Continuing Health Care - Preparing to fight PCT's decision

CHCscandal

http://www.people.co.uk/news/tm_headline=gagged&method=full&objectid=21788837&siteid=93463-name_page.html

Errata

CHC That's very interesting, but I don't understand why the daughter had to 'plunder her savings' to pay her mother's fees.

Katykat

I had an interesting call from a lady at the Alzeihmers society the other day. She was very helpful, went through mums DST with me & ascertained that she thinks she had been marked low in 3 separate domains, so this gives me scope to appeal if (WHEN) the CHC is denied. Also, she sent me a copy of the Local Authority guidelines published in the aftermath of the National Framework. Interestingly, these guidelines use different criteria for decision making.

• 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).
This guideline is based on an ADASS review of cases that were fully NHS funded or had clear evidence that they had needs that were beyond the power of the LA to meet. The guideline should not be used prescriptively but rather, when someone has this combination of needs, LAs should look to the PCT for clear evidence why the person does not have a PHN before they (the LA) consider full or part funding any care or support needs. Every case must be assessed and decided on its facts.

This contrasts sharply with PCT guidelines of 1 priority or 2 severe scores & suggests that The LA ( or in many cases, patients themselves) are funding care that is out of their responsibility. I am now going to contact the social worker who sat in on mums assessment and ask her if she is going to apply their own guidelines.
The lady from AS said that unfortunately, PCT's & LA's very often collude & apply the fact that these are only guidelines, not law. Nevertheless, I wonder if LA's adhere to the guidelines more rigidly when they are funding the care rather than patients themselves.

CHCscandal

Errata wrote: »

CHC That's very interesting, but I don't understand why the daughter had to 'plunder her savings' to pay her mother's fees.

SIMPLE, the social services took over the responsibility for her mother, advising that it was social needs only, the NHS either did not assess for CHC or did but did NOT invovle the family not advise them of the outcome of any assessment therefore giving them the opportunity to complain/appeal.

After social services successfully means test but do not carry out their duty of care by applyiing a FAC or SAP assessment, they can do what they like unless people know the process/procedure which is mandatory, not a benefit, not to abe applied for & a normal process daily duty of care.

If social services had carried out their assessments correctly, they would clearly show health as the major reason for requiring services in this case, they are duty bound to convene a multi disciplinary team assessment with NHS totally involved, as the social services cannot assess for a health need, to see if CHC is applicable, FIRST, before any other test/assessment, whatever the outcome, the directions, within SS/NHS/Discharge etc have for many years outlne that social services are not handed the person until all of the appeal process has taken place, if CHC not found.

What probably happened here, hopefully in time further details will be released to advise, & what generally happens all voer the country is that social services tell relatives, especially very close relatives, that they must pay and that they will be held responsible.

In order for charging under SS to happen the person should have means over and above the limit at the time, but often social sevices, due to the lack of funding, will apply any charges they can to vulnerable people, vulnerable people term includes stressed relatives and family when faced with this situation.

Alternatively, the charging Pauline Hardinges paid could represent top-up fees, if the council were paying for the placement, if the means were less than the limit at the time, they very often advise top up fees are required, over and above their limit that they will pay, until this year, relatives could be held responsible for this.
(charging for residential accommodation) C.R.A.G.

This was repealed in April 2009, but still being applied by councils all over England to this day.
When it was in CRAG, it was discretionary!


Cornwall and Isle of Scilly, have had many funding and financing problems, mainly caused by health being reclassified as social, i.e. recently, learning difficulties.

As many health responsibilities as possible are being shunted over to social, in order to means test, but budgets are still cut, frontline are not being fortified to handle the extra work, etc etc.

Examples below of problems with this area in particular

http://www.mencap.org.uk/page.asp?id=9587

Les_Booth

I collected the DST on Thursday 5th November. It appears I was misled, the assessor had not put forward a positive checklist and it was indeed the CHC assessment we attended on 20th October – albeit that was not made clear at that time. I believed, wrongly, that what we were attending was a screening to determine if the case should be put forward for a CHC assessment.
Those present were:-
NHS assessor - Simon
Person from the Nursing Home. - Pat
His wife (my sister) - Enid
Myself (brother-in-law). - Les
During the meeting, Simon spent a considerable time talking to myself and Enid about Patrick’s background and his current condition. Towards the end of this meeting he explained that the case would be reviewed again in 3 months and then a year later.
Bearing in mind I thought I was attending a ‘screening’ this came as quite a surprise. I asked about the possibility of CHC funding and Simon replied that based on the evidence so far he didn’t think Patrick would qualify for CHC funding and he offered to show me and explain his rationale for various ratings on the DST – albeit he said that might change when he actually SAW Patrick . I said that would not be necessary if he was going to forward me a copy – I would look at it in due course – I still did not realise this was the full assessment, neither Enid nor I was asked to sign anything.
The DST:
Simon’s recommendation “The available evidence suggests that Mr ******** (name mis-spelt) does not meet NHS continuing Healthcare at this time.
To review in 3 months or sooner if needs change”
PCT Response “5/11/9 PCT supports the recommendation that Mr ******* does not currently have a Primary need for healthcare”
Domain ratings on DST
Behaviour.......................Low
Cognition.........................Severe
Psychological needs.........Low
Communication..............Moderate
Mobility...........................Moderate
Nutrition...........................Moderate
Continence.......................Moderate
Skin....................................Low
Breathing...........................No needs
Drug therapies...................Low
Altered states etc...............No needs
Other.................................None
Summary
Severe 1, High 0, Moderate 4, Low 4, No needs 2
It is my belief that a number of domains have been ‘scored’ on the low side and I will be investigating further. I am seriously considering appealing using the letter from the NHSinfo site.
Would be grateful for any help anyone can give.
Regards
Les

