CHC funding verbally refused & no' formal' response from CCG 2 months later.

[Brodie]

hi - my father had a DST in early december 2013.

I have verbally been told by the CCG contact that he does not qualify. the SW said he should qualify in the meeting and then changed her mind outside of the meeting!! the NH think he is borderline and as there was disagreement in meeting we should definitely push for a re-assessment. last week the nurse at the NH refused to sign the report as she felt it did not reflect his needs. ( the NH told me this not the CCG contact)

Since early January I been chasing them for a formal response and copy of the report. to date nothing has come back. they have not responded to 2 emails I sent requesting this information. in my last email dated 10 February I asked the CCG team to re-assess my father because they have not followed the process as stated in the NHS national framework and the process has been totally unsatisfactory (i.e. missed 28 day deadline and still no report and explanation why he does not qualify)

so my question is - can I keep pushing them for a re-assessment on the basis that they have not followed the process even though I don't have a formal response from them?

I have the feeling that as they have not replied there is an issue (their end) with his case and this definitely needs following up... or maybe they are delaying as they know I am going to pursue a re-assessment.

any thoughts - suggestions would be greatly appreciated.


Brodie

 

[nitram]

"...there was disagreement in meeting..."

Which means that the higher level should have been chosen.

"...If, after considering all the relevant evidence, it proves difficult to decide or agree on the level, the MDT should choose the higher of the levels under consideration and record the evidence in relation to both the decision and any significant differences of opinion...."

Para 22 Page 13
DECISION SUPPORT TOOL

 

[Brodie]

hi nitram - the SW said after all the scoring was done that "my father has complex needs and he should get funding" so this was never reflected in his scores and in hindsight section 12 should have have been scored to reflect her comments and scored appropriately (as opposed to low).

I, in my ignorance of the whole process did not understand this and push hard enough. I believe we were rail roaded in the meeting because of my lack of understanding and preparation.

so should I be pushing for re-assessment on this basis of disagreement in meeting or failure to follow process (i.e. response in 28 days) or both?

 

[BeckyJan]

When I appealed a few years ago now, I appealed on the basis of the nurses not completing the forms correctly. It was classed as 'poor processing' and I would definitely use that line. The chances are then you may get a non local peer support group - in our case they were fair and very thorough (it took 5 hours to go through the form).

 

[nitram]

I like the idea of "Poor processing" - a polite way of saying 'you made a total mess of it all by not following procedures'.

It's nonsense waiting for a decision before appealing as part of your appeal is that they broke the 28 day deadline.

I'd include all your factual complaints.

You could ask the AS NHS continuing care volunteer support group for guidance, the link also includes a link to the 'Top ten tips and hints on preparing your case for NHS continuing healthcare'

 

[crazyfish]

hi - my father had a DST in early december 2013.

I have verbally been told by the CCG contact that he does not qualify. the SW said he should qualify in the meeting and then changed her mind outside of the meeting!! the NH think he is borderline and as there was disagreement in meeting we should definitely push for a re-assessment. last week the nurse at the NH refused to sign the report as she felt it did not reflect his needs. ( the NH told me this not the CCG contact)

Since early January I been chasing them for a formal response and copy of the report. to date nothing has come back. they have not responded to 2 emails I sent requesting this information. in my last email dated 10 February I asked the CCG team to re-assess my father because they have not followed the process as stated in the NHS national framework and the process has been totally unsatisfactory (i.e. missed 28 day deadline and still no report and explanation why he does not qualify)

so my question is - can I keep pushing them for a re-assessment on the basis that they have not followed the process even though I don't have a formal response from them?

I have the feeling that as they have not replied there is an issue (their end) with his case and this definitely needs following up... or maybe they are delaying as they know I am going to pursue a re-assessment.

any thoughts - suggestions would be greatly appreciated.


Brodie

Hi Brodie,
You say your dad had a DST in Dec was this a full MDT assessment or just the checklist.
If it was the full MDT assessment were you fully informed as to what this assessment entailed.
Either way you should have been informed in writing of any decision failing to do so is a contradiction to NHS guidelines.
Your dad has statutory rights as every other UK citizen has and that is to free NHS care at the point of need if he is ill or disabled.
I agree with NItram this is probably total incompetence by whoever is handling this.
If I were you I would write a strongly worded letter to the CHC co ordinator at the CCG and tell them as far as you are concerned your fathers case has been handled in a way that is causing you and your family concern.
If this situation is not remedied within a modest time frame you will be taking legal action against them on the grounds that they are in breach of their statutory obligations.
Unfortunately do not take to much heed of anything your SW says as they are not qualified or in any position to pass any judgement on any medical needs as they are simply not qualified .
They may however use their influence to try and get CHC for you dad as they don't want their council tax payers picking up the bill for your dad's care.
Download the National framework for continuing health care.
You must get up to speed with this as it is the rule book written by the DOH and to which all CCGs must abide by to the letter.
It is also the route for you to achieve funding as most frontline NHS people don't even understand it themselves.
The more you find out about this process the more angry you will become as it is a complete con by the powers that be to rob the old and sick of any remaining money they have before they pass on.
But don't give up even if you think you can't cope with all of this as well as your dad's illness.
There are many here who have been or are going through this same process and many of us have won on behalf of our loved ones.
Good luck and come back here as there are many others here who will give good advice.
Mick

 

[Saffie]

It's nonsense waiting for a decision before appealing as part of your appeal is that they broke the 28 day deadline.

