Continuing Health Care - Preparing to fight PCT's decision

Les_Booth

Hi CHC and Katycat
I have PM'd you both in the last 2/3 days - but can not see these PM's anywhere - can you confirm receipt or non receipt please ?
Thanks
Les

CHCscandal

Les
Indeed you have been misled, sadly this is common practice throughout the PCT's.
[URL="mhtml:{648DC2E2-4F05-4994-9C5D-0F22C5857FA6}mid://00000874/!x-usc:http://www.nhs.uk/chq/pages/2392.aspx"]http://www.nhs.uk/chq/pages/2392.aspx[/URL]
The link above is not perfect, but to satisfy your need to understand the complexity of the whole situation, made complex in order to deliberately confuse at a time of duress and stress for most people, this link on the actual NHS choices site may help.

To put things into perspective though, the paragraph below taken from the link above, quite clearly states that the full assessment after screening must be a multidisciplinary team, not a single person.
Also within the paragraph, wrong information is given too, the part I refer to is in red:-

Quote:- 'If your initial screening shows that you should be referred, a multidisciplinary team of health and social care professionals will carry out a comprehensive assessment of all your 1. care needs,
( SHOULD SAY HEALTH NEEDS) using a 'decision support tool'.
2, As well as your nursing care needs, they will assess your physical, mental, psychological and emotional needs.
When your assessment is carried out, you and, where appropriate, your carer will be consulted.
The decision support tool ensures that people's needs are assessed consistently and fully.
3. If you're not referred for a full assessment after your initial screening, your case will be reviewed three months later.'
1 & 2. Nursing CARE needs are NOT being assessed, INPUT's are not relevant & not be assessed within CHC full assessment & cannot be included in any rationale, nor is the setting where the need will be addressed.
3. If CHC is found to be not eligible, appeal has to take place, if before 1/10/09 the person being assessed was in the system, then the 2007 rules apply, NHS are responsible for all costs until determined that CHC does not apply.

Now this usually meant that the person was kept in hospital whilst all this is taking place, attempts were generally made to transfer to SS, where means testing took place and charges attempted to be initiated.

This is not the process, if the NHS want the person out of the bed, if they are medically fit? for transfer only, not rehabilitation back into society, then the NHS must make provision for transfer to a community bed for rehabilitation assessment, mental health assessment or care home or back home with a suitable package in place to cover the needs emanating from the comprehensive needs assessment, they must pay until decided otherwise and cannot ask for repayment if not successful.

BUT they have attempted to change the 'rules' from 1/10/09 serrupticiously, by adding in the appeals section, that any new patients from 1/10/09 not in the system prior and not in review under a previous system, having had a CHC assessment, if found Not eligible, then that decision remains throughout the appeals process until proved otherwise!
As you can imagine, most PCT's are applying this to any case asap, even prior to 1/10/09, as it is a key perverse incentive to them in the quest to reclassify health needs as social care.

All of these details are in the Framework 1/10/07, DST, delayed discharges, general hospital discharge planning and especially the actual mandatory directions and responsibilities which are not the actual cog turning directions, but the instruction of how, when,where from the secretary of state and DoH.

Yes, the emotive point of possible infection in hospital is a first excuse nowadays to remove asap, but care homes and other institutions are just as vulnerable.
Another emotive point being used in order to remove asap is that assessing in a hospital environment is not conducive to 'good assessment criteria' but the point is all 'MDT' people are probably there and already have made A decision based on their findings and assumptions from the 'presenting conditions' and the needs resulting from them.

Three months later when someone hopefully is 'settled' in a care home that fully meets their needs at that time, is merely just that, 'settled' 'managed' 'stable through the management', but this 'presenting condition' is often used as the denial factor at this point as many can testify and have within this thread.

After the CHC process is full exhausted, only then can another assessment be conducted for funded nursing care, the old RNCC, this ahs to be assessed, it is not to be assumed, when CHC is found to be ineligible, but once again most do not assess separately for this, they just apply RNCC, one band at this point and never re-assess for CHC, as the statement advises, unless YOU ask.
RNCC, or funded nursing contribution, is an INPUT based funding, that is why there were three bands, the assessment was supposed to identify all of the inputs required daily/weekly/monthly from a registered nurse, including the planning, reviewing and monitoring/overseeing time, but as there is just one band now, which they want to apply to everyone to replace continuing healthcare, they do not see the need to do the actual assessment, it has morphed into the social services SAP, but has to be carried out by a registered nursing practitioner.

The RNCC assessors have the discretion to use a 1 page/front sheet determination tick sheet, which according to my MiL's nursing home, used to be filled in over the phone with a mere telephone call asking if anything had changed, if they said no, just the determination sheet was put in the records which kept the weekly payment on course.

