Your browser isn't supported
It looks like you're using an old web browser. To get the most out of the site and to ensure guides display correctly, we suggest upgrading your browser now. Download the latest:

Welcome to the MSE Forums

We're home to a fantastic community of MoneySavers but anyone can post. Please exercise caution & report spam, illegal, offensive or libellous posts/messages: click "report" or email forumteam@.

Search
  • FIRST POST
    • monkeyspanner
    • By monkeyspanner 15th Mar 08, 1:13 PM
    • 2,119Posts
    • 1,933Thanks
    monkeyspanner
    Continuing Health Care - Preparing to fight PCT's decision
    • #1
    • 15th Mar 08, 1:13 PM
    Continuing Health Care - Preparing to fight PCT's decision 15th Mar 08 at 1:13 PM
    Long Story so I'll try to keep it short.

    My MIL (age 84) was hospitalised for 7 weeks after a fall in July 2007. The family were advised to look for a care home as in their medical opinion my MIL could not return to her sheltered accommodation due to a high risk of falls and the council's care team being unable to provide the frequency and timing of visits required to meet my MIL's revised medication regime.

    The family were not made aware that a continuing health care checklist had been performed on my MIL prior to discharge in September and in fact all of us were completely unaware of the CHC system. The checklist concluded that a full CHC assessment was not necessary in my MIL's case. Had we been made aware of this decision as we should have been we would have challenged the decision at the time.

    My MIL had at the time of discharge:
    Diabetes (type 2)
    Parkinsons Disease (meds beginning to 'wear off' requiring supplementary meds)
    Acid reflux (previous hospitalisation due to near fatal gastric bleeds in 2005)
    Cognition problems (dislocated in time and location)
    Severe short term memory loss
    Paranoia (the medical staff were trying to poison her)
    Severe Mobility problems
    Circulatory problems due to beginnings of heart failure
    Vascular Dementia

    This combination of problems requires 9 different meds to be given at 7 different times in 14 doses, timing is critical. She has been unable for some years to manage her meds and would not be able to list her medical conditions if asked.

    Shortly after discharge in September we 'caught up' with the possibility of CHC and after some weeks persuaded the CHC team to assess my MIL in December. At this time we were assured that the assessment would be carried out as though it was done at the time of her discharge and we subitted a letter in support of our application. Predictably the CHC application was declined.
    We have since discovered.
    -The assessment team and lead nurse who prepared the case for consideration by CHC panel did not take our supporting letter into account.
    -The assessment was prepared in relation to MIL's condition at the time of the assessment and no regard to her condition at the time of discharge was made.
    -There was no social services input into the assessment even though the new assessment framework says there should be.
    -The contemporanous notes of the assessment teams are routinely destroyed when the assessment is 'typed-up' by the lead nurse (who did not take part in the assessment) so there is no way of seeing what the assessors actually wrote during the assessment.
    -The assessment prepared by the lead nurse was 'altered' by the CHC panel.

    Since this application was declined we have been asking for the official appeals procedure but this either does not exist in my MIL's area or the CHC team is unwilling to provide it. We have persuaded them to do a retrospective assessment for the period from discharge to the date of the declined assessment and to submit the declined assessment for 'peer review'. This may take some time as we have been told only retrospective reviews that relate to deceased claimants are being dealt with at the moment and that some of these date back up to 8 years!

    It seems that anyone who is in a care home is automatically assumed not to have a significant medical need and that anyone who is self-funding (my MIL has modest savings from the sale of her property) goes to the bottom of the priority list.

    We have also approached the PCT and SHA to inform them we wish to appeal but cannot find out how to, and we have also tried Age Concern and Altzeimers Society.

    Thanks for reading this far.

    We would be very grateful if anyone can give us some pointers on:
    -How to progress from here.
    -Specialist legal practises who can help.
    -Where we can obtain an independant medical assessment in support of any appeal we mount.
    Last edited by monkeyspanner; 15-03-2008 at 1:30 PM. Reason: Spelling
Page 39
    • monkeyspanner
    • By monkeyspanner 29th Jul 12, 9:28 AM
    • 2,119 Posts
    • 1,933 Thanks
    monkeyspanner
    It is difficult to judge if your father should have received CHC funding. I will set out a few bits of information below to help you investigate further.

