NHS Continuing Healthcare

Are You Entitled To A Refund Of Care Fees?

It can be confusing to understand who qualifies for a refund of care fees. We’ve broken down the five reasons why you may be entitled to a refund.

1. Do you have intense, complex or unpredictable care needs?

This does not have to be from a specific diagnosis. It may be the result of, for example:
• a severe illness such as Alzheimer’s, multiple sclerosis, chronic obstructive pulmonary disease, or Parkinson’s;
• a physical or learning disability;
• the effects of stroke or diabetes;
• an accident that caused injury;
• a severe mental illness.

If so, you may be eligible for NHS Continuing Healthcare funding. This is personal health and social care arranged and funded by NHS Integrated Care Boards (ICBs). It can be received whether in a residential or nursing facility or at home. It is not means-tested and must cover all assessed care needs. If you have been paying care fees, you may be able to claim these back for assessed periods of care.

2. Have you been told you were not eligible for NHS Continuing Healthcare funding without being assessed?

Your ICB should assess you for NHS Continuing Healthcare if it seems you may need care. Usually there is an initial checklist assessment, which helps decide quickly if you need a full assessment. The exception is for urgent care needs – usually as a result of terminal illness – in which case the assessment should be fast-tracked. If the checklist suggests the need for a full assessment, this should be carried out by a team of trained health and social care professionals. If you think you should have been entitled to an assessment, you can ask for one retrospectively.

3. Has the NHS has carried out an NHS Continuing Healthcare assessment but downplayed or ignored your care needs?

The NHS should not carry out an NHS CHC assessment behind closed doors – it should involve the person needing care and their family and carers and consider their input where appropriate. If you believe the assessment did not give a complete or accurate picture of needs, you may be able to challenge this with evidence of your own.

4. Have you had NHS Continuing Healthcare funding withdrawn following a review, on the grounds of a reduction in care needs?

Were you told your care needs have reduced, even though this is purely down to good management of your condition – rather than any underlying improvement? Do you believe your needs are as intense, complex and unpredictable as ever? Again, you may be able to challenge a review with evidence.

5. Have you been asked to “top up” your NHS Continuing Healthcare to meet the needs set out in the care plan?

While the legislation governing local authority social care expressly provides for “topping up” care fees (though only in specific circumstances) the NHS is not permitted to ask for NHS Continuing Healthcare top-ups. (You can, however, pay for additional private services over and above those you need from the NHS – in certain circumstances.) Yet we know many recipients of NHS Continuing Healthcare are paying “top-ups”. You may be able to claim these back.

Please note:

Because of Government rules you cannot now claim for a refund of care fees paid before 31st March 2012 unless there are exceptional circumstances as a strict deadline applies. You can claim a refund of care fees on behalf of someone who has since died as long as you have the authority to do so.

If you fill in our initial online questionnaire, Just Caring Legal can advise you further on whether you may have a claim.

By Rosalind Hughes, founder, Just Caring Legal

Are You Entitled To A Refund Of Care Fees? Read More »

The Average Care Fees Will Set You Back Nearly £44,000 a Year. But Should You be Paying Anything at All?

The average cost of residential care for someone paying their own way is at an all-time high. It now stands at £846 per week – or nearly £44,000 per year – according to a report in November 2017.

Meanwhile, the average length of stay in a care home is around two and a half years. It’s clear the majority of elderly people will struggle to afford long-term residential or nursing care without financial help.

Local authority care is means-tested. This means people must use up almost all of their assets, savings and income before the council pays for care. To make matters worse, most councils are now setting the amount they are willing to pay for residential care well below the level the care actually costs. Those requiring local authority support often have to ask their families to pay expensive “top up fees”. This might be the only way for them to plug the gap.

Should you be paying anything at all for care?

However, many of those struggling to pay for care are doing so unnecessarily. They simply aren’t aware that if they have severe, complex or unpredictable care requirements arising from a ‘primary health need,’ they shouldn’t have to touch their own cash. Instead, the NHS should pay through NHS Continuing Healthcare funding. This funding is NOT means tested and must cover all the costs of care.

Free care is hard to find.

There is a catch, however. Access to NHS continuing Healthcare can be difficult. The eligibility assessment process is complex and often flawed. The professionals involved may ignore or downplay evidence of care needs, fail to consult experts, and/or leave families out of the loop.

You can maximise your chances of success.

Ensuring success requires first-class knowledge of the complexities of the National Framework on NHS Continuing Healthcare. This is the “bible” that all NHS funding decisions should follow. There is also in-depth case law outlining the distinction between health and social care needs and in what circumstances the NHS should step in.

