Independent Review Panel - Re Retrospective NHS Healthcare Funding

Discussion in 'Legal and financial issues' started by BillDe, Oct 20, 2015.

  1. BillDe

    BillDe Registered User

    Jul 20, 2015

    As a 'newbie' to the Forums, I would appreciate members experiences and comments regarding the following.

    I am in the process of gathering information to request an Independent Review Panel after it was decided that my late father did not meet the eligibility criteria for retrospective NHS Continuing Healthcare.

    BACKGROUND -My late father was diagnosed with Alzheimers. Whilst at home on his own the local authority arranged for carers and nurses to attend to his needs under the direction of Social Services. But after a while it was suggested that he go into a home with a locked door policy as he was at risk of wandering, and a risk to himself . He moved to another care home with a locked door policy in another part of the country. He repeatedly tried and succeeded in getting out of both these homes. There were instances where he physically and verbally attacked residents and care staff, and needed long term medication (administered by trained staff) to treat this behaviour. He also needed medication and assistance to control his anxiety, occasional aggressive behaviour, low moods, poor memory, and later prostate cancer, and ongoing skin treatments for eczema and other skin and scalp conditions.

    The Multidisciplinary Team stated that there was no indication of a level of intensity of need that required additional care or carers, and his unpredictability of needs did not constitute a primary health need. They concluded that although he had severe cognitive impairment and episodes physical and verbal aggression that non of these increased the overall complexity,unpredictability or intensity of his needs.

    Has anybody had the experience of successfully achieving Retrospective NHS Continuing Healthcare?
    The main areas I aim to highlight to the IRP are :

    1 ... quote the landmark "Coughlan Case" and hopefully prove his needs were more than " incidental and ancillary to accommodation ."
    2 ... disagree with many of the levels of need the MDT applied in the eleven domains in the Decision Support Tool,and the reasons why I disagree.
    3 .. how the needs in one domain impacted on another other domains were not taken into consideration.

    Your comments ,thoughts, advice would be much appreciated.

    Kind regards

  2. katek

    katek Registered User

    Jan 19, 2015
    Hi and welcome to the site

    The points you want to base your appeal on are exactly what they should be. Out of interest, what did your late father score on the DST? If it was 2 Severes, he should have got CHC anyway, as that is what the guidelines say (and is also way above Coughlan).

    However, as you say you disagree with scores in many domains, I imagine that wasn't the case. Without knowing how he scored in all 11, I think just from your brief description he should have scored Severe for Behaviour, which is the way the majority of dementia patients who manage to get CHC do so (alongside their Severe for Cognition). If he attacked other patients and care staff, surely that warrants Severe?! Otherwise, given that there is another level above Severe - Priority - I dread to think what someone would have to do to get that!!!

    So, I think your main focus would be to try to secure that second Severe, as that is the most straightforward way of getting CHC. Obviously, try to up the other domains too if you think they were underscored, but it is the top of the scale that really counts. The complexity etc arguments mainly need to be applied when someone scores less than two Severes, and are quite difficult to argue as they are hard to 'measure' as it were, but no harm in doing that as well.

    Your late father, as are many people refused CHC, is clearly well above the Coughlan Judgement level (she herself has correctly said she wouldn't score very highly on the DST)but find themselves having to go to these lengths to prove it. I wish you well, and let us know the outcome.
  3. Saffie

    Saffie Registered User

    Mar 26, 2011
    Near Southampton
    I agree that severe aggression Is a criteria for gaining CHC but was told by the CHC assessor that 'occasional attacks on staff and aggression' did not even warrant a B rating on the assessment. She said she would expect to see the attacks and aggression reported on regular and even a daily basis.
    I think too, that the other elements mentioned, such as low moods, anxiety, poor memory and severe cognitive impairment could be applied to most sufferers of dementia in nursing homes. Skin conditions too to a certain extent.

    Go for it certainly but with a certain amount of cynicism. Good luck.:)
  4. nitram

    nitram Registered User

    Apr 6, 2011
    North Manchester
  5. katek

    katek Registered User

    Jan 19, 2015
    Obviously CHC assessors say that, as they have their budgets to take into consideration, but in doing so are making people who are above the Coughlan level appear to be actually below it, thereby depriving them of what is their right by law. They should not be allowed to have the power to do that.

    You are right to say we have to be cynical, but it's so sad, isn't it, that people have to grovel in this way? It shouldn't be like that.

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