By Rosalind Hughes, founder, Just Caring Legal
Most people breathe a sigh of relief when their assessment of eligibility for NHS Continuing Healthcare is successful. Just getting someone to accept that your family member has a primary health need that qualifies for NHS care can be the fight of your life. The comfort of knowing they are finally getting the care they need when they are at their most frail and vulnerable is immense. But this is very rarely the end of the matter. There will normally be an NHS Continuing Healthcare review after three months, and then again annually. The NHS Continuing Healthcare review is supposed to focus on whether the care package is meeting the person’s needs adequately. But in our experience, it very rarely does.
The NHS Continuing Healthcare review should not in most cases revisit eligibility
The National Framework for NHS Continuing Healthcare is quite clear. In most cases there should be no need to reassess for eligibility. Only where there is clear evidence of a change in the person’s care needs should it result in another eligibility assessment. This should be by reference to the Decision Support Tool from the previous assessment.
In our experience, however, the review is very rarely about ensuring that the care package is sufficient. In most cases, these processes are budget-led, not needs-led. This means there is a laser focus on whether the person still presents a “primary health need“. (This is not about the reason why an individual requires care or support, nor is it based on their diagnosis. It is about the level and type of their overall actual day-to-day care needs.) Many reviews will search out “evidence” that current care needs do not meet this high bar. Then they can justify another assessment with a view to withdrawing NHS Continuing Healthcare.
Is it possible that the care needs of someone this vulnerable can genuinely disappear?
It is not impossible. Sometimes, if someone has been particularly unstable, a period of intense care in the right environment can bring genuine improvement. In these cases, care needs may permanently reduce to the level that they are no longer intense, complex or unpredictable enough to indicate a “primary health need”. But in most cases, people who qualify for NHS Continuing Healthcare funding are suffering from multiple deteriorating conditions. Alzheimer’s. Cancer. Parkinson’s. Or they have permanent cognitive impairment from a disability, stroke or brain injury that impacts permanently on many aspects of their care needs, making them difficult for carers to meet. Short of a miracle, their care needs are never going to just go away.
A well-managed need is still a need
Often, reviewers will use evidence that someone appears more stable and settled as evidence that they no longer have a primary health need. However, the National Framework anticipates this. It warns assessors not to marginalise a care need just because it is successfully managed. Well-managed needs are still needs. Only where the successful management of a healthcare need has permanently reduced or removed the need will this have a bearing on NHS Continuing Healthcare eligibility. This will only be the case where active management of this need is reduced or no longer required.
However, time and again, we see this requirement ignored. Reviewers argue that, for example, a reduction of aggressive behaviours in care records is justification for withdrawing NHS Continuing Healthcare. Yet they fail to acknowledge what is going on behind the scenes. These behaviours often require copious amounts of time, skill and knowledge of the individual to manage. By failing to scrutinise risk assessments, behaviour support plans and care records, reviews ignore crucial evidence that the need is just as great, just better managed.
Has your relative had NHS Continuing Healthcare withdrawn following a review?
If so, you are not alone. We are dealing with these cases every day. We know how devastating it is to have someone accept your relative’s needs, only to snatch it all away again after 12 or even three months. As if they have miraculously just got better. And often just when you feel they have settled into their current setting. We feel the frustration of families whose views of their own relative’s needs count for nothing.
If this is you, please get in touch for your free initial assessment. We will review as much evidence as you can provide about your NHS Continuing Healthcare experience. Then we will give you our honest assessment of whether we can help. Often our clients tell us they just don’t recognise the person described in the document. So tell us the full story. The real story. And we can take it from there.