Have you or a loved one had your care funding withdrawn following an NHS Continuing Healthcare review? Here at Just Caring Legal, we are hearing of more and more cases like this. A review of NHS Continuing Healthcare takes place after the first three months, then at least once a year thereafter. Of course, there will be times when the withdrawal of funding is justified, if the intensity or complexity of care needs have genuinely reduced. However in some cases, even those with long-term, degenerative conditions such as Alzheimer’s, other forms of dementia and Parkinsons, are losing much needed support. This often means the loss of trusted and familiar carers, or even a move to a different (cheaper) care home.
However, you may be able to challenge a decision to withdraw funding following an NHS Continuing Healthcare review. The key is whether the most recent assessment has followed the correct procedures. Here are five key questions to ask.
How have care needs reduced since the previous assessment?
Before withdrawing funding following an NHS Continuing Healthcare reassessment, the Clinical Commissioning Group (CCG) should be able to demonstrate how care needs have reduced. This should be with reference to the previous assessment based on the Decision Support Tool. But we know that this doesn’t always happen. In fact we find some people have never even seen their previous Decision Support Tool document. And it is never fully explained to them why they are no longer eligible for NHS Continuing Healthcare.
Who has given their input to the review?
The National Framework on NHS Continuing Healthcare is clear. Any review should take place in consultation with the person receiving care and “any other relevant people who know the person who are present”. In short, an NHS Continuing Healthcare reassessment should never take place behind closed doors or by an unqualified member of staff.
Has the review followed the correct processes?
An NHS Continuing Healthcare review should not just look at previous care needs. Often as conditions progress, needs change. Each case is unique and requires a thorough and detailed assessment. Has the review considered the full medical and care records? Has it taken into account the carers’ and family’s views? In short, has it examined overall care needs? Does it establish whether they are any less intense, complex or unpredictable than before? The review should give a complete picture across all the NHS Continuing Healthcare “domains”.
What would happen if current care was withdrawn?
A well-managed need is still a need. Nevertheless, we know people sometimes have their NHS Continuing Healthcare withdrawn on the grounds their condition has “improved” or “stabilised”, even though this is actually a reversible phenomenon purely down to the interventions of skilled carers. Ask what would happen if the same level of care was no longer provided? Would they remain stable or would they deteriorate?
Has the review also assessed whether current care is good enough?
The review should not just focus on continuing eligibility for NHS Continuing Healthcare. It should also address the question of whether the care provided is appropriate and adequate. If you have any concerns about the level of care provided, now is the time to raise it.