Just Caring Legal has today sent an open letter to Clinical Commissioning Groups (CCGs) across England to challenge what we believe to be widespread abuse of the eligibility process for NHS Continuing Healthcare.
People all over the country have been getting in touch to tell us that they have been effectively shut out of their NHS Continuing Healthcare eligibility assessments. They have not been permitted to play an active part in the process or to give their views directly to the professionals making decisions about their or their relative’s care.
This goes against both the spirit and the letter of the National Framework for NHS Continuing Healthcare (the National Framework), which CCGs are required by law to follow. It is a core principle of this Framework that the decision-making processes of NHS Continuing Healthcare be person-centred. This means the individual undergoing the assessment and/or their representative(s) must be fully and directly involved in it. Representative can mean any friend, unpaid carer or family member who is supporting the individual in the process. It can also be anyone acting in a more formal capacity (such as a welfare deputy or someone holding lasting power of attorney).
Because of the Covid-19 pandemic, most assessment meetings now take place via digital platforms such as Zoom or Teams. A multi-disciplinary team of professionals involved in the individual’s care meet to discuss a range of assessments relating to their needs. They complete a document, the Decision Support Tool (DST), to help them assess the nature, severity, complexity and unpredictability of these needs across 12 different domains. The DST has different “scores” for each domain to help the professionals agree on the correct level of needs. The National Framework requires that individuals and their representative(s) be enabled to take a full part in this meeting and to give their own views about their care needs. The DST must record whether they agree with the domain levels the professionals select and if not, why not.
Many of our clients say NHS CHC assessors have contacted them to ask for their views on their or their relative’s care needs. But then the MDT has completed the DST in a separate meeting, without them or their relative present. And the decision – invariably of ineligibility – has been communicated to them as a fait accompli weeks, sometimes months, afterwards.
This story appears to be so widespread as to point to a system-wide shift in processes. So we have written to all CCGs in England demanding total transparency and clarity. We demand to know the rationale for what appears to be the wholesale abandonment by CCGs of the person-centred principles which form the very core of the NHS Continuing Healthcare process. And we are demanding that CCGs share with us any revised guidance, programme of work or policy changes that may be behind it.
Furthermore, we are demanding that CCGs take immediate steps to ensure that NHS Continuing Healthcare coordinators and MDTs are complying with their legal duties by organising and carrying out the eligibility assessment process in compliance with the National Framework. Any failure to do so is an abuse of process, representing clear grounds for appeal of any subsequent decision.
CCGs are undoubtedly under enormous pressure. Not only must they clear an assessment backlog created by the suspension of NHS CHC processes last year due to the pandemic. They must also complete all assessments for new referrals within six weeks, on pain of picking up the care bill if they fail to do so. But this is no excuse for abandoning their legal duties. CCGs must complete assessments in line with the principles and processes of the National Framework – or face the extra work caused by the enormous number of appeals that will inevitably result if they do not.