    - The first point to mention is that time limits for appealing CHC decisions were applied from April 2012. So if your father was assessed for CHC funding you could be out of time. Here is a link to the guidance notes for time limits http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_133055

    - In order to judge you will need to find out if an assessment was carried out. This in itself could prove difficult. You could approach the hospital discharge team or the local Social Services and ask.

    -If there was no assessment and you wish to follow this up you will need medical records from hospital (a charge will apply) your father's GP and the care home. You should then approach the PCT (if in England) and request a retrospective review. I think it is likely that at least in the first instance their response will be you are out of time. You will probably need to be assertive and persistent to get any reasonable response. If you draw a blank you could then approach the SHA and ask them to review if the PCT followed the proper proceedure in your fathers case.

    - Your fathers case predates the introduction of the National Framework and DST (decision support tool) in England so it will have been judged by the PCT rules in force at the time. These vary from PCT to PCT so you will need to assertain what their proceedure was.

    - For information support you could try www.counselandcare.org.uk they run a free helpline.

    I hope this helps and good luck
    Originally posted by monkeyspanner
    Sorry this is incorrect in that the new National framework and DST were introduced in October 2007 so when your father had the TIAs he should have been assessed under the new framework.
    • monday23
    • By monday23 29th Jul 12, 6:36 PM
    • 7 Posts
    • 0 Thanks
    monday23
    thanks moneyspanner.
    Thanks. I should add that I have already written to the local MP of my parent , who has forwarded my quetion to the health minister. He did reply more or less saying that there where no guidelines and it was up to the local health board but no help or advice on how to do this. When I contact the health board they don't know what I am talking about. Back to the health minister me thinks! I was just interested if anyone had actually managed to get further than this and what these local health board criteria might be. I am fully aware of the situation in England and feel very confident that they would qualify, even if they didn't at least they would have gone through a process.
    • monkeyspanner
    • By monkeyspanner 30th Jul 12, 9:56 AM
    • 2,119 Posts
    • 1,933 Thanks
    monkeyspanner
    I hope the MP can make some headway for you. I did find an article that said CHC funding was available in NI but that it was not possible to make retrospective claims. I am not sure if this is the case. Your experience sounds like England used to be prior to the National Framework. It took us 3 months to identify the correct department in the PCT (equivalent of the NI health board ). You could try one of the solicitors that specialise in this area to try to clarify what the NI rules are. If this is of interest PM me and I will send you details of one that has had some success in making CHC claims.
  • pmrita
    Question for Monkeyspanner
    Don't know where to put this question to ensure you read it !
    I am trying to find information for an elderly aunt in her 80's who lives in Liverpool. She suffers from schizophrenia, has mobility problems,uses a wheelchair if she is taken outside of the house, continence problems etc. She currently has a carer that comes in twice a day for 30 mins am & pm. My aunt lives with her daughter who sometimes has to work away from home for a couple of days a week. In the past a carer has come to the house to stay over for the night. My cousin has been informed that my aunt is entitled to only16 night covers per YEAR anything over that she will have to pay for herself. A major problem is the safety aspect of my aunt and her close neighbours,as she lives in a terraced property and because of her mental condition can turn and leave the gas on, leaving the front door open, letting people in etc. Do you know or can you advise where I can info regarding "her entitlements", have tried the Lpool website without any luck.
    My cousin/aunt is having a visit from a Social Worker on Monday to discuss her situation, she last had a visit 2 years ago for the same thing. Would be grateful for help advice or info
    Many thanks
    • monkeyspanner
    • By monkeyspanner 5th Aug 12, 8:23 PM
    • 2,119 Posts
    • 1,933 Thanks
    monkeyspanner
    Don't know where to put this question to ensure you read it !
    I am trying to find information for an elderly aunt in her 80's who lives in Liverpool. She suffers from schizophrenia, has mobility problems,uses a wheelchair if she is taken outside of the house, continence problems etc. She currently has a carer that comes in twice a day for 30 mins am & pm. My aunt lives with her daughter who sometimes has to work away from home for a couple of days a week. In the past a carer has come to the house to stay over for the night. My cousin has been informed that my aunt is entitled to only16 night covers per YEAR anything over that she will have to pay for herself. A major problem is the safety aspect of my aunt and her close neighbours,as she lives in a terraced property and because of her mental condition can turn and leave the gas on, leaving the front door open, letting people in etc. Do you know or can you advise where I can info regarding "her entitlements", have tried the Lpool website without any luck.
    My cousin/aunt is having a visit from a Social Worker on Monday to discuss her situation, she last had a visit 2 years ago for the same thing. Would be grateful for help advice or info
    Many thanks
    Originally posted by pmrita
    Your Aunt is receiving care at home. This care falls under the responsibility of the local council social services. At present there is no national standard of what the council has to provide and what the patients contribution has to be. So your cousin will need to ask the social worker what the local rules are.

