Continuing Health Care - Preparing to fight PCT's decision

Errata

Monkeyspanner -I know that you know the DST and guidance notes inside out. Would it be possible, and I appreciate it's a bit of an imposition, to post a link to the exact place where the below is specified ?

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

DiggerUK

I am not clear what the status of the meeting was. It has all the hallmarks of a full assessment using DST, but I am not sure. It could just have been a 'case meeting' between SW and hospital. All info is coming via the SW, not the hospital. She has been in hospital for 6 weeks now.
We will need to see what comes back in writing; I am convinced they realise my sister has support, and is being given advice. Does that sound the case?

To update, it seems that on Monday the SW came up with an LA contribution of 415 pound a week, which was an unexplained increase on the original 370? pounds on the table last week. Am I reading too much in to that increase.

They also picked a time that they knew she could not attend any meeting due to the full time needs of her terminally ill father (FIL), a fact that is well known to all involved.
Reading through this thread it seems that she may be entitled to CHC funding and extra nursing care for her FIL, does that sound a wild assumption.

malid

monkeyspanner wrote: »

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.

Hello Monkeyspanner, good to see that you are continuing with your expert input into this thread.

Yes I have been reading all about the new framework in Wales and in general, I think it's pretty much on par with the England situation. His FIL is in Wales so yes, it's the Welsh system that will apply. On reading DiggerUK's contribution, it may be the same issue - checklist done before putting forward for full CHC assessment; nothing supplied in writing (although this has now been requested) and no carer/relative input.

Fear not, I will supporting my relative and fighting with all the means at my disposal. I will post updates regularly in order to help and inform others.

monkeyspanner

DiggerUK wrote: »

I am not clear what the status of the meeting was. It has all the hallmarks of a full assessment using DST, but I am not sure. It could just have been a 'case meeting' between SW and hospital. All info is coming via the SW, not the hospital. She has been in hospital for 6 weeks now.
We will need to see what comes back in writing; I am convinced they realise my sister has support, and is being given advice. Does that sound the case?

To update, it seems that on Monday the SW came up with an LA contribution of 415 pound a week, which was an unexplained increase on the original 370? pounds on the table last week. Am I reading too much in to that increase.

They also picked a time that they knew she could not attend any meeting due to the full time needs of her terminally ill father (FIL), a fact that is well known to all involved.
Reading through this thread it seems that she may be entitled to CHC funding and extra nursing care for her FIL, does that sound a wild assumption.

An increase from £370 to £415 probably means that care needs level has been increased. The Social Services in each area can set one of I think 4 levels which is the maximum they will support up to. Within this £415 is the assumption that all residents income (apart from around £22/week pocket money) will be taken to fund part of the £415. So this means SW has accepted in part that the care needs are greater than originally assessed. On top of this the NHS can provide a nursing level support of around £101/week if some nursing is required.

However assessment for CHC funding must take priority as stipulated by the national framework section 24.

24.

Eligibility for NHS continuing healthcare must always be considered prior to any consideration of eligibility for NHS-funded nursing care. The interaction between NHS continuing healthcare and NHS-funded nursing care was further considered by the High Court in R v Bexley NHS Trust, ex parte Grogan (2006). The key points from this judgment are set out at Annex C.

If the FIL is terminal there is a fast track CHC assessment which should be requested which may mean some additional help.

monkeyspanner

Errata wrote: »

Monkeyspanner -I know that you know the DST and guidance notes inside out. Would it be possible, and I appreciate it's a bit of an imposition, to post a link to the exact place where the below is specified ?

I think you credit me with more knowledge and certainly better memory than I actually have!

Reference the revised National Framework Document July 2009.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_103161.pdf

To a certain extent this subject is covered by the phrase I have highlighted in section 25 page 9 below.

25. [FONT=AGaramond,AGaramond]To assist in deciding which treatment and other health services it is appropriate for the NHS to provide under the National Health Service Act 2006, and to distinguish between those and the services that LAs may provide under section 21 of the National Assistance Act 1948, the Secretary of State has developed the concept of a ‘primary health need’. Where a person’s primary need is a health need, they are eligible for NHS continuing healthcare. Deciding whether this is the case involves looking at the totality of the relevant needs. Where an individual has a primary health need and is therefore eligible for NHS continuing healthcare, the NHS is responsible for providing all of that individual’s assessed needs – including accommodation, if that is part of the overall need.[/FONT]
[FONT=AGaramond,AGaramond][/FONT]
[FONT=AGaramond,AGaramond]But specifically by section 47 on page 15.[/FONT]
[FONT=AGaramond,AGaramond][/FONT]
[FONT=AGaramond,AGaramond]47. [FONT=AGaramond,AGaramond]NHS continuing healthcare may be provided by PCTs in any setting (including, but not limited to, a care home, hospice or the person’s own home). Eligibility for NHS continuing healthcare is, therefore, not determined or influenced either by the setting where the care is provided or by the characteristics of the person who delivers the care. The decision-making rationale should not marginalise a need just because it is successfully managed: well-managed needs are still needs. Only where the successful management of a healthcare need has permanently reduced or removed an ongoing need will this have a bearing on NHS continuing healthcare eligibility. [/FONT]
[FONT=AGaramond,AGaramond][/FONT]
[FONT=AGaramond,AGaramond]Of course the final sentence of 47 does give the NHS a small escape route but I would argue this applies to say.[/FONT]

