CHC (Continuing Healthcare) support thread

[LocalResident]

Were you ultimately successful LocalResident?

My partner had a badly conducted fast track review in February this year. Complained twice to CCG, but both times they completely ignored the grounds of my complaint and gave fob-off replies. Now waiting for full MDT assessment. l am weighing up whether to extend the courtesy of informing them that I will be recording the meeting, and if so whether to do it at the meeting or in advance.

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It is good that you record the meeting. If it is possible also take along someone who can make detailed notes. The aim is to for all the info to be accurate etc. It could be eligibility is turned down because of reasonable judgements with the key indicators. In my case, for complicated reasons, the key indicators weren't the main problem. The DST document was shoddy because, to give two simple examples, dates were wrong, and I hadn't been given copies of relevant correspondence.
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Your question - was I successful? No. The appeal I made dragged on, and was no longer applicable.
My mother's condition deteriorated and she got fast tracked CHC.
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In my opinion the DST document which you receive needs to be a decent piece of work, even if eligibility isn't granted …. [and you appeal]. That's why in addition to an appeal which is made, you should make a separate complaint if the DST document contains errors etc. There is nothing preventing you highlighting errors etc. at the local review meeting [local review MEETING, not local review panel] which is part of the appeal process.

 

[LocalResident]

I hope this is not too off topic, briefly...my husband is in a care home, self funding, on end of life care. For a couple of months a wheelchair had been used to move him from bed to lounge, but, as his body has stiffened it proved too difficult to use. The care home arranged a physio assessment for a wheel chair that would support his head, and body, in a more comfortable position. It made matters worse in that I was not involved in the process because of the COVID restrictions.
The decision was made by the physio that he ‘was not eligible’ for such a chair. I assume if he had been deemed ‘eligible’ it would have opened the way for us to try and get CHC. In fact, had such a chair been thought helpful, we would have purchased, or hired, one if possible.
As it happens, he is now too ill to be moved from his bed at all. It just annoyed me that the decision looks as if it was made not in his best interests, but from a financial point of view.

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Just an idea, the GP, I think, could be asked to do a fast tracked CHC assessment if your husband's condition is so bad.

 

[Weasell]

I hope this is not too off topic, briefly...my husband is in a care home, self funding, on end of life care. For a couple of months a wheelchair had been used to move him from bed to lounge, but, as his body has stiffened it proved too difficult to use. The care home arranged a physio assessment for a wheel chair that would support his head, and body, in a more comfortable position. It made matters worse in that I was not involved in the process because of the COVID restrictions.
The decision was made by the physio that he ‘was not eligible’ for such a chair. I assume if he had been deemed ‘eligible’ it would have opened the way for us to try and get CHC. In fact, had such a chair been thought helpful, we would have purchased, or hired, one if possible.
As it happens, he is now too ill to be moved from his bed at all. It just annoyed me that the decision looks as if it was made not in his best interests, but from a financial point of view.

I am so sorry to hear your story.
when people are at end of life and don’t get everything they need it is heartbreaking.
may I take a couple of guesses as to why?
The chair that he needed would not be ‘ off the shelf’ it would be especially made.
The time delay in the order being placed and the chair arriving would be long.
Perhaps they could not guarantee the adapted chair would still fit him when it arrived?
@LocalResident, makes a very good point on the fasttrack.

 

[Amethyst59]

Thank you for these replies. I don’t think it is worth going for CHC now, as he is so very poorly. We are very, very lucky in that he has a good personal pension and his costs are well covered.
As for the second point, that an adapted or specially constructed chair may no longer be fit for purpose, is I am afraid probably spot on. I have continually made the mistake throughout his illness of underestimating how badly he is affected, and how the disease will progress. I still keep thinking, let’s solve this problem. And he is now in a place where the problems cannot be solved. Poor man.
@LocalResident @Weasell

 

[kindred]

Thank you for these replies. I don’t think it is worth going for CHC now, as he is so very poorly. We are very, very lucky in that he has a good personal pension and his costs are well covered.
As for the second point, that an adapted or specially constructed chair may no longer be fit for purpose, is I am afraid probably spot on. I have continually made the mistake throughout his illness of underestimating how badly he is affected, and how the disease will progress. I still keep thinking, let’s solve this problem. And he is now in a place where the problems cannot be solved. Poor man.
@LocalResident @Weasell

My husbands nursing home went for CHC when he was dying, and he was awarded it three days after he died. They backdated it for a month, so this was nearly five thousand towards his care.
Warmest, Geraldine

 

[ancistrus]

Helli,

Just an update on my case. I rang the chc nurse who dud our assessment over six weeks ago asking where our decision letter is considering that he told us straight away that my mum did not qualify.
His response was that the letter may not have gone out because the building may be shut due to the pandemic. He said he would ask if the letter could be emailed to me.
Not heard since.

