CHC (Continuing Healthcare) support thread

[Dave63]

It's a minefield @spirituscorpus - and I think it's designed to be in order to wear people down.

"Let's give an opportunity for the Mental Health Team to "stabilise" the patient and then we will assess how unpredictable their behaviour is after that......"

It's completely irrelevant how 'stable' the patient is after the mental health team have intervened. It falls under the area of a managed need and a managed need is still a need. A managed need should only be assessed with a view to what would happen if the management of that need were withdrawn or reduced. It's spelt out in the National Framework guidance which they are well aware of but at times choose to ignore.

If someone is fasttracked to CHC then does that mean they have had a full assessment of their eligibility prior to the funding being put in place (and usually when they are still in hospital awaiting discharge)?

No, full assessments are not carried out for fast track. The decision for eligibility will have been made by the medical professional in charge of your mums care whilst in hospital.

However, the initial three month (and then annual) review will be carried out by the CCG's nurse assessor. As you say, the reviews primary purpose is to ensure the care plan put in place is still sufficient to meet your mums needs. Only if there is a significant change in needs should a full MDT assessment be recommended. There have been numerous reports of these reviews being used to force a full MDT as a mechanism to find the patient ineligible and stopping funding. I think both @luggy and @Palerider have experienced this and may be able to give advise on how best to prepare for the review.

 

[spirituscorpus]

It's a minefield @spirituscorpus - and I think it's designed to be in order to wear people down.


It's completely irrelevant how 'stable' the patient is after the mental health team have intervened. It falls under the area of a managed need and a managed need is still a need. A managed need should only be assessed with a view to what would happen if the management of that need were withdrawn or reduced. It's spelt out in the National Framework guidance which they are well aware of but at times choose to ignore.


No, full assessments are not carried out for fast track. The decision for eligibility will have been made by the medical professional in charge of your mums care whilst in hospital.

However, the initial three month (and then annual) review will be carried out by the CCG's nurse assessor. As you say, the reviews primary purpose is to ensure the care plan put in place is still sufficient to meet your mums needs. Only if there is a significant change in needs should a full MDT assessment be recommended. There have been numerous reports of these reviews being used to force a full MDT as a mechanism to find the patient ineligible and stopping funding. I think both @luggy and @Palerider have experienced this and may be able to give advise on how best to prepare for the review.

Thank you. I haven't been given any information as to the exact nature of the meeting.

The nursing staff at the care home refer to it as a "best interests" meeting but have said it needs to be done within 3 months of mum getting the funding hence, why I assume this is the CHC review.

What is the difference? The social worker already presented me with the DST pamphlet so I assumed that the 3 month review will be the same as a full MDT assessment

 

[luggy]

Thank you. I haven't been given any information as to the exact nature of the meeting.

The nursing staff at the care home refer to it as a "best interests" meeting but have said it needs to be done within 3 months of mum getting the funding hence, why I assume this is the CHC review.

What is the difference? The social worker already presented me with the DST pamphlet so I assumed that the 3 month review will be the same as a full MDT assessment

Hello again @spirituscorpus the 3 month 'best interests' meeting referred to by the care home nursing staff will almost certainly be the 3 monthly review following Fast Track. I expect that their terminology is not quite in line with that used by the ICB and their CHC assessors.

The 3 month review is a scaled down version of the full MDT assessment. Usually, the assessor will have the previous DST document in front of her/him and it will be annotated. However, with Fast Track, there isn't a previous DST, but just the Fast Track document completed by the recommending clinician.

In theory, this 3 month review is carried out by a CHC nurse assessor to determine whether the care package is still appropriate to meet the needs of the individual. In reality, it is a tool to trigger a full assessment with the intention of withdrawing funding - not one mention was made of the suitability of the care package at my mum's review and subsequent MDT.

If you wish to fight your mum's corner at the review, it would be wise to ask the care home for your mum's records, and that includes everything from the Care Plan, Daily Records, Food & Fluid Intake Charts, Medication Records, Behaviourial Charts etc. Check the records carefully and if you think that they contain insufficient evidence, insist that the records are more detailed - eg. if your mum has behaviourial issues and the care home are not keeping ABC charts, insist that they do. Usually, those involved in the review will be a CHC Nurse Assessor, a care home representative (nurse) and the individual concerned or their representative (you). There has to be clear evidence of a change in needs to such an extent that it may impact on eligibility - it does not mean that just because someone hasn't died within the first 3 months of a positive Fast Track decision, the individual is no longer eligible. A review cannot decide eligibility - it can only trigger a full assessment which determines whether an individual is eligible or not.

