Continuing Health Care - Preparing to fight PCT's decision

tubsmacker

Bakewell 54 and Energise. You like me are in a good position in that you are not currently paying. I dont accept that the 2009 framework removes the responsibility on the NHS to continue funding. It's just that they failed to put it in the framework. I have some evidence for this so pm me if you want it KatyKat, do you have any evidence that the revised framework has removed that liability? if so please let me know soonest as it is pretty crucial.
I have told the PCT to fund and they have not been able as yet to transfer duty of care to the social services and I dont believe they have the right to do so unless I consent or announce that I am not a self funder.
SS shouldn't want to take on any cases they don't have to in the current climate of cutbacks I would have thought.

Regards
Tubs

Katykat

Tubsmacker, I cant copy & paste the document because I only have it as a PDF file ( i know there is a way, but I'm a bit dense in that dept). however, the info you want is on page 39 of the 2009 N. Framework, paragraph 143. It quite catagorically states that current funding arrangments must be continued until the dispute is resolved. this puts you in a good position because if the PCT have to continue paying, believe me, they will give priority to any MDT necesary. I've had a dispute going for over a year and because we are already self funding, the PCT couldn't give a toss about how long they take.

tubsmacker

Katykat wrote: »

Energise, you will also find lots of help and support on the free nursing care forum ---- http://freenursingcare.findtalk.net/general-chat
Incidently i,like you, had a relative sectioned under section 117. I was under the (wrong) impression that she would be automatically entitiled to free aftercare. However, the description is blatantly vague, --ie
Aftercare under section 117 must be provided free of charge.
In 2002, the House of Lords held that this section imposes a freestanding duty to provide aftercare services and not simply a gateway to other community care services. As there is no express power to charge for services provided under it, such services must be provided free of charge.
All aftercare services must therefore be funded by the relevant Health Authority, Primary Care Trust or local social services authority. If someone chooses to make private arrangements for care, either in addition to or instead of, aftercare that should have been provided, it may be possible to claim repayment for this on the basis that the authority had failed to discharge their duties under section 117. However, the authority or the court would be entitled to consider the reasonableness of the private arrangements and the level of reimbursement appropriate.
You'll notice that I've outined the term "local social services authority". What it means is that if you local PCT deems that you have a Primary Health need, then indeed the care will be free, because its provided by the NHS. However, if they deem that you DONt have a primaryh health need, then the aftercare is provided by the local authority, and this is means tested, so if you have over £23500 in assests 9 including your house), then you have to pay. The truth is, very few people are deemed to have a primary health need without a very long fight ( & of course someone to fight that battle for you). So, even though section 117 SAYS that aftercare is free, it isn't free for everyone. Only people sectioned under section 2 will get free NHS care.

Hi KatyKat,
What I am getting at is that even though the PCT may deem you not to be eligible, The liability for payment should NOT arise until the appeals process is exhausted. Therefore if your relative is in hospital at the time of the first refusal, the liability for providing 'appropriate care' AND the funding thereof falls on the shoulders of the PCT and Social services should not be pressing for means testing or payments.

The 2007 framework annex E para 8 makes this clear. I don't believe that this has been revoked but instead, the DOH has simply failed to incorporate it in the later revision of the framework. I believe that it still applies. There is a huge difference in the two scenarios here. If anyone has any evidence to the contrary, I would be keen to hear about it.

Tubs
PS. Yes you are right that if you are actually already paying a Nursing Home the PCT will simply run circles around you until you get exhausted and depressed. The whole CHC assessment and appeal procedure is designed to make sure that you don't get paid out any-time soon and they simply hope that you will get fed up and go away as MANY do. That's why its important for anyone who is not yet currently paying to capitalise on their fortunate position and NOT to get pushed into a position where you are paying or bullied by the system or social services who in my view are complicit in the scam to get you paying.

malid

Hi everyone (BTW I live in Wales)

I contributed to this thread some time ago when I was fighting for CHC assessment for my uncle. Sadly, my uncle passed away on the morning the assessment was taking place.

I have continued to read the thread with interest, dismay and anger and I am full of admiration for those of you that continue to try to help people at a time when they are least able to deal with all this hassle. I shan't name you in case I miss anyone out but you will know who you are.