Our speciality.

As a solicitor’s firm specialising in NHS Continuing Healthcare cases, this is daily fare at Just Caring Legal. Every day, we deliver robust, evidence-based medico-legal arguments to maximise the chances of success in NHS CHC assessments. We also negotiate with local authorities and care homes on families’ behalf over care fees and third-party top-ups.

So, are you struggling to work out how you will pay for care?

Do you think you should be paying at all? Then contact Just Caring Legal today to see how we can help you obtain the best possible outcome for all your care funding needs.

The Average Care Fees Will Set You Back Nearly £44,000 a Year. But Should You be Paying Anything at All? Read More »

Some Patients Die While Waiting For a Decision on NHS Continuing Healthcare

You’re not alone! New report highlights how tens of thousands are failing to receive NHS care funding they are entitled to.

Are you trying to access NHS Continuing Healthcare funding for yourself or a relative – but getting nowhere? If so, you are far from alone. A new report by the government Public Accounts Committee says tens of thousands of people in England are having this vital care funding denied by the NHS. And it has criticised NHS England for failing to enable people to access NHS CHC funding, saying this put thousands at risk.

What is NHS Continuing Healthcare funding?

NHS CHC is available for people who have intense, complex or unpredictable care needs arising from a primary health need. They do not have to be a specific diagnosis. It may be the result of a severe illness such as Alzheimer’s, multiple sclerosis, chronic obstructive pulmonary disease, or Parkinson’s; and accident or a disability. NHS CHC is personal health and social care arranged and funded by NHS Clinical Commissioning Groups (CCGs). The care may be in a residential or nursing facility or at home. The funding is not means-tested – anyone can receive it regardless of savings, assets or income.

Some patients die while waiting for a decision on NHS Continuing Healthcare Funding.

In a report released this week, the Public Accounts Committee (PAC) slammed “inconsistency and delays” in assessing eligibility for NHS CHC. In some cases, it says, patients die while still waiting for this vital assistance.

NHS England has asked the local CCGs that administer NHS CHC to save £855 million from their CHC and nursing budgets by 2021. Which means even more people could miss out on this vital care funding. The report warned this would ultimately put patient safety at risk.

The report also criticises the postcode lottery that means the number of people receiving CHC funding varies from 28 per 100,000 in some parts of the country to 356 per 100,000 in others. It puts this down partly to the different ways CCGs are interpreting the rules governing eligibility. The chair of the committee Meg Hillier MP said this funding could make a “critical difference” to the quality of life of seriously debilitated patients.

She added that the demand for CCGs to make big efficiency savings would add to the financial pressures on the frontline. She said there should be “remedial action” against CCGs that fail to provide this vital lifeline for deserving applicants.

How can Just Caring Legal help?

Are you struggling to pay for care? Do you think you or a relative should be eligible for NHS CHC? If you are you should not be paying at all. Unfortunately there are many obstacles to overcome in accessing this vital funding. Just Caring Legal specialises in NHS CHC cases.

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Where Is the Meaningful Data on NHS Continuing Healthcare Assessments

What do we really know about the experiences of those going through NHS Continuing Healthcare eligibility assessments?

If someone is eligible for NHS Continuing Healthcare this should cover both their health and social care costs. If the NHS Continuing Healthcare assessment finds they are not eligible, the individual may have to pay some or all of their social care costs. However, this depends upon their assets, savings and income.

At Just Caring Legal, we hear anecdotal evidence every day about how the assessment process is working – and not working – for people. But what do the statistics tell us? Sadly, not enough.

NHS England published its latest data this month, covering April to June 2017. It told us the total number of people receiving assessments for NHS Continuing Healthcare was 35,654. Of these, 14,668 were via the Standard NHS Continuing Healthcare assessment route and 20,986 via the Fast Track assessment route. Less than a third (31%) of standard assessments resulted in eligibility. Yet, most applicants would have undergone an initial screening process to assess their likelihood of success before a full assessment.

On the other hand, nearly all (99%) of those receiving Fast Track assessments were successful. Fast Track assessments are designed for those who require end of life care.

What the NHS England figures can’t tell us is why there are such huge variations nationwide in both the number of assessments and the proportion of applicants qualifying for NHS Continuing Healthcare funding.

How different local bodies are applying national guidelines.

The National Audit Office found that in 2015-16, the proportion of people referred for an assessment who were subsequently deemed eligible for NHS Continuing Healthcare funding ranged from 41% in some local Clinical Commissioning Groups, to 86% in others.

NHS England itself admits it cannot explain the variation in so-called “conversion rates”. There must be significant differences in the way local bodies are applying the national guidelines on NHS Continuing Healthcare assessments.

