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  1. #1
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    Urgent request for info on councils' & hospitals' "right to family life" rulings

    Any information at all from TP members would be helpful - I'm up against a dreadful time limit.

    Would very much appreciate plse info on how various councils and hospitals have interpreted the "right to family life" requirements laid down by the Human Rights Act. I'm going to a local CCG / STP meeting this Tuesday (morning) at which this subject will come up.

    The CCG plans to cut CHC funding by 40% in spite of recognising the numbers of people needing CHC will increase significantly because of the ageing population (no explanation given on how they achieve that miracle!). Several of the money-saving CCG /STP plans impact on article 8 Human Rights Act "right to a family life".

    The CCG /STP proposes CHC will only be offered as residential care (ie not care at home with nursing & other support as stanleypj and others used to have for their loved ones) if the cost of care at home amounts to 10% more than the cost of residential care. The current rules are that care at home will be funded if the cost is no more than 25% greater than the cost of care at home.

    I find the documentation difficult to interpret so I'm not sure whether the CCG plans to apply the new cost restrictions above to "end of life" situations.

    The CCG will restrict CHC funding to services provided via organisations which have contracts with them. User experience with NHS /social care partnership contracted organisations to date has been often horrendous - the contracted organisations haven't had enough staff or management capability to meet their obligations.

    CHC funding won't be available for anyone who needs 24 hour support at home from a qualified nurse. There are a number of patient groups who'd be affected by that ruling according to the briefing I've seen ... but I don't know which. The Spinal Injuries and Motor Neurone groups are particularly irate about what's proposed by the CCG - perhaps people with these conditions will be affected?

    Generally, however, the "right to family life" will be most harmed by the insistence on residential care instead of care at home for an increased proportion of people awarded CHC funding. In our locality, these plans mean families may have to travel long distances to reach their loved ones. Public transport is bad and being reduced. Many family members won't be physically fit enough to travel by public transport (a one-way 4 mile journey can involve 1.5 hours travel, walking and standing at unsheltered bus stops with nowhere to sit). Many family members won't be able to afford to visit more than on an occasional basis.

    Article 8 of the Human Rights Act is a qualified right.

    Please TP members tell me how CCGs and councils known to you have interpreted this "right to a family life" for cared ones whose:-

    - health needs are challenging, making it more difficult for local services to meet those needs

    - whose families are dependent on public transport and /or suffer mobility, sensory or other health impairments making travel more difficult.

    When service users have warned the CCGs about specific problems in provision (eg services aren't at the right level for the cared for person; or place is bad quality; or unreachable) have their local CCGs listened and come to mutually satisfactory decisions on changing service provision?

    If they haven't, what has it been possible for TP members or others to do to make these bodies change their minds? Have they involved AS, press, solicitors, MPs etc to back them up?

    Does the right to family life in TP members' experience mean in practice the right of family members to visit fairly often, once a week or what?

    I'd appreciate any help TP members can offer to guide what I ask at the meeting.

    Yours hopefully ....
    Last edited by AlsoConfused; 06-08-2017 at 04:28 PM.

  2. #2
    Registered User stanleypj's Avatar
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    This is very concerning AlsoConfused. Thanks for posting it. If this goes ahead, and other areas adopt the same approach, many people will be affected. You've certainly highlighted a number of serious potential consequences.

    It will be interesting to see whether any TP members are aware of similar proposals on other areas.
    See my blog at: http://adventureswithdementia.blogspot.co.uk

    There is no 'they': Everyone is different.

  3. #3
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    It's a national review.
    A Google on CCG /STP <CGC name> should bring up detail for each CGC

    If you look at yours StsnleyPJ you will find that it's now involving DEVOMANC with a statement something like my CGC

    NHS Bury CCG will be part of the Greater Manchester Sustainability and
    Transformation Plan (STP), as part of the GM Devolution agenda, which will be
    developed using a ‘bottom-up’ approach with each Locality Plan from across the
    footprint of Greater Manchester shaping the overarching STP.



    The Bury CGC 2016/2017 operating plan is a 77 page pdf.

    I imagine they all are similar, they take a lot of reading and understanding.

    I don't know if the OP's specific concern is addressed in detail.

  4. #4
    Registered User Kevinl's Avatar
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    According to the link below
    "At least 37 CCGs put restrictions on NHS Continuing Healthcare funding
    The research, printed in the Health Service Journal, found at least 37 CCGs are restricting NHS Continuing Healthcare funding for home care. Many won’t fund care at home if it is more than a certain percentage (often 10%) above care home costs."
    Unfortunately the original source the Health Service Journal is subscription only, it may make interesting reading to see the full story.
    CHC isn't just an AZ issue many people with other conditions get it too so people with all kinds of conditions could be affected.
    I do think that how people have been treated in the past may turn out to be different to how they are treated now and in the future. A change in the rules or the interpretation of the rules by the LA means historic events may not be relevant to current LA thinking.
    K

    http://www.justcaringlegal.co.uk/res...hcare-funding/
    If you're going through hell, keep going

  5. #5
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    A change in the rules or the interpretation of the rules by the LA means historic events may not be relevant to current LA thinking
    Agreed ... but if the current / past position on CHC was very much better AND the current / past position has been supported in case law, Ombudsman reports etc then we've a very much better chance of resisting what our local CCG is up to. We may only need to resist these changes for a very few months, given the current political situation.

