Continuing Health Care - Preparing to fight PCT's decision

Bakewell54

As I posted recently my mum has now passed away while we were in the 3rd year of applying for NHSCHC.
A couple of people have picked up on my opinion that using a solicitor helped our family and my recommendation of that.
Personally, I read this thread from beginning to end. I also read ALL advice available on-line.
A friend helped me as she worked in this area.
We then brought in a solicitor at an appropriate point - going to SHA - this cost £1,800 including Counsel's opinion. It saved my mum thousands.
I did nearly all the work myself.
The solicitor, barrister and our MP helped a great deal.
I don't want readers to get the wrong idea, you have to do the majority of the work yourself.
As above, the Alzheimer's Soc forum support network helped us too.
But the solicitor was good, for us anyway.

arunadasi

Thanks, Moneyspammer! I will do that. How do I find the PCT in my area?
?

monkeyspanner

arunadasi wrote: »

Thanks, Moneyspammer! I will do that. How do I find the PCT in my area?
?

Here is a list of PCTs and links hope it helps
http://www.nhs.uk/ServiceDirectories/Pages/PrimaryCareTrustListing.aspx

Also SHAs
http://www.nhs.uk/servicedirectories/pages/strategichealthauthoritylisting.aspx

If you do a web search worded something like "NHS funded healthcare team" you may get a more direct link to the appropriate team in your local PCT.

weanie

Just over a week ago, we met up with a social worker, two PCT nurses and the manager of the Residential home to complete a retrospective review to see if my mother [who sadly died on Xmas Eve] was eligible for CHC funding. At the end of the meeting, I felt dizzy with the toing froingof arguments and it was clear that they were knocking back on a lot of the domains we had thought were secure.
Apparently the MDT meeting whih agrees or disagrees with the proposal to go forward with this, decided against! Surprise surprise. It is patronising to ask for our views and then rail road the whol ething and make the decision whilst excluding us. I guess this is the process.
I am eager to appeal - but it the reports are not yet written up and so perhaps I will have a while to wait for this.
An advice regarding appeals would be very welcome.
Many thanks

monkeyspanner

weanie wrote: »

Just over a week ago, we met up with a social worker, two PCT nurses and the manager of the Residential home to complete a retrospective review to see if my mother [who sadly died on Xmas Eve] was eligible for CHC funding. At the end of the meeting, I felt dizzy with the toing froingof arguments and it was clear that they were knocking back on a lot of the domains we had thought were secure.
Apparently the MDT meeting whih agrees or disagrees with the proposal to go forward with this, decided against! Surprise surprise. It is patronising to ask for our views and then rail road the whol ething and make the decision whilst excluding us. I guess this is the process.
I am eager to appeal - but it the reports are not yet written up and so perhaps I will have a while to wait for this.
An advice regarding appeals would be very welcome.
Many thanks

This sounds all too familiar. During one of my MILs assessments we spent a lot of time discussing the meaning of words on the DST, their interpretation of english being very different from ours. The problems with these decisions is that as far as I can tell no guidelines as to what should mean a successful award based on the DST results.

When you receive the results of the decision the PCT should have set out their reasons for not awarding CHC and also provide a copy of the DST. Write to the PCT setting out why you disagree with the decision and make a request for an IRP (Independant Review Panel). In my MILs case the IRP was held at regoinal NHS officices and comprised an independant chair (ex-NHS manager I believe), a senoir nurse assessor from a different area, and a retired senior social worker. Our experience was that they were very much more open to our opinions than the DST assessors and wished to hear our views. Our position was helped I believe in that the panel had not been provided with a copy of the latest DST (neither had we) and also the results of a retrospective review carried out by a senior nurse assessor based on hospital and care home records had gone "missing". The chair of the panel was less than impressed and adjourned the first IRP in an attempt to obtain the missing information. This information was not found and the second IRP awarded CHC from the date of the last DST. We were advised that the panel did not have sufficient information to award prior to that date and that if we were unhappy with that decision we should approach the SHA for a process review. We are unsure what happened behind the scenes but shortly after the CHC manager made a decision to award retrospectively. I suspect the PCT were told if we went to the SHA that they would find errors in the assessment process.

My advice would be to gather as much evidence as you can for the IRP if you do that you will more than likely be better informed than the panel and will be able to make your case more strongly than the PCT.

woolly_wombat

I posted a while ago, just before attending a review meeting ,alongside my sister, with health professionals involved in my Mum's care. Mum suffered a very serious stroke which left her hemiplegic, incontinent and with reduced cognitive function. At that time Mum was in an 'intermediate care' hospital in the hope that she would make further progress with physio. The meeting confirmed our worst fears as regards Mum's (lack of) progress. The social worker remarked that sis and I had come 'well prepared' - our transparent folders bearing documents downloaded from the counsel and care website were clearly visible! As it happens the social worker has since been extremely helpful.