Katykat

Les- I think you are correct thinking that they have scored Patrick low. You have previously mentioned that he is now wheelchair bound, so it seems the mobility domain should be at the least High, or if he needs a hoist to lift him, perhaps Severe. Also, you say he is doubly incontinent, so that should be High too. If you read my post above you will see that an advisor from Alzeimers suport rang me and pointed a few areas out where she disagreed with the scoring. One of these was Altered states of conciousness, where my mum scored No Needs- like Patrick. at the time, I agreed with this becuase she is not "unconcious". owever, she pointed out to me that because mum has Vascular Dementia, as opposed to Alzeimers, then she has invariably sufferred many "mini strokes" and it is medically recognised that this has resulted in several episodes of loss of conciousness. Now, this is incredibly difficult to prove, but it is not our job to prove it, the PCT should go with the medical evidence.
Also in my post, you may see that the Local authority has different criteria. If you applied Patricks DST (with my suggested alterations) you can see that he exceeds the LA's criteria. The first thing you should do is appeal the decision on the grounds of an unfair assesment ( & state why & if possible, back it up with evidence) & approach Patricks social worker & ask him/her if he is going to apply his own employers criteria. Its my guess though, that like me, if Patrick is paying for his own care, you will have a fight on your hands, but good luck anyway.

Les_Booth

Hi Katykat
We certainly intend to appeal and my sister and I are going through each of the domains to see where we disagree with the assessment. I thank you for your advice and will check further on those two points.
Just one thing - do you have a link to your comment "she sent me a copy of the Local Authority guidelines published in the aftermath of the National Framework" I've tried unsuccessfully so far to Google any such info'
Regards
Les

Katykat

Hi Les, I'm attaching the document that she sent me. Its a long document that includes other information, but the relevant information is on page 16/17. If the link doesn't work, PM me your email address & I'll try to send it that way.



http://www.lga.gov.uk/lga/aio/19069

CHCscandal

Several posters have put the site below on various threads re continuing care & who/qhat conditions/health needs may qualify.

NHS choices last week, removed the drop down menu showing examples of people who qualify, below is the exact wording, luckily copied from the site prior to removal.

NHS fully funded continuing healthcare is a statutory requirement, mandatory at discharge from hospital, assessments MUST be carried out before anything else and only at the end of the hospitalisation period not on admission or any other period of time.

The hospital MUST NOT notify social services of a potential 'customer' for community care, until the NHS CHC assessment process has been exhausted right through appeals and the social services MUST NOT accept any person on a section 2 notice from a hospital unless it indicates that all CHC process has been carried out, exhausted and the person does not qualify, including all appeal timescales.

The mandatory assessment is not to be 'CLAIMED', it is not a 'BENEFIT', it is not 'MEANS TESTED' it is a statutory obligation, duty of care and a right of every british citizen and visitor to this country.



QUOTE:-

Decisions on NHS continuing care are made on individual facts and circumstances for each person, but here are some examples of people who qualify:


1. Alan has been diagnosed with Alzheimer’s disease and it has reached an advanced stage.
He lives at home with his son and needs assistance with all personal care tasks such as washing and eating.
He has both bowel and urinary incontinence, and needs constant supervision to ensure his safety.


2. Marie is in her 50s. She has had a severe stroke and is currently in hospital but will soon be discharged.
A urinary catheter has been fitted and, as she has lost her swallowing reflex, a tube will be fitted so that she can take food in through her stomach.
She is at risk of developing pressure sores so needs to be moved carefully at regular intervals.


3. Dan suffered brain damage after being involved in a road accident.
He is unable to walk or communicate, has severe respiratory problems and frequent epileptic fits.
After a long period of time in hospital, he was moved to a care home that gives nursing care.


Decisions about NHS continuing healthcare
The decision-making process to establish whether NHS continuing healthcare should be delivered is complicated. If you and the person you're looking after think that NHS continuing care was wrongly refused, see Problems with getting NHS continuing care.

UNQUOTE



~~~~~~~~~~~~~~~~~~~~~~~~~~~
The link to this piece / WAS / on this page/section:-

http://www.nhs.uk/carersdirect/guide/practicalsupport/pages/nhscontinuingcare.aspx

Errata

Thanks CHC. It's slightly concerning that discharge from hospital could be significantly deayed by the assessment process given the risks of picking up a hospital acquired infection.

A question: I'm sure the info has been posted before, I just can't find it. Do you have a link for assessment for Nursing Care funding for those discharged from hospital back to a care home ?