    From what you have said your Aunt would score highly in a number of categories if assessed for NHS CHC funding but your cousin will need to request a CHC assessment. It is unlikely this assessment will be volunteered and your cousin will be faced with an uphill struggle to acheived funding. there are a number of things I should point out.
    - Your cousin should request a CHC assessment when she sees the social worker. It is likely that the social worker will be ill informed as to the workings of CHC funding and assessment and may say that it is not available to your Aunt and your cousin will need to be persitent.
    - CHC funding will be administered by the PCT in your Aunts area (if in England) so if the social worker is reluctant to help your Aunt will need to approach the PCT direct.
    - Whilst CHC funding is more usually provided in a formal care setting it can be provided in any setting including the patients own home,
    - In England the assessment process is formalised across all PCT's. A similar system applies in Wales with the Local Health Boards. There are no formalised national processes in Scotland or N.Ireland.
    -The English system starts with a CHC checklist. This should be weighted in the patient's favour so that all that may be eligible will then have a full assessment based on the DST (decision support tool). The DST assesses a number of areas of health.
    -Although the assesment process is formalised there are no hard and fast rules about how to decide if a patient is eligible. i.e. what scores on the DST will lead to a successful application.

    I hope this helps but if I haven't addressed your concerns please ask again.
  • pmrita
    Monkeyspanner

    Many thanks for your quick response.

    I did not realise CHC at home could be applied for schizophrenia. My aunt has had this condition probably for 40+ years which is controlled by drugs, I remember as a child my Mum had to have her sectioned into Rainhill Mental Hospital, which must have been horrendous for her.

    As a result of your advice, I was successful in obtaining CHC at home for my Mum 5 years ago. She had lung cancer and dementia, which meant for the last 2 years of her life, she could stay comfortable and "happy" in her own home until she died.

    I remember well attending a meeting with the GP, Mental Health Nurse, District Nurse, Social Services, PCT and me ! They were trying to reduce my Mums care, but because of you, we won !

    Now the next fight begins !
    • monkeyspanner
    • By monkeyspanner 7th Aug 12, 3:12 PM
    • 2,119 Posts
    • 1,933 Thanks
    monkeyspanner
    Monkeyspanner

    Many thanks for your quick response.

    I did not realise CHC at home could be applied for schizophrenia. My aunt has had this condition probably for 40+ years which is controlled by drugs, I remember as a child my Mum had to have her sectioned into Rainhill Mental Hospital, which must have been horrendous for her.

    As a result of your advice, I was successful in obtaining CHC at home for my Mum 5 years ago. She had lung cancer and dementia, which meant for the last 2 years of her life, she could stay comfortable and "happy" in her own home until she died.

    I remember well attending a meeting with the GP, Mental Health Nurse, District Nurse, Social Services, PCT and me ! They were trying to reduce my Mums care, but because of you, we won !

    Now the next fight begins !
    Originally posted by pmrita
    It is always good to hear of success. Good luck with your new fight.
  • pmrita
    29-03-2011, 9:03 PM
    MoneySaving Convert
    Monkeyspanner

    I did post a thank you at the time regarding my Mum's care, I hope you did see it

    Message of Thanks for Monkeyspanner

    I just wanted to send my heart felt thanks to you for the help advice and expertise in CHC you offered during my Mums illness. As a result of this my Mums received CHC for over 2 years whilst in her own home. In fact she only left her beloved home 18 hours before she died in Marie Curies Hospice. I take strength from the knowledge that she is no longer suffering from the horrific lung cancer and dementia which blighted her twilight years.
    RIP Mum x


    Many thanks
  • stu1960
    Reclaiming solicitors fees.
    Hi folks newbie here so please be gentle.
    My partner is currently claiming care home fees with a solicitor for her, now deceased, mother.
    Its quite complicated but seems to be based on did she need a care home or nursing care.
    This is not something we could have fought without professional help, but its costing us 30%.
    So my question is,
    If my partner is succesful can we claim back solicitors costs from nhs.
    If nhs admit they should have been paying the home fees should they not redress us for any costs involved?
    • monkeyspanner
    • By monkeyspanner 19th Aug 12, 10:59 AM
    • 2,119 Posts
    • 1,933 Thanks
    monkeyspanner
    Hi folks newbie here so please be gentle.
    My partner is currently claiming care home fees with a solicitor for her, now deceased, mother.
    Its quite complicated but seems to be based on did she need a care home or nursing care.
    This is not something we could have fought without professional help, but its costing us 30%.
    So my question is,
    If my partner is succesful can we claim back solicitors costs from nhs.
    If nhs admit they should have been paying the home fees should they not redress us for any costs involved?
    Originally posted by stu1960
    Sorry to hear of your loss. I assume your partner is making a claim on behalf of the estate.

    It sounds like your partner has agreed a conditional fee (no win no fee) arrangement with the solicitor. If successful there will be compensation and solicitors fees paid. But your partner will still be liable for the 30% arrangement as this effectively is the bonus the solicitor has agreed with you to pay them for the risk they take i.e. if they don't win the case for your partner they will not be paid for their effort. This should have been explained by the solicitor when they agreed to take the case. Your partner should however be able to claim your own out of pocket expenses related to the case. These expenses should be discussed with the solicitor if not prompted by them in due course.

    The other (more traditional) fee arrangement would be for your partner to agree to pay all fees irrespective of the result of the case this could have put your partner at risk of a solicitors bill of several 000s in the event the claim was lost or the other side would pay if the case was won (if awarded costs as well as compensation). It would then depend on the potential amount of the retrospective claim and the solicitors possible charges whether your partner considered the risk worth taking. Personally I would not risk it as solicitors fees have a habit of running away especially if the solicitor is not paying them!

    I hope my assumptions are correct and this helps.Good luck with the case.
    Last edited by monkeyspanner; 19-08-2012 at 11:03 AM. Reason: spelling
    • realshannon
    • By realshannon 20th Aug 12, 5:11 PM
    • 231 Posts
    • 109 Thanks
    realshannon
    I am trying to put my claim for CHC to rest but it is sticking in my mind - can I briefly "chuck" this on here and see what the concensus of opinion is please? IN 2010 my v elderly MIL repeatedly fell and eventually hospitalised with broken pubic rami x 2. after a very short period, we had a telephone call from the hospital to say she was being discharged. originally they said she would be going into a rehab unit but this was later retracted for whatever reason. no thorough discharge assessment was undertaken and we had asked for communication thro the family as she had dementia also and was deaf anyway so wouldnt have understood and we wanted to make sure she got the best and correct treatment. we knew nothing of CHC at this stage, like many others. we have obtained the medical notes and the assessment that was done is a joke, it clearly shows she couldnt even make a cup of tea and actually poured the boiling water over the worktop, they said she was confused with her surroundings - the long and short of it is, we couldnt send her home as it wasnt feasible or safe (another long story) and they suggested a residential home, that home couldnt cope with her behaviour and health and she was moved again to another home which coped better but still not that well and she was contstantly under the docs care - meanwhile, social workers got involved and I heard about CHC and wondered why before discharge or just after, she didnt have an assessment. after asking and asking the SW did an assessment, she scored v high but this was overuled by a district nurse as the assessment had been done with the SW on her own. they redid it and she did not score highly. we appealled, the sheet was done again, low score. MIL's health was deteriorating rapidly and we noticed she kept falling even within the home, we continued to ask for more assistance and eventually she was rushed into hospital again with internal bleeding, we then insisted before she was discharged again she had a CHC done properly. this didnt happen but they did arrange to send her to a more suitable nursing home where, when she was a little bit more stable, we had an assessment done. out of the dates suggested where everyone could attend, when we got there, only one person attended. the end of which was that he agreed she could have nursing care element. within 2 weeks she had died from internal bleeding, heart failure and dementia at 91. Now, having started a complaints procedure and got nowhere with the hospital, do I pursue that for the CHC or do I pursue a negligence case? or is it both. I feel the SW and DNs were all negligent and I still cant believe that when she was discharged from hospital so promptly that no proper assessment or care package had been put in place, regardless of going into a small residential home. we have paid for everything apart from the last nursing home, this was funded under another scheme. surely this proves the point that she needed nursing care from the beginning? I am biased of course but what does everyone else think? I want to put this to rest but it is niggling me and it isnt to do with the money. I tried Hugh James who were v helpful but they felt because we had already had several assessments albeit incorrectly done, they didnt want to get involved for a no win no fee basis - help or suggestions all gratefully received please, thank you
    • margaretclare
    • By margaretclare 20th Aug 12, 5:20 PM
    • 10,199 Posts
    • 17,270 Thanks
    margaretclare
    All I can comment on here is the fact that I had a fractured pubic ramus (the narrow bit of the pelvis that joins in front - 1 ramus, 2 rami). I tripped on a granite sett outside a petrol station, about 5 years ago now, fell backwards with a bang and that was what happened. It was extremely painful, but after 8 weeks on crutches it healed and no long-term effects. But then, I'm not 91 with dementia.

    This poor woman probably didn't understand what had happened to her and would have been in extreme pain. I used crutches to avoid weight-bearing but she probably couldn't do that, couldn't understand and couldn't co-operate.

    BTW I wasn't hospitalised - went to A&E, the fracture could be clearly-seen on X-ray. I saw a rehab person who offered me help at home, someone to come in and get me up, put me to bed etc. I'd have had to pay for it, but in fact I didn't need it. So long as I avoided weight-bearing it was painful but it was fine. But, trying to walk without crutches, that would have been extremely painful and unstable - no wonder there was repeated falling! Yes, she should have had rehab, teach her to walk using crutches, avoiding weight-bearing, but OTOH maybe it was thought that she wouldn't take all this in, couldn't learn. Impossible to say.
    Last edited by margaretclare; 20-08-2012 at 6:23 PM.
    r ic wisdom funde, r wear ic eald.
    Before I found wisdom, I became old.
    • monkeyspanner
    • By monkeyspanner 21st Aug 12, 10:12 AM
    • 2,119 Posts
    • 1,933 Thanks
    monkeyspanner
    Hi Realshannon
    Sorry to hear of the NHS shambles your late MIL had to suffer.

    I will assume your MIL was resident and received hospital care in England. (Rules for Wales Scotland and N.I. are different)

    I am not 100% sure where you are with your dealings with the local PCT. If you have not exhausted their appeals proceedure you will need to apply to their CHC assessment department for a retrospective review and IRP (independant review panel) to assess your MIL's case.

    If the PCT review process has been exhausted you can apply to the SHA (Strategic Health Authority) for a review of how the CHC process has been managed by the PCT. The SHA can only look at the way the process has been handled not the actual CHC decision. I am tempted to say that on the face of it the process has been so badly handled that you could approach the SHA in parallel with asking for an IRP. This might well be a way of applying indirect pressure on the PCT to undertake a proper retrospective review.

    I am not surprised that you have not got anywhere with the hospital complaints proceedure, their sole purpose IMHO is to block and convince people to give up rather than deal with the problem. You could go to the health ombudsman but I think you may be out of time on at least some of the care as complaints have to be referred to them within a year of the incident. Here is the link for you to raise the matter http://www.nhpct.nhs.uk/aboutus/pals/ombudsman.html

    If you want to proceed with a medical negligence case you would need to be prepared for a lengthy process of possibly several years and would need a no win no fee arrangement unless you have extreemly deep pockets.