I doubt whether this would hold water. My checklist assessment was at the beginning of September and I have yet to have the full asssessment.
Apart from a formal confirmation that my husband passed the checklist for assessment around Christmas time, which I already knew as the assessor had told me this at the time, I have heard nothing.
The assessor did warn me it might be some time as the CCG have been inundated with applications due to the September 2012 deadline plus the later March 2013 one.
Mine was one of the September 2012 ones though the present application is for current funding rather than retrospective.

I have little hope of obtaining either I have to say.

 

[Brodie]

well after my initial post I phoned the CCG to double check they had received my emails (which they had). they confirmed that my emails have been passed onto their 'Lead Nurse' and someone will phone me soon. not sure what that means - will have to wait and see.

the support on this site is amazing (and thank-you all for your comments) - I do feel empowered to take this on and I have a much better knowledge base now from reading other peoples posts, information links and finding out that a NHS national CHC funding framework existed!

I am actually very angry because I feel they are treating me (and ultimately my father) with zero respect and as if I am a complete idiot. I will not be bullied, rail-roaded or ignored by the CCG/NHS and will fight for what is rightly due to my father. perhaps if I also challenge this terrible process it might also help other people in the situation - or at least make my PCT think twice before doing this to someone else.

rant over.

brodie.

p.s. my father has the full MDT assessment.

 

[crazyfish]

well after my initial post I phoned the CCG to double check they had received my emails (which they had). they confirmed that my emails have been passed onto their 'Lead Nurse' and someone will phone me soon. not sure what that means - will have to wait and see.

the support on this site is amazing (and thank-you all for your comments) - I do feel empowered to take this on and I have a much better knowledge base now from reading other peoples posts, information links and finding out that a NHS national CHC funding framework existed!

I am actually very angry because I feel they are treating me (and ultimately my father) with zero respect and as if I am a complete idiot. I will not be bullied, rail-roaded or ignored by the CCG/NHS and will fight for what is rightly due to my father. perhaps if I also challenge this terrible process it might also help other people in the situation - or at least make my PCT think twice before doing this to someone else.

rant over.

brodie.

p.s. my father has the full MDT assessment.

Hi Brodie,
You are quite correct there is unfortunately no respect shown generally by the NHS when dealing with the CHC question.
Yes they will try to railroad the vulnerable and uninformed because this all boils down to one thing and thats ££££.
Why do you think you have been given very little or no guidance in this matter by those people who are supposed to be helping you.
The reason is they want an easy life and for people to roll over and accept everything they are told without question and not rock the boat.
When dealing with the NHS or the SS get EVERYTHING in writing.
Do not accept phone assurances or verbal promises.
Do not sign anything.
Do not give ANYONE any financial info.
Get LPA for health and welfare as well as finance if you haven't already.
Get a second opinion before you agree to anything you are not quite sure of.
Take everything told to you by the NHS or SS with a large pinch of salt.
Mick

 

[Cornishman]

Hi Brodie

I'm very sorry to read about your problems.

As Mick says, the NHS in the context of CHC devotes much time and effort on one particular objective: Not paying!

My mother was last assessed for CHC in August 2012 (when London Olympics were still on!).

Nothing much happened for a full year (let alone the mandated 28 days in the NHS' own framework document for CHC), and then in August 2013 the CCG at last wrote to say my mother's CHC eligibility was to be withdrawn the following month - the NHS granted CHC to my mother in 2009, by which time she had been self-funding for the previous 6 years, meaning we had to previously sell the former family home around 2004.

When we complained about lack of due process, the CCG adopted a "talk to the hand" approach, rather meanly adding that any invoices received from the care-home would just be sent on to me.

I put in a written complaint which was supposedly handled by "The NHS Complaints Manager for Southern England", who just sent it to the CHC team in the CCG and was in turn answered by the very person who had made such a hash of everything to date. Unsurprisingly, the CCG considered there was no case to answer, even alleging the NHS CHC framework document "didn't apply" to my mother.

We have an appeal date now, and I'm hopeful justice and common sense will prevail.

Probably not at all what you wanted to hear, but thought you might like to see the types of behaviour by healthcare professionals you might be up against.

It might be a long haul, but one step at a time, keep strong and I'm confident eventually, once in the right hands, these cases will succeed, even if it has to be the result of legal action. We haven't got that far yet - watch this space!