I am now supporting a relative who's father in law can no longer stay in his own home and will need residential nursing (in my opinion; also Social services and hospital staff talk refer to a 'nursing home') care. He has a string of health problems and has been hospitalised as an emergency admission at least four times in the last 18 months and on each occasion spends around 10 weeks in hospital. To the 'shock' of the nursing staff, we asked for CHC assessment to be told that he wouldn't qualify but that it would be discussed at a MDT meeting. My relative was told last week that it had been decided not to put him forward for a CHC assessment as he did not 'qualify'.

I have now told him to go back and ask for more information - what checklist was used; who led the meeting/process; who was present and for a copy of the decision and reasons in writing. I shall let you know what happens next.

tubsmacker

malid wrote: »

Hi everyone (BTW I live in Wales)

I contributed to this thread some time ago when I was fighting for CHC assessment for my uncle. Sadly, my uncle passed away on the morning the assessment was taking place.

I have continued to read the thread with interest, dismay and anger and I am full of admiration for those of you that continue to try to help people at a time when they are least able to deal with all this hassle. I shan't name you in case I miss anyone out but you will know who you are.

I am now supporting a relative who's father in law can no longer stay in his own home and will need residential nursing (in my opinion; also Social services and hospital staff talk refer to a 'nursing home') care. He has a string of health problems and has been hospitalised as an emergency admission at least four times in the last 18 months and on each occasion spends around 10 weeks in hospital. To the 'shock' of the nursing staff, we asked for CHC assessment to be told that he wouldn't qualify but that it would be discussed at a MDT meeting. My relative was told last week that it had been decided not to put him forward for a CHC assessment as he did not 'qualify'.

I have now told him to go back and ask for more information - what checklist was used; who led the meeting/process; who was present and for a copy of the decision and reasons in writing. I shall let you know what happens next.

Get the local MP to write and demand that a full CHC assessment is conducted. Refuse discharge to anywhere where payment is expected and sign NOTHING is my advice.
Tubs

DiggerUK

Have had to study up on care issues as my sisters MIL, has now been diagnosed with Vascular Dementia. This is on top of her being the carer for her terminally ill FIL at home.
Her husband died a while back, so I'm sure most here will understand she is at her wits end.

The issue of funding is why I am working through this thread.
After reading the DH/NHS Continuing Healthcare Practice Guidance, till I am blue in the face, I feel more capable of helping my sister through this issue, which I feel deserves CHC funding.

Two issues before I post again.
What are the acronyms 'MDT', and 'LPA'. I've figured out the others.
What wording, in a letter, works best to get the so'andsows to carry out the assessment in the first place! All my sister seems to be getting is a 'butter wouldn't melt in their mouths/ don't know what you are on about' response.

malid

DiggerUK wrote: »

Have had to study up on care issues as my sisters MIL, has now been diagnosed with Vascular Dementia. This is on top of her being the carer for her terminally ill FIL at home.
Her husband died a while back, so I'm sure most here will understand she is at her wits end.

The issue of funding is why I am working through this thread.
After reading the DH/NHS Continuing Healthcare Practice Guidance, till I am blue in the face, I feel more capable of helping my sister through this issue, which I feel deserves CHC funding.

Two issues before I post again.
What are the acronyms 'MDT', and 'LPA'. I've figured out the others.
What wording, in a letter, works best to get the so'andsows to carry out the assessment in the first place! All my sister seems to be getting is a 'butter wouldn't melt in their mouths/ don't know what you are on about' response.

MDT is Multi Disciplinary Team - i.e. Health Professionals, Social Worker etc
LPA is Lasting Power of Attorney

I would go down the verbal route in the first instance as far as pressing for an assessment. Get her to ask for an assessment; they may opt to go through a 'checklist' first before referring for a full assessment with the DST. If the response is negative, see Tubsmaker's response below to my post. Ask for reasons in writing. Also consider contacting your PCT by phone. I would use the more formal letter writing approach when the talking has failed.

Good Luck

DiggerUK

One theme that comes up consistently in this thread is how the powers that be drop surprises on everyone. Up till last week behaviour of sisters MIL, (Wendy), was erratic, aggressive and she was not sleeping. Awake for over 60 out of 72 hours at end of last week. On visits at weekend Wendy was asleep following sedation.

Today my sister finds out that the assessment was done yesterday, at a time she had already said she could not make; and guess what. Wendy is stable, fine, happy and all is hunky dory, and that there was no need to do the assessment with family reps there, and the medication did not influence the findings.
The findings say that health care is not needed anymore, as Wendy is stable. Seems all she needed to get over Vascular Dementia was a good sleep!!!

