Continuing Health Care - Preparing to fight PCT's decision

Errata

This is the national tool Download decision support tool Final version 20 September 2007 (DOC, 421K)

Info on scoring from 14 onwards. HTH

greenflamingo_2

I have also just noticed a note on the Continuing Healthcare Assessment Meeting by my FIL GP's "unfortunately unable to attend MDT meeting". Really my partner should be sorting all this out but he has become so dispirited by the whole saga that he has left it all to me! Would this have been detrimental to my FIL initial CHC assessment?

greenflamingo_2

Thanks Errata - wouldnt it be great if there was actually a number so you knew whether you had a chance or not.

Errata

You're welcome. If you can think of the score as numbers eg severe = 5 etc it might give you a better idea.
Also, it's not unusual for GP's not to attend MDT meetngs, but if you feel their input was important and would have made a difference to the decision it would be worth discussing that with them and what should be done about their opinion.

monkeyspanner

greenflamingo wrote: »

Thanks Errata - wouldnt it be great if there was actually a number so you knew whether you had a chance or not.

Yes wouldn't it! The DST is really an assessment support tool and does not give a definitive guide as to which cases will be successful for CHC funding.

There is a commentary from the Association of Directors of Adult Social Services (ADASS) which you may find interesting. See link below:
http://www.buckscc.gov.uk/moderngov/Published/C00000124/M00002459/AI00002867/$ContinuingCareGuidanceAppendix3.doc.pdf

On page 5 of this commentary it states

• The correct use of the DST is essential to ensuring a consistent approach
to assessing eligibility. However inconsistency may continue if LAs or
PCTs adopt different views on the combination of high/moderate (etc.)
needs that would normally indicate a PHN. As one guideline it is
suggested that anyone found to have the following combination of needs:

• two or more high needs (or need above high), AND at the same
time

• three or more moderate needs (or needs above moderate)
should normally be considered to be beyond the scope of LA provision
(see para. 5 h) below).

Section 5h refers to the DST definition of requirements.

5 h) There is concern that paragraph 17 of the Decision Support Tool (as
published in September 2007) is vague and too open to local
interpretation, leaving it possible for PCTs to effectively set very different
thresholds for NHS CHC across the country, thereby perpetuating the
‘postcode lottery’. Paragraph 17 states:

‘If there is:

• 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 can also indicate a primary health need.’

The ADASS commentary obviously is written from the perspective of LAs rather than the NHS but this may be relevant as funding is often negotiated between LAs and the relevant PCT.

Do you agree with the DST assessment? The scoring you mention could be viewed as borderline and it would be preferable if you could argue for at least one severe.

Errata

MS - the commentary is extremely helpful, thanks. In the past I've had some involvement with my local PCT and LA trying to shove health funding onto each other - meetings could get quite nasty. I know my local PCT still fight to the bitter end in any way it can to reduce its costs. I doubt other districts are much different.

greenflamingo_2

This is certainly an eye-opener ! I would if each PCT receives a bonus payment for funding as few as possible !

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robgoingcrazy

greenflamingo wrote: »

Hi all again
We are currently preparing documentation for submission to the SHA.

On looking again through Bury PCT Decision Support Tool we see that my FIL has scored 3 highs, 5 lows and 3 moderates. Is it a done deal that if he scores a certain number of highs he will get funding? Also does it matter on which sections he scores the highs?

That seems to be something like what my mother was assessed at, although I think she had slightly more moderates and less lows. She did deteriorate somewhat more after this, but I am happy to say that we got a call this morning to say she had been awarded CHC, fully backdated - without having to go through the arduous process of complaints and all that palaver.

I do wonder how much they took it into account that I turned up to all the meetings armed with information, documentation, arguments and counter-arguments, and presented myself as fully ready to fight for it if necessary - maybe just coincidence, but it didn't do any harm I guess!

So it's still a terribly difficult situation, but at least the financial side of things are one less worry for us now - just wanted to share this good news, as sometimes it seems that nobody ever gets CHC without a fight - I guess those who do get it just don't post on forums as there's no need.

Best of luck to everyone else who is trying to secure what is rightfully theirs, and don't let the !!!!!!s grind you down :grouphug:

greenflamingo_2

Thats absolutely brilliant Rob. I hope we achieve the same but we are fighting a particularly awkward PCT who seem to throw everything in our way to avoid having to pay. I guess if we fail the next step would be the Ombudsman.

lesdew

I have been following this thread with a great deal of interest and used it to research the steps I should take to get the Local Health Board in Swansea to accept responsibility for the cost of my father's health care. He has been in a nursing home since May 2008 and was refused continuing care after his first assessment, which I accepted without appealing, as I knew no better - the LHB agreed to pay £116 per week towards the cost.
He suffers from 'Normal pressure Hydrocephalus' which now means he is incontinent, bed bound and unable to communicate - he no longer recognises my mother or myself. We at last reached the stage of a MDT in Jan 2009 where I went armed with a file and a lot more knowledge than I had before, the result of which was 'borderline.' The case then went to the panel and I heard today that the LHB has agreed to pay for his care. I have also, through a solicitor, started a claim for the fees to be paid retrospectively, from the day he went into the nursing home.
I do not think I would have reached this stage without the fountain of knowledge that I have gleaned from this site - so thank you all. :beer: