Your CHC Appeals support thread

[Dave63]

Relative had 1 severe, 3 Highs and others are mainly moderate however we have challenged 3 of the moderates as being higher.

The DST guidance notes starting at para 34 states:

35. At the end of the DST, there is a summary sheet to provide an overview of the levels chosen and a summary of the individual’s needs, along with the MDT’s recommendation about eligibility or ineligibility. A clear recommendation (and decision) of eligibility for NHS Continuing Healthcare would be expected in each of the following cases:

• A level of priority needs in any one of the four domains that carry this level.
• A total of two or more incidences of identified severe needs across all care domains.

36. Where there is either:

• A severe level need combined with needs in a number of other domains or
• A number of domains with high and/or moderate needs.

It seems that the ICB and LRP have cherry picked the comments they wish to use in the Key Indicators and omitted others which would be beneficial to the case.

Throughout my dealings with the ICB I always had the impression they were applying very woolly and subjective opinions rather than objectively considering how my mums needs were impacted. It was almost as if they were trying to crowbar a predetermined narrative into the decsion making process! This did change when the solicitors got involved however.

There are also procedural issues from not following the framework but I've read that these wont be taken into account by the NHS.

That's correct. Procedural issues, whilst infuriating, do not prove a primary health need and are dealt with seperately via the complaints process.

 

[Norris]

Para 121 of the National Framework allows for skipping the checklist stage and going straight to DST so you would assume (always a dangerous thing when dealing with ICB's) that the start date of redress would be from the date of referral as opposed to receipt of a checklist? Also, if the referral was based on a previously completed checklist I agree that that should either be the start date of redress or at the least looked at retrospectively.

Slightly off topic, but it's ironic that legal fees can't be included in redress due to the ombudsmans view that the NHS has a robust complaints and appeals process which negates the need for legal representation. Then you look at cases like yours and think 'hmmm, I'm not so sure'.

That was my reading/assumption of the situation as well, that the redress start date should be from the date of the referral as a minimum. As you imply though, dangerous to assume anything when dealing with the ICB

for once I’m looking forward to the fight… as if they do go back to the previously completed checklist it then opens another door.

Social services complete another checklist prior to all of these, which had a positive outcome… but due to their maladministration, it couldn’t be sent to the ICB for processing (father in law was admitted to hospital and they hadn’t completed a mental capacity assessment and didn’t know one was needed!).

After going down their complaints process, we also have a formal acknowledgement whereby they admit that the only reason why things didn’t progress to a DST was their error.

the failed checklist was carried out as soon as the ICB could after my father in law got out of hospital.. so it will interesting to see if they go back a step further as well…

if it goes back that far great, if not it isn’t a major issue, that was getting CHC in the first place

 

[Norris]

Para 121 of the National Framework allows for skipping the checklist stage and going straight to DST so you would assume (always a dangerous thing when dealing with ICB's) that the start date of redress would be from the date of referral as opposed to receipt of a checklist? Also, if the referral was based on a previously completed checklist I agree that that should either be the start date of redress or at the least looked at retrospectively.

Slightly off topic, but it's ironic that legal fees can't be included in redress due to the ombudsmans view that the NHS has a robust complaints and appeals process which negates the need for legal representation. Then you look at cases like yours and think 'hmmm, I'm not so sure'.

I couldn’t agree more re the fact that legal can’t be claimed…. by the time you get to the appeals and complaints process you no longer trust the system and feel the need to have someone in your corner….

you Case is the perfect example of that…. You have as good a knowledge of the system as anyone on here and felt the need to go down that route yourself

 

[Norris]

@Norris, that's excellent news about your father in law.
I'm sorry to hear your own father is poorly and although he's been awarded fast track it must feel like a double edged sword.

I'm sure you're already aware but the CHC financial redress rules mean that any fees paid by your father in law should now be refunded in full from a date which is 29 days after the original checklist assessment was received by the ICB.