    So please - any info you have on what councils and the NHS currently decide on safeguarding right to family life would be VERY welcome!

  6. #6
    Registered User Kevinl's Avatar
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    Quote Originally Posted by nitram View Post
    A Google on CCG /STP <CGC name> should bring up detail for each CGC. The Bury CGC 2016/2017 operating plan is a 77 page pdf.
    I did this for my LA and it's only 9 pages of meaningless waffle, the Bury in is quite interesting though, here's an quote:
    "Benefits of the new pathway include a reduction of 40% in the number of referrals to the local Memory Assessment Service and an accompanying decrease in the time taken by the service to assess and diagnose patients..."
    A 40% reduction in referrals to the memory clinic...that'll work well...NOT.
    If we knew the area the OP is in then their LA may have something similar.
    It's long been a standard thing that an LA suggests that if you won't pay a top up they may have to move someone out of the area, I asked how that sat within Article 8 and got ignored by the social worker.
    In the earlier link I put up it says 37 LA's have admitted they're going to use the care home fee + 10% as the cut off point for care at home and quotes the example that
    "XXXXXXX CCG, for example, in Greater Manchester, says home care packages of more than eight hours a day indicate a “high level of need”. These “may be more appropriately met within a care home placement”.
    So they're making a pretty bold statement there, but that said some quote the figure of 4 visits a day and 4x30 minute visits is only 2 hours.
    K
    If you're going through hell, keep going

  7. #7
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    Strongly recommend you all look very closely at these CHC proposals amongst others. This is just one of the "goodies" from our local CCG document:-

    17.5. The CCG has a duty to ensure that all staff providing care are not subject to violence and abuse in any form. The CCG and care provider will work to ensure that positive behaviour support is reflected in an individual’s care package where necessary. However, under extreme circumstances, it may be appropriate for the CCG to remove CHC services where the situation presents a risk of danger, violence to or harassment of care staff who are delivering the package and/or all attempts of positive behaviour support have failed.

    Doesn’t take account of issues where the person’s HEALTH (eg “paranoid” dementia patients) is responsible for the BEHAVIOUR; and the individual concerned requires 1:1 support to stop him harming others and himself. Remember this is a cost-cutting exercise to cut CHC costs by 40% even though the population needing it is rising fast. Can you imagine trying to argue with the CCG that the reason your loved one lashed out is that their preferred provider isn't employing trained people, isn't providing the 1:1 care they promised to; and has ignored the pain or infection driving the patient's behaviour? All against a backdrop of the provider wanting to get rid of a troublesome resident and the CCG wanting to stop their budget going further into the red. God help us!

  8. #8
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    Would like to ask AS to investigate all these proposals locally and nationally and consider making representations to the CCGs,STPs and Sec of State for Health. Here's another goodie from our CCG:-

    16.6. Where there is a decreased need, the CCG will consider the cost effectiveness of the package to be delivered in the current care home, and may move the individual to a suitable alternative provider in accordance with this policy.

    Moving the frail elderly and those with dementia out of the surroundings which are familiar to them without good reason can stress, confuse and even kill them. How come the CCG doesn't know that .. or simply doesn't care?

  9. #9
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    Has your are got an active DAA?
    If so what is their opinion?

  10. #10
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    Sorry, don't know what a DAA is - please advise.

  11. #11
    Registered User Kevinl's Avatar
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    Quote Originally Posted by AlsoConfused View Post
    Sorry, don't know what a DAA is - please advise.
    These people I assume?
    K

    http://www.dementiaaction.org.uk/local_alliances
    If you're going through hell, keep going

  12. #12
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    Yes

  13. #13
    Registered User stanleypj's Avatar
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    Clearly this policy will lead to more people needing care home places.

    Yet we read that care homes around the the country are being closed. Maybe the 'savings' will all have to be used in an emergency care home building project!
    See my blog at: http://adventureswithdementia.blogspot.co.uk

    There is no 'they': Everyone is different.

  14. #14
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    You're right - have a look at this Our local CCG document did this research into when other CCGs would refuse home-based CHC care. It's as follows:-

    Settings of Care Policy thresholds

    Birmingham CCGs – 10%
    North Tyneside CCG – 0% threshold with a criteria in the policy that would enable decision to provide care at home
    Sheffield CCG – 0% policy makes it clear that the cost of care provided within the home
    setting should not exceed equivalent cost of care within a registered care setting
    Enfield CCG – 10% threshold
    Waltham Forest - 0% criteria of exceptionality provided
    Wirral CCG – 0% needs to be equivalent cost to residential care setting as appropriate – exceptional circumstances would be considered but does not state what these are
    Southampton CCG – they base their criteria on the number of hours – home care packages in excess of 8 hours would indicate a high level of need therefore more appropriate to be met within a residential/nursing home care setting for example and this is how they determine the appropriate setting of care.
    South Gloucestershire CCG – same as Southampton based on hours
    Wolverhampton CCG – 10% threshold in place
    Camb & P’Boro CCG – same as Southampton and Gloucestershire CCG –any requirement of excess of 8 hours will trigger settings of care
    South Warwickshire CCG – 0% clear criteria mentioned in the policy to consider home care

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