CHC: Finally after 18 months of legal quibbling...

[Palerider]

Well the requested 21 days extra has now passed and there is still no response from the regional CHC IRP. On Monday I will be looking at the next steps as clearly this is now a breach of their own guidance. Nothing on this dementia journey has been easy and frankly I am weary of services that are supposed to help people but when the cookie crumbles they just don't. No wonder people get fed up and begin to develop 'attitude' -I am beginning to see why!

 

[Dave63]

Well the requested 21 days extra has now passed and there is still no response from the regional CHC IRP. On Monday I will be looking at the next steps as clearly this is now a breach of their own guidance. Nothing on this dementia journey has been easy and frankly I am weary of services that are supposed to help people but when the cookie crumbles they just don't. No wonder people get fed up and begin to develop 'attitude' -I am beginning to see why!

We have an issue with the reimbursement period quoted in the outcome letter after mums appeal. It says Dec 2021, when it should be April 2021. The solicitors queried this six weeks ago and have had no reply despite continually chasing. We even included the written confirmation from the Chief Exec of the ICB agreeing to April 2021 should mums appeal be successful. We couldn't have made it any easier for them!!

One thing I've noticed over the past three years is that the level of management and administritive dysfunction is staggering, to the point where it's just not fit for purpose. It seems like everyone is paralysed with indecision until it's filtered through several layers of managers and then gets lost - some how.

Hope you get a response soon @Palerider

 

[Palerider]

We have an issue with the reimbursement period quoted in the outcome letter after mums appeal. It says Dec 2021, when it should be April 2021. The solicitors queried this six weeks ago and have had no reply despite continually chasing. We even included the written confirmation from the Chief Exec of the ICB agreeing to April 2021 should mums appeal be successful. We couldn't have made it any easier for them!!

One thing I've noticed over the past three years is that the level of management and administritive dysfunction is staggering, to the point where it's just not fit for purpose. It seems like everyone is paralysed with indecision until it's filtered through several layers of managers and then gets lost - some how.

Hope you get a response soon @Palerider

There have been numerous issues over lost evidence (paper work) in the last 12 months which has driven me to despair at times. This last IRP were very different and seemed to agree with me on each point raised. The local CCG representative gave very poor evidence for their reasoning and I made it clear that I did not accept the overall professional judgement of the original ICP assessors. My point is that I have cut to the main point -the professional judgement is wrong and what really eats away at me is that I know this is about budget spend and the root of all evils in the care system -money!

I agree with you @Dave63 the system is not fit for purpose and openly allows CGG representatives to display extreme bias in what they choose to say is in their professional judgement. If you weigh mums case against any legal challenge in case law she would win -but these guys like to faff and throw up smoke screens repeatedly -my advice to anyone reading this is not to give up but to push further and harder over the final 'professional judgement'

I personally think that 'professional judgement' by CCG's is a get out clause and they will downplay anyones eligibility for CHC

 

[Palerider]

Finally after over two years I am now in receipt of mums CHC IRP outcome as follows:

NHS Continuing Healthcare Independent Review Procedure

Letter from the NHS Regional Director Review Outcome

An Independent Review Panel has now considered NHS ********** ICB’s (formerly NHS **********CCG) eligibility decision for NHS Continuing Healthcare funding for ************** and has recommended that the original decision is unsound…I have accepted the Chair’s report and the recommendation that the ICB’s original decision is unsound and have asked that the ICB reconsider your case taking into account the shortcomings that have been identified by the Panel.

And..

The IRP’s application of the “incidental and ancillary” test in *********** case:

The IRP considered that, taken as a whole, the nursing or other health services required by *********** were more than incidental or ancillary to the provision of accommodation which local authority social services are under a duty to provide and were of a nature, intensity and complexity beyond which a local authority whose primary responsibility is to provide social services could be expected to provide.

The IRP’s view on the primary health need test:

Taking into consideration all of the evidence of ************* needs and the nature, intensity and complexity of those needs, the IRP concluded that she did have a primary health need.

 

[nitram]

Excellent news and a vindication of all your hard work.

Now just a matter of back dating and repayment of all fees, hope this does not turn into another marathon.

