If you have never heard of NHS Continuing Healthcare (NHS CHC) don’t worry. You are far from alone. It’s amazing how many people don’t realise that the NHS should pay full care fees for those with a “primary health need”. People who are eligible should receive it however much money they have in the bank or whether or not they own their own home. But who is eligible? And how do you establish that they are? It isn’t always easy.
Take one of our recent clients, let’s call her Jane. Her mother, who lived with Alzheimer’s Disease, had been receiving care at home – where she lived alone – for a number of years. After a series of falls, serious illnesses and worsening behavioural problems, she sadly ended up in hospital in early 2017. It soon became clear she would not be able to return home – her care needs were too great.
There then followed a two-month period of assessment and re-assessment as Jane fought to establish whether her mother qualified for NHS Continuing Healthcare. NHS staff told her that an NHS Continuing Healthcare “checklist” had established that her mother would not qualify.
The “checklist” helps establish whether there are grounds to carry out a detailed NHS Continuing Healthcare eligibility assessment. It is designed to be quick and easy. However, there are clear rules that the NHS should follow when completing the checklist. If they do not you can challenge the outcome.
Which is exactly what Jane did. There were a number of irregularities in the way hospital assessors had carried out the checklist. They had included information that was incomplete, downplayed her mother’s condition or was just plain wrong. And they had completed the checklist without Jane’s knowledge as her attorney as her mother no longer had mental capacity to make decisions herself. Eventually, after endless phone calls and requests for meetings, the hospital accepted Jane’s argument. They agreed her mother should receive a full NHS Continuing Healthcare assessment.
How Just Caring Legal was able to help
By this point Jane and her husband were exhausted and had little faith in the hospital to get it right.
That is when Jane picked up the phone to Just Caring Legal. For a modest fixed fee we prepared a written submission based on the information she gave us and our detailed, in-depth knowledge of the eligibility criteria and process. Jane then presented this to the multi-disciplinary panel that was to decide on her mother’s future.
It worked. The panel decided that the nature, intensity and complexity of her mother’s care needs meant she should receive the full cost of her care fees – over £2000 a month – from the NHS.
Jane’s is just one of the families Just Caring Legal has helped after losing out on NHS Continuing Healthcare funding. Here are our top three tips for success.
Check the assessors have followed the correct process
You may hear that a checklist has already been carried out – without your knowledge or involvement – and your relative doesn’t qualify. But there are clear rules about the assessment process which the NHS has to follow. Insist on seeing the assessment documents for yourself and check they are complete and accurate.
Keep your own records
Don’t rely too heavily on carers’ or hospital records – keep your own detailed, dated notes of the person’s health condition and care needs. Check records when you visit and cross reference these with your journal to ensure they present a true and full picture of the person’s needs. If they don’t, challenge those in charge.
Keep focusing on the individual’s healthcare needs from your own unique perspective. It is often only those like Jane who challenge these decisions based on evidence – and keep challenging –that succeed. If you need help and support to take things to the next step, give us a call today and find out how we can help.