CHC (Continuing Healthcare) support thread

[nitram]

Several links in the RH pane of
http://www.wales.nhs.uk/continuingnhshealthcare

They contain detailed info on the process, I haven't got time to study them all but the second link refers to the use of the checklist used in England, I haven't dug further to find out what circumstances can lead to the use of a checklist.

3.35 In those circumstances where a checklist is employed, the NHS CHC
Checklist developed by the Department of Health in England should be
used in order to ensure that a consistent approach adopted
https://www.gov.uk/government/publi...inuing-healthcare-and-nhs-funded-nursing-care
.
3.36 In order to comply with the ethos of this Framework, the use of the
Checklist must not replace professional judgement or dialogue with the
individual and their family/representative.
3.37 When used in Wales it should be completed by at least two
practitioners, including a representative of the Local Authority. When
completing the Checklist, practitioners must be mindful not to make
premature assumptions regarding reablement and comprehensive
assessment outcomes.

http://gov.wales/docs/dhss/publications/140630section3en.pdf

 

[Timeout]

Thank you. I have written a huge email again to send to the LHB quoting all the points i disagree with, the 'well managed needs' argument etc.

Should I send it to them pr shall I sit on it until the MDT meeting and bring it all up with them then?

I don't want to give them too much information at this point. What do you think?

 

[nitram]

"I don't want to give them too much information at this point. What do you think?"

If any of the links on the web page I posted are new to you I'd study them in detail to look for a flawed process so far. If you think the process so far is flawed I'd ask for the correct process to be followed before the MDT or the MDT to be postponed.

I'd tend to hang fire on disclosing things like your argument about 'well managed need'.
You may find a reference to this in some of the links on the web page.

 

[nitram]

Section on 'well managed needs' is on P9 of

http://gov.wales/docs/dhss/publications/140630support-toolen.pdf

Third link in list.

 

[Timeout]

Thanks again,

I'm not sure they have followed the correct process to be honest.

Mum was discharged from hospital on end of life (but shes now stabilised thankfully) so we asked for a CHC assessment.

The checklist was carried out and was so far removed from the truth that we complained and asked for another one. The second one was a review, not a full checklist and again we disagree on the scores. We have been given a date for a MDT meeting in April and I understand that the checklist and review will form part of that. I'm unhappy as I can tell from the scores mum wont be eligible.

Looking at the guidance there is no mandatory requirement for a checklist to be carried out in Wales, just a full assessment. Now, do I kick up a stink and ask for another full checklist to be done? Should I say one SHOULDNT have been done? What works best in our favour? I'm feeling overwhelmed to be honest.

 

[geum123]

http://www.sfe.legal/assets/media/NHS_CONTINUING_HEALTHCARE_BOOK_MARCH_2014.pdf

This may be of use to you too, Timeout.
It is edited by Lisa Morgan, (One of the solicitors who worked together with Luke Clements.) The solicitors she works for had a lot of success in NHSCC )
She is based in Wales.

 

[Timeout]

Thank you for that, there are lots of bits of very useful information in there.

Reading the links that Nitram posted earlier I have realised that they have used the wrong checklist and there was only one practitioner there, not two as stated in the framework.

I have emailed the LHB to request that it is done again before the DST meeting and using the two practitioners as is stated.

I am making an absolute nuisance of myself to the LHB I know but I am losing patience and just want it done correctly and fairly. Even if mum is not eligible I want it done properly.

 

[Timeout]

I have seen this posted online - please can someone explain what it means by care being beyond what an LA can take responsibility for? Does anyone have an example please?

"One of the most important factors in determining whether a person is eligible for Continuing Healthcare (and this gets ignored so often) is whether their care needs are beyond those for which a local authority can legally take responsibility for. This was reinforced in the Coughlan case at the Court of Appeal. If the care needs are beyond the scope of a local authority, they are by default the responsibility of the NHS to fund. This is why it's vital that a social worker or other representative from the local authority attends a full assessment MDT meeting. If a person is found not eligible for Continuing Healthcare and yet their needs are beyond the local authority's remit, the local authority will be acting illegally in taking responsibility/means testing, and the NHS will have been wrong in its conclusion that the person is ineligible for Continuing Healthcare"

 

[stanleypj]

I'm sure the info will be of great interest Timeless. Could you say where the quote comes from?

 

[nitram]

"Could you say where the quote comes from?"

