Continuing Health Care -NHS

homerhotspur

My mother(89 yrs) had a serious stroke 4 months ago and has been in Hospital since then . She is now paralysed down her left side, bed -ridden, doubly incontinent and has significant dementia. She is now about to be moved to a local Nursing Home. Due to having savings over £23k, she will be self-funding.
We are told that NHS continuing care does not apply. but are yet to see the full report.
Logic tells me this seems rather harsh, in as much as how ill do you have to be to qualify? Has anyone had recent experience of this procedure who could comment or offer advice. Thank you.

Pollycat

Hi there.

Sorry to hear about your Mum.

There's quite a lot of discussion about CHC on the Over 50s board, including a very long thread about fighting to get NHS agreement to fund care.

Here:
https://forums.moneysavingexpert.com/discussion/800521

There's also some mention about CHC on this thread:
https://forums.moneysavingexpert.com/discussion/3905045

You might find this website helpful too:
http://www.counselandcare.org.uk/finding-and-paying-for-a-care-home

There is guide (#27) about CHC.

Regards

monkeyspanner

homerhotspur wrote: »

My mother(89 yrs) had a serious stroke 4 months ago and has been in Hospital since then . She is now paralysed down her left side, bed -ridden, doubly incontinent and has significant dementia. She is now about to be moved to a local Nursing Home. Due to having savings over £23k, she will be self-funding.
We are told that NHS continuing care does not apply. but are yet to see the full report.
Logic tells me this seems rather harsh, in as much as how ill do you have to be to qualify? Has anyone had recent experience of this procedure who could comment or offer advice. Thank you.

It seems pretty standard to be rejected at the first attempt to get CHC funding what ever your medical condition. Officially you have to be judged to have a primary health need but in reality you have to be very ill indeed to succeed without a long battle,

If your mum is in England the process is in various stages. The first is an initial checklist this should be lenient and is designed to see if a full assessment should be performed, If performed at discharge fro hospital this is normally delegated to the hospital discharge team. The full assessment is normally carried out by nurse assessors employed by the PCT and is based around a DST (decision support tool) which looks at a number of criteria and grades each criteria up to severe level. Unfortunately there are no guidelines setting out how many severe/high etc. you need to score to be successful. This leads to a difference dependant on which PCT is overseeing the process. The process is governed by the National Framework document.

It is unclear from your post whether a full assessment has been done. Based on the details of your mium's conditions it would seem likely that she should have passed the initial checklist but thios is by no means certain. Many medical staff think CHC funding is only available if the patient at imminent risk of dying.

The next stage after the formal assessment and rejection is for you to request an IRP (independant review panel) if this fails you can ask the SHA (stategic health authority) to review the case but they will only look at process not the medical details. Finally you can resort to legal action.

The system is similar in Wales and quite different in Scotland.

If you would like links to various documents I can provide them.

xylophone

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_103328.pdf
http://www.ms-solicitors.co.uk/resource-centre/community-care-law-resources/fact-sheets/accessing-continuing-healthcare-funding/

homerhotspur

Thank you

I still need to clarify exactly what stage has been reached in the process.

We had a brief meeting at which the initial checklist to which you refer was completed by a Nursing Sister and a Social care person whose position I am not completely sure about. The outcome of the check list was that my mother's condition was such that the Sister would now need to complete a 56 page(or question) document which I presume is the ' full assessment' you mention. A few weeks have passed since then and my mother's overall condition has improved somewhat in that she is now eating and drinking much better although her physical/mental position is as stated in my OP.
We have heard nothing formally about the assessment decision just a comment on the phone to my Sister that my mother was now unlikely to satisfy the criteria for NHS funding.
Should we receive formal written confirmation and /or a copy of the assessment?
Links to the various documents would be appreciated.

monkeyspanner

Were you allowed to take part in the decision making process and advocate for your mum? Yes you should be advised in writing and given the chance to respond to the assessment. If you don't get a copy of the assessment you should request one. If you disagree with any part of the assessment lodge your objection in writing. It sounds paranoid but you should get copies of anything you can get and make contemporaneous notes of any dioscussions you have with any NHS/social services staff. You may need this information to prove proceedure was not followed.

In the case of sucessful assessments this is normally followed up by a reassessment typically after 3 months. It would seem reasonable therefore if you feels your mum's condition changes to request another assessment.
You say your mum has improved slightly, one aspect of the National Framework is that any period of recouperation should be NHS funded.

Here are some links
Checklist http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_103328.pdf
DST http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_103329.pdf
National Framework http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_103161.pdf
CRAG http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073650
CHC figures by PCT http://www.theyworkforyou.com/wrans/?id=2010-01-11c.309312.h&s=receiving+nhs+continuing+healthcare#g309312.r0
Counsel and Care fact sheet http://www.counselandcare.org.uk/category/advice/pdf/care-home-fees---paying-them-in-england-guide-16