As I mentioned before I believe that the process was flawed as the social worker failed to attend the meeting on the day so the panel was effectively the chc nurse and a trainee nurse.
Before appealing I need the decision letter so do you think it would be useful to write a complaint about the decision letter not being sent? How would you tackle this issue?

Regards

 

[Louise7]

As I mentioned before I believe that the process was flawed as the social worker failed to attend the meeting on the day so the panel was effectively the chc nurse and a trainee nurse. Before appealing I need the decision letter so do you think it would be useful to write a complaint about the decision letter not being sent? How would you tackle this issue?

If you haven't already done so, I suggest that you read through the CHC National Framework. It's a lengthy document but it explains the CHC process and the steps relating to an appeal submission. In addition to the decision letter, you should also be provided with a copy of the DST form, so make sure that you have these prior to submitting an appeal. I suggest that you make all requests regarding the decision letter via email so that you have an audit trail. With regards to whether the lack of a social worker at the MDT is grounds for appeal, the National Framework does not state that this is a 'mandatory' requirement:

Page 118: the MDT should usually include both health and social care professionals, who are knowledgeable about the individual’s health and social care needs and, where possible, have recently been involved in the assessment, treatment or care of the individual.

https://assets.publishing.service.g...rk_for_CHC_and_FNC_-_October_2018_Revised.pdf

Be prepared for a complaint to be a 'drawn out' process - we submitted a complaint almost 3 years ago and it is still ongoing.

 

[ancistrus]

Hello Louise,

Was your a complaint or an appeal?

Regards,

 

[LocalResident]

Helli,

Just an update on my case. I rang the chc nurse who dud our assessment over six weeks ago asking where our decision letter is considering that he told us straight away that my mum did not qualify.
His response was that the letter may not have gone out because the building may be shut due to the pandemic. He said he would ask if the letter could be emailed to me.
Not heard since.

As I mentioned before I believe that the process was flawed as the social worker failed to attend the meeting on the day so the panel was effectively the chc nurse and a trainee nurse.
Before appealing I need the decision letter so do you think it would be useful to write a complaint about the decision letter not being sent? How would you tackle this issue?

Regards

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Hi,
Yes make complaints. However don't mix these up with any future appeal.
You could make a formal complaint in writing about not receiving the DST.
And wait for the decision letter.
Also talk to someone in your local (independent) Health Watch Team.

 

[Louise7]

Hello Louise,
Was your a complaint or an appeal?

It was a complaint about a number of process failings.

 

[ancistrus]

It was a complaint about a number of process failings.

were you successfull in your chc application in the end?

 

[Louise7]

were you successfull in your chc application in the end?

No, but then we didn't expect mum to qualify for CHC, although she was deemed to be eligible for funded nursing care (FNC).

I was wondering what happens if we put my mum in a nursing home without the socisl worker agreeing, can we still request nursing funding care? Also shoukd the chc assessment have considered funded nursing care as well as chc or would this be assessed in a separate process? No mention was made of mum not qualifying for chc but potentially qualifying for nursing funded care.

As mentioned above, it's not a separate process. If during the CHC assessment process the MDT identify that your mum has nursing needs (requires care from a registered nurse) then they can recommend FNC. This is only paid to those who are resident in a nursing home, and is paid directly to the home, not to the individual. If the CCG agree that your mum isn't eligible for CHC but is eligible for FNC they should state this in their decision letter.

 

[Lone Wolf]

Were you ultimately successful LocalResident?

My partner had a badly conducted fast track review in February this year. Complained twice to CCG, but both times they completely ignored the grounds of my complaint and gave fob-off replies. Now waiting for full MDT assessment. l am weighing up whether to extend the courtesy of informing them that I will be recording the meeting, and if so whether to do it at the meeting or in advance.

Advice please:
Is it worth the stress and anxiety of pursuing CHC by appeal procedures if the local council will likely fund the nursing home where my partner has already been for 16 months? (Through FOI I know that the local council has funded placements at my partner's nursing home and one of those placements is ongoing.)

 

[ancistrus]

.