To cut a long story short, Mum has been awarded NHS continuing healthcare but it came at a price to her welfare. The aforementioned hospital turned out to be hopelessly inadequate for the level of care that she needs, and she has ended up suffering with bed sores due to inadequate nursing by untrained assistants. The ward sister admitted to us on the day she went through the assessment that she was the only trained nurse on the ward that day. She had the paperwork signed off within 10 minutes by a senior manager. We think Mum was sent to that hospital when she should have gone to a nursing home because we asked for NHS CHC - according to the ward sister, staff at the district hospital Mum had previously been in had been told by senior managers not to do any more CHC assessments.

Mum is now back in the district hospital (the only way to get her there was to send her via A&E in an ambulance - they had refused to take her back - I could hear her crying out when I walked in to A&E). She is getting much better care but she has suffered dreadfully. We are waiting for them to get their act together and send her to our chosen nursing home now.

It's all been very difficult.

realshannon

hi, update from me - have easily done the registration of enduring power of attorney via court of protection. would recommend anyone to do it yourself, solicitor quoted £500 to do. I did read it several times but it was, I found, very straightforward and logical. Now, eventually, it has taken from early this year to get to where we are now with the CHC debarcle. we have finally managed to get another checklist done. 1st was A and B scores mainly, done by the SW, DN decided to review this without telling us, so 2nd one wasnt A and Bs! we now also have medical notes, with missing parts strangely enough missing the CHC and dementia assessment done in hospital for an earlier admission last year, that we didnt know about. anyway, Tuesday we are having another checklist done by 2 new people, a Matron from the PCT and someone else from SW. any tips please? I am very keen, to get this nailed this time and wonder what people thought - we have this week off and although not much fun, it would be great to get an assessment done too, so we dont need to take yet more time off work to, what seems, entertain the system - it is all done, I am sure, to make us give up but I have already told them we wont. The matron has already said that CHC is only for people with VERY unpredictable and serious conditions. I highlighted that in one of the many documents I found on line from the NHS it states a scenario of a person who could have been my MIL - she didnt answer so think she has got the gist of me!! any thoughts or tips would be very welcome as we are now a bit anxious - thank you

monkeyspanner

realshannon wrote: »

The matron has already said that CHC is only for people with VERY unpredictable and serious conditions.

There seems to be an implicit pre-judgement on her part contained in this statement. Also how does this statement stand when the CHC National Frameworks states that a well controlled need is still a need.

I think if I was you I would start compiling a list of proceedural omissions e.g. "missing" documents so that these can be drawn to the attention of the SHA if you exhaust the PCT process.

realshannon

I have had the last batch of documents today, they werent with the hospital medical records but filed with another data protection officer, so another cheque was needed. However, the documents that one of the consultants referred to, isnt there still. Umm, smell a rat or 2! we will take it all the way, have invested so much into the process just have to and its morally not right. just as she is more settled and stable they are now saying she is just a frail old lady, when I said to the manager, she might well be frail but it is because she is managed well, it is still a health need that needs managing, she cant do it on her own, her face dropped a bit. I am not looking forward to talking about her toilet habits in front of MIL, doesnt seem right but not sure how they will manage this.

woolly_wombat

realshannon wrote: »

I have had the last batch of documents today, they werent with the hospital medical records but filed with another data protection officer, so another cheque was needed. However, the documents that one of the consultants referred to, isnt there still. Umm, smell a rat or 2! we will take it all the way, have invested so much into the process just have to and its morally not right. just as she is more settled and stable they are now saying she is just a frail old lady, when I said to the manager, she might well be frail but it is because she is managed well, it is still a health need that needs managing, she cant do it on her own, her face dropped a bit. I am not looking forward to talking about her toilet habits in front of MIL, doesnt seem right but not sure how they will manage this.

I would have no hesitation getting a solicitor involved. Bakewell54 has posted that it helped her to get a resolution.

My Mum has been in 3 different hospitals since her stroke: Hospital A's hyper-acute stroke ward (2 days), Hospital B's acute stroke ward (2 months), Hospital C intermediate care (2 months), Hospital B's medical ward (3 weeks). Hospital B's stroke ward told us to look for a nursing home, which we did, then when we asked for her to be assessed for NHS CHC they said they didn't think she would fulfil the criteria and they transferred her to Hospital C. Hospital C couldn't meet her needs but told us that Hospital B weren't allowing her to be transferred back. Hospital C assessed her for NHS CHC (the ward sister told us that Hospital B staff had been told not to assess patients for NHS CHC) then sent her back to Hospital B's A&E in an ambulance on a hard trolley which was agony for her bedsores. Hospital B is now stalling on having her transferred to a nursing home although we know there is space for her there.

They play games and it is impossible to know what their agenda is at the time. Please consider getting legal assistance.