By Rosalind Hughes, founder, Just Caring Legal
Thank you to Jane Steen for her kind recommendation, following a successful conclusion to her Mum’s review of NHS Continuing Healthcare.
Jane got in touch with a tale that is all too familiar to us here at Just Caring Legal. Her mum had been receiving NHS Continuing Healthcare since 2018. Now, the local Clinical Commissioning Group (CCG) informed her that, following a review of NHS Continuing Healthcare, her mum might no longer be eligible. This was because she might no longer present with a “primary health need“. It meant putting her vulnerable, poorly mum through another full assessment. Even though her healthcare needs had actually increased in line with her progressive condition.
What was Just Caring Legal able to do for Jane?
After hearing Jane’s story about her dealings with the CCG, we decided to strike while the iron was hot. Just Caring Legal presented a full written representation ahead of the reassessment, explaining why it was both unlawful and unnecessary. As a result, the CCG cancelled the forthcoming multi-disciplinary team meeting and agreed to continue funding her care in full.
Here is what a review of NHS Continuing Healthcare should – and should not – do
- It should not primarily focus on eligibility. The National Framework for NHS Continuing Healthcare, which all assessments must have regard to, is very clear on this. “Reviews should primarily focus on whether the care plan or arrangements remain appropriate to meet the individual’s needs. It is expected that in the majority of cases there will be no need to reassess for eligibility.” However, in these budget-led times, many CCGs will be looking for any excuse to revisit eligibility.
- It should refer to the most recent eligibility assessment to decide if there has been any change in needs.
- A full eligibility re-assessment should take place only if there is clear evidence of a change in needs “to such an extent that it may impact” on the individual’s eligibility for NHS Continuing Healthcare.
- The review should not marginalise a need just because it is successfully managed. Well-managed needs are still needs.
- The review should only find clear evidence of a change in needs where the successful management of a healthcare need has permanently reduced or removed it. In other words, where the active management of this need is no longer required.
- The review should not expect specialist care providers to routinely produce detailed recording of the extent to which a need is being managed. It may be necessary to ask the provider to complete a detailed diary over a suitable period of time to establish this.
Do you have a review of NHS Continuing Healthcare coming up?
Is your relative due a review of NHS Continuing Healthcare? This will usually happen three months after first receiving NHS CHC, and then annually thereafter. Perhaps the review has recently taken place, and you have been informed that a full re-assessment is necessary. If so, we can carry out a thorough initial assessment of your case for free, informing you honestly and in plain English what your options are. And we can provide as much or as little advice and representation as you like. So please get in touch – and let us help you get the fair treatment your relative deserves.