    Incidentally one of your first points was made about rehab care. The probable reason this was not done is that under discharge processes rehab is at NHS expense.

    I hope this helps you see a way to progress.
    • realshannon
    • By realshannon 23rd Aug 12, 5:47 PM
    • 231 Posts
    • 109 Thanks
    realshannon
    i need to look at the files over the bank hols I think and make a decision as I am aware there is a deadline looming if I am going to fight on. I dont want to but feel it is so wrong that I must. She never had crutches and we got a wheelchair to get her out of the hospital, no one offered one and she wasnt offered any help anywhere, they just wanted her discharged and at home, it was us that said she couldnt possibly manage and they then said maybe a residential home would be best for a short period, but again, nothing arranged, we did all the work once they gave us names of where we could try, we had no idea where to start - she paid for everything, I so wish we had the knowledge at the time, but with an accident you just deal with what is in front of you, I had never heard of CHC - thank you for taking the time to comment, it means alot
  • Bakewell54
    Hi. Your experiences are horrendous but very familiar to me. I would urge you to just take it up today and press forward following Monkeyspanner's great advice. The PCT + SHA will have to listen and once you have begun you will no doubt have time to dot i's etc. just do it! The authorities do as MS has said, block you all the way.
    To my dying day I will have the words of the Community Matron ringing in my ears "the PCT say we must do this because you have not paid one penny towards your mother's care..." No, we didn't and I will be eternally glad that we didn't. Sometimes the admin mistakes they make can act in your favour, peversely. Such as the MDT meetings you refer to being mis-handled.
    I urge you to press on, today. The money is a matter of principle. And if you do win, go on a well earned holiday maybe. I would!
    • monkeyspanner
    • By monkeyspanner 29th Aug 12, 9:38 AM
    • 2,119 Posts
    • 1,933 Thanks
    monkeyspanner
    Retrospective CHC Reclaim Deadlines Act Now.
    If you or a relative/friend were paying own care home fees and you believe the primary care needs were medical the government has imposed deadlines to make retrospective claim for repayment of care home fees under the NHS continuing care home funding scheme.

    If you paid for care between 1 April 2004 and 31 March 2011, the deadline to start the process is 30 September 2012. Starting simply means contacting your local Primary Care Trust and asking to be assessed. There's no deadline to complete the process by.

    If the care was received between 1 April 2011 and 31 March 2012, the deadline is 31 March 2013.


    MSE have just published a guide to making a reclaim including suggested letters to the PCT. http://www.moneysavingexpert.com/family/care-home-costs-reclaiming There is also a new comments thread.
    • Savvy_Sue
    • By Savvy_Sue 29th Aug 12, 10:17 AM
    • 40,263 Posts
    • 37,702 Thanks
    Savvy_Sue
    MSE have just published a guide to making a reclaim including suggested letters to the PCT. http://www.moneysavingexpert.com/family/care-home-costs-reclaiming There is also a new comments thread.
    Originally posted by monkeyspanner
    That discussion thread is here.

    I'm going to close this thread, but make it a sticky so it's easy to find, and I'll ask the Forum Team to put a link to the article and discussion in monkeyspanner's very first post.

    Huge thanks to monkeyspanner and others who have shared their expertise in fighting these battles with us.
    Still knitting!
    Completed: TWO adult cardigans, 3 baby jumpers, 3 shawls, 1 sweat band, 3 pairs baby bootees, 2 sets of handwarmers, 1 Wise Man Knitivity figure + 1 sheep, 2 pairs socks, 3 balaclavas, multiple hats and poppies, 3 peony flowers, 4 butterflies ...
    Current projects: pink balaclava (for myself), seaman's hat, about to start another cardigan!
Welcome to our new Forum!

Our aim is to save you money quickly and easily. We hope you like it!

Forum Team Contact us

Live Stats

2,273Posts Today

7,695Users online

Martin's Twitter