Continuing Health Care - Preparing to fight PCT's decision

Bedpan.

Thanks or all that info ianau1, I'm awaiting an appeal date with the local PCT. as my Dads assessment this week scored him as not elligible. He's 95, immobile,needs help to dress and feed,cannot stand on his own,memory loss and incontinent. I think you already have to be dead before you actually get any continuing healthcare. Unfortunately my sisters health has been effected by all this and she is now on blood pressure tablets. The Social people are very keen to get you involved with the finance side of things, like does your Dad have a house??? wonderful. Its like giving your car up when you go in hospital for a broken arm-yes?
I am putting together my case now and will try and do updates as I go. Any help will be greatly appreciated and I will reciprocate with my findings. Just before I go, at the assessment (DST. one) the previous checklist scores were not related to and I felt that the PCT. who did the test was very persuasive how she manouvered you into accepting a decision. Trouble is it is only now after the event that you realise all of this. Also the nurse in the meeting had never done or used the DST. before. OK, signing off now.
Power to the People!:T

Savvy_Sue

cohentb wrote: »

Just to update we have finally got the PCT to agree to a small payment towards our expenses and costs. Despite the fact that they are constantly seeking legal advice they refuse point blank to refund any legal costs as " the appeal process is simple and legal advice should not be necessary"! The other problem is that we do not have receipts for the other costs like attending panels ,petrol receipts, recorded delivery letters etc.
My experience is that if you persist you will get refunded incidental expenditure if you have receipts, otherwise I suspect the chances are slim.

I wonder if it's worth claiming for mileage at 40p per mile for any meetings you attended? You can get the distance from something like googlemaps, and I would definitely add them to the list.

Savvy_Sue

cohentb wrote: »

Just to update we have finally got the PCT to agree to a small payment towards our expenses and costs. Despite the fact that they are constantly seeking legal advice they refuse point blank to refund any legal costs as " the appeal process is simple and legal advice should not be necessary"! The other problem is that we do not have receipts for the other costs like attending panels ,petrol receipts, recorded delivery letters etc.
My experience is that if you persist you will get refunded incidental expenditure if you have receipts, otherwise I suspect the chances are slim.

I wonder if it's worth claiming for mileage at 40p per mile for any meetings you attended? You can get the distance from something like googlemaps, and I would definitely add them to the list.

tubsmacker

Katykat wrote: »

www.carelaw.co.uk is a firm run by Rob campbell. He sets a fixed fee of £595 + VAT. However, this just covers 4 hrs work. He says that this is usually enough to establish the case & obtain medical reports ( something which may be difficult for relatives to do). If the PCT have not caved in by that point, you can elect to either take over the case yourself, or continue & pay him hourly.

I wrote to him on email and never got a response. If my divorce was anything to go by. 4 hrs work isnt going to go very far. I approached another firm that wanted £195 for an initial consultation by phone or email.
I think if I get refused CHC, then I will save the lawyers fees until it gets to court

Bakewell54

Bedpan. wrote: »

Thanks or all that info ianau1, I'm awaiting an appeal date with the local PCT. as my Dads assessment this week scored him as not elligible. He's 95, immobile,needs help to dress and feed,cannot stand on his own,memory loss and incontinent. I think you already have to be dead before you actually get any continuing healthcare. Unfortunately my sisters health has been effected by all this and she is now on blood pressure tablets. The Social people are very keen to get you involved with the finance side of things, like does your Dad have a house??? wonderful. Its like giving your car up when you go in hospital for a broken arm-yes?
I am putting together my case now and will try and do updates as I go. Any help will be greatly appreciated and I will reciprocate with my findings. Just before I go, at the assessment (DST. one) the previous checklist scores were not related to and I felt that the PCT. who did the test was very persuasive how she manouvered you into accepting a decision. Trouble is it is only now after the event that you realise all of this. Also the nurse in the meeting had never done or used the DST. before. OK, signing off now.
Power to the People!:T

Just be resolute, if you are appealing the decision tell Social Care that this is not an appropriate time to begin an assessment of your dad's assets. If you reject the decision of the appeal process the PCT are required to fund his hospital bed whilst the appeal is ongoing. The DST is an evidence based tool and as such is dependent upon good evidence. Insist upon SAP reports from those who have had recent contact with your dad, like his GP and District Nurses, carer/agency. Has he had any falls or other incidents which put him in danger? Is he on any drugs? It sounds like they are trying to put in your mind that his major problems are those which relate to social care, like tasks of everyday living. Focus on his medical needs and refer to them by their proper names of the condition. Know what drugs he needs and when he needs them.
Is he low in mood? Ask if he has been seen by a psycho-geriatrician or a psychiatric nurse? There are 2 assessments of mood in elderly people, 15 questions and 30 questions which you can almost do yourself with him...just google for it. Do NOT be sidetracked, be focussed. Tell your sister that you will deal with it if she cannot cope. It isn't that bad if you present an immovable and resolute counter argument.
I can't vouch that what I have said is right for you, but I add this in good faith.

soolin

I've been reading through some of this thread and wonder if I ought to be doing something for my father, I was only told by the powers that be in the past that there was no point in asking for help towards fees as he is only in a dementia home, not a nursing home. Is that really the case as I notice that several people have mentioned that their relatives are also in a dementia home?