 

[GillP]

So pleased to read this. Your perseverance has been admiral, and no doubt, stressful.

There is some justice after all.

 

[Dave63]

I have accepted the Chair’s report and the recommendation that the ICB’s original decision is unsound and have asked that the ICB reconsider your case taking into account the shortcomings that have been identified by the Panel.

Either that bit is not clear or I'm being a bit dim (probably the latter ). Does it mean the ICB is only obligated to reconsider their original decision or do the IRP's findings over-rule the ICB and they have no choice now but to award CHC?

 

[Jaded'n'faded]

Finally after over two years I am now in receipt of mums CHC IRP outcome as follows:

NHS Continuing Healthcare Independent Review Procedure

Letter from the NHS Regional Director Review Outcome

An Independent Review Panel has now considered NHS ********** ICB’s (formerly NHS **********CCG) eligibility decision for NHS Continuing Healthcare funding for ************** and has recommended that the original decision is unsound…I have accepted the Chair’s report and the recommendation that the ICB’s original decision is unsound and have asked that the ICB reconsider your case taking into account the shortcomings that have been identified by the Panel.

And..

The IRP’s application of the “incidental and ancillary” test in *********** case:

The IRP considered that, taken as a whole, the nursing or other health services required by *********** were more than incidental or ancillary to the provision of accommodation which local authority social services are under a duty to provide and were of a nature, intensity and complexity beyond which a local authority whose primary responsibility is to provide social services could be expected to provide.

The IRP’s view on the primary health need test:

Taking into consideration all of the evidence of ************* needs and the nature, intensity and complexity of those needs, the IRP concluded that she did have a primary health need.

Is that a yes? Please say it's a yes!

 

[Palerider]

Either that bit is not clear or I'm being a bit dim (probably the latter ). Does it mean the ICB is only obligated to reconsider their original decision or do the IRP's findings over-rule the ICB and they have no choice now but to award CHC?

And @Jaded'n'faded ....The outcome from the IRP is a strong recommendation to the ICB that their decision was unsound based on the lengthy response the IRP have provided which includes at length discussion over why it has said their is a primary health need. The regional director has accepted the IRP's view and now sent a letter to the original local ICB to reconsider its original decision. Only in exceptional circumstances can the ICB dispute the IRP's outcome. I am not expecting the ICB to dispute the IRP's finding as there are no exceptional circumstances to my knowledge -we will know in the next two weeks otherwise there will be a third marathon as @nitram has said, but having come this far I am willing to fight again if I have to. Its not about the money, it's about the principle that there has always been a primary health need and the way how they managed this from the start by the original withdrawal of CHC funding -all very underhandedly done at the time.

Thanks @GillP its been stressful but worthwhile in persevering

 

[Elle3]

I really hope it's not too early to say Congratulations, but very well done for your perseverance, fingers crossed all the money that is owed to you/your mum is paid promptly and it's not another long drawn battle.

However, I must say it has been appalling what you have had to go through to get to this point. But I hope it gives others the confidence to keep on pushing if they feel CHC is justified.

Take care. Elle x

 

[Palerider]

Thanks everyone. I am currently sifting through the IRP outcome and figuring out how I can relay my mums case so others can get a feel for the salient features of the process and understand better how to tie the levels of need together with the four key characteristics: nature, intensity, complexity and unpredictability

 

[Helly68]

@Palerider - I appplaud your determination on this.

It is so wrong that ICBs can obscure decision making to ensure financial concerns trump health issues. I know it is more complex than that, but it is wrong. They assume that people will not dispute these decisions, whch is very cynical. As you say, the process is absolutely not fit for purpose.

Should not have to happen, but given how high the stakes are with CHC, I expect to see far more organisations appearing, to be paid by families, to officially take on and dispute CHC decisions. As if we all did not have enough to contend with given this awful disease.
I hope you hear back soon.

 

[Palerider]

Well its now over two weeks since the IRP decision and as yet have heard nothing from the ICB. Is there going to be another issue or are they dragging this out for as long as possible?

 

[Give me grace]

Watching this thread

 

[Dave63]

Is there going to be another issue or are they dragging this out for as long as possible?

