By Rosalind Hughes, founder, Just Caring Legal
Recently we received a phone call from someone whose father, who suffers from Alzheimer’s Disease, had “screened in” for a full NHS Continuing Healthcare assessment. This was as the result of a positive NHS Continuing Healthcare checklist. He has recently moved from his home into a secure dementia unit. This followed a best interests decision by the local authority with the input of his consultant psychiatrist. The gentleman’s cognitive, psychological and behaviour care needs have greatly increased due to his rapidly deteriorating dementia. His behaviours and hallucinations were putting his own, his neighbours’ and his carers’ safety and wellbeing at risk. A specialist care setting was deemed to be the best and safest place for him to be.
Given the severity of his care needs, his son requested an NHS Continuing Healthcare checklist. It was positive. The checklist is merely the start of the NHS Continuing Healthcare process. It does not decide if someone is eligible to receive NHS Continuing Healthcare funding. It is designed as a quick and relatively simple indicator of whether someone requires a full assessment to decide if they have a primary health need.
For this gentleman, with a positive checklist, a full assessment was the appropriate next step. However, the CCG decided otherwise. They said there was evidence he was “unstable” and not at his “baseline”. There were “changes in behaviour” and he had recently been prescribed “new medication”. They were therefore disregarding the checklist – as if it had never happened.
Can CCGs refuse to follow up a positive NHS Continuing Healthcare checklist?
The National Framework for NHS Continuing Healthcare, which all CCGs are duty bound to have regard to, is clear. Once an individual has been referred for a full assessment following a positive checklist, then, a multidisciplinary team must assess whether the individual has a primary health need using the Decision Support Tool. The relevant CCG should carry out a full assessment as soon as it is possible to make a reasonable judgement about the individual’s ongoing needs.
Under the National Framework, there are some circumstances in which CCGs can delay an NHS CHC checklist. This is generally for people needing care following the acute phase of an illness. It is most common following discharge from hospital, where reablement may reasonably be expected. In these instances, a checklist may be delayed if the person has not reached their “optimum potential”.
But there are no clear grounds for refusing to follow up a positive checklist outside of these circumstances. Especially not when needs are the result of a progressive condition, without realistic prospects of recovery. It is then up to a Multi-Disciplinary Team of social and healthcare professionals to decide eligibility based on completion of a Decision Support Tool. This allows them to carry out a full assessment of needs in the round. If there is improvement in the person’s presentation between the positive checklist and the MDT, the National Framework allows for this. Just do another checklist.
Has your CCG refused to do a full assessment following a positive checklist?
Has it disregarded the checklist on the grounds your relative may not be “stable” or at their “optimum potential”? If so, you should challenge this, especially if they are not coming out of hospital or an acute phase of ill-health. On what reasonable clinical grounds are they saying care needs may be temporary? What justification do they have for saying the person is likely to improve?
If you are in any doubt about this, why not call or email us here at Just Caring Legal? We can advise you on whether you have grounds for challenge. We deal with cases like this day in, day out, so we can cut through the medico-legal jargon to get to the heart of the matter. The initial discussion of your case is free, so you have nothing to lose. And potentially months – or years – of wrongly paid care fees to gain.