The Continuing to Care report, which came out last week, is a reminder of the difficulties facing many of those who apply for NHS Continuing Health Care (NHS CHC) funding. NHS CHC pays care fees in full for those with a ‘primary health need’. However, many NHS CHC assessments are flawed, the report found.
How are NHS CHC assessments carried out?
Someone is eligible for NHS CHC if healthcare is more than ‘incidental or ancillary’ to their care needs. The National Framework on NHS CHC provides detailed guidance to local health boards (CCGs) on how to conduct NHS CHC assessments. Yet the Continuing to Care report suggests some CCGs do not apply the guidance correctly.
NHS CHC assessments rely heavily on the “Decision Support Tool” (DST). This detailed document separates the person’s care needs into 12 broad “domains”. It should be used by a multi-disciplinary team of professionals to grade how severe the person’s care needs are for each domain. Using their expert judgement, the team should then consider the overall nature, intensity, complexity and unpredictability of needs.
However, 73% of respondents to the report who had applied for NHS CHC felt the DST did not “enable an accurate impression of the person’s situation”.
Here is an extract outlining Alison’s story.
“It was very clear to me that the assessment was a sham”, Alison told researchers
At 96 Tom, a former teacher, had developed vascular dementia. So his daughter-in-law Alison, a nurse for 40 years, applied for NHS CHC.
Alison said: “I believe the team assessing Tom manipulated some of the information. For example, when assessing his mobility they decided that because he could shuffle about in bed, he was mobile and therefore did not qualify. What’s their definition of mobility? He couldn’t walk, stand or even turn over in bed, which I think means he was immobile. It was very clear to me that the assessment was a sham. It was awful to watch… I felt the assessors seriously downplayed most of his problems.”
What to do if an NHS CHC assessment goes against you
The good news is you can challenge an NHS CHC ineligibility decision. The first step is to use the local complaints procedure. If this fails, you can take the case to an Independent Review Panel. And, if all else fails, you can go to the Parliamentary and Health Service Ombudsman. However, the report found many people were “too distressed and exhausted to go through the complex appeals process”.
As the Head of Just Caring Legal I echo a lot of the views from this vital report. Which is why I felt compelled to start my own business, challenging the NHS CHC assessment process on behalf of vulnerable people.