Conversion rates for NHS CHC assessments vary wildly in England from region to region, according to the latest official statistics. Conversion rates measure the percentage of NHS CHC assessments that result in a finding of eligibility. They range from 16% in Kent, Surrey and Sussex, to 38% in Greater Manchester, according to the latest NHS England statistics.
Local CCGs (Clinical Commissioning Groups) are responsible for arranging and funding NHS Continuing Healthcare (NHS CHC) for all eligible individuals. The funding should cover all care requirements that arise as the result of a “primary health need”. This could be anything from severe dementia to Multiple Sclerosis to the effects of a stroke.
Those living in the north of the South West region – the Swindon, Bristol and Bath area – were the least likely to receive a positive assessment for NHS CHC according to the stats. Just 119 were assessed as eligible in the third quarter of 2018-19, out of a total of 659 assessments. That’s a conversion rate of just 18%.
NHS CHC assessments
The stats show that the number of assessments that took place overall also varied hugely from region to region. For example, CCGs in the North East and Cumbria carried out 1,845 assessments for standard NHS CHC during the quarter whereas Greater Manchester completed just 512.
Yet another example of the postcode lottery for NHS CHC
This is yet another stark example of the postcode lottery for NHS CHC. Why do the conversion rates for NHS CHC vary so widely? The reason is that many CCGs are failing to follow the National Framework on NHS Continuing Healthcare that provides standardised guidance on assessments. There is still wide disagreement about what constitutes a primary health need. Some CCGs are reported to interpret this more narrowly than others, while others downplay or even disregard evidence that would point to such a need.
This means many people are wrongly paying substantial care home bills, despite living with the devastating effects of health issues such as Alzheimer’s disease and other forms of dementia, Multiple Sclerosis, Parkinson’s disease, the effects of stroke and cancer.
The assessment process is often unfair
The first stage of the eligibility assessment process is the Checklist. This is a straightforward process to decide quickly whether someone requires a full assessment. But the huge variation in numbers of full assessments suggest some CCGs are screening more people out at checklist stage than others.
The full assessment should be carried out by a multi-disciplinary team using a dedicated Decision Support Tool. The DST sets out different levels of needs in relation to 12 care ‘domains’, including behaviour, cognition, mobility, and more. But the tool is not designed to be a full assessment in itself. Assessors should use it in conjunction with a comprehensive assessment of the nature, intensity, complexity and unpredictability of the individual’s overall care needs. Often they fail to do so, taking a tickbox approach that doesn’t give the full picture.
However, if you feel that the assessment your family member received was unfair, you can appeal. Unfortunately, this can be a long, exhausting and bureaucratic process.
This is where Just Caring Legal can help.
With our specialist expertise in NHS CHC and litigation experience, we can prepare and fight your appeal for you, maximising your chances of success. We will draft and submit the complex medico-legal arguments required to unlock the many thousands of pounds of NHS Continuing Healthcare funding that you may be entitled to.