Continuing Health Care - Preparing to fight PCT's decision

hortibob

Many thanks for the information monkeyspanner :beer:

Sadly there is increased confusion here due to our government creating;

Community Care & Health (Scotland) Act 2002
http://www.scotland.gov.uk/Topics/Health/care/17655/guidance-profesionals/9803

IMHO to reduce the burden on the NHS and farm out patients to Local Authorities.

My faltering( I simply don't have the time to do this research, hold down a full time job and raise a family AND support my parents who are becoming increasingly confused) research has identified some major differences between Scotland and the rest of the UK.

I'll try to post more as soon as time allows.

To add to the confusion;
www.dwp.gov.uk/docs/continuing-health-care.pdf

Here's an extract;

"NHS Continuing Healthcare is available in England and Wales (each country has it’s own framework). In Scotland, only care packages where a person is terminally ill and requires specialist palliative health care are fully funded by the NHS. There are no circumstances in Northern Ireland where certain triggers require the NHS to fund the full package of care."


I've just found this little gem;
http://www.bbc.co.uk/blogs/theoneshow/consumer/2009/10/14/advice_on_how_to_claim_back_ca.html

Here's an extract;

"Scotland follows a completely different system, where all NHS care costs are always paid for. But individuals may have to pay for their room and board costs, on a means tested basis."

More info relevant to Scotland;
Hospital discharge arrangements and NHS continuing healthcare srevices
http://www.agescotland.org.uk/documents/1022

monkeyspanner

When it comes to healthcare the 4 administrations are diverging in their approach and scope and it will only get worse as the egos of politicians have their way. We have recently been trying to access specialist healthcare in England (we live in Wales) and to continue seeing a specialist in England for a 15minute anual consultation after 7 years of regular consultations. We have had to apply to a panel for "special funding". All the funding originates in Westminster as Wales has no tax raising powers (yet) so why waste money having a panel to decide if we can travel 40 miles down the road.

hortibob

monkeyspanner wrote: »

When it comes to healthcare the 4 administrations are diverging in their approach and scope and it will only get worse as the egos of politicians have their way. We have recently been trying to access specialist healthcare in England (we live in Wales) and to continue seeing a specialist in England for a 15minute anual consultation after 7 years of regular consultations. We have had to apply to a panel for "special funding". All the funding originates in Westminster as Wales has no tax raising powers (yet) so why waste money having a panel to decide if we can travel 40 miles down the road.

Sadly, it would appear that, whilst the rest of us are encouraged by the government to rally together to combat "our" budget deficit, there seems no end to the amount of administrators being employed merely to justify the existence of other administrators.
IMHO if we were to cut the endemic corruption ( sorry that should be allowable expenses....!) within our public services, this thread would not exist....the NHS would be fully funded and OAPs along with the rest of us would have dignity from cradle to grave.

woolly_wombat

Monkeyspanner thank you so much for posting here. My sister and I are due to attend a review meeting this afternoon with my mother's health care team so finding this thread could not have come at a better time. Mum suffered a massive haemorragic stroke at the end of November, is hemiplegic, incontinent and has reduced cognitive function. We have repeatedly asked for her to be assessed for continuing NHS health care. The latest request was during a phone call two days ago with the OT who immediately said in that case perhaps a social woker should be present - little did I realise the trap I could be falling in to until I read this thread. Had better go and get some sleep now. Thanks again.

monkeyspanner

Sorry to hear about your mum. I hope your meeting went well.

pixelchick10

Hi there - this really seems to be the start of an uphill battle - we had a meeting this week re continuing health care - our elderly mum (80) is seriously ill in hospital, immobile, incontinent (bowels and urine - and on a catheter), eats very little (on malnourished scale), is weak with a v low heart function after suffering a heart attack, and has dementia, which was worsened by the heart attack. She can't even get out of bed without being hoisted and scored 1 severe for mobility, a high for cognition and 3 moderate scores on the Decision Support Tool - not enough to qualify for the funding at this stage - so we plan to appeal. Presumably our best hope is to try to raise a couple of the other scores, from moderate to high? They rushed through the assessment (only a nurse from the care team was present - and she did her best by flicking through the hospital notes, but that is not the same as a doc being there). They also didn't consider the sum total/volume of her other needs - she is bed-bound, and requires 24 hour care. Of course the hospital are desperate to kick her out - but I figure we are in a position of strength if we are occupying the bed. Their faces dropped when I said that no way would we move her to a care home while the appeal was underway. Presumably that's our right still - to occupy the NHS bed, while the appeal is underway? There was a social worker present too (no doctor - though :O)- but thanks to this forum I was prepared! Someone who's been through it (Monkeyspanner??) I would so appreciate your advice about the best tack to take. I can't believe we are having to fight for this when the NHS guidelines say anyone with a health need should get funding. As far as I can see, these criteria are designed to screen people out, rather than genuinely assess if they have a health need or not. We've taken away the part of the assessment where we can put it down and plan to fill it in. Thanks ...