Probably all of the above @Palerider

Mums LRM outcome letter stated her reimbursement would be backdated to the MDT which is not only incorrect based on the Framework guidance (it should be 28 days after receipt of the positive checklist assessment) but also ignores the agreement by the chief executive of the ICB who assured our solicitors that it would be backdated to the date of the checklist assessment. We even included a copy of his letter with the reimbursement paperwork.

There have been five requests for clarification on the reimbursement period and so far all have been ignored.

They're a law unto themselves and an absolute disgrace. Whilst I have nothing but admiration for the frontline staff the administration side is completely broken and not fit for purpose and staffed by people who are totally detached from the upset and frustration they cause.

 

[Palerider]

Probably all of the above @Palerider

Mums LRM outcome letter stated her reimbursement would be backdated to the MDT which is not only incorrect based on the Framework guidance (it should be 28 days after receipt of the positive checklist assessment) but also ignores the agreement by the chief executive of the ICB who assured our solicitors that it would be backdated to the date of the checklist assessment. We even included a copy of his letter with the reimbursement paperwork.

There have been five requests for clarification on the reimbursement period and so far all have been ignored.

They're a law unto themselves and an absolute disgrace. Whilst I have nothing but admiration for the frontline staff the administration side is completely broken and not fit for purpose and staffed by people who are totally detached from the upset and frustration they cause.

It never ceases to amaze me how much power these people have, even when they are wrong they cannot be held to account unless you have a large money pot. They have dragged this out over two years knowing full well that they agreed in principle but then downplayed my mums needs in a very short summary of why she was not eligible. The IRP summary is lengthy and even highlights learning points for the ICB to take note of. I can only assume they are grappling with the IRP's reasons as to why there is a primary health need. I think the IRP's response is well written and clearly justifies the decision that the ICB's outcome was unsound.

I hope you find resolution soon. I have informed mums legal team that once this over I will be writing to the Ombudsman about my concerns in how this was all initially conducted.

 

[Palerider]

I feel as if I should have a drum roll for this next bit. The CHC ICB have not as yet given a decision on refunding any monies and they have now also called for a further review at short notice to assess if CHC eligibility still applies the week beginning 21st August -of course there is no way on Gods green earth anyone can access the last years care records and assimilate them by next week not to mention the IRPs recent lengthy explanation as to why the original decision was unsound -so here we go again , but I am not giving up.

 

[Dave63]

I feel as if I should have a drum roll for this next bit. The CHC ICB have not as yet given a decision on refunding any monies and they have now also called for a further review at short notice to assess if CHC eligibility still applies the week beginning 21st August -of course there is no way on Gods green earth anyone can access the last years care records and assimilate them by next week not to mention the IRPs recent lengthy explanation as to why the original decision was unsound -so here we go again , but I am not giving up.

Totally understand your frustration. We're having similar issues.

Just when you think everything is sorted they just can't help themselves and start playing silly beggars again. After 2.5 years I'm no longer shocked by those who gatekeep this part of the NHS. I wonder sometimes if they go home in the evening with a big smile on their face after another successful day of obstructing and frustrating the most vunerable. I never know whether to be angry with them or to pity them.

Keep pushing that stone up the hill @Palerider we'll get there in the end

 

[Palerider]

Totally understand your frustration. We're having similar issues.

Just when you think everything is sorted they just can't help themselves and start playing silly beggars again. After 2.5 years I'm no longer shocked by those who gatekeep this part of the NHS. I wonder sometimes if they go home in the evening with a big smile on their face after another successful day of obstructing and frustrating the most vunerable. I never know whether to be angry with them or to pity them.

Keep pushing that stone up the hill @Palerider we'll get there in the end

It really is a case of 'call my bluff' -these guys know it is costly to instruct a legal team and they also know that a persons money is getting ever smaller to challenge each and every turn of events and they also know if they award a refund for the last 18 months they hope we will go away and not challenge the next review and so on and so on.

What I don't fundamentally understand and here is the bight, the clinching point is that the ICB can break the law as it stands proven by three cases and not be held to account -no one else in healthcare has that immunity, no one.

 

[Palerider]

A further drum roll......ICB review is on 20th September and yes I will be attending (give me strength). Care home documentation has been summoned so hopefully we will be ready by then🧐