News and Comment from Roy Lilley

News and Comment from Roy Lilley
Roy Lilley has  never met Sharon Brennan but he thinks she should be in the running for a prize for journalism.  Maybe not quite a Pulitzer but certainly a something for the sideboard or the shelf in the downstairs loo.
She works with the HSJ (Note to new owners; give her a pay-rise ), and earlier this week wrote a story about the madness of CCGs, based on an FoI dug up by campaigners Disability United.  It would have been so easy to dismiss it as ‘just another press release’ and gone unnoticed.
Sharon didn’t do that.
It emerges, some CCGs have a cockamamie plan to force frail  vulnerable people out of their own homes and into care homes.  Why?  Because it is cheaper.
To quote Sarah’s article:
“Thirty-seven CCGs have set cost restrictions on NHS Continuing Healthcare funding, which pays for ongoing care for adults who are assessed as having a primary medical care need. It is arranged and funded solely by the NHS.
Nineteen CCGs have said they will not fund care in a person’s own home if the cost is more than 10 per cent above that of an “alternative option”, which is normally a residential care home placement. A further seven CCGs have set cost caps at 20, 25 or 40 per cent above care home fees.
Eleven commissioners have said they will restrict the cost of individual Continuing Healthcare funding but have not set a cap.”
If you’d just pause for a moment and consider the ramifications.  Yes, yer granny can be forced out of her home.  It gets worse.
Both Dorset and North, East, West Devon CCGs have said that “if a person refuses to consider or accept any of the placements” offered, the CCG would consider it has “fulfilled its statutory duty” and expect the individual to make their own arrangement within 28 days.
In other words, clear out or clear off.  
It appears that the human right; the right to a family life, does not extend to an older person living in the dark shadow of a poor CCG.
Aside from being morally reprehensible, it is almost certainly lawful.  Yes, read that again… it is lawful. 
It’s a policy first attempted by Camden PCT 15 years ago and also came up in the case of Gunter v’s South Western Staffordshire PCT in 2005.
In the Gunter case the judge said:
“… to remove XXXXX from her home will interfere with her right to respect for her family life…. the interference with family life is obvious and so must be justified as proportionate. Cost is a factor which can properly be taken into account.”
… ‘cost can properly be taken into account’.
Unwittingly Sharron Brennan’s report has demolished a huge plank of policy and exposed a fiddle.  Caring for someone in the community and in their own home is paraded as cheaper and preferable.  It may not be.
CCGs can set  varying and entirely arbitrary caps, 10%, 20%, whatever% at the stroke of a pen.
CCGs can ignore patient and family

CCGs set their own prices for  

domiciliary support and therefore can make the threshold comparison fall entirely in their favour.
My view is, this dodgy policy needs an urgent further test in the high court.
That said, the reality is, attempting to create a bespoke “hospital at home” can cost 3 times the cost of a care home place. CCGs are faced with a real dilemma; spending say £150k on a care home placement or what could be  £450k for a single patient at home.
Little realised is the parallel with social care. A patient only gets a “choice” of settings, in which to have care services, if they are no more expensive than the alternative that the local authority are prepared to fund. Hence there is not even a 10% buffer.
Expect yer granny to be thrown out of her home, to end her days in a single bed, in a tiny room, with her few belongings in a box on top of a wardrobe… if she’s lucky.  She certainly won’t die in her own home.
One nursing home a week is closing because they are not viable.  Where exactly will these refugees from the NHS end up?  Does anyone in a CCG have the first clue?
Regular readers will know, it takes a lot for a CCG to impress me.  They are mostly too small to carry risk and this is an excellent example.  
Over two hundred CCGs fiddling about with silly budgets, screwing up people’s lives.  They are not big enough.
Time to force CCGs, drive them, crash them, into no more than 120 organisations, before they do any more damage