Just received all of the paperwork re the decision from the LRM and for once have been pleasantly surprised

the financial redress has been backdated to run from the checklist completed by social services, which the ICB originally refused to accept because social services had completed it incorrectly, i.e. the earliest possible date.

this was without us evening having to put this argument forward.. still trying to recover from the shock of not having to fight our corner on this issue

 

[Dave63]

Just received all of the paperwork re the decision from the LRM and for once have been pleasantly surprised

the financial redress has been backdated to run from the checklist completed by social services, which the ICB originally refused to accept because social services had completed it incorrectly, i.e. the earliest possible date.

this was without us evening having to put this argument forward.. still trying to recover from the shock of not having to fight our corner on this issue

Great news @Norris.
If you have any questions regarding completing the redress paperwork let me know and I'll try my best to help. In the meantime, feet up and enjoy a glass or three

 

[Norris]

Great news @Norris.
If you have any questions regarding completing the redress paperwork let me know and I'll try my best to help. In the meantime, feet up and enjoy a glass or three

I must admit we did have a celebratory drink or two

thanks for the offer of help re the redress paperwork… I’ve had a Quick Look and seems to be straight forward…. It’s the one area i should be ok with in any case, as I’m an accountant in the real world, so invoices, bank statements and all that sort of stuff is my thing

thank you and the forum generally, whether from just reading everyone else’s posts or the specific posts and advice received, in helping me to get to this stage

 

[Dave63]

I must admit we did have a celebratory drink or two

thanks for the offer of help re the redress paperwork… I’ve had a Quick Look and seems to be straight forward…. It’s the one area i should be ok with in any case, as I’m an accountant in the real world, so invoices, bank statements and all that sort of stuff is my thing

thank you and the forum generally, whether from just reading everyone else’s posts or the specific posts and advice received, in helping me to get to this stage

I had a couple of issues with the redress team which took a while to sort out. The first was the LRM outcome letter had the start date for redress from when the MDT was conducted instead of the 29 days from checklist. This was an eight month period and it amounted to about £45k, they completely refused to engage with us about the issue. Every communication was ignored and we had to raise the issue with the Parliamentary Ombudsman, that took six months to resolve which resulted in it costing them an additional six months in interest as the interest is applied up to the date of actual redress not the date of the LRM.

The second issue I had was with their calculation of interest on the redress amount. The redress period covered three years and my argument was that the calculation should be based on the RPI rate at the beginning of the period and the rate at the end. What they actually do is calculate the RPI based on the rate at the beginning and end of each year, which results in a significantly lower amount. In the end I let it go as the guidance regarding how RPI should be calculated is left open to interpretation and after nearly four years I really couldn't be bothered having another battle.

Useful info about how RPI should be calculated:

Retrospective Review Claims - Everything You Need To Know

If you have made a retrospective claim against your local Clinical and ‘won’ – ie you have been found eligible for NHS CHC...

caretobedifferent.co.uk

 

[Norris]

Thanks for the heads up

the start date for our redress is fine, the letter from the LRM has it as early as it could be

i had looked at the interest calculation and was surprised at how poorly drafted the guidance is… I’m used to dealing with the Revenue on issues like this and in those instances it is water tight what you must do, with no room for interpretation

will be interesting to see what they come back with… we are probably quite fortunate in that the period we are looking to reclaim for is almost a perfect year… so relatively short in the scheme of things… and may not be that effected by the method you highlighted above

 

[luggy]

The Local Resolution Meeting went ahead this morning. Myself, my (mum's) legal representative, a note taker and the Head of CHC (for our ICB) were present. The Head of CHC agreed with everything we had submitted as evidence to support our appeal and admitted that there had been a number of failings on their part.

Having researched the subjects of CHC, primary health needs, social care needs and late stage Alzheimer's to the nth degree during the last couple of years, I felt confident that I could present a good challenge. However, I was so grateful to have our legal representative present - she was able to think on her feet and come up with the right things to say at the drop of a hat.

