Here at Just Caring Legal we are dedicated to fighting the postcode lottery in NHS Continuing Health Care. This is the funding that exists to meet the care costs of those with a “primary health need”.
Some local health boards (known as CCGs) are three times more likely to grant NHS CHC than others. (See Just Caring Legal’s story in the South Shields Gazette on this). Even allowing for local health variations, how can this be right? After all, there is a National Framework designed to ensure all CCGs follow the same process. Now a new report from the Continuing Healthcare Alliance has shed light on why this postcode lottery exists. A coalition of leading charities, the alliance has gathered evidence from hundreds of professionals as well as NHS CHC applicants.
The report finds some CCGs are not following the National Framework on NHS CHC
Flawed processes mean many people who are eligible for NHS CHC are failing to get this much needed support. The researchers found the system is “complicated, confusing and intimidating” for individuals and families. As for the National Framework, “some local decision makers appear to be choosing which bits they intend to follow.” Around a third of respondents said their NHS CHC assessment was not carried out by a multi-disciplinary panel. Very worrying, since this is a basic requirement under the Framework.
The report suggests some NHS CHC decisions are based on “financial ulterior motives”
One NHS worker, Kathy, explained to the CHC alliance why she thinks the postcode lottery exists. “I really believe decisions are being based on financial ulterior motives and not on the patient’s needs,” she says.
This is how it goes in Kathy’s area. In order to complete a decision on NHS CHC, the CCG asks relevant professionals and care providers for evidence of need. They usually give 28 days to respond. If no information is forthcoming, or if some reports miss the deadline, the case is closed. Thus many patients never even make it to the assessment stage, Kathy explained.
Even where the CCG does receive evidence, however, Kathy says the decision-makers do not always take it into account. “They cherry pick bits from the professionals which gives a distorted reflection of the patient – this seldom results in eligibility.”
The report says some decision-makers “rarely find anyone eligible” for NHS CHC
Kathy continues: “I’ve also seen panels come together and downgrade the [original] findings – despite the fact they’ve never seen the person…My CCG rarely find anyone eligible.
“Some local areas have someone whose job it is to co-ordinate the assessments. That person is a health professional, usually a nurse, but shouldn’t form part of the [decision-making panel]. They are supposed to be an impartial resource. But in my area this person gives the patient a score, and sometimes even has their opinion rated more important than others. I have been in situations where the [panel] members recommend someone is eligible, and the co-ordinator says no.”
Kathy doesn’t know where to turn any more. Despite raising her concerns with NHS England, nothing has changed.
Her testimony is shocking. But unfortunately, in our experience, not unusual. The good news is you can challenge NHS CHC decisions. You can get the funding you deserve – but you will need time, perseverance and lots of hard evidence.