monkeyspanner

pixelchick10 wrote: »

Hi there - this really seems to be the start of an uphill battle - we had a meeting this week re continuing health care - our elderly mum (80) is seriously ill in hospital, immobile, incontinent (bowels and urine - and on a catheter), eats very little (on malnourished scale), is weak with a v low heart function after suffering a heart attack, and has dementia, which was worsened by the heart attack. She can't even get out of bed without being hoisted and scored 1 severe for mobility, a high for cognition and 3 moderate scores on the Decision Support Tool - not enough to qualify for the funding at this stage - so we plan to appeal. Presumably our best hope is to try to raise a couple of the other scores, from moderate to high? They rushed through the assessment (only a nurse from the care team was present - and she did her best by flicking through the hospital notes, but that is not the same as a doc being there). They also didn't consider the sum total/volume of her other needs - she is bed-bound, and requires 24 hour care. Of course the hospital are desperate to kick her out - but I figure we are in a position of strength if we are occupying the bed. Their faces dropped when I said that no way would we move her to a care home while the appeal was underway. Presumably that's our right still - to occupy the NHS bed, while the appeal is underway? There was a social worker present too (no doctor - though :O)- but thanks to this forum I was prepared! Someone who's been through it (Monkeyspanner??) I would so appreciate your advice about the best tack to take. I can't believe we are having to fight for this when the NHS guidelines say anyone with a health need should get funding. As far as I can see, these criteria are designed to screen people out, rather than genuinely assess if they have a health need or not. We've taken away the part of the assessment where we can put it down and plan to fill it in. Thanks ...

Sorry to hear you are experiencing the usual problems with gaining CHC funding. My response below assumes you are in England.

The problem with the DST is that it does not give guidance regarding what scores are required for an award of CHC funding. This leaves the gate open for differing opinions and interpretation across assessors and PCT's. The only guidance I have ever seen is a document published by ADASS (Association of Directors of Adult Social Services) unfortunately this document was withdrawn from their website following the publication of the revised national framework and has not been revised so I cannot provide a link. As far as I can remember they were pretty vague about what the requirements should be but essentially it was a combination of high and severe scores across a number of areas but they did state that it may not be necessary to score a severe if there were sufficient high scores. So yes your assumption is correct it would be better if some of the moderate scores were higher. It seems that the normal assessors tatic is to avoid any severe scores if at all possible (in your case if a hoist is required avoiding a severe would not be possible) and to downplay scores from high to moderate. So I would look at raising the high to severe and the moderates to high.

Practically it is worth remembering that the framework spells out that "a well controlled need is still a need" so has to be assessed as though it were not controlled. Additionally any conditions which are unstable and need careful monitoring carry extra weight. Also if conditions interact and medication or treatment timings are critical this can add weight to the assessed severity of the medical needs.

Proceedurally if they have already given a decision prior to you providing your advocate's input it would seem they are not giving your input any consideration. This IMHO would be against the proceedural guidlines laid out in the National framework. During the DST assessment were you given the opportunity to give your opinion and were these given proper consideration? Was the nurse carrying out the DST assessment a nurse assessor or just someone from the care team? The decision should be provided to the patient or their advocate in writing setting out their reasons for refusal. You should then respond to this decision setting out your reasons for not accepting their decision. The next stage would be an IRP(Independant Review Panel) where the assessment and decision could be challenged. If you are turned down at that stage you can ask the SHA (Strategic Health Authority) to carry out a review of proceedure. Looking at what has already happened you probably have grounds for this already but you have to exhaust the appeal process with the PCT first. The SHA cannot examine the decision itself but look at the way it was reached and if necessary instruct the PCT to look again. If all this fails you can then go for a judicial review but I don't know how this would be done and you would probably need specialist legal advice.

One futher bit of advice do not rely on verbal communication alone make sure you put everything in writing even if it is a confirmation of what has been discussed verbally. NHS documents can and do go missing particularly when an IRP is a possibility so it as well to have copies to hand. I would also ask for a copy of all hospital and GP records. You may be asked to pay for this but it is worth it for background information.

I am unsure of what powers the hospital has to remove patients in these circumstances but I believe the proceedure is detailed in the framework document. In the old framework the NHS remained liable until process was complete but I am unsure if this was altered in the revision to the framework.

I hope this helps and good luck.

margaretclare

Just something that occurs to me: If someone is said to 'require 24 hour care', isn't this what would be called 'acute' and not suitable for any type of care home? I cannot see how a care home - a 'home' implies something different - can provide care over the 24 hours.

Errata

All residential care homes provide 24/7 care, that's their reason for existing.

monkeyspanner

Errata wrote: »

All residential care homes provide 24/7 care, that's their reason for existing.

There would be someone on duty 24/7 but many would not be staffed up 24/7 to provide care which in this case would include using a hoist to lift a patient. Most care homes now are very specific about the residents they can and cannot take.