 

[Brodie]

thanks cornishman - the situation regarding your mother is just awful.

I have a feeling this is going to be a very long drawn out process. I have heard that my CCG areas is very very difficult to get funding out of.

however what really made my decision to pursue this is that I was told that other people in the same NH as my father, whose needs are not so high, are getting funding....

I am giving them 1 more week to reply to me and then I start escalating, 1st to head of continuing care, if still no response then to chief executive....

how did you get an Appeal initiated? is that through the CCG team or someone else?

I will keep an eye out for your posts - I expect there will be loads of invaluable information in them for me!

all the best with your appeal!

brodie

 

[nitram]

"...however what really made my decision to pursue this is that I was told that other people in the same NH as my father, whose needs are not so high, are getting funding..."


Do you know when these people were awarded CHC?

I know that is entirely needs based and nothing at all to do with funding so it should not make any difference when the award was made but.............?????????????

CHC is normally reviewed every year (except for fast track which has an initial 3 month review), you could ask if there have been any recent reviews. Even if they have had a review they may not yet have been told the result, there can be a long delay as in the case of Cornishman.

 

[Cornishman]

Brodie

From what I understand you haven't been formally informed of the CHC decision (ie in writing). When that happens the letter should provide clear guidance on your options to appeal and a brief description of the next stage and what you need to do if you wish to appeal.

The whole CHC assessment process is laid down in the NHS Framework Document for CHC and FNC (can't provide link because doing this from my phone, but there are links elsewhere on the Alzheimer's Society site or just Google it).

Don't forget there's lots of experience and support here and the Alzheimer's Society volunteer mentors will help if you make enquiries to have someone allocated to help you.

The NHS will on occasions "try it on" to see whether you're going to fight back, but as others have said, in the final analysis, for those with a demonstrable health need, the NHS has a STATUTORY duty to provide care (in any setting), and not the local authority.

Good luck.

 

[LYN T]

"...however what really made my decision to pursue this is that I was told that other people in the same NH as my father, whose needs are not so high, are getting funding..."


Do you know when these people were awarded CHC?

I know that is entirely needs based and nothing at all to do with funding so it should not make any difference when the award was made but.............?????????????

CHC is normally reviewed every year (except for fast track which has an initial 3 month review), you could ask if there have been any recent reviews. Even if they have had a review they may not yet have been told the result, there can be a long delay as in the case of Cornishman.

Nitram thanks for your informative post; my Husband has been awarded CHC and I have been informed that there will be a 3 month review.Does that mean he was fast tracked? It didn't go to panel it was just given after the assessment-(within one hour). Under what criteria is CHC fast tracked? Anyone know?

Take care

Lyn T

 

[crazyfish]

Nitram thanks for your informative post; my Husband has been awarded CHC and I have been informed that there will be a 3 month review.Does that mean he was fast tracked? It didn't go to panel it was just given after the assessment-(within one hour). Under what criteria is CHC fast tracked? Anyone know?

Take care

Lyn T

Hi lyn t,
No it doesn't mean that your husband was fast tracked.
As all CHC funded patients should have a 3 month review after the award.
Although this doesn't always happen.
If your husband doesn't get a review after 3months if I were you I wouldn't ask for one.
However make sure you are prepared for the review as if you have been reading Cornishmans threads they can have devastating results.
Make sure you have access to the CH notes and any GP notes if he has attended your husband since being in the Ch.
Remember a well managed need is still a need .
If the care your husband has been receiving since being in the CH were removed what would his condition be.
Don't worry too much about the review but be prepared as best you can and also talk with the CH manager about your husbands care.
Mick

 

[Egeon]

Nitram thanks for your informative post; my Husband has been awarded CHC and I have been informed that there will be a 3 month review.
Lyn T

Remember to raise a dispute if they take away the CHC funding at the review:
while "disputes are being resolved, bearing in mind the principle of ‘no unilateral withdrawal of funding’."

 

[Saffie]

Under what criteria is CHC fast tracked? Anyone know?

I couldn't swear to it Lyn, but it seems to be when someone is near the end of life.

 

[nitram]

"...Under what criteria is CHC fast tracked?..."

An 'appropriate clinician' signs

'He or she has a rapidly deteriorating condition and the condition may be entering a terminal phase. For the purposes of Fast Track eligibility this constitutes a primary health need. No other test is required.'

>>>FAST TRACK TOOL<<<

 

[LYN T]

Hi lyn t,
No it doesn't mean that your husband was fast tracked.

Mick

But his assessment didn't go to panel-it was just given after 1 hour

Thank you

Lyn T

 

[Saffie]

I think that just probably shows how definite the decision was Lyn and how highly Pete scored on the 2 most important areas of need as far as being awarded CHC funding is concerned, behaviour being one of them.

As far a we are concerned, that's the one area, of three, that Dave doesn't score highly on, the others being breathing and nutrition - even though, left to himself he would starve as he cannot even hold a beaker.