Since the DoH realised the illegality of the three bands and the fact that high and medium probably represented full CHC they changed it to one band, following the Ombudsman investigation, the assessment for it has paled into insignificance, and treated as the NORM, for all cases if they can using the CHC assessment as the basis, with CHC eligibility becoming as the exception, rather than the rule, where is reality it is CHC first and foremost then RNCC.

oldguy_2

Katykat wrote: »

My PCT scores 28 out of 50,000 in the league table for CHC awards.

I am new to the the forum and I am horrified to see how many people are suffering the same problems regarding CHC funding. Having had the recommendation of the multi disciplinary team set aside without it going before a panel (for which the PCT have now apologised) we have got as far as a commitment to complete a retrospective review and undertake a new current review. In all my dealings I am left with the clear impression that there is a systematic abuse of process to deny people like my dad their entitlement to CHC.

I have searched for comparative data across PCTs but have failed to find anything meaningful. Can someone direct me to this league table?

Despite the requirement for CHC decisions to be 100% based on the assessment of health needs I find that those making the decisions have budgets for CHC expenditure and are regularly updated on expenditure against this budget. I can't imagine any legal use that this information could be put to. Is this common?

CHCscandal

Les,

Within your case, both the process and the application fo the process have not been followed.

When appealing after a CHC assessment has supposedly been carried out and the PCT have held their first level panel. There is generally no going back after this point, that is why it is essential that the CHC MDT/MDA is carried out correctly and comprehensively right first time.

The appeal process is the only hope and it's remit is to merely check

1. has the process been followed,
2. has the 'criteria' been applied in accordance with the directions.

When a PCT IRP panel or the SHA IRP panel is the next stage after CHC assessment, it is imperitive that either or both of these points are applicable, the panel will not deliberate on the actual eligibility decision, that is made quite clear within the framework.
Appeal panels have two functions, they merely scrutinise the PCT for the process and application of the process, that is amde clear within the framework.

It is clear that in your case Les, the process has not been followed and the application, resulting in the weakest rationale I have every seen, from both the assessor and the PCT panel is another area for appeal.

These are definite grounds for appeal to the relevant to the IRP panel, the IRP panel must return the case back to the PCT to complete properly, if they are doing their job correctly.
This is the basis of the appeal submission, firstly the process has not bee followed, secondly the application/rationale is not robust.

The rationale for ineligibility must be comprehensive, and state why a health need doesn't exist, from both the assessor and the panel ratification of the assessors findings,
the sentences in your case are not acceptable.
The Ombudsman can always be consulted at any time to verify any informaiton, prior to 1/4/09 the Health Care Commission was the first step prior to the Ombudsman for Current Cases,
they could 'clarify' whether or not the process had been followed.

A current case, is any case where the predominant relevant period which may be CHC is after 1/4/04, this includes periods prior to 1/4/04 as long as' most of the period' is after 1/4/04.

If anyone was in 'care' or thought to be eligible within 'a care regime at home' prior to 1/4/04 as time moves on each year the period prior to 1/4/04 comes within the 'current' classification not a restitution classification.

Although cases for resitution have been advised as closed off, anyone can bring any cases to the attention of the PCT at any time, if their case is current.

If anyone discovers that their case may be relevant to CHC they can legitimately request a review, the relevant date that the PCT cannot go beyond is April 1996.

monkeyspanner

oldguy wrote: »

I am new to the the forum and I am horrified to see how many people are suffering the same problems regarding CHC funding. Having had the recommendation of the multi disciplinary team set aside without it going before a panel (for which the PCT have now apologised) we have got as far as a commitment to complete a retrospective review and undertake a new current review. In all my dealings I am left with the clear impression that there is a systematic abuse of process to deny people like my dad their entitlement to CHC.

I have searched for comparative data across PCTs but have failed to find anything meaningful. Can someone direct me to this league table?

Despite the requirement for CHC decisions to be 100% based on the assessment of health needs I find that those making the decisions have budgets for CHC expenditure and are regularly updated on expenditure against this budget. I can't imagine any legal use that this information could be put to. Is this common?

Hi I think this might be the kind of figures you are looking for.
http://www.theyworkforyou.com/wrans/?id=2009-09-09b.290895.h

If you want older figures this might help
http://www.theyworkforyou.com/wrans/?id=2008-06-20d.211755.h

The first set of figures relate to the 4 quarters 2008/9 so I assume April 2008 to April 2009. I have only just found these so haven't had a close look. The figures seem to indicate a 10 fold difference between the number of people being awarded CHC per 50000 of population between the highest awarding PCT and the lowest. So I think it is safe to assume that the new DST system and National framework introduced in Oct 2007 have not eliminated the postcode lottery for NHS funding of CHC.