Don't be surprised if the outcome of the review is to conduct a full CHC assessment with a Multi Disciplinary Team (MDT). It will consist of the same representatives as the review, but will also include a Social Worker whose role is supposed to determine whether the individual's care needs are beyond those for which the local authority can legally take responsibility. Again, evidence will be gathered from care records, upon which the decision will be based.

The above is how it all unfolded for us. Unfortunately, I was unable to attend the initial review as I was in hospital and, of course, the assessor decided that mum's needs had changed and a full assessment subsequently took place. I think that the ICB have to conduct a full assessment within 28 days of the review. I did attend the full assessment (MDT) and I really had to argue each point very strongly with the recorded evidence I had gathered, but the outcome was that mum remained eligible. Mum may not have died within the 3 month period, but her care needs hadn't changed and she was still deteriorating, albeit no longer rapidly.

You may wish to have a look at the 'Care to be Different' website, which is often referred on this forum, and also 'Beacon CHC'.

I hope that is of some help.

 

[luggy]

My mother was fast-tracked 10 weeks ago by a hospital consultant with weeks or months to live. She is bedbound and dependent on the nursing home staff for all of her needs.

I now worry about the three-month review being discussed here. Surely, CHC reviewers could not decide that she is dying less or that her care needs are less. Would the reviewers stop funding at this stage?

@Sterlingtimes yes, it ispossible that they will try to stop the funding. Perhaps you would like to have a look at my reply to @spirituscorpus post, a little further along this thread, where I've tried to explain my own experience with the process.

 

[spirituscorpus]

Hello again @spirituscorpus the 3 month 'best interests' meeting referred to by the care home nursing staff will almost certainly be the 3 monthly review following Fast Track. I expect that their terminology is not quite in line with that used by the ICB and their CHC assessors.

The 3 month review is a scaled down version of the full MDT assessment. Usually, the assessor will have the previous DST document in front of her/him and it will be annotated. However, with Fast Track, there isn't a previous DST, but just the Fast Track document completed by the recommending clinician.

In theory, this 3 month review is carried out by a CHC nurse assessor to determine whether the care package is still appropriate to meet the needs of the individual. In reality, it is a tool to trigger a full assessment with the intention of withdrawing funding - not one mention was made of the suitability of the care package at my mum's review and subsequent MDT.

If you wish to fight your mum's corner at the review, it would be wise to ask the care home for your mum's records, and that includes everything from the Care Plan, Daily Records, Food & Fluid Intake Charts, Medication Records, Behaviourial Charts etc. Check the records carefully and if you think that they contain insufficient evidence, insist that the records are more detailed - eg. if your mum has behaviourial issues and the care home are not keeping ABC charts, insist that they do. Usually, those involved in the review will be a CHC Nurse Assessor, a care home representative (nurse) and the individual concerned or their representative (you). There has to be clear evidence of a change in needs to such an extent that it may impact on eligibility - it does not mean that just because someone hasn't died within the first 3 months of a positive Fast Track decision, the individual is no longer eligible. A review cannot decide eligibility - it can only trigger a full assessment which determines whether an individual is eligible or not.

Don't be surprised if the outcome of the review is to conduct a full CHC assessment with a Multi Disciplinary Team (MDT). It will consist of the same representatives as the review, but will also include a Social Worker whose role is supposed to determine whether the individual's care needs are beyond those for which the local authority can legally take responsibility. Again, evidence will be gathered from care records, upon which the decision will be based.

The above is how it all unfolded for us. Unfortunately, I was unable to attend the initial review as I was in hospital and, of course, the assessor decided that mum's needs had changed and a full assessment subsequently took place. I think that the ICB have to conduct a full assessment within 28 days of the review. I did attend the full assessment (MDT) and I really had to argue each point very strongly with the recorded evidence I had gathered, but the outcome was that mum remained eligible. Mum may not have died within the 3 month period, but her care needs hadn't changed and she was still deteriorating, albeit no longer rapidly.

You may wish to have a look at the 'Care to be Different' website, which is often referred on this forum, and also 'Beacon CHC'.

I hope that is of some help.

Thank you for taking the time to explain it more.

The 3 month review meeting which is pending for my mother very much sounds like it already is the full MDT assessment.

A social worker has already been assigned to my mother and has met her (for about 3 mins). This social worker even gave me a copy of the DSTG pamphlet. They have also explained that they will be prfesent at the meeting along with someone from the home and an assessor.

Is it normal for the "review" meeting to be bypassed and go straight to a full assessment?

