CHC appeal back to 1996???

amilotte

Hi

Just wondering whether you can appeal CHC decisions back to 1996. It has just transpired (after watching the one show with my Nan last night) that she paid £230 plus had my Grandad's pensions and DLA taken off her to pay for his nursing home fees from 1996 - 1998. My Mum had always thought that she did not contribute anything and I have wanted to ask her for a while but until last night when I had a prompt didn't feel comfortable bringing it up (my Grandad died in 1998).

My Grandad had severe Parkinson's and Dementia and required 24 hour care after my Nan could no longer care for him in her two up two down house. I would say that if he was being assessed now he would be classed as high nursing need.

I know this amount may not seem vast compared to some who have had to lose their homes but my Nan and Grandad we never that well off to start with and it is the principle! I thought I had read that it was back to 1996 but then Dom said on the One Show last night that it was back to 2004???

Any advice would be great!

monkeyspanner

I think continuing healthcare funding dates back to the Coughlan case which was won in July 1999. Presumeably this case dated back futher for payments already made. I am not sure if there is a legal staute of limitation(i.e. time limit) on this kind of case. In Wales the Assembly has imposed a deadline of 4 December 2009 for backdated claims for periods prior to April 2003 but I don't know of a similar deadline for other parts of the UK.

You might like to have a look at this web site http://gpss.npl.com/nhscare/

also there is a long MSE thread on CHC which gives links to successful cases http://forums.moneysavingexpert.com/showthread.html?t=800521&page=16

you could also try this solicitors who will give an initial reaction to the viability of a case for free
http://www.hughjames.com/our_services/services_to_individuals/nursing_care.aspx

you could also try this charity for advice
www.counselandcare.org.uk

I think there may be practical difficulties in proving your relative had a right to care as you will need to have sufficient medical and care home records to demonstrate a primary medical care need but good luck anyway.

amilotte

Thanks for the info, I shall have a read through it all.

You have a very valid point re proving the care that was required as I know medical notes etc are not kept forever.

Ill look into things anyhow.

Thanks again!

monkeyspanner

Thought you might be interested in this successful laim which dates back to 1998 http://news.bbc.co.uk/1/hi/wales/north_west/8198159.stm

CHCscandal

amilotte wrote: »

Hi

Just wondering whether you can appeal CHC decisions back to 1996. It has just transpired (after watching the one show with my Nan last night) that she paid £230 plus had my Grandad's pensions and DLA taken off her to pay for his nursing home fees from 1996 - 1998. My Mum had always thought that she did not contribute anything and I have wanted to ask her for a while but until last night when I had a prompt didn't feel comfortable bringing it up (my Grandad died in 1998).

My Grandad had severe Parkinson's and Dementia and required 24 hour care after my Nan could no longer care for him in her two up two down house. I would say that if he was being assessed now he would be classed as high nursing need.

I know this amount may not seem vast compared to some who have had to lose their homes but my Nan and Grandad we never that well off to start with and it is the principle! I thought I had read that it was back to 1996 but then Dom said on the One Show last night that it was back to 2004???

Any advice would be great!

Although DOM was right to quote that the DoH advised closure of the retrospective review to 1/4/04, which the ombudsman ordered, it is still possible to start an appeal if you discover at any time that you believe your case should have been funded under fully funded CHC, do not be put off even if theyshould attempt to tell you otherwise.

Some useful sites and information to help understand the complexity of the situation.

Current case studies by Wandsworth CHC tean, first one Parkinson sufferer, where only 1 severe is deemed to be eligible.

http://209.85.229.132/search?q=cache:uMec8fTN3P0J:www.wandsworth-pct.nhs.uk/pdf/ContinuingCare/TrainingPack/4.%2520Case%2520studies.doc+wandsworth+case+studies+continuing+ehalthcare&cd=1&hl=en&ct=clnk&gl=uk

bbc site with practical info on the situation by a solicitor
http://news.bbc.co.uk/1/hi/business/8270740.stm




Some useful basic generally available information on what happened when:
1990 – The Community Care Act is passed which requires Local Authorities to begin charging for social and personal care for all those with adequate assets and income.
April 1993 – Higher rate income support payments for people living in nursing and residential care homes are abolished. A large increase is soon noted in the number of nursing home beds being funded by Local Authorities. Many people are now paying for the full cost of care that would previously have been funded by the NHS.
1994 – The Health Service Ombudsman (HSO) publishes a report on the ‚Leeds Case‛ highlighting the misconception that has increasingly arisen since 1990 that the NHS will no longer fund continuing care.
1995 – In response to the HSO’s report, the Department of Health draws up the first set of guidelines for Health Authorities to set local eligibility criteria to decide when a patient qualifies for NHS-funded continuing care.
February 1996 – The Department of Health issues follow-up guidance to improve the quality of continuing care decisions.
April 1996 – Health Authorities begin applying their new eligibility criteria.
1997 & 1998 – The Department of Health issues more follow-up guidance.
March 1999 – A Royal Commission on Long Term Care submits its report. The Commission has looked at a range of issues around the provision of long term care for the elderly. One of its main recommendations is that, if assessed as required, personal care for the elderly such as help with feeding and washing should be funded by general taxation. When the Government responds in 2000, it does not accept this proposal but instead announces its intention to make nursing care available free of charge in care homes by funding it through the NHS (see October 2001 below).

