CCGs to cut NHS Continuing Healthcare assessments in hospital

CCGs to cut NHS Continuing Healthcare assessments in hospital

CCGs to cut NHS Continuing Healthcare assessments in hospitalWatch out for more pressure on families to get relatives out of hospital

If you have a relative in hospital and they need ongoing care, you may soon come under even greater pressure to get them out before the proper NHS Continuing Healthcare assessments in hospital have taken place.

NHS England has issued new guidance to CCGs regarding hospital discharge and Continuing Healthcare assessments. It means that CCGs may now do whatever they can to avoid assessing people while they’re still in hospital.

The new guidance comes in the form of a letter sent by NHS England to CCGs. It’s dated 17th August 2017 and you can read it here.

We’ve pulled out a few points from the letter and added our comments and words of caution below. The focus of the letter is, on the surface, about making the NHS Continuing Healthcare assessment process more efficient. However, it may make things even more difficult for families.

Here’s what the letter says about NHS Continuing Healthcare assessments in hospital:

“1. CCGs must ensure that less than 15% of all full NHS CHC assessments take place in an acute hospital setting;”

and…

“These CCGs are required to submit a plan for improving this to less than 15% by March 2018…”

There are some crucial things to watch out for here:

  • You may come under enormous pressure to get your relative out of hospital. If you can stand firm and insist that the NHS Continuing Healthcare assessment process takes place while they are still in hospital, you will have more leverage to get it done quickly.
  • If/when your relative is discharged, they may be offered intermediate care (rehab) – if that’s appropriate for them. Your relative should not be charged for this. At the end of the period of rehab, and if your relative still has ongoing care needs, there should be an NHS Continuing Healthcare assessment. Again, your relative should not be charged a penny for any care until this process is complete – even if they have left rehab.

The NHS England letter also states:

“2. CCGs must ensure that in more than 80% of cases with a positive NHS CHC Checklist, the NHS CHC eligibility decision is made by the CCG within 28 days from receipt of the Checklist (or other notification of potential eligibility). CCGs are expected to ensure that full assessments are only undertaken when required, for example, assessments are not required for people who are going on to NHS rehabilitation services or do not have long-term care needs;”

The last few words here contradict existing guidance and are, frankly, alarming: NHS Continuing Healthcare funding is for any stage of life. It doesn’t have to be ongoing; instead, it can be provided during those times when a person’s care needs meet the criteria, and then cease if/when the person no longer needs it.

So, saying that people who don’t have long term care needs shouldn’t be assessed at all would seem to mean that anyone recovering from illness or accident (and who is actually recovering) would never get the funding. This must surely be in conflict with the whole legal basis on which the NHS operates, i.e. to provide healthcare.

Be alert also for the following:

  • The scores in Checklist assessments may be lower than they should be, essentially to avoid the need for the CCG to do full multidisciplinary team (MDT) assessments.

“NHS CHC assessments should only be undertaken when an individual has recovered after an acute period of care and when their long term care needs can be more clearly identified.”

This is essentially the same as before. However, remember that part of the purpose of the NHS Continuing Healthcare assessment process is to inform the kind of care that is required. If people are being shunted out of hospital without a clear ongoing care plan in place, this presents a huge risk to patients.

“CCGs must ensure that decisions can be made swiftly throughout the week, as soon as patients are ready for discharge. Verification of MDT recommendations should take no more than 2 working days.”

Whilst it’s good news that funding decisions will be made more quickly, be alert for the following potential scenarios:

  • NHS Continuing Healthcare full MDT assessments being arranged in haste without families being informed.
  • NHS Continuing Healthcare full MDT assessments being carried out so quickly that they do not reflect the true picture of need of the individual being assessed.

This may all sound cynical, but there is already a huge amount of impropriety in the way NHS Continuing Healthcare assessments take place (or don’t take place); these extra requirements placed on CCGs risk making this even worse.

Remember always 3 crucial things:

  1. Guidelines are just guidelines; they are not the law.
  2. Whether or not a person pays for care has nothing to do with their money, house or assets; it’s about their care needs only – and the decision about who does actually pay can ONLY be made once the NHS Continuing Healthcare assessment process is complete and a finding decision has been made, in writing, and with a full rationale.
  3. The local authority has a vital role to play in the NHS Continuing Healthcare assessment process.

So be vigilant, stand your ground and don’t be afraid to dig your heels in and get the Checklist carried out while your relative is still in hospital.

Read more about hospital discharge and NHS Continuing Healthcare assessments.

 

9 Comments

  1. SL 2 weeks ago

    In my area people are discharged from hospital into an NHS funded bed for 28 days to enable a Checklist and Continuing Healthcare assessment to take place.

    • Chris-G 1 week ago

      Sounds like a plan…….. Until of course one is already in a nursing home for which you have had your NHS Continuing Healthcare (CHC) funding removed. The hospitals seem to believe that all sick and recovering patients already within a nursing home that are sick enough to require repetitive hospital admissions, already receive CHC funding (because they are so sick???), and so they are simply sent home with even greater needs for funding than when they were previously funded or even as in my mother’s recent case, without any Fast Track or followed up palliative care….. Even having clearly been discharged to her care home to die……. The care she eventually received was only given once, (three weeks after discharge), we had demanded the discharge notes and then had a meeting and then got the GP who had clearly not read the discharge notes to do her job. Just a pity that pain relief and antibiotics etc. was not given as prescribed by the consultant for three weeks prior to my mum’s death.

  2. Amanda Weeks 3 weeks ago

    I have just received a response this morning from The Ombudsman where I complained that my mother was discharged from hospital with a package of 6 weeks intermediate care to a care home, which we were then charged for. The Ombudsman’s response is that the Council states on its website that they will not pay