment for NHS funded continuing healthcare.
By law, patients with complex long term conditions are entitled to free social care funded by the NHS, so long as they are assessed as having a primary medical care need under the official CHC process.
An expert in CHC cases told HSJ that West Norfolk’s test is “significantly flawed”, because it screens out some patients who should be eligible for an official assessment.
Dan Harbour, managing director of Beacon, a company which specialises in CHC cases, said ward nurses have raised concerns to his organisation.
The CHC process involves two steps. Patients are initially screened using an official Department of Health and Social Care checklist to identify those who may be eligible. Patients who pass through this screening receive CHC funding until their full assessment decides if this funding should continue.
National guidance published by the DHSC says the initial screening checklist “is the only screening tool that can be used” to identify patients who should receive a full assessment.
West Norfolk’s 5Qs test takes place before either of those steps and decides if a person needs nursing care or social care. If it’s the latter, they are referred to means-tested local authority services and not offered a CHC checklist unless the individual requests one or their case is “subsequently triggered”.
If more patients are discharged straight to social care without an initial CHC screening, there is a saving to the CCG.
The 5Q test was first devised in 2016 as part of a pilot project supported by NHS England (see box below). The CCG has said it does not replace the CHC process.
An internal review of the project, published in December 2016, said the test was introduced to determine which patients should be screened under the CHC checklist. DHSC guidance does not dictate how a local system should decide who should be assessed, but says “where there may be a need for NHS CHC, a checklist should normally be completed”.
Mr Harbour said: “The great innovation purported to have been achieved by the 5Q test is to identify whether somebody primarily has health needs or social needs. By law, the only way of determining that question is through the CHC assessment process.”
Meanwhile, HSJ has learned several other CCGs that were considering using the 5Q test have now dropped their plans.
The four CCGs in Greater Nottingham – Nottingham City, Nottingham North and East, Nottingham West and Rushcliffe – said they were “advised by the [NHS Improvement] emergency care improvement programme not to proceed and have reverted to following the national guidance”.
Sheffield, and Ipswich and East Suffolk CCGs have also dropped the test, but would not explain why.
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