Hello everybody , I am new here but have read several posts in the past on here to get some advice but really need a few things clarifying before I can continue the appeals process and before the deadline runs out in two weeks !!
My mum is in a residential care home for last three and a half years. She has a very long history of illnesses and conditions as well as severe dementia for last two years. So basically she is both physically and mentally a wreck
now . She is 90 this year. She is double incontinent and totally bedridden , cant sit in a chair (she had a special one she could sit in for twenty mins or so but now cant sit in that as flops forward/cant support herself sitting ) she is on a special mattress because of her immobility to prevent bedsores and has severe contractures in both legs and some in arms. She can no longer be hoisted as too painful so now has to be moved for washing purposes etc by at least two carers and a Pat slide. She cannot change position in bed at all or even shufty about slightly. She has AF ,very poor kidney function (only one working) and had severe leg and head injuries in an RTA in her sixties. She is prone to bedsores and skin tears (all well managed /kept at bay by care home). She has recently started aspirating her drinks (she is on a completely soft diet only to prevent choking) and is now under the SALT team.
Late last year there was a safeguarding issue raised i.e. one of the carers complained about another carers treatment of mum (shouting ,being stroppy with her) and although nothing came of it (carer spoken to severely but reinstated due to one word against another) it prompted the social worker involved to arrange a checklist to be done for mums care needs which she 'passed' with flying colours. The social worker also mentioned she would arrange a financial assessment as mums money gone by now (paid privately and I was meeting shortfall personally on top of mums pensions to pay her fees) SW even said later at one point (when I questioned mums scores on the DST by NHS representative) that I was in a 'win win' situation - as if to say 'Does it matter where the money comes from to fund her, you will no longer have to pay it ?' !!!!
So mums DST meeting was held with this social worker and an NHS nurse (?) rep and the care home manager/mums main carer , myself and my daughter about five months ago (hence deadline from refusal letter coming up).
Mum got a severe for cognitive , all in room agreed. She got a couple of highs and a few lows and should have been given another severe for mobility which everyone except the NHS woman was in agreement with who insisted she was only a high. SW very strongly stood her ground and said she had never had this before (where two professionals really couldnt agree in one of these assessments - so she'd obviously done a few). In the end they went out of the room to argue this one score out (is it against framework to do this, could I have insisted on being present throughout the scoring process? )They came back in unable to agree and both their scores were entered on DST.
Later when I [finally] got the full breakdown of their decision including DST (they sent me one page A4 almost standard letter first time without the DST form or scores etc)....lo and behold it said both scores (I know now this is against the framework and they should go for the higher one if cant agree).
I have since attended a three month review with a different NHS (lead nurse) lady (who is very pushy and kept trying to get me to say on phone I wanted to appeal and that this review would be an appeal ?? motive ?) and a different SW . No idea why as I get the impression from everything I read that a 3mth review should only be carried out if the subject has been refused initially or some major change in circs. or condition. The scores of this 'mystery' review were all the same as first assessment BUT the NHS lead nurse and the SW this time agreed (surprise surprise) that mum was only a high in mobility.
My main question atm is where can I find a template letter of sorts to appeal to CCG. Plus do I have to list everything or will I get a chance to present more detailed evidence at the next stage(IRP? NHS England? ) Should I just stick to the main obvious procedural impropriety above and state that had it been done correctly to framework mum would've had two severes and almost automatically qualified. If I dont go into detail about much else (and there's loads of skullduggery that I can pick out and mountains of medical history and minutes etc. ) or into every relevant detail does that mean at the next stage they will just present my appeal as it came to them (the CCG) and I will be unable to pull out more detailed ammunition? Can I present /put together a new more detailed case to the independant panel or do the CCG flag it up to them and will I be time barred from presenting any new supporting evidence?
Oh just one more thing for now, the letter I got refusing mum after the three month review opened with the line that this review was as a result of my letter disagreeing with the first decision (which is what the NHS lead nurse mentioned up post was trying very hard to get me to say on the phone). I have never sent any such letter saying any such thing and I in fact stressed to her that I did not wish to discuss this by phone and I reserved my right to decide whether to appeal within the six months allowed after the first assessment. I smell a rat and wonder if anyone else thinks that the following happened: Mum gets given two severes (or one that was and one that should've been) CCG lead nurse sees this ,knowing implications of this immediately sets about trying to justify a further non scheduled review so that this can be 'put right' with herself and a different SW who kept basically bowing to her 'superior clinical knowledge' throughout .
I am feeling very overwhelmed and like heading for the back of the settee
