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Surge in care claims puts pressure on CCGs

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Clinical commissioning groups across England are forecasting large overspends on continuing healthcare as a result of a surge in new claims for the funding.

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CCGs in Hampshire are on track to spend up to £10m more than expected on the claims, according to Andrew Wood, chief finance officer at Fareham and Gosport CCG.

He said commissioners across the county were facing a “perfect storm” of an ageing population with complex health needs and increasingly expensive care packages.

“Historically it was always a big area of spend for primary care trusts, but suddenly over the last few months it’s got out of line,” he told LGC’s sister title Health Service Journal.

“Across Hampshire we’re looking at quite a big overspend, somewhere between £5m and 10m if things keep going in this current trend.

“It’s a very volatile budget because it tends to be very dependent patients who have complex packages of care, so its reasonably low volume but high cost.”

Mr Wood said increased claims could be partly due to a backlog of applications being processed more efficiently.

“There’s possibly an element that our assessment teams have had more investment put in so they’re getting on top of the backlog a bit better, which accelerates the costs, ironically”, he added.

“It’s great if you’re treating peoples’ claims more quickly but it crystallizes the costs more quickly as well.”

Zoe Pietrzak, chief finance officer at Great Yarmouth and Waveney CCG, said it was forecasting an overspend of £750,000 on continuing healthcare.

Elderly in man in bed with health worker tending to him

Increased costs are partly due to efforts to clear a backlog of claims, reviews of claims and high tariffs

“We are experiencing an increase in both continuing healthcare activity and the number of claims we are receiving,” she added.

“As a result, we are currently forecasting an overspend of £750,000 by the end of the financial year.”

Leicester CCGs are experiencing “significant financial risks” because of continuing healthcare costs, according to Dave Briggs, managing director of East Leicestershire and Rutland CCG.

East Leicestershire and Rutland oversees continuing healthcare on behalf of all three CCGs in Leicester, Leicestershire and Rutland.

Mr Briggs said increased cost across the three CCGs could be due to the need to quickly discharge large numbers of patients from hospital to “help manage challenges around the urgent care pathway”.

Increased costs were also due to efforts to clear a backlog of claims, the result of reviews of claims and the relatively high tariffs in the area.

Mr Briggs added: “Tackling these issues and reducing the financial risk is a high priority for us.

“Ultimately, and importantly, we want to ensure patients receive consistent and fair access to continuing healthcare claims and receive appropriate levels of care in a timely manner.”

Fylde and Wyre CCG’s latest board papers pointed to concerns over continuing healthcare costs which were “not exclusive” to its patch.

“The CCG has set aside additional monies to fund the [continuing healthcare claims] expenditure area following its fluctuating overspend in 2013-14.

“However, the information received at month five continues to suggest that the increased budget may prove inadequate and a further investment of £800k from reserves is estimated to be required.”

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