July 1999 – An important Court of Appeal judgment – known as the Coughlan judgment – rules that eligibility criteria used by the Health Authority concerned in this case were far too restrictive. The judgment also rules that a Local Authority can only provide healthcare services that are:
(i) Merely incidental or ancillary to the provision of the accommodation which a local authority is under a duty to provide; and
(ii) Of a nature which it could be expected that an authority whose primary responsibility is to provide Social Services could be expected to provide. 2
All other healthcare services must be provided and funded by the NHS.
August 1999 – In response to the Coughlan judgment, the Department of Health issues guidance asking Health Authorities to review their local eligibility criteria to ensure that they are ‚Coughlan-compliant‛ and to revise them if necessary. If criteria are revised, the Health Authorities should decide if current service users should be re-assessed. This guidance does not make any changes to current continuing care policy but announces that revised guidelines will be issued by the end of 1999. In fact, the new guidelines are not published until June 2001.
June 2001 – The Department of Health issues revised guidelines to Health Authorities for setting local eligibility criteria for continuing care funding. These replace the previous guidelines and refer to the Coughlan judgment and the necessity that all local criteria should be ‚Coughlan-compliant‛. The guidelines also anticipate the introduction in October 2001 of NHS-funded Nursing Care.

October 2001 – The Government introduces NHS-funded Nursing Care which provides NHS-funded care by a registered nurse (but not by other staff) to patients in nursing homes who are otherwise paying for the full cost of their care. The Registered Nursing Care Contribution (RNCC), the amount of nursing care required, is assessed by a NHS nurse as low, medium or high band.
Each band attracts a different level of NHS funding. In April 2003, RNCC funding is brought in for all care home residents, not just those who are self-funding.

The guidance that is issued on NHS-funded Nursing Care specifically states that the NHS is still responsible for funding continuing care if a patient requires it, based on the same local criteria as before.
BUT THAT AN ASSESSMENT FOR FULLY FUNDED CONTINUING HEALTHCARE IS CARRIED OUT IN ALL CASES BEFORE THE RNCC ASSESSMENT, THAT IS STILL THE CASE TODAY.

ALSO IF IN HOSPITAL, THE HOSPITAL HAS A DUTY OF CARE TO ASSESS FOR FULLY FUNDED CHC FIRST AND FOREMOST, IF THIS HAS NOT BEEN CARRIED OUT, MALADMINISTRATION HAS OCCURRED, THEIR DUTY OF CARE HAS BEEN BREACHED.The DoH has introduced, integrated working, mainly since 2001, with social and health, as they want the public to assume that all care required is to be assessed by social services for means testing purposes first, they introduced the single assessment process (SAP) and the fair access to care )FAC) assessments, each includes health tick boxes, the social services are supposed to organise a full multi disciplinary team meeting if health is outlined, but as they cannot be involved in any health matters by the existing law of the land, and are not qualified to assess health matters, they generally categorize all needs as social needs within their FAC system tick boxes in order to get around the problem.

Note: now that the new framework has been in operation since Oct 07, the NHS assessment at discharge, first stage being the 'checklist', is being used now as the current denial tool by the NHS, if this A/B/C tick box initial assessment does not appear to show that a full assessment is required, the NHs pass straight to SS.

The authors of the documentation state, that they specifically set the checklist 'criteria' LOW to capture as many as possible to go through to full assessment, this is now the major area of denial nationally.


Link to BBC piece re the 2006 panorama programme, the piece outlines where Health redefined as Social was first attempted and continues today.

http://news.bbc.co.uk/1/hi/programmes/panorama/4764060.stm

amilotte

Thanks so much for all that info!!! Makes very interesting reading. It is quite a minefield and I'm not sure that my Grnadmother could face having to jump through the hoops that it would require but I shall pass on the info to my parents.

What makes me so cross is that people are STILL having to fight for their right to CHC funding this far down the line.

margaretclare

amilotte wrote: »

Thanks so much for all that info!!! Makes very interesting reading. It is quite a minefield and I'm not sure that my Grandmother could face having to jump through the hoops that it would require but I shall pass on the info to my parents.

What makes me so cross is that people are STILL having to fight for their right to CHC funding this far down the line.

Well, they are - as the post by CHCscandal, and the BBC report quoted, makes clear, the problem has arisen since the closure of 'continuing care' or 'long-term care' wards.

Some heart-rending examples have been quoted. It should be obvious that there are cases of individuals who can never recover but for whom it is far more than just a question of 'feeding and washing'. They do require skilled nursing but not active medical intervention. There used to be 'chronic' wards for those who could not recover but who could not return home. There were small 'cottage' hospitals where people were cared for locally. There was even a separate grade of nurse - State Enrolled as opposed to State Registered - who were qualified to give the skilled basic care for those who were not expected to recover their full health and strength. 'Social care' is a denigratory term - it implies that it is something that anyone could do. This is not the case. Feeding by 'peg', for instance, has to be done by someone who knows what they're about. Care of the skin, prevention of pressure sores, use of special beds, hoists, mattresses - none of these come within the category of 'anyone could do it'. Mental illnesses such as Alzheimer's are something else again and require understanding and knowledge.

monkeyspanner

Yes and because more and more nursing training is being focused on the University degree it is less about basic care and nursing and more about data statistics and career progression.