Withdrawal of NHS Continuing Healthcare

noclaf

The full review has been provided/sent to me in a letter. In Jan I received an initial letter notifying that he had been 'referred for an assessment to see if elligible for CHC, I was invited but unable to attend due to work. I gave consent for the review to go ahead in my absence.
FNC contribution is £165.56/ week. Let's assume higher AA is £80+/week and state pension is also around £165/week. The nursing home advertises their weekly fees for nursing at £900-2000 per week and given my father is receiving nursing care there is potentially a significant shortfall if the CHC stops....I don't know how much my father's care costs but assume that the CHC element was covering any potential shortfall though it's possible he receives other funding I am not aware of...not sure exactly how the funding works but aware that the LA manages it. The latest letter that came with review and decison mentions as my father is not elligible for continuing healthcare it's now his responsibility to pay for any care costs that are over and above what the CCG will contribute using FNC. The letter then goes on to suggest contacting the LA who may assess his care needs and undertake a financial assessment. Confusingly the final paragraph states if my father is already receiving care in a nursing home I do not need to do anything and the CCG will continue to contribute towards his care costs untill the next review which usually takes place within 3 months of this decision and then annually thereafter.
The final section mentions right to appeal and the address to write to within 6 months of the decision date and that if an appeal is lodged the CCG will continue to meet the contribution of funded nursing care whilst the appeal is ongoing.
Re S 117 - in the summary section that includes his medical history there is no mention of previous detention under s117. I have letters to evidence his previous sectioning and a email from LA mentioning his care services are provided free by virtue of s117 obligations...whether that is still a legal obligation after the section is lifted I will need to clarify.
They have made a no of small errors in the assessment such as the date he has been in the nursing home but not too concerned with that at the moment.

 

elsien

You need to contact the local authority.
The FNC is a nursing top up as dad is no longer considered to need full nursing care. While health funded they would have paid the lot.  If the 117 does no longer apply (and definitely raise that with the CCG) the LA  take over responsibility and will need to do their own assessments for both his current care needs and a financial assessment to see what (if anything) he needs to contribute towards his from here on in. 

noclaf

Thanks for the tips, I will speak to the LA to clarify.
Do you think it's worthwhile checking with a solicitor for any further guidance? As I am actively going through deputyship application for mum thinking I could mention re dad or would it be a better idea to clarify the LA position with regards to dad's care first then speak with the solicitor?

elsien

Find out what's happening with the LA and 117 funding first, so you've got the information to challenge. There are also some very good fact sheets on Age UK with regards to CHC , and also the property disregard rules which you might find helpful. Is there a law Centre round your Way?
You don't need a solicitor for the deputyship, btw; it is something you can download the forms for yourself. 

noclaf

elsien said:

Find out what's happening with the LA and 117 funding first, so you've got the information to challenge. There are also some very good fact sheets on Age UK with regards to CHC , and also the property disregard rules which you might find helpful. Is there a law Centre round your Way?
You don't need a solicitor for the deputyship, btw; it is something you can download the forms for yourself. 

I used a solicitor for mum's Deputyship to save time but potentially could just apply myself for dad.
Ive also realised that there has never been any formal notification or communication that dad was discharged from s 117 if that's relevant. He has also been under 'Dols' or Deprivation of Liberty Safeguards in the last few years but again not sure if that's relevant here.

Keep_pedalling

Vegastare said:

Just two things can you Dad feed himself or does he need to guided or fed by another as he could have the possibilty of choking and second you need to find out the reason for withdrawing continuing care and what improvement has lead to this.
Either way if there is improvement(goodness know how) you need to dispute this and with regard to my first point, if your Dad has a risk of choking if not feed due to cognative reason etc then this in itself is one of the points of continuing care.
I can't really comment of the funding side and your parents home, but my focus firstly would be to get help to appeal maybe speak with Mind or look at there site as there maybe charities with knowledge to advise

I don’t really think this could be classed as an improvement, but is entirely possible that specific mental health issues no longer manifest themselves once dementia takes over. 

noclaf

I don't think their decision is based on any improvement as such. He needs nursing care as unable to walk now, food has to be administered in a certain way due to choking risk and his meds are administered covertly in food due to non compliance. 
What this appears to be is a convenient way to palm off his funding needs to the LA using a convoluted system to 'assess' people so that it's difficult to identify clearly how they arrive at a certain decision. just too add I have no issue whatsoever if he needs to top up using his state pension but untill I get an idea of the figures involved then it's difficult to assess the situation.

elsien

Dols isn't relevant to funding. It's a means to ensure that as your dad doesn't have capacity to agree to stay there, to ensure that any restrictions placed on him (such as locked doors) are lawful and in his best interests.
Full CHC funding tends to be given where the issues are more complex/less predictable. So if the needs are predictable and are being well managed by staff then CHC funding is less likely to be agreed than where things are a bit over the place. Poor mobility, for example, is common in older people and will not generally be  a nursing need. You need to show that your dad's needs are over and above this.
The assessments are based on how he is now, not how he was when he first went there. You could probably do with looking at your dad's care notes as it's not unusual for things not to be fully documented. I worked with someone where the CHC tried to withdraw funding because the behaviour was manageable, whereas he was actually hitting people so often, they'd stopped recording it. 
Have they given you the information about how the different domains were scored? You need to know that so you can see where potentially the scores should be higher. 

Have you seen this?
https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs20_nhs_continuing_healthcare_and_nhs-funded_nursing_care_fcs.pdf

And the relevant scoring bits:
MDT recommendation to the CCG The MDT must make a recommendation as to whether you have a primary health need and are therefore eligible for NHS CHC.  They should take into account the range and level of your needs, including their nature, intensity, complexity and unpredictability; evidence from risk assessments; and if and how needs in one domain interrelate with another to create additional complexity, intensity or unpredictability. The recommendation should refer to all key characteristics but any one can on its own, or in combination with others, be sufficient to indicate a primary health need.  Clear recommendation of eligibility is usually expected if you have:  priority level of need in any of the four domains with a priority level   two or more instances of severe needs across all care domains.
If there is either:  one domain recorded as severe, together with needs in a number of other domains, or  a number of domains with high and/or moderate needs this may also, depending on the combination of needs and your overall needs, indicate a primary health need. Whatever recommendation the MDT makes, it must be supported by clear, evidence-based reasons.      It is not possible to equate incidences of one level of need with those of another level, for example two moderates do not equate to one high.

noclaf

Thanks Elsien, will look through the link you provided and compare Vs the assessment notes in dad's review as they did provide details on the scoring.

noclaf

I've made contact with dad's social worker and awaiting them to get back in touch once they have checked his file and history.
A few more questions have popped into my head as I'm doing research:
1. Dad was reviewed last year and a letter came simply stating his CHC funding had been approved/continued. I received no review notes as to how they derived the decision, am I entitled to have sight of the review documentation the CCG used last year to make their decision to approve CHC?
2. I assume dad's nursing home has notes the staff make on a daily basis, is it worth going there and browsing for anything that contradicts what's written in his review? someone posted earlier that some reviews have not always taken into account carers/staff notes e.g omitted key information such as aggression or other episodes
3. Has anyone heard of Beacon and/or Compass? They are specialists in the area of assisting with CHC appeals but would be useful to know if anyone has experience using them?  I'd prefer to do it myself based on my own research but given the nature of the review I would like to ensure I can pinpoint the areas where the review might potentially be inaccurate e.g:on the grading for each of the areas they use to determine an overall decision