Scroll down

http://caretobedifferent.co.uk/typical-mistakes-in-nhs-continuing-healthcare-assessments-2/

I can't find any information on the extent beyond which LAs cannot lawfully provide care.

 

[stanleypj]

Thanks nitram. Presumably, the extent relates to the difference between a care need and a health need. This is not necessarily a clear-cut distinction.

 

[nitram]

Agreed, it's all about care needs v health needs but

"...whether their care needs are beyond those for which a local authority can legally take responsibility...

implies there is a legal limit which would be useful to know.

 

[tigerlady]

I am interested in this, as I feel so many people are let down by the system..I read the link and clicked on another line within this which trys to explain it a bit more.
I am in a bit of a rush so I havent studied it fully, but it seems to imply that if the social worker just nods and agrees with the others, he/she could be breaking the law

http://caretobedifferent.co.uk/nhs-continuing-healthcare-assessments-2/

quote from the link

And the social worker in NHS Continuing Healthcare assessments should play a vital role in making sure the NHS does not wrongly try to offload responsibility for nursing care to the local authority.

The social worker is not just there to make up numbers or so that the NHS can ‘tick the box’ to say that the multidisciplinary team was properly constituted. If the social worker just nods and agrees with whatever the NHS assessor says, the social worker could be leading the local authority to break the law.

 

[Timeout]

I'm sure the info will be of great interest Timeless. Could you say where the quote comes from?

Yes, it was an extract from the care to be different website.

How frustrating that it doesn't explain an example. I have no idea whether mums care needs are beyond the responsibility of the local authority? What does it mean!

 

[nitram]

"I have no idea whether mums care needs are beyond the responsibility of the local authority? What does it mean!"

The legal limit of the LA's responsibility will be hidden somewhere in an Act, maybe

http://www.legislation.gov.uk/ukpga/Geo6/11-12/29/contents

Searching Coughlan may provide the answer.

 

[Timeout]

Oh God, i opened it and closed it again very quickly! Looks scary!

Is it worth asking my social worker? She seems 'on our side' a bit more than the LA are!

 

[Timeout]

What is the difference between a healthcare need and a social care
need?

The Welsh Government published ‘Practice Guidance’ which addresses
frequently asked questions in regard to NHS CHC. The guidance defines the
difference between a healthcare and a social care need as follows4:
“Whilst there is not a legal definition of a healthcare need (in the context of
continuing NHS healthcare), in general terms it can be said that such a need
is one related to the treatment, control or prevention of a disease, illness,
injury or disability, and the care or aftercare of a person with these needs
(whether or not the tasks involved have to be carried out by a health
professional)”.

“In general terms (not a legal definition) it can be said that a social care need
is one that is focused on providing assistance with activities of daily living,
maintaining independence, social interaction...and (in some circumstances)
[finding and] accessing a care home or other supported accommodation”.

“Social care needs are directly related to the type of welfare services that
[local authorities] have a duty or power to provide. These include, but are not
limited to...practical assistance in the home; assistance with equipment and
home adaptations; visiting and sitting services; provision of meals; facilities
for occupational, social, cultural and recreational activities outside the
home...and assistance in finding accommodation (e.g. a care home)”5.
Note: “Deciding on the balance between local authority and health service
responsibilities with respect to long-term care has [also] been the subject of
key court judgments”6. These have influenced developments in NHS CHC
policies, including the introduction of a National Framework (which is covered
in sections below). There is an Appendix section at the end of this factsheet
that has additional background information on some of the legal judgements.

Found this on the Age Cymru Website

http://www.ageuk.org.uk/Global/Age-Cymru/Factsheets and information guides/FS20w.pdf?dtrk=true

How on earth can Alzheimers and all the associated problems and health needs that go with it NOT be classed as a health need - It is a disease / illness!!!

 

[stanleypj]

Timeout, I agree entirely with the sentiments expressed in your last sentence. The distinction between care needs (which arise from a disease) and health needs is an entirely artificial one. But we are never going to win that argument, in terms of CHC funding, for our loved ones. So we have to work with the system as it is. That's why we started this thread to try and help each other to have the best possible shot at CHC success.

 

[Timeout]

I know Stanley, it's so wrong. What I don't understand is if they are not following the law, or in some cases breaking it how are they allowed to get away with it?

 

[nitram]

"...how are they allowed to get away with it?"

Most people don't realise and those that do haven't got the finances to start a legal challenge on the scale of Coughlan.