We now have to wait for 4 weeks before we know the outcome. The legal rep is optimistic, but I'm more guarded. It is easier to gather and present evidence to secure a conviction for murder in a crown court before a judge, than it is to get the ICB to fund care.

Whilst we wait for the outcome of today's episode, I have another MDT to endure in 2 weeks. I'm not quite sure how that's going to pan out, given the circumstances.

Anyway, I'm going to have a break from CHC for a few days. Time for a tipple.

 

[Dave63]

However, I was so grateful to have our legal representative present - she was able to think on her feet and come up with the right things to say at the drop of a hat.

I felt the same way about our legal rep at the LRM. On questions which I would have stumbled on or not had the knowledge to answer adequately she batted them out of the park.

It is easier to gather and present evidence to secure a conviction for murder in a crown court before a judge, than it is to get the ICB to fund care.

Brilliant. Wish I'd thought of that analogy. I'm stealing it

All digits crossed for a positive outcome @luggy.

 

[helpingpeggy]

Welcome to Dementia Support Forum’s new support thread for NHS Continuing Health Care.

We are the Continuing Healthcare appeals team at Alzheimer’s Society. We are a team of 2 service coordinators supported by a group of highly knowledgeable and experienced volunteers who come with both a personal and professional understanding of Continuing Healthcare (CHC).

This new thread aims to provide carers, advocates, and people living with dementia with the tools to pursue an appeal should you wish to do so. You may seek practical and emotional support, and share your own experiences of best practices.

If you have any questions or would like more information, please comment below.

Best wishes,
Esther, Georgia, Tim and Tony

Please note:

• The team are happy to share their experiences and knowledge, but cannot provide legal advice.
• Appealing a CHC rejection is a personal decision that we cannot make for you, but we can support you to navigate the process.

We aim to respond to comments and questions within 5 working days.

Hello and thank you for your help. I contacted the relevant CHC team in early January and asked that they assess mum’s eligibility for CHC. She had recently been discharged from hospital to a care home. They acknowledge my email but I’ve heard nothing since, despite emailing them twice more. How long might it be before they contact me?

 

[Dave63]

Hello and thank you for your help. I contacted the relevant CHC team in early January and asked that they assess mum’s eligibility for CHC. She had recently been discharged from hospital to a care home. They acknowledge my email but I’ve heard nothing since, despite emailing them twice more. How long might it be before they contact me?

Are you in England, Wales, Scotland or N. Ireland?
Has a CHC checklist assessment been carried out? If not, you could ask her social worker or the nursing home staff to carry one out. If the checklist assessment results in possible eligibility for CHC then it will be forwarded to the ICB to arrange for a full CHC assessment (MDT). Once the ICB acknowledge receipt of the checklist they have 29 days (in England) to arrange a full assessment, so the clock starts ticking. It probably won't be arranged within 29 days but at least the ball is rolling.

Depending on where you are in the UK the guidelines will differ.

The Checklist Assessment - to understand your relative’s needs

A preliminary screening tool used by the NHS to help practitioners assess a basic level of need and determine whether an individual is eligible to move forward to a full assessment for NHS Continuing Healthcare Funding.

caretobedifferent.co.uk

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

 

[helpingpeggy]

Thank you very much. She’s in England, not got a social worker and is in a care home (not nursing) .

 

[luggy]

CHC Funding & Moving To Another ICB Area.

Hi Everyone. This is a hypothetical query which may become a reality in the next couple of days, so I'd really appreciate some guidance.

We live on the border of 2 counties in the east of England, which means that we're also on the boundary of 2 ICB's. Mum's having an MDT tomorrow and I fully expect that CHC will be declined again (I will be going into the meeting with a positive attitude, armed to the hilt with loads of evidence). In the event that CHC is awarded by the current ICB, what happens if I decide to move mum to a different care home which is just down the road, but within the boundary of a different ICB? Does the awarding ICB carry on with the funding, or does the new ICB take it on and, if they do, will they arrange for another MDT?