Hope this helps

I answer to your last question yes it is common and makes a nonsense of the decision making process. In addition to budgets there are often substantial financial reserves set aside in PCT accounts to settle successful legal claims for CHC. The whole system is a scandal with elderly and infirm people and their relatives who are usually unaware of this statutory funding being systematically robbed of their resources by PCTs often incollusion with LA Social Service departments. At the ground level it may well be ignorance but at a higher management level this is a deliberate policy to keep patients and their relatives in the dark in order to save money.

Errata

At the ground level it may well be ignorance but at a higher management level this is a deliberate policy to keep patients and their relatives in the dark in order to save money

I have to agree with you. It's a nightmare and how a 70+ year old spouse could possibly pick their way through the minefield beggars belief.

oldguy_2

Thanks monkeyspanner. The disparity in the figures is shocking. Like many on here we must fight on.

CHCscandal

monkeyspanner wrote: »

Hi I think this might be the kind of figures you are looking for.
http://www.theyworkforyou.com/wrans/?id=2009-09-09b.290895.h

If you want older figures this might help
http://www.theyworkforyou.com/wrans/?id=2008-06-20d.211755.h

Here is another site which provides very useful information and a central base for anyone wishing to fire off a FOI request.

I believe the figures quoted in the 'theyworkforyou' tables include children, receving CHC, as the wording says 'people' the provider doesn't split the data into 'client groups', perhaps the relevant question could be asked, rephrasing 'people' to 'by client age group'.

http://www.whatdotheyknow.com/request/continuing_health_care_expenditu_12#incoming-10887

Errata

Good point, CHC. I thought the figures for my district were amazingly high.

Les_Booth

Hi CHC
Had sent off this e-mail before your last two postings:
Hello ****,

Thank you for the DST re Patrick.



I am now totally confused.



1.Social Services state that "...a Continuing Healthcare Assessment is required for Patrick"



2.The NHS Continuing Healthcare Checklist July 2009 Item 19 states that A full assessment for NHS continuing healthcare is required if there are....etc"



3. I have received a completed DST stating that Patrick is not eligible for funding.



I would be grateful if you could explain what the relationship is between items 1,2 and 3

eg. When was the checklist completed ?

Has Patrick had a full NHS Continuing Healthcare Assessment ?



Thank you



Les Booth

and received this e-mail today in response:

Dear Mr Booth



I reply in response to your email.



Social Services carried out an Adult Care Assessment, dated 7/10/09. The social worker identified that Mr ***** required a Continuing Healthcare (CHC) Screening. The screening is carried out when someone becomes a permanent resident in a Nursing Home and looks to see if the client is eligible for CHC funding. There is a further screening after 3 months and thereafter, a routine annual review unless there is a change in health needs.



The NHS Funded Care Advisors (FCA) assess eligibilty for NHS continuing healthcare based on assessed health needs. The first part of the screening is completion of a checklist. This was carried out by Simon **** (FCA) at the review visit on 20/10/09 at ****Nursing Home (NH). The result of the screening was that Mr ***** had a positive checklist, therefore, Simon completed the Decision Support Tool (DST). This took into account supporting evidence from Nursing Home documentation and NH staff. I understand that you were present at the review meeting with Mrs ***** and that Simon spoke with both of you.



Following completion of the DST a recommendation is made based on the assessment of health needs. The DST is then considered by the Continuing Healthcare Senior practitioner who signs it off and a letter is sent to the appropriate relative/next of kin. This letter will give you the information which you require should you wish to appeal. The Senior CHC practitioner signed off Mr *****’s DST on 5/11/09. The CHC Team is based in Worcester.



As you sent the Power of Attorney documentation to the office (via email) we were able to let you have a copy of the DST, which you collected in person from the Funded Care office. You should also receive a letter from the CHC Senior Practitioner explaining the outcome of the review – which was that Mr ****** is not eligible for continuing healthcare funding at this time. He will be due a review in 3 months.



As Mr ****** is now a permanent resident at ***** NH, he receives a ‘Funded Nursing Care’ payment from the NHS of £106.30 per week (paid directly to the NH on a monthly basis) to pay for the registered nursing element of his care. At the date he became a permanent resident there would have been a retrospective payment made for the period of respite care – paid to ***** NH.



In brief the CHC checklist was completed on 20/10/09 and Mr ***** has had a full NHS Continuing Healthcare Assessment.





Kind Regards,

******



**************

Funded Nursing Care Manager



Any comments ?

Regards
Les