Should you challenge flawed process in NHS Continuing Healthcare assessments?

Should you challenge flawed process in NHS Continuing Healthcare assessments?

Should you challenge flawed process in NHS Continuing Healthcare - mother and daughterIs it worth appealing flaws in the NHS Continuing Healthcare process?

No. 9 in our series of 27 tips on NHS Continuing Healthcare…

Yes, it’s essential to challenge flawed process in NHS Continuing Healthcare funding decisions, as these flaws could deny your relative the NHS funding they may be entitled to in law.

Many families report both CCGs and individual assessors failing to abide by the proper process when managing and carrying out assessments.

This includes cases where assessors have failed to follow the NHS Continuing Healthcare national guidelines and where they have ignored the local authority legal limit.

However…

Before you invest a lot of time challenging flawed process in NHS Continuing Healthcare, make sure you genuinely believe your relative should be found eligible. Make sure you’ve read the eligibility criteria in the NHS Continuing Healthcare guidelines yourself – and that you understand the local authority legal limit (the limit beyond which the NHS must pay for all care). That way you’ll have more clout when appealing your case.

Read more about this here: Should social workers be involved in NHS Continuing Healthcare eligibility decisions?

Tip no. 8: 3 questions to ask an NHS Continuing Healthcare assessor

Tip no. 10: How ill do you have to be to get NHS Continuing Healthcare funding?

You don’t have to fight this battle alone

Fighting a Continuing Healthcare funding battle alone can feel daunting. If you need to talk to someone about your case, read more here.

4 Comments

  1. Phil 4 months ago

    We have just reported our CCG for organisational and emotional abuse. My wife, who has had NHS Continuing Healthcare since 2009 had a review in November 2017. Despite all medical experts saying care is essential for a life-threatening condition, our CCG is trying to reduce or remove it. We have presented a huge amount of evidence that they have failed in so many ways to follow process or have literally lied, yet they continue to be in denial or refuse to answer questions to avoid admitting mistakes. We have reported four nurses to the Nursing and Midwifery Council as well as reporting specific details the the Ombudsman’s and the Information Commissioner’s Office. We just hope that other agencies can be trusted. (PS – as a headteacher in a very large primary school, I have professional knowledge of safeguarding and abuse.)

  2. Chris Bauer 5 months ago

    Could not agree more Roger. I am currently awaiting a decision on withdrawing NHS Continuing Healthcare (CHC) funding and have managed to obtain the completed Decision Support Tool (DST) bearing in mind I have not yet received the official letter from the CCG to withdraw funding. The way they change statements to read completely differently is tantamount to criminal fraud. As an example I explained at length the dementia/cognition/behavioural/trust related problems regarding dietary intake and the fact I can get my Mother to eat far, far more than the Care Home manage. I don’t have any such issues feeding her.
    The DST wording to that 10 minute discussion in the Multidisciplinary Team was simply recorded as “fluctuating appetite”.

  3. Yvonne 6 months ago

    My mother has had NHS Continuing Healthcare (CHC) for 2 years now. She has been paying half her care home fees herself. I thought and have read when you are assessed as having a primary care needs the NHS CHC is fully funded. We have been told by both Social Services and CHC that there are three different bands and that my mum is on the maximum for her condition. She has mental health problems. Mum was reassessed 3 months ago, we are still awaiting the outcome but I feel sure that she will lose her funding. I will appeal as I know she is being managed within the care home and with the help of medication. Would I be able to appeal retospectively for the half that she has funded herself for the last 2 years. She has chronic delusional disorder of a persecutory nature and onset dementia diagnosed 2 years ago after being sectioned whilst living in Spain

  4. Roger Burgess 6 months ago

    I have been advocating for many years that the ‘impartial’ co-ordinator should always remain impartial. Impartiality means exactly what it says, the word impartial is clearly defined in the English dictionary. This means that whoever the co-ordinator maybe they MUST NOT be allowed to takes sides, or have any direct input regarding an individual NHS Continuing Healthcare (CHC) status, otherwise they would not remain impartial and the whole and process becomes completely unfair, unreasonable and above all undemocratic, it also means that the assessment process is heavily weighted in favour of the CCG. Therefore the minimum requirement at an Multidisciplinary Team (MDT) meeting would have to be two individuals from different healthcare professions, or one from healthcare and one ‘from social services and in addition an ‘impartial co-ordinator, this forms the basis of a democratic process, The use of the impartial co-ordinator is repeatedly echoed in other NHS related documents. Failure to recognise the importance of any impartiality within the CHC process means that the individual undergoing the assessment is clearly at a disadvantage and far to often left to the mercy of sometimes unscrupulous and corrupt CCG / MDT members, who willfully deny would-be eligible individuals with ‘primary health needs’ the status to which they are legally entitled, this is mainly carried out to protect budgets, unfortunately at the expense of vulnerable individuals. When an individual has a primary health need which is mainly determined by their actual needs in relation to the Nature, Intensity,Complexity and Unpredictability of their care requirements and any one of these alone could indicate a “primary health need”. The NHS have a duty to award continuing healthcare to anyone who has a primary health need, it is not a discretionary option like so many NHS staff seem to believe it is. However, I firmly believe that no one can ever get a fair CHC hearing unless an impartial coordinator is assigned to their MDT meeting.

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