CHC (Continuing Healthcare) support thread

[Sterlingtimes]

Following a series of hospitalisations, my mother is in hospital again. I have had a long meeting with a consultant, and we agreed that palliative care was essential. My mother would be discharged to a nursing home funded by the NHS.

However, some approvals are required.

With a consultant completely on side, what is the process to get things into motion?

 

[nitram]

Following a series of hospitalisations, my mother is in hospital again. I have had a long meeting with a consultant, and we agreed that palliative care was essential. My mother would be discharged to a nursing home funded by the NHS.

However, some approvals are required.

With a consultant completely on side, what is the process to get things into motion?

First see if anybody (consultant?) will sign a fast track

The individual fulfils the following criterion: They have 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.

NHS continuing healthcare fast-track pathway tool

Identify individuals who need to be fast-tracked for immediate provision of NHS continuing healthcare.

www.gov.uk

 

[Sterlingtimes]

First see if anybody (consultant?) will sign a fast track

The individual fulfils the following criterion: They have 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.

NHS continuing healthcare fast-track pathway tool

Identify individuals who need to be fast-tracked for immediate provision of NHS continuing healthcare.

www.gov.uk

Thank you so much for your fast response. I have read the appropriate Fast Track process.

I think that Fast Track fits because my mother is seriously ill and terminal. The consultant worked through the case with me and produced detailed notes. The hospital will want to free up a hospital bed. With leukaemia myself, her discharge last week left me unable to cope, even with carers, with a serious worsening of her condition: dementia, hallucinations, infection, great pain, completely immobile, on morphine, sleeping or moaning and not eating.

 

[nitram]

we agreed that palliative care was essential

Palliative care in itself does not warrant fast track.
Palliative means not treating the cause, only trying to reduce symptoms, it can go on for months.
If consultant has sent notes to GP ask them to sign.

 

[Sterlingtimes]

Palliative care in itself does not warrant fast track.
Palliative means not treating the cause, only trying to reduce symptoms, it can go on for months.
If consultant has sent notes to GP ask them to sign.

Thank you. I'm learning. For now, I'm leaving it in the consultant's hands. The next juncture will be the move from the hospital to another location. You have helped me understand the decision points.

 

[Dave63]

From what you have said it sounds like the decision for fast track has already been determined as appropriate by the appropriate clinician (in this case the consultant), may be get clarification from him/her that this is the case.

If this is the case, then I believe the process is that the consultant will complete the relevant paperwork which sets out your mums primary health needs and forward that to her local ICB. With fast track it should normally be set up fairly rapidly.

In addition to the fast track guidance @nitram has linked you to it might be worth a look through the fast track section of the CHC National Framework (page 76). The important part of that section is para 243 which states the following:

In Fast Track cases, the Standing Rules state that it is the ‘appropriate clinician’ who determines that the individual has a primary health need. The ICB must therefore decide that the individual is eligible for NHS Continuing Healthcare and should respond promptly and positively to ensure that the appropriate funding and care arrangements are in place without delay.

Simply put, what the above means is that the appropriate clinician has decided that a person has a primary health need and is eligible for funding and that the ICB should accept that decision and put it in place asap.

https://assets.publishing.service.gov.uk/media/64b0f7cdc033c100108062f9/National-Framework-for-NHS-Continuing-Healthcare-and-NHS-funded-Nursing-Care_July-2022-revised_corrected-July-2023.pdf

 

[Sterlingtimes]

From what you have said it sounds like the decision for fast track has already been determined as appropriate by the appropriate clinician (in this case the consultant), may be get clarification from him/her that this is the case.

You are very kind, Dave63, for guiding me through this. As a son, I was embarrassingly a little emotional when the consultant came to my rescue. As well as my love and concern for my mother, I felt that a huge pressure had been lifted from my shoulders. This highly experienced consultant immediately understood all aspects of the issue.

 

[nitram]

@Sterlingtimes

With fast track it should normally be set up fairly rapidly.

In my wife's case the GP telexed the fast track documents in the morning and had a telex confirmation in the afternoon (it's only recently that telex gave way to emails in the NHS.

There's a bit of background.
A consultant, with a registrar, nurse, myself, and two daughters present informed me that my wife did no have much life left, I queried fast track and the consultant said 'yes'. As the nursing home my wife was self funding in had said it would take her back there was no problem with finding a placement

Time passed and nothing happened despite me hustling the PCT (forerunner of CCG and ICB).
After three weeks I told GP the situation and he immediately applied.

I then went into attack mode with the PCT stating what had happened naming the 3 clinicians and where and when the event rook place.
The response to my email was a phone call saying CHC would be backdated 3 weeks and I would be informed by letter, which I was.