He has severe vascular dementia long term deafness, he is now incontinent and has no idea where he is or who any of us are. he is happy and content but is on medication for blood pressure, an undractive thyroid and all sorts of other problems. He falls quite a bit and ends up in hospital (where i have to say the treatment is appalling).

He is self funded because I sold the house, but the funds are limited. Have I anything to lose by starting a process to try and get any part of his care paid for? It;s just that his fees go up next month to £570.76 a week and it is getting a bit worrying. He certainly has no independence, he doesn't even drink a cup of tea unless he is constantly reminded to do so.

Errata

Soolin - I'm about to start the (dreaded) process to obtain the NHS Nursing Care contribution for my stepdad. He has: COPD, v deaf even with hearing aids, macular degeneration getting very much worse, indwelling catheter which district nurses sort out once a week and do a bladder washout, bladder cancer, prostate cancer (on palliative care for both), dementia (short term memory probs, can't turn take in conversations or keep the thread), congestive heart failure, medicated for severe depression, high blood pressure, high cholesterol (plus other meds I can't remember).
He's in a dual registered home and the manager and I are working on it. Have a meeting on the 18th with SS, health, Uncle Tom Cobbley etc to start the process.

I'd say go for it. If you don't succeed this time you'll know what's what if you need to re-apply in 6-12 months time.
Good luck

Nurse_assessor

I just wanted to say that as a nurse assessor for chc we do not make any decision lightly. We have to work with paperwork we dont agree with and we find every not eligible decision very difficult. However the money pit is not bottomless and every person that meets the criteria will get the funding. It is not our falut that evidence is needed to meet chc. We work within goverment restraints. I am willing to offer advice if needed Thanks

monkeyspanner

Nurse_assessor wrote: »

I just wanted to say that as a nurse assessor for chc we do not make any decision lightly. We have to work with paperwork we dont agree with and we find every not eligible decision very difficult. However the money pit is not bottomless and every person that meets the criteria will get the funding. It is not our falut that evidence is needed to meet chc. We work within goverment restraints. I am willing to offer advice if needed Thanks

I really appreciate your offer of help. Of course you have to work within the system as you are trained to do.

However, the new DST system has not eradicated the postcode lottery for NHS CHC funding and there are huge differences in the rates of successful assessments as clearly demonstrated by the governments own figures. It is apparent therefore that the application of the assessment system is not uniform across the UK. To compound this due to devolution of health services the Welsh and Scottish assemblies have not adopted the same system as England.

As far as I understand the core of the CHC National Framework if a patient's primary need is medical then the cost of care should be picked up by the NHS and this has been tested by the courts. Despite this patients with dementia who need constant care and supervision are still being classed as having only domestic care needs by some PCT's when they clearly have a recognised medical condition which is affecting their brain function. If they had suffered a stroke causing similar symptoms the result of the assessment would be different.

As an aside and IMHO this all or nothing approach to care funding is rediculous as for all care situations at least part of the care is domestic and part medical. The current situation sets up a confrontational situation as patients and their representatives have to fight to protect the patient's assets as a resonable compromise is not posible.

It seems that the NHS has ample funds to waste on non-essential treatments and for treating self-inflicted illness nd injury but the elderly infirm are an easy target because they are unable or unwilling to demand what the courts have ruled is rightfully theirs. I should also mention endless tiers of NHS management on huge salaries acheiving very little and sometimes causing actual harm to patients and then sitting at home still drawing their huge salaries whilst on suspension pending their disciplinary hearings.

beaujolais-nouveau

Nurse_assessor wrote: »

I just wanted to say that as a nurse assessor for chc we do not make any decision lightly. We have to work with paperwork we dont agree with and we find every not eligible decision very difficult. However the money pit is not bottomless and every person that meets the criteria will get the funding. It is not our falut that evidence is needed to meet chc. We work within goverment restraints. I am willing to offer advice if needed Thanks

Well, of course I don't know which PCT/SHA you work in but I do now have experience of two SHAs' attitude to assessing my mother for CHC; and both of them have been absolutely dreadful - untruthful, lazy, ignorant, incompetent, negligent, bullying. I am too angry to say any more at the moment.