Where is the meaningful data that might help shed light on this? It simply isn’t there. The independent Continuing Healthcare Alliance put it in a nutshell:

“At the moment…we know nothing about all of those who were unsuccessful. We don’t know how long they waited for an assessment, why they were unsuccessful, or if they appealed. Healthcare professionals have huge demands on their time, but it is essential that accurate information around NHS Continuing Healthcare is recorded so the system can be improved, and problematic areas can be tackled.”

We need to fill in these blanks so we can make sure the NHS Continuing Healthcare system works justly and efficiently for everyone. Their postcode should not be a factor.

We find that if our client’s seek our help earlier in the process, there is usually a greater chance of success in a shorter period of time. If you have queries about your family’s situation then contact us today.

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Perseverance Pays When Applying for NHS Continuing Healthcare

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.

Jane’s story

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.

Be persistent

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.

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Will NHS England’s New Plan be Enough to End Delays to NHS CHC Assessments?

NHS England’s latest plan to improve delays to NHS Continuing Healthcare assessments – published on August 17th – appears to promote positive progress. In reality, it may be the biggest anti-climax of the summer since Venus Williams and Marin Cilic crashed out of Wimbledon in straight sets.

After the damning, forensic report on NHS CHC assessments by the Government’s own watchdog, the National Audit Office, in July, we expected NHS England to have far more to say about the confusion, delay and inconsistency that those waiting for NHS CHC assessments currently experience.

The NAO put into context what many of us involved in NHS CHC assessments already knew.

That many people are having to wait far longer than the stipulated 28 days for a decision on whether they are eligible for NHS CHC. In 2015-16 one-third of assessments took longer than that. This causes considerable stress and financial difficulty for patients and their families.
That CCGs, in general, are cutting approvals for CHC. They are down from 34 percent to less than 30 percent between 2011-12 and 2015-16 (despite an aging population).
That there is a huge variation in eligibility for NHS CHC between CCGs. Approvals range from 41% in some to 86% in others. These variations cannot only be down to local demographics or other factors. They must mean CCGs are interpreting the national framework on CHC assessments in different ways.

NHS England wants to reduce NHS CHC assessments in acute hospital settings

NHS England’s opinion is that delays in NHS CHC assessments are to blame for around a quarter of all NHS delayed discharges. Also known as, ‘bed blocking’ in the old jargon. Consequently, something must be done to reduce them.

As a result, CCGs are to submit a plan to reduce the number of NHS CHC assessments in an acute hospital setting to 15% by next March. Currently, in over 100 CCG areas it is 30%. Patients who are going on to rehabilitation services or who “do not have long-term care needs” should not have an NHS CHC assessment before discharge.

Furthermore, CCGs must ensure that at least 80% of cases with a positive NHS CHC checklist receive an eligibility decision within 28 days.

The 84 CCGs currently completing less than half of their NHS CHC decisions within that timeframe must submit to an audit “to understand the reasons for lengthy delays” before expecting any help or support.

There are a number of flaws with this plan.

First, it does not address the problems that currently make it impossible for many CCGs to meet the deadline. In our experience, these include holes in resources, disputes between the local authority on the differences between ‘social care needs’ and a ‘primary health need’, and the lack of staffing and training. Our own anecdotal evidence suggests that medical evidence is often incomplete. Misinformation is the norm and there is a lack of understanding of the eligibility criteria. Until this changes, it is unlikely many CCGs will be in a position to meet the NHS England targets.

Second, when patients are considered for discharge from hospital, the first question is supposed to be whether they have been considered for CHC eligibility if they have complex healthcare needs. This is intended to ensure any long term care needs are taken into account BEFORE making major decisions about their next port of call. Refusing to do an NHS CHC assessment before discharging someone because they do not appear to “have any long term care needs” is putting the cart before the horse. Surely, if a more robust and thorough assessment was carried out sooner, delays would be minimised. This should not be yet another block to accessing NHS Continuing Healthcare assessments whilst in hospital.

Third, that large numbers of assessments, most of them resulting in ineligibility, are causing delays in the system is not necessarily an argument for carrying out fewer assessments. It is about assessing whether an individual has a ‘primary health need’. Instead, NHS England should be asking why so few people are officially meeting the criteria, why the delays in decision making are so severe, and why there is so much variation between postcodes.

Faster assessments and greater accountability are welcome.

There are many who believe the answers to these questions have far less to do with inefficiency and time-wasting, and far more to do with a lack of resources and trained CCG assessors. Families with a relative in hospital with complex healthcare needs must always insist that clinicians carry out an NHS CHC Checklist. After all, the recent NHS England letter is for ‘guidance’ only and does not change the eligibility criteria.

