Now we have the revised National Framework for NHS CHC and NHS-funded Nursing Care (published last week on 28 November 2012) the role of CCGs’ and their CHC functions have been clarified to some extent.

Those who read my blog in September will recall that we were expecting CCGs to inherit CHC responsibilities akin to the current responsibilities of PCTs under the current Directions (2009). This has been confirmed.

However, although the revised National Framework is now out, we still do not have the promised Standing Rules Regulations for CCGs or the proposed revised Directions for local authorities.

Under the new Section 14Z3 of the National Health Service Act 2006 (as inserted by the Health and Social Care Act 2012) CCGs may make arrangements as between themselves to delegate the exercise of their functions to another CCG or to exercise their functions jointly with another CCG. These arrangements may include the payment of money, the secondment of staff and the setting up of pooled funds.

However, whatever the arrangements made, the CCGs involved remain liable for the exercise of their health functions. CCGs do not have the same power as PCTs to form joint committees with delegated decision-making powers. CCGs are limited in their powers of delegation and may only delegate their authority to their own Governing Bodies, their own committees and sub-committees and to their members and employees. This is confirmed by the Department of Health’s Model Constitution Framework for CCGs (section 6).

In relation to CHC this means that CCGs will not be able to delegate their decision-making functions either to CSSs (at first instance as part of a commissioned CHC service) or to a neighbouring CCG as part of any local resolution process (ie first line appeal against a ‘No’ decision).

So, in relation to CHC, this means that, although CCGs will be able to commission from CSSs or other provider organisations CHC services including assessments (following completion of a Checklist) the making of MDT recommendations as to eligibility, as well as the provision of clinical CHC services themselves to eligible patients, CCGs will need to reserve to themselves or their lawfully authorised delegates the actual decisions as to whether to undertake a full CHC assessment and as to eligibility itself.

What CCGs need to do is to check that their Constitutions and Schemes of Reservation and Delegation have granted the necessary and appropriate authorities for effective CHC decision-making. CCGs that may not have done this will need to amend their Constitutions with the approval of the National Commissioning Board.