 

[ancistrus]

Hello again,

Here is a copy of the decision letter. It does not state nything regarding nursing care.
Should the decision letter mention nursing care?
Basically the ccg and ss reckon personal care is enough for my mum but the care home reckon she needs a nursing bed due to having to be moved at night because of the sires.

thanks

________________________________________________________________________________

Further to the Continuing Healthcare (CHC) Multi-Disciplinary Team (MDT) meeting which was undertaken on the 9th October 2020 NHS .... CCG have discussed your care needs to determine if you are eligible for NHS Continuing Healthcare funding. NHS ....CCG agrees with the Multi-Disciplinary Team’s recommendations that a primary health need was not identified as the completed Decision Support Tool (DST) did not demonstrate the level of complexity, intensity or unpredictability that is usually associated with a primary health need. NHS ....CCG carefully considered your needs and agreed that your primary needs specifically relate to assistance with activities of daily living and that you need to be maintained in a safe environment and be able to access social care provision. Therefore, based on this rationale, you are not eligible for NHS Continuing Healthcare funding. NHS .... CCG accept that the outcome may be disappointing and if you wish to discuss this in more detail, please do not hesitate to contact your Nurse Assessor, ....., in the first instance or the Complex Care Team Lead, or alternatively put your concerns in writing to the above address, within the next 6 months. In your letter you will need to outline why in your opinion, you believe the National Framework for Continuing Healthcare has not been robustly applied. NHS .... CCG will then consider through local resolution how to resolve your issues with this process. Should your needs or circumstances change in the future, please do not hesitate to contact us for further CHC funding consideration. I have enclosed a copy of the completed Decision Support Tool, which may have already been supplied to you.

 

[nitram]

However I was wondering shoukd there be a separate assessment for nursing funded care?

FNC is included in the framework
Pre-covid flow chart

https://chcfunding.files.wordpress.com/2014/03/national-framework-for-nhs-chc-flowchart.pdf

 

[LocalResident]

For poorly handled COMPLAINTS ... if the ccg an/or trust fail to deal with it, you should try and [after you've received their final response], contact the Parliamentary and Health Service Ombudsman. Be prepared for a long wait, and remember the PHS Ombudsman will require full details.
IF the complaint is to do with an appeal or the appeal process, then before contacting the PHSO ensure all the procedures set out by the ccg/trust/nhs england have been followed.

My view is, if the complaint is about the content of a DST document then it is best to deal with this separately, - even if you are going to appeal.
It is all very hard work. Good luck - with hope and prayers.

 

[Georgina63]

the social worker was supposed to be involved but on the day of the assessment her technology failed apparently. I had a hard job even getting the checklist done as the social worker was adamant there was no point doing one. We got the district nurse involved to do the checklist and when she came she said my mum should be in a nursing home....
the social worker put in a plan where two carers visit four times a day, she reckons my mum would not need a nursing home as the district nurses can sort her bed sores and carers can address her personal care needs...
The district nurses currently visiting my mum say she should be in a nursing home yet social worker says otherwise and the ccg think my mum does not qualify for chc.
What a mess

I was wondering what happens if we put my mum in a nursing home without the socisl worker agreeing, can we still request nursing funding care? Also shoukd the chc assessment have considered funded nursing care as well as chc or would this be assessed in a separate process? No mention was made of mum not qualifying for chc but potentially qualifying for nursing funded care.

A CHC Assessment should always take place first before any assessment for FNC, and yes that should have been considered on the day. With regards to the CHC Assessment, the National Framework (and the Standing Rules which underpin it) state the MDT (Multidisciplinary Team) should consist of both Health and Local Authority representatives. You should have heard the official outcome by now and you need that if you plan to appeal to the next level which is a Local Resolution Meeting. I would chase up the CCG and keep copies of all correspondence, use read receipts etc if emailing. I also recommend visiting https://www.nhschcscandal.co.uk/ where you'll find lots of helpful links, including to 'Care to be Different' to navigate through what is a completely flawed system. Gx

 

[Georgina63]

A CHC Assessment should always take place first before any assessment for FNC, and yes that should have been considered on the day. With regards to the CHC Assessment, the National Framework (and the Standing Rules which underpin it) state the MDT (Multidisciplinary Team) should consist of both Health and Local Authority representatives. You should have heard the official outcome by now and you need that if you plan to appeal to the next level which is a Local Resolution Meeting. I would chase up the CCG and keep copies of all correspondence, use read receipts etc if emailing. I also recommend visiting https://www.nhschcscandal.co.uk/ where you'll find lots of helpful links, including to 'Care to be Different' to navigate through what is a completely flawed system. Gx

Sorry - have just seen you received the letter!

 

[ancistrus]

Hi again,

Yes I did get the decision letter and the scores.

I think one issue could be that the social worker put a plan in for care at home with 4 visits a day.

However this was not working for my dad of 85yrs who has lost weight because of the stress so as a family and with my mum's agreement it was decided that a nursing home would be best.
At the time of the CHC assessment I was asked what the current arrangements were so it may be that they will argue that nursing funding is not applicable?
even if I agree with the scores given do you think I can appeal on the basis of nursing funding?