NHS Continuing Healthcare - about to join battle

beaujolais-nouveau

Norman-B wrote: »

Cut a long story short, I won after a very heated meeting. I found the 5 months fighting the PCT a most depressing time. Sadly, my dad died less than 6 weeks later.

Keep fighting!

I am sorry to hear that your dad died. You did the right thing, though. Well done.

beaujolais-nouveau

I have now received a copy of the care records from the first nursing home to which my mother was admitted and where she spent three months. The thing that struck me on first reading was that no one appeared to have an informed "over-view" of my mother's care - and I am sure that this applied to other residents, too - eg when the speech therapist wrote that her speech had much deteriorated since last seen, no one seems to have twigged the significance, no one seems to have asked "why".

The Neurological Observations sheet is completely blank. What does that mean - that the nursing home had no one qualified to do this? What should appear on this sheet?

beaujolais-nouveau

This is with the West Country PCT, where my mother lived when first taken into institutional care. It was several hours' work on my part but I tore apart the so-called needs assessment that they sent me, and asked for a telephone conference call. During the telephone conference, it became clear that (a) the other end had read nothing that I sent her other than the covering letter and (b) had assumed that I would not have read the current National Framework. She told one lie after another - I didn't challenge all of them at the time, as that would have side-tracked the conversation - but I did follow up with an e-mail detailing what she had said and why it was wrong.

I am not relaxing, though; these people are so slippery and mendacious.

ukmaggie45

Well done! Keep at 'em! :T

Just one thought - suggest you follow up with a letter as well as sending an email. Just to ensure there's a paper trail. If the idiot dealing with this decides not to read it, well that's their fault. But I think you need to make sure everything is in black and white. I'd be inclined to send it "signed for" too.

Best wishes, and remember there's a load of people on here rooting for you.

woohoo

Hi,
Can i say that there is a lot of misunderstanding about the CHC guidance from professionals as well as everyone else. Not very helpful I know.

The over-riding need has to be for healthcare - not 'just' care, for the individual. Scores on the DST support with the decision, but there is an element of clinical judgement that has to be applied. Decisions have to be made on the presentation of the person at the time, and not in diagnosis alone (although of course there are cases where when there will be a likely deterioration then this must be taken into account). There is space on the DST for the assessor to record and score 'additional needs' that do not seem to be reflected in the rest of the assessment. Interactions between domains are important too.

Unfortunately, is someone can stand, 'weight bear' with support then they do not score very highly. If they are at risk of choking, then maybe request swallowing assessment from speech and language therapy to support this? Routine administration of medication scores low even if the person is reliant on others and couldn't do it themselves. Routinely being fed, with adequate nutritional status scores low - all as has already been mentioned I know.

If a person is moved from one PCT to another, then there is sometimes a debate about who is the responsible commissioner. If the receiving PCT feel that there should have been an assessment by the previous, then a lengthy debate can ensue .

I hope none of the people or families I assess think I am slippery and mendacious! I can honestly say that some of us work very hard to get the best result that we can for our patients!

Good luck to those who are appealing. I'm sure it is the last thing people need when loved ones are unwell.

monkeyspanner

beaujolais-nouveau wrote: »

This is with the West Country PCT, where my mother lived when first taken into institutional care. It was several hours' work on my part but I tore apart the so-called needs assessment that they sent me, and asked for a telephone conference call. During the telephone conference, it became clear that (a) the other end had read nothing that I sent her other than the covering letter and (b) had assumed that I would not have read the current National Framework. She told one lie after another - I didn't challenge all of them at the time, as that would have side-tracked the conversation - but I did follow up with an e-mail detailing what she had said and why it was wrong.

I am not relaxing, though; these people are so slippery and mendacious.

This is fairly typical of the experience we had when appealing my MIL's CHC assessment.

I was convinced that not only did the assessor not expect us to have read the National Framework but she had not read it, or if she had did not understand its intent.

We paid for a copy of my MIL's hospital records and received about 50+ pages, when we queried missing periods of records we received another 50+ pages, we were still convinced there were more records but could not track down anything further. We had asked for and received a lengthy reveiw of my MIL's medical history in order to progress a retrospective assessment and CHC claim. This was carried out by a senior nurse assessor but when we came to the IRP the review not been passed to them for consideration and in fact seemed to have "been mislaid". To compound this a second DST was not passed to the IRP. The lay-chair suspended the IRP to "request further information", when reconvened some weeks later the panel still had neither document. Had they been buried by the PCT???

We were convinced that my MIL was awarded retrospectively by the PCT CHC manager because of the blatant disregard of proceedure and that the PCT had been lent on by the lay-chair of the IRP and the SHA as the IRP had told us they had insufficient evidence to award retrospectively and we had made contact with the SHA regarding lack of adherence to proceedure.

My advice would be keep on plugging away. Good luck.

beaujolais-nouveau

monkeyspanner wrote: »

My advice would be keep on plugging away. Good luck.

I'm ba-a-a-ack! The West Country PCT which I will now name and shame - NHS Somerset - held their own little review panel on 19 May to assess retrospectively my mother's primary health needs as at April 2005.

You will perhaps not be surprised to hear that NHS Somerset did not comply with its own Operational Policy on retrospective reviews. The panel was made up of three third-tier managers - and NO independent clinical advisor. They cherry-picked the evidence, they referred to my mother being able to "tell" people what she wanted whereas, due to a series of strokes, even her own family had difficulty understanding her; at the time she was able slowly to write things down to help us but that did not always clarify what she was trying to convey. They totally played down the battle with managing her incontinence and its impact on her skin integrity. There was no insight whatsoever into how her schizophrenia impacted on her ability to understand and cope. I know that she suffered unnecessarily because she believed that invisible doctors were experimenting on her, and none of us was able to persuade her otherwise.

So I have appealed the NHS Somerset decision, on the grounds that they failed to comply with their own Operational Policy (a copy of which they had already sent me) and failed to consider all the relevant factors. Their incompetence and carelessness is beyond description.

beaujolais-nouveau

beaujolais-nouveau wrote: »

Their incompetence and carelessness is beyond description.

Forgot to say: the letter notifying me of the panel's decision was dated 21 May, there was a 28 day period within which one had to respond if one was going to appeal - but the letter was not actually posted to me until 17 days of those 28 days had elapsed.

monkeyspanner

Sorry to hear you are still facing an uphill battle with Somerset. This level of incompetence can only be deliberate IMHO. No doubt we will hear the cries of anguish if the Public Sector workers get hit in todays budget, but really any private sector company that acted like this would have failed long ago.

artha

Good luck to all posters pushing the system to do what is morally right.
Can empathise as my FIL is in care and heading the same way.

Lets hope for others that will inevitably go down this path that David Cameron takes some actions on his pre-election criticism of the current system in this respect. Or was this just vote winning half promises that will quietly get lost in the accelerated cuts to government spending