[FONT=AGaramond,AGaramond]- A broken hip which has been repaired well and the patient is mobile once more.[/FONT]
[FONT=AGaramond,AGaramond]- A leg ulcer which has been treated and has healed and no longer needs regular dressing.[/FONT]
[FONT=AGaramond,AGaramond][/FONT]
[FONT=AGaramond,AGaramond]not[/FONT]
[FONT=AGaramond,AGaramond][/FONT]
[FONT=AGaramond,AGaramond]- Parkinsons disease which is responding well to a drug regime but is not cured and is still an underlying problem.[/FONT]
[FONT=AGaramond,AGaramond][/FONT]
[FONT=AGaramond,AGaramond]I hope this helps.
[/FONT]
[/FONT]

DiggerUK

monkeyspanner wrote: »

........ On top of this the NHS can provide a nursing level support of around £101/week if some nursing is required.
If the FIL is terminal there is a fast track CHC assessment which should be requested which may mean some additional help.

I will need to check some facts, but I think the 101 pound a week would cover the shortfall. If accepted would it be 'out of the frying pan...' or not. No sense in solving a problem now and be left with a bigger problem next year.
I seem to remember the figure of 22 pound pocket money coming up in talking to my sister.
Something also about the pension having to be left alone due to husbands financial needs. Need to get back on that one.

In the DH/NHS Continuing Healthcare Practice Guidance I read the FTPT details in section 5 and saw that they did not apply to Wendy (MIL). Now I will need to talk to my sister and find out more details of FIL package, and what is being allowed.

Many more thanks.

Edit, I turn my back on this thread for five minutes, then find I have another document to burn my eyes out with. Does it ever end?

malid

DiggerUK wrote: »

I will need to check some facts, but I think the 101 pound a week would cover the shortfall. If accepted would it be 'out of the frying pan...' or not. No sense in solving a problem now and be left with a bigger problem next year.
I seem to remember the figure of 22 pound pocket money coming up in talking to my sister.

I think the package you may be referring to above is a Joint Care Package between NHS and the Local Authorities that may either be NHS Funded Nursing Care (NHSFNC) or other care packages with NHS and Local Authority contributions. The NHS contribute the 'nursing bit' but this goes direct to the LA against its contribution.

This would mean that if an individual had savings of over £22,000 they would have to pay (you need to check exact amount here as there is a scale when savings are near the £22K). Only £22 a week pocket money can be kept. I think your sister(?) needs to push for the full CHC assessment and exhaust all appeal routes before acceptign any other package. CHC as you know will pay all the costs with no input from the individual concerned.

DiggerUK

malid wrote: »

I think the package you may be referring to above is a Joint Care Package between NHS and the Local Authorities ......... CHC as you know will pay all the costs with no input from the individual concerned.

Your point seems valid, and I suspect true.
My sister just needs in-laws needs taken care of; like you I don't want to see the b*stards get away with it.
Sadly, they sometimes do.

Thanks for your help. Will update as and when.

atoneswitsend

I am much obliged to all the help and advice received via this forum which has assisted in my succeeding to obtain CHC funding for my SiL. From my army background this is merely the first battle. The war has yet to be won.
Now I wish to turn to making a retrospective claim. However I am uncertain how to progress this. Any advice or guidance would be much appreciated.

weanie

I have been 'lurking' amongst this thread off and on for some time. My mother has Vascular Dementia and a range of other needs which now seem to be 'relatively' insignificant in comparison to the speed that Dementia has taken over.
At our wits end over ayear ago, we gave up trying ot care for Mum within the family and she moved to a Care Home where she had spent some respite weeks during our care.
Mum's home has been sold and she has funded [we had the 12 week disregard and we managed her payments for her]. Her bank account has now reached the critical less than £23000 and we were obliged to contact the finance team and they in turn contacted Social Services and eventually there was a review with a social worker. The decision for PCT advice was reached during this meeting and we waited and waited for the PCT nurse to make an appointment. We had stressed to the social worker that we were quite insistent upon being invited to the assessment whenever it should be and we have waited over a month to be told that the waiting was to continue as they were busy. After a bit of a rant and a visit to see Mum I discovered quite by chance that an appointment had been made and that we had not been invited. We turned up anyway and it was obvious that the nurse thought that there was no need for PCT involvement and funding but as we assisted with the answers to the pre assessment, it was clear that there WAS a need to apply the Decision Support Tool. Apparently this will be during a multi disciplinary meeting and at a date unknown.
It seems so rude and dismissive to ignore our request for an invitiation and given the attitude of the nurse [appeared to think it was not a necessary visit at first and certainly not a priority], we wonder how many scores of A or B, Mum would have achieved without our input.
I found the whole process disturbing and stressful and wonder what is ahead for us all.
As Mum's money is practically gone, it may seem that we are wasting our time but if she were to receive PCT funding, then we/she could top up a better placement [or even the one she is in now] with her weekly pension. For this reason, we wll press on.