 

[Dave63]

Is it normal for the "review" meeting to be bypassed and go straight to a full assessment?

As far as I'm aware, no.

The reviews primary purpose is to check if the care plan is still sufficient but, if there is clear evidence of a significant change in needs whether it necessitates a full MDT assessment. Skipping the review would seem (to me at least) as though they have made a predetermined judgement without any evidence which is completely not in line with the guidance.

Page 64 shows the flow chart for the review process.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1170290/National-Framework-for-NHS-Continuing-Healthcare-and-NHS-funded-Nursing-Care_July-2022-revised_corrected-July-2023.pdf

 

[spirituscorpus]

As far as I'm aware, no.

The reviews primary purpose is to check if the care plan is still sufficient but, if there is clear evidence of a significant change in needs whether it necessitates a full MDT assessment. Skipping the review would seem (to me at least) as though they have made a predetermined judgement without any evidence which is completely not in line with the guidance.

Page 64 shows the flow chart for the review process.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1170290/National-Framework-for-NHS-Continuing-Healthcare-and-NHS-funded-Nursing-Care_July-2022-revised_corrected-July-2023.pdf

Thanks Dave-yes, I've seen that flowchart before.

I'll do a bit more digging in trying to ascertain whether the actual review needs to be with the patient/family members present/informed or whether it's an internal review which then prescipitates a full assessment.

The nurses on site have told me several times that mum is due a 3 month review meeting but then the social worker appears to be describing the forthcoming meeting as a full assessment meeting

 

[luggy]

Thank you for taking the time to explain it more.

The 3 month review meeting which is pending for my mother very much sounds like it already is the full MDT assessment.

A social worker has already been assigned to my mother and has met her (for about 3 mins). This social worker even gave me a copy of the DSTG pamphlet. They have also explained that they will be prfesent at the meeting along with someone from the home and an assessor.

Is it normal for the "review" meeting to be bypassed and go straight to a full assessment?

@spirituscorpus I haven't heard of a reassessment being conducted without there having been a review beforehand. I wonder if the review has taken place without your knowledge?

I came across this advice on the Beacon CHC website, which relates to the Fast Track review & reassessment process:-

"if you are told that a reassessment is required we would suggest asking for clear rationale as to why this is the case, and for a copy of the review document identifying the reason why an assessment is required. If the ICB cannot justify the appropriateness of an assessment in line with national policy, it should not go ahead."

Unless there has been a misunderstanding, it sounds as if due process is not being followed, and if they have conducted a review without your knowledge and/or informing you of the outcome, they are not being transparent and person-centred. It may be worth asking to see the review document and see what response you get.

 

[spirituscorpus]

@spirituscorpus I haven't heard of a reassessment being conducted without there having been a review beforehand. I wonder if the review has taken place without your knowledge?

I came across this advice on the Beacon CHC website, which relates to the Fast Track review & reassessment process:-

"if you are told that a reassessment is required we would suggest asking for clear rationale as to why this is the case, and for a copy of the review document identifying the reason why an assessment is required. If the ICB cannot justify the appropriateness of an assessment in line with national policy, it should not go ahead."

Unless there has been a misunderstanding, it sounds as if due process is not being followed, and if they have conducted a review without your knowledge and/or informing you of the outcome, they are not being transparent and person-centred. It may be worth asking to see the review document and see what response you get.

Thank you. I think I will ask one of the nurses in the home and see what they say. Once the meeting has been rescheduled I will ask again for them to clarify.

I will report back here just as a record to help others if indeed due process has not been followed.

 

[Dave63]

@spirituscorpus is it worth double checking with the home that this is indeed a CHC related review/assessment meeting? I noticed you mentioned something about a best interests meeting in an earlier post and was wondering if there's been some miscommunication by the home? Also, all reviews are instigated by CHC not the care home or social worker so not something they have a hand in arranging. Just a thought.

 

[spirituscorpus]

@spirituscorpus is it worth double checking with the home that this is indeed a CHC related review/assessment meeting? I noticed you mentioned something about a best interests meeting in an earlier post and was wondering if there's been some miscommunication by the home? Also, all reviews are instigated by CHC not the care home or social worker so not something they have a hand in arranging. Just a thought.

Thanks Dave. Yes, I will speak to the nurse to clarify.

The nurses at the home mentioned a review meeting some time ago as there was some concern my mother may have to be moved due to her agitation and distress at times and that this meeting could decide what happens.

They also have pushed for the mental health team to get involved to see if medication may help make my mother more manageable for the staff.