Nevertheless, faster assessments and greater insight and accountability are welcome. Delays to NHS CHC assessments can cost families money, as well as cause huge stress. NHS England has said the audits on failing to meet NHS CHC deadlines must be complete by 11 September. Let’s hope NHS England itself is as speedy in formulating a plan at both local and national level. This must ensure sufficient resources for NHS CHC assessments, putting an end to the waiting game for so many families.

Do you think your relative requires an NHS CHC assessment? Have you faced delays in receiving an eligibility decision? Call us today to see if we can help.

Will NHS England’s New Plan be Enough to End Delays to NHS CHC Assessments? Read More »

John Partridge’s Story Highlights The Importance Of Fighting For NHS Continuing Healthcare

Last week, former EastEnders actor John Partridge revealed his mum died penniless after she had to sell her home to pay for social care. It’s a story that highlights the importance of fighting for NHS Continuing Healthcare funding. The NHS CHC is paid regardless of assets.

John’s mum Bridget died three weeks ago, after a seven-year battle with Alzheimer’s disease. She eventually moved into a £45,000-a-year care home when her condition deteriorated. The star, 45, entered the Celebrity Big Brother house in 2016 to help cover the spiralling care bills.

“Care is incredibly expensive, I don’t come from money,” John told ITV News.

“My mum had a two-up, two-down in Manchester which we sold for £75,000 and that was in 2010, so then what do you do?”

People living with dementia can lose the entire proceeds from their property in little more than five years.

Many people believe they must sell their home to meet the costs of residential care.

According to figures from the insurer Royal London, the average length of stay in a care home is two and a half years. This will use up almost 43% of the value of the average North West home. Those, like Bridget, needing a higher level or a longer period of care will quickly use up all their assets.

John’s story illustrates how important it is to ensure people are getting the care funding assistance they are entitled to. Many people think they need to pay for all of their care if they have assets. But this is not necessarily the case. There are many people funding their own care who should be receiving NHS Continuing Healthcare (CHC) funding.

Many people don’t realise they may be eligible for care funding that isn’t even means-tested.

People who need care due to a primary health need, often because of a complex illness like dementia or a disability, should receive NHS CHC regardless of how many assets or savings they have. There is no means test for this. The problem is many people are not aware of it, or wrongly believe they are not eligible for it.

It would appear that some NHS Clinical Commissioning Groups are failing to follow national guidelines and case law when assessing people with dementia for NHS CHC. The result is that many are denied this much needed funding.

People work all their lives to pay off their mortgage so they have something to leave behind. Then they lose it all in care fees in a few short years. In many cases, the NHS should be paying these fees from the start.

This is one of the main reasons I set up Just Caring Legal. We give vulnerable individuals and their families a voice in fighting for NHS Continuing Healthcare. We deal on their behalf with NHS Clinical Commissioning Groups who decide on complex care funding issues.

So if you, like John Partridge, fear running out of money to pay care fees, contact Just Caring Legal on 0191 5 561 078 for advice or visit the website at www.justcaringlegal.co.uk.

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Restricting NHS Continuing Healthcare Funding For Home Care May Infringe Rights We Take For Granted

Years of government spending cuts are starting to threaten the human rights that underpin our way of life. Many of those rights have become so ingrained we take them for granted. Spend time with a person who needs care, however, and it may soon become clear what is at stake. Dignity. Family life. Choice. Independence. Restricting NHS Continuing Healthcare Funding for home-care is threatening these basic rights. Some decision makers in local government and the NHS think they are values we can no longer afford.

The thought of “warehousing” people with care needs to reduce costs is something many disagree with. The disability rights movement won the battle for independent living in the 1970s and 80s. It enabled many people to live at home with the right support.

Now it is starting to feel like we are reversing back down that road. Research by the pressure group Disability United found some local NHS groups are limiting people’s right to receive care at home. A number of Clinical Commissioning Groups operate policies that may effectively force people into residential care.

At least 37 CCGs put restrictions on NHS Continuing Healthcare funding.

The Health Service Journal found at least 37 CCGs are restricting NHS Continuing Healthcare funding for home care. Many won’t fund care at home if it is more than a certain percentage (often 10%) above care home costs. Disability United estimates around 22,000 people could be affected.

Disability United’s Fleur Perry, explains what this means.

“Somebody who has never met the person in question can sign a bit of paper and change everything about a person’s way of life. They could read a summary of a person’s medical needs, look at the cost, decide where they’re going, send a letter, have a taxi arranged and that would be the end of the matter. It wouldn’t make a difference whether the person was happy to be moved or not, or whether their health needs were well provided for in their own home.”

