In Continuing Healthcare well-managed needs are still needs
When we’ve reviewed NHS Continuing Healthcare assessment notes for families, with a view to helping them appeal NHS decisions to deny funding, we notice many mistakes made by Continuing Healthcare assessors.
Assessment errors stem from poor interpretation of Department of Health guidelines on the part of assessors, whether out of ignorance or wilful intention to deny funding. We also hear of assessors who haven’t even read the guidelines they are supposed to be following. The result of this is that elderly people are often wrongly charged for care.
Of all the mistakes made and flawed arguments presented in Continuing Healthcare assessments there are two that stand out in particular. Today’s two-part article looks at these – and shows you what you can say in response.
Here’s the first point:
“Well-managed needs are still needs.”
This is clearly stated in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care – the official guidelines for the Continuing Care assessment process. And yet time after time we see assessment notes where the person being assessed has been wrongly scored with a low score because they are receiving care and their needs are being managed.
It is always the underlying need that should be assessed, together with the associated risks if no care were in place.
- If your relative was malnourished and dehydrated at home, but is now eating better because they are in care, their risk of malnutrition has not disappeared; it is simply being managed. An assessment should reflect the serious underlying need and risk.
- If your relative was falling a lot before going into care, and suffering injury as a result, this is a clear falls and mobility risk and should be assessed as such. The fact that a care home may be a safer environment does not negate the underlying risk and need.
- If your relative with dementia is less aggressive or confused in a care home than they were at home, the aggression and confusion should still be assessed as if no care were in place.
The same principles apply across all the health needs assessed in a Continuing Healthcare review.
In addition, it doesn’t matter whether your relative is in a residential home, nursing home or in their own home, a health need is still a health need, and a managed need is still a need – and must be assessed as such.
The National Framework (November 2012) clarifies this in full:
“NHS Continuing Healthcare may be provided in any setting (including, but not limited to, a care home, hospice or the person’s own home). Eligibility… is, therefore, not determined or influenced either by the setting where the care is provided or by the characteristics of the person who delivers the care. The decision-making rationale should not marginalise a need just because it is successfully managed: well-managed needs are still needs. Only where the successful management of a healthcare need has permanently reduced or removed an ongoing need, such that the active management of this need is reduced or no longer required, will this have a bearing on NHS Continuing Healthcare eligibility.” (page 21, paragraph 56)
It also states that:
“The reasons given for a decision on eligibility should not be based on… the fact that a need is well-managed.” (page 21, paragraph 58(f))
See also page 61, paragraph 11.1, and page 62, paragraph 11.3 of the National Framework for more about this.
What can you do?
If you come up against the argument that your relative’s needs are ‘managed’ – and that therefore they’re not eligible for funding – quote the National Framework to the assessors and remind them that they have a duty to follow their own guidelines, and a legal duty to fund all care that is beyond ‘just’ social care.
Coming up in our next article…