Continuing Health Care - Preparing to fight PCT's decision

SallyG

Is this a reliable explanation of the system?
http://www.counselandcare.org.uk/category/advice/pdf/continuing-healthcare-should-the-nhs-be-paying-for-your-care-guide-27
I can't keep up with NHS reforms - do PCTs still exist/still make the decision?
Can the person denied NHS CHC apply for legal aid to pursue a case?

monkeyspanner

SallyG wrote: »

Is this a reliable explanation of the system?
http://www.counselandcare.org.uk/category/advice/pdf/continuing-healthcare-should-the-nhs-be-paying-for-your-care-guide-27
I can't keep up with NHS reforms - do PCTs still exist/still make the decision?
Can the person denied NHS CHC apply for legal aid to pursue a case?

Yes the Counsel and Care factsheet provides a good clear basic explanation and starting point. To fully understand the process I would recommend people read the National framework, DST and checklist documents. The NHS reforms in England are still under discussion and PCT's still exist in england. The Welsh, Scottish and N.Ireland systems are different.

The revised CHC system introduced in 2007 was aimed at reducing the postcode lottery involved in this funding. Whilst this has worked to an extent the rates of CHC awarded across different PCTs still vary widely. In my opinion this is because although the assessment is "standardised" by using the DST the actual decision is then open to judgement and there is no definitive level at which a DST score will mean success. Also there is a wide variation of interpretation in relation to dementia between PCTs.

I don't know about the legal aid position.

monkeyspanner

woolly_wombat wrote: »

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.

This is just terrible treatment but not unusual I fear. If hospitals treated children like this there would be an outcry, why is it seen as ok to treat the elderly and infirm like this?

realshannon

i totally agree, whilst children are in need of protection because they are vulnerable, so are our elderly and infirm - the fact that they have paid into the system and like my MIL, scrimped and saved to have a very modest home, now is a joke. those that dont work all their lives, have benefits for this that and the other, or dont own their own home (which if council or housing association is then looked after for you too) no council tax to worry about - get exactly the same care home as we are now paying nearly £2500 per month. she only recently claimed AA and would not claim anything before this. we dont mind that her money is going this way, to support her when she needs it but there should be a reform on, possibly, anything over the inheritance tax bracket, means you have to contribute and anything under, you dont. or a smaller proportion.
I feel I am being passed from pillar to post but am looking forward to the new checklist, bring it on, I actually did find a piece of paper that indicated she should have had an assessment when we thought, and it was mrked Urgent referral but the DN on the day changed this to a 2nd checklist so that needs addressing with the matron. grrrrr

realshannon

we had a new checklist done a few weeks ago now, further to our complaint to the PCT - we had a matron and another social worker. MIL was having a good day! typical, not that you dont wish her well but after months of bickering it had to be that day! anyway, the matron was as patronising as you can get, she basically disagreed with everything we said, talked to MIL all the way thro, which sounds good, but, you know, she has dementia and just thought it was great this nice lady in a uniform was talking and taking an interest in her! everything MIL said was gospel - she scored nearly all Cs and a few argued Bs but even tho while we were there she had an accident x 2 - they still wouldnt change the incontinence to a B or A - might as well have been talking to myself - husband was brill too but they had a script and stuck with it. although I quite liked the social worker, he said at the end, that he didnt have any training in mental health issues, which I thought was hilarious! how can you make an informed judgment without that - anyway, waiting for the Altheimers support group to ring and give me some support now as to be honest I am feeling overwhelmed with it all and you almost lose the point of the exercise with all the paperwork. we have asked for her attendance allowance to be reinstated as it had been suspended, we/she is now paying everything. is there anything else we can claim to help?

baz808

Echo that, Initially quoted £1500 by a solicitor to complete a health and financial LPA, there are two you can apply for. We were advised by a Dementia consultant that the Health LPA was pointless as the NHS would not want to be making the decisions on behalf of my father in law and we would be able to without it. We eventually completed the Financial LPA ourselves and then submitted to a solicitor for checking prior to sending to the OPG. The solicitor was free of charge through our employers legal scheme but you will often find you have free legal advice and help through an insurance policy etc.
For anyone reading this dont be afraid to at least have a look at the forms they are fairly straightforward to complete and you can telephone the OPG if you get stuck.

The Office of the Public Guardian website has closed and been moved to a Directgov site I tried to attached links but was unable to due to being a new user but search for 'direct.gov' and look for 'Mental Capacity and the Law' then 'What is a Lasting Power of Attorney' etc.

We are awaiting the registration of LPA but we have had confirmation that it has progressed to the statutary 6 week period to see if anyone disagrees with it so it has passed first scrutiny.

Hope these notes help someone...

madesimple

To what degree can medical testimony be ignored? Because it seems no matter what medical information or supporting information is given at the NHS CC Assessment or to the Review Panel it is ignored?

I am severely disabled as a result of MS.

My needs are quite complexand not all immediately obvious but they are to me! and other professionals, except the Nurse Assessor! who has her opinion regarding eigibility criteria (which we know to be unlawful!) Medical testimony supporting or stating that my primary need is health and that social care is secondary. GP, and Neurological Consultant. Also supported in part by physiotherapy report.

Anybody know of sample cases or other relevant information which deals with the competency of a Nurse Assessor to make a judgement which can override such testimony of say a Specialist professional such as a Neurological Consultant?

Thanks – One of the many now extremely Frustrated

Errata

madesimple wrote: »

To what degree can medical testimony be ignored? Because it seems no matter what medical information or supporting information is given at the NHS CC Assessment or to the Review Panel it is ignored?

I am severely disabled as a result of MS.

My needs are quite complexand not all immediately obvious but they are to me! and other professionals, except the Nurse Assessor! who has her opinion regarding eigibility criteria (which we know to be unlawful!) Medical testimony supporting or stating that my primary need is health and that social care is secondary. GP, and Neurological Consultant. Also supported in part by physiotherapy report.

Anybody know of sample cases or other relevant information which deals with the competency of a Nurse Assessor to make a judgement which can override such testimony of say a Specialist professional such as a Neurological Consultant?

Thanks – One of the many now extremely Frustrated

Could the MS Society help you? They may have the info you need, see here for a start http://www.mssociety.org.uk/about_ms/care_and_support/health_care_services/continuing_care.html

madesimple

I probably will try this at some stage next week. However, I am hoping for some kind of text or narrative which says that there is case law or something which means they should take account of this in accordance with. Hopefully a clear simple statement of something similar to that but because of the ad hoc nature of case law it's difficult for me to identify or find this.

Thanks

Racoulter200752

My father was taken into a rehab hospital on 12th May last year and discharged to a nursing home on 22nd June.. He was admitted twice to hopital, in August and November. He was fast tracked on Dec 12th for full payment of his fees. He died on 27th December. It has taken from last June to this week to persuade the authorities he had a primary health need which was complex and unpredictable. They have now agreed to fund him from last June.

If you are in a similar situation I recommend you have POA and get hold of all your loved one's medical notes and research their conditions on the internet. It has been the most awful time for me. Not only did I watch my father dying but I had friends who suggested that, "this was life" and I should accept the system.

Since December I have not been able to grieve. Even my husband, who is a GP, did not think I should take it so far. I have cried many tears but now someone has listened and I will now receive reimbursement of his fees.

For those of you still struggling - keep at it. However, I just can't feel I can celebrate as I am worn out by the whole situation,