It’s a scary thought. Some CCGs justify restricting NHS Continuing Healthcare funding for home-care on the basis of achieving value for the taxpayer. But many have taken advice on whether their policies leave them open to legal challenge. Not only do these policies fail to comply with the National Framework on NHS Continuing Healthcare, they may also infringe patients’ human rights to a private or family life.

Policies allow CCGs to make decisions based on financial rather than human cost.

These policies are often couched in quite vague terms. Trafford CCG, for example, in Greater Manchester, says home care packages of more than eight hours a day indicate a “high level of need”. These “may be more appropriately met within a care home placement”. They say decisions are on a “case by case basis”. In this age of austerity, however, those words have a sense of foreboding. They just give more latitude for decisions based on financial cost rather than human needs.

Anecdotal evidence suggests CCGs may be restricting NHS Continuing Healthcare funding on a “case by case basis”. One commenter on the Disability United website, whose husband needs 24/7 care, said she was being effectively forced to accept an inadequate care package as the price for him remaining at home. This chimes with similar stories we have heard at Just Caring Legal. Some families are also being asked to “top up” home care packages. However this is not permitted under NHS regulations.

We must not let such policies lead us back to the old days of institutionalised care. We cannot make choices about how and where people live out their lives in this piecemeal way. There needs to be a proper discussion about what kind of a society we are, and want to be. Vulnerable people need a voice to ensure their human rights are not ignored due to funding cuts.

This is where Just Caring Legal can help. As a solicitor’s firm specialising in NHS Continuing Healthcare cases, your Just Caring Legal solicitor can ensure decisions on your case are in line with the National Framework. We can also ensure you have received everything you are entitled to.

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Should You Be Asked To Pay an NHS Continuing Healthcare “Top-Up”?

With a loved one living in a residential or nursing home will probably be familiar with the concept of top-up fees. These are third-party payments which bridge the gap between the cost of care home fees and the amount the local authority is willing to pay. They are so common that the charity Independent Age calls them a “secret subsidy” propping up the residential care system. So you may not be surprised if a social or healthcare professional asks you for an NHS Continuing Healthcare “top-up” to help meet the costs of care. But here are some things you should know before you agree.

There is no such thing as an NHS Continuing Healthcare “top-up”

While the legislation governing local authority social care expressly provides for “topping up” care fees (though only in specific circumstances), the NHS are not permitted to ask for an NHS Continuing Healthcare “top-up” for assessed needs. The only way you can “top up” an NHS Continuing Healthcare package is if you choose to pay for additional private services. These are over and above services to meet your full needs as set out in your care plan. They should be provided by different staff and preferably in a different setting, though there should be liaison where necessary to ensure continuity of care.

What do the rules on NHS Continuing Healthcare say about covering the cost of care?

The National Framework says the funding package should be sufficient to meet all needs in the care plan. The CCG should base this on its knowledge of the local costs of services for those needs. It is also important that the models of support and the provider used are appropriate to the individual’s needs. And they should have the confidence of the person receiving the services.

So why is one in five recipients paying an NHS Continuing Healthcare top-up?

Yes that’s right – one in five. According to Continuing to Care?, a major report released before Christmas by the Continuing Healthcare Alliance, almost 20% of those awarded NHS Continuing Healthcare said the funding did not cover the full costs of their care, resulting in them having to pay “top-up” fees. This fits in with what we are hearing from clients here at Just Caring Legal.

Could social workers be blurring the lines between local authority and NHS Continuing Healthcare “top-ups”?

We are hearing of an increasing number of cases in which social workers are taking the main role in dealing with NHS Continuing Healthcare cases. Could this be blurring the lines between NHS and local authority funding? It can be difficult for those applying for NHS Continuing Healthcare to understand the different rules that apply to each, around areas such as top-up fees. It is right that social workers play a vital role in NHS Continuing Healthcare cases as part of a multi-disciplinary team of professionals assessing care needs. But once eligibility is established for NHS Continuing Healthcare, like all NHS care it is designed to be free at the point of use.

This is one of the founding principles of our NHS and its constitution: that it should provide a comprehensive service, available to all based on clinical need – not on the ability to pay.

Should You Be Asked To Pay an NHS Continuing Healthcare “Top-Up”? Read More »

Many NHS CHC Assessments Are Flawed, Reports Reveals

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.

Because it does take a great deal of perseverance, knowledge and hard evidence to successfully appeal an NHS CHC decision. But it can be done! For further inspiration, read Don’s story.

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