9 insights to help you with NHS Continuing Healthcare
One of our readers, Nick, wrote to us about NHS Continuing Healthcare: he shares his 9 practical tips – to help other families going through the nightmare Continuing Healthcare application process.
Nick’s case involved his father. (Nick’s name has been changed for reasons of confidentiality.)
His father’s cognition had been gradually deteriorating over the last year or so, but then took a sharp turn for the worse. His father’s behaviour then became extremely challenging, posing a serious risk to both himself and others.
His father has sadly now died, but Nick has kindly shared his tips and advice here, based on his own personal experience trying to make sense of the Continuing Healthcare application process.
NHS Continuing Healthcare: 9 practical tips
1. One of the things I’d like to reinforce is the issue of being dispassionate during the Continuing Healthcare application process – and in care situations in general. It is difficult and yet important. When I say dispassionate, I means towards your parent/relative and their suffering in order to be able to ‘hold the line’ with the authorities. We should have delayed my father’s discharge from the mental hospital into the care home. This happened straight after he had started on antipsychotic drugs, but no time had been given to see how he would react to them. Once we were out of the NHS system we had little or no leverage. I also noticed I felt guilty about ‘bed blocking’ and yet also had the feeling of David trying to hold the line with Goliath.
2. The level of manipulative behaviour and downright lying on the part of NHS staff to try to avoid NHS accountability for my father’s care was shocking, so be prepared for this.
3. I don’t think there is a substitute for reading from cover to cover the National Framework for NHS Continuing Healthcare as well as the Checklist and Decision Support Tool documents. Although it was painful for me to have read all that stuff, I was able to highlight what I considered to be relevant sections. I stapled in tabs on the various pages I’d highlighted and even labelled those tabs with a note about what a particular paragraph was about. I then always carried these documents in a file. Every time I saw Dad I had it with me, with the expectation that if I needed to ‘educate’ somebody about the process I could just pull out the documentation and show them. This had the impact of lessening my anxiety going in to see Dad because I felt better armed should I be approached. It also enabled me to evidence my position rather than being for the most part in a situation where I would say one thing and the NHS staff another – which meant nothing would happen.
4. There is a quick reference guide to the National Framework that I found useful as well. It helped me interpret all the jargon.
5. There’s a really useful diagram on page 23 of the National Framework guidelines. I wish I’d come across that earlier. Perhaps it’s the way I learn things, but the flow chart of the whole NHS Continuing Healthcare assessment process really helped give me clarity and cut through the complexity of all the stages around eligibility. I believe just showing that to an ‘uninformed’ member of NHS staff would in of itself be useful as a way of clarifying or overcoming some of the misinformation around Continuing Healthcare.
6. Another insight that wasn’t clear to me initially, was that fundamentally the information gathered via the Checklist and Decision Support Tool provides evidence around the four characteristics of need: of nature, intensity, complexity and unpredictability. I hadn’t realised this linkage early on and had been trying to figure out how these were connected.
7. Without help, it’s difficult for most people to score the Checklist and not be bamboozled by NHS staff. I have no solution for that.
8. Something of a quick and dirty test that was really useful was this: if your relative doesn’t have money, would social services be willing to care for him? Of course the answer in our case would have been no, and just knowing that was somehow reassuring to potentially help cut through scores on domains etc.
9. Another point that was useful to know was about Dad’s sectioning. By being sectioned under Section 2 the NHS was covering itself against future financial liability for his ongoing care, rather than by sectioning him under Section 3. A Section 2 can only last one month and we were curious to see what would happen after that month. What they did was to remove the section and instead hold him under the Mental Health Act – to avoid any ongoing financial liability. Otherwise they would have had no choice but to resection him under Section 3. Very crafty and it is happening much more.
If you can relate to these points from your own family’s experience, please share your thoughts and insights below.