My reason for the query is because mum's current care home is likely to ask for top-up fees and I have no intention of paying them. I know that it's unlawful for care homes to ask for top-up fees, but many of them get around it by stating that the top-up fees are for the additional luxuries that constitute a lifestyle choice and have nothing to do with care and accomodation. After what I've been through this last couple of years with the CHC process, I haven't got any fuel left in the tank to fight the care home on this top-up issue. It would be simpler to just move mum.

If mum isn't awarded CHC tomorrow, I'm going to have to move her anyway because her current home also asks for proof of sufficient funds to pay for care for 2 years, which we're unable to do.

I hope that makes sense? I really wish I didn't have to be deaing with all this squit.

 

[Dave63]

Hi @luggy

My reason for the query is because mum's current care home is likely to ask for top-up fees

Have they mentioned this? If so, ask them to confirm this in writing with a breakdown of the cost for each additional 'luxury' being charged for.

My mum was paying £926 pw prior to receiving CHC funding and the home was also receiving £219 pw FNC. Her current CHC funding covers those amounts in full so the home is no worse off.

In the event that CHC is awarded by the current ICB, what happens if I decide to move mum to a different care home which is just down the road, but within the boundary of a different ICB? Does the awarding ICB carry on with the funding, or does the new ICB take it on and, if they do, will they arrange for another MDT?

The funding will continue to be paid by whoever the original awarding ICB was. There won't be any need for another full assessement (MDT) because of the move - but that may not stop them from using a three or twelve month review to move some goal posts!

Hope everything went well today.

 

[sdmhred]

ive just had a call saying that SS can not make our MDT and do I want to go ahead or postpone?

Ive chosen to postpone - I’m assuming that’s the right thing to do???

 

[luggy]

ive just had a call saying that SS can not make our MDT and do I want to go ahead or postpone?

Ive chosen to postpone - I’m assuming that’s the right thing to do???

Hi @sdmhred I think I'd be inclined to postpone too. Social Workers have an important role at the MDT to ensure that the needs of your relative do not go above the level which the Local Authority are lawfully allowed to provide, therefore placing the responsibility with the NHS. However, their influence on the decision for eligibility does tend to vary, depending on who you get on the day. I've been through 4 MDT's now and the SW's input has been variable. I attended an MDT this morning and the SW knew his stuff, had done his research on my mum and played an active part. I'll report back with how our MDT panned out in a separate thread - as is usual for us, there were complications.

 

[sdmhred]

Thanks @luggy
I asked about the role of the SW and got some waffle about self funding but how U have explained it is very clear.
Im happy to postpone as each passing weeks reveals and provides more evidence for the complexity of mum’s conditions.

 

[Dave63]

ive just had a call saying that SS can not make our MDT and do I want to go ahead or postpone?

Ive chosen to postpone - I’m assuming that’s the right thing to do???

I agree with @luggy, their usefulness is definitely variable depending on who you get. The SW at mums first MDT was gold standard, the SW at her second MDT was absolutely in the wrong job. Still, it's better to have them at the MDT for the reason luggy has mentioned regarding the LA's legal limits.

NHS Continuing Healthcare assessments | Care To Be Different

NHS Continuing Healthcare assessments – and the legal limit for local authority care. One vital question to ask the social worker in an assessment...

caretobedifferent.co.uk

 

[luggy]

Hi @luggy


Have they mentioned this? If so, ask them to confirm this in writing with a breakdown of the cost for each additional 'luxury' being charged for.

My mum was paying £926 pw prior to receiving CHC funding and the home was also receiving £219 pw FNC. Her current CHC funding covers those amounts in full so the home is no worse off.


The funding will continue to be paid by whoever the original awarding ICB was. There won't be any need for another full assessement (MDT) because of the move - but that may not stop them from using a three or twelve month review to move some goal posts!

Hope everything went well today.

Thanks @Dave63 as it turns out, everything is on hold, but your advice is much appreciated.