Have advised my sister to find out what medication is being prescribed, to get a copy of the report, and not agree to the discharge from hospital that is now being talked about. Any other pointers I can pass on.
Thanks to all.

monkeyspanner

malid wrote: »

Hi everyone (BTW I live in Wales)

I contributed to this thread some time ago when I was fighting for CHC assessment for my uncle. Sadly, my uncle passed away on the morning the assessment was taking place.

I have continued to read the thread with interest, dismay and anger and I am full of admiration for those of you that continue to try to help people at a time when they are least able to deal with all this hassle. I shan't name you in case I miss anyone out but you will know who you are.

I am now supporting a relative who's father in law can no longer stay in his own home and will need residential nursing (in my opinion; also Social services and hospital staff talk refer to a 'nursing home') care. He has a string of health problems and has been hospitalised as an emergency admission at least four times in the last 18 months and on each occasion spends around 10 weeks in hospital. To the 'shock' of the nursing staff, we asked for CHC assessment to be told that he wouldn't qualify but that it would be discussed at a MDT meeting. My relative was told last week that it had been decided not to put him forward for a CHC assessment as he did not 'qualify'.

I have now told him to go back and ask for more information - what checklist was used; who led the meeting/process; who was present and for a copy of the decision and reasons in writing. I shall let you know what happens next.

I am not sure if your relative's FIL is also in Wales but as you probably know the CHC system in Wales has followed a different path due to devolution of control of the NHS in Wales to WAG (Welsh assembly Government). WAG published a new CHC framework for Wales fairly recently and here is the link http://wales.gov.uk/topics/health/publications/health/ministerial/letter01810/;jsessionid=rlSKMQnNQw9Q49vnQ8DmBTphnHL7Ttl62jdngyyv58n0QJ4WhV1M!179347272?lang=en
I haven't had time to read it so I'm not sure if it broadly follows the English model or if it is different.

Under the English system a patient in your relatives position should have an initial CHC checklist performed prior to discharge under CRAG rules and the results of that checklist should be communicated to the patient or the patient's representative, but again I am unsure if this also applies in Wales.

monkeyspanner

DiggerUK wrote: »

One theme that comes up consistently in this thread is how the powers that be drop surprises on everyone. Up till last week behaviour of sisters MIL, (Wendy), was erratic, aggressive and she was not sleeping. Awake for over 60 out of 72 hours at end of last week. On visits at weekend Wendy was asleep following sedation.

Today my sister finds out that the assessment was done yesterday, at a time she had already said she could not make; and guess what. Wendy is stable, fine, happy and all is hunky dory, and that there was no need to do the assessment with family reps there, and the medication did not influence the findings.
The findings say that health care is not needed anymore, as Wendy is stable. Seems all she needed to get over Vascular Dementia was a good sleep!!!

Have advised my sister to find out what medication is being prescribed, to get a copy of the report, and not agree to the discharge from hospital that is now being talked about. Any other pointers I can pass on.
Thanks to all.

First of all your advice to your sister was spot-on.

Was this a full DST (decision support tool) assessment or an initial checklist assessment prior to discharge?

If an initial assessment these are supposed to be on the cautious side so that all who need a full CHC assessment based on a DST get one.

If the hospital are trying to downplay the severity of her condition then that is contrary to the priciples of the National Framework as well controlled medical conditions should be aseessed as if they were not under control, this concept seems virtually impossible to convey to assessors. This would also seem daft as obviously her condition is not well controlled if she was exhibiting prolonged periods of wakefulness.

My advice would be get as much information as you can about medical records. If it can be afforded make a formal written request for all hospital records. There may be a charge for this but I think there is a maximum fee of around £50. Asking for this will send a signal to the hospital that the family will not be fobbed-off. If your sister does not get everything she expects she should insist that the records are checked again. We got at least as much when we asked the second and third times as was "found" on the first request for my MIL. Your sister could expect a frosty reception when this news filters down to the staff who will have to collate the information. In particular look for things like feeding records and medication charts. If the patient is on drugs check them out to see if any are mood altering or anti-psychotic drugs as this will indicate attempts to control behaviour. Also any evidence of falls, wandering, cognitive problems or uncooperative/agressive behaviour which are recorded in her records.

I would also advise your sisiter to familiarise herself with both the CHC National Framework and the DST documents.

Hope this helps.