There's no harm in contacting ICB/CHC and querying if fast track has been agreed and if placement is causing the delay
.
If you search around you should be able to find contact details of the consultant's secretary and ask them if fast track has been submitted.
If NHS search does not provide secretary's contact, search on consultant and find a local private hospital where they work, then search name on hospital website which will probably give secretary details.

 

[Rayreadynow]

I think it may well go to the end of the Que.....I read there is a backlog. It is still a flawed system as I believe the ICB focuses on the written reports for its decision.

 

[Dave63]

I think it may well go to the end of the Que.....I read there is a backlog. It is still a flawed system as I believe the ICB focuses on the written reports for its decision.

There's definitely a backlog for regular CHC (not to mention the battling involved). However, the process is significantly different for Fast Track.

Where as the process for regular CHC is governed by guidelines (National Framework) which is interpreted differently by each ICB and leads to months/years of wrangling, Fast Track is governed by the NHS Standing Rules which is it's legal responsibilities and written into Parliamentary law.

Any decision about eligibility for Fast Track lies with the appropriate clinician not the ICB. Once they receive the decision from the appropriate clinician they must put funding in place without delay.

 

[Sterlingtimes]

Any decision about eligibility for Fast Track lies with the appropriate clinician not the ICB. Once they receive the decision from the appropriate clinician they must put funding in place without delay.

My wife, who was with me during the "Family Meeting" with the consultant, recalled that Fast Track was referenced. The consultant suggested that there was a further decision point beyond his. You raise my confidence that the process will progress in a timely manner.

 

[Sterlingtimes]

If my mother's Fast Track claim comes to fruition, is she required to surrender the following in full or in part:

her State Pension; or
her small teacher's pension; or
her Attendance Allowance?

 

[Dave63]

If my mother's Fast Track claim comes to fruition, is she required to surrender the following in full or in part:

her State Pension; or
her small teacher's pension; or
her Attendance Allowance?

Her pensions will not be effected in any way. She gets to keep them as she would be funded via the NHS. I believe it only affects pensions if a person is local authority funded.

Prior to getting full CHC funding my mum was in receipt of the higher rate of mobility allowance. That benefit was stopped when she became eligible for CHC. It was stopped 28 days after the initial start of CHC funding, I assume it's probably the same for AA?

 

[Dave63]

Just double checked the benefits issue and it depends on where the person is living as to whether they keep or lose a benefit, ie nursing home, residential home or own home.

The Age UK site sets out the details on page 29 of the following FAQ:

https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs20_nhs_continuing_healthcare_and_nhs-funded_nursing_care_fcs.pdf

 

[nitram]

For peace of mind check with the ICB whether or not fast track has been signed,

The individual fulfils the following criterion: They have 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.
My red

The consultant suggested that there was a further decision point beyond this.

The only decision to be made is choice of care/nursing home when funding level may come into play.

 

[Sterlingtimes]

For the purposes of Fast Track eligibility this constitutes a primary health need. No other test is required.

The only decision to be made is choice of care/nursing home when funding level may come into play.

Thank you. This gives me much relief. I also note: "The ICB should accept a Fast Track recommendation and staff should promptly action it, so that a suitable care package is in place, preferably within 48 hours."

The consultant did indicate that a decision is required beyond his, but perhaps he is just being cautious.

 

[Sterlingtimes]

https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs20_nhs_continuing_healthcare_and_nhs-funded_nursing_care_fcs.pdf

Thank you. The information in the link answers all of my questions.

 

[luggy]

If my mother's Fast Track claim comes to fruition, is she required to surrender the following in full or in part:

her State Pension; or
her small teacher's pension; or
her Attendance Allowance?

Hi @Sterlingtimes

My mum was Fast Tracked a few months ago. She's still with us, has had a review and is currently still fully funded. Pensions are not affected, but it's a requirement that DWP are informed with regards to the Attendance Allowance. I informed them by phone and was told that the information would be verified by a decision maker. I still haven't heard anything, but at least I've done my bit. The AA do take forever to act upon any updates you give them, I've found.

 

[Sterlingtimes]

Hi @Sterlingtimes

Pensions are not affected, but it's a requirement that DWP are informed with regards to the Attendance Allowance.

Thank you, luggy. I see that there is also a hospitalisation rule. I will contact the DWP. I agree AA is a slow process.

 

[Sterlingtimes]

Hi @Sterlingtimes

My mum was Fast Tracked a few months ago. She's still with us, has had a review and is currently still fully funded.

I received a call from the hospital today asking for the power of attorney, which allowed me to ask further questions. The scheme is Fast Track (although I was told, "It's more like slow track at the moment"). It is virtually certain that the application will go through, but sometimes, clarification may be sought from the consultant making the application.

This forum prepared me well for this brief meeting.

My mother did recognise me today although she quickly drifted back into sleep. I think that for the first time in two years, she is pain-free: the morphine is doing its job.

This is so much better than the social service mantra, "We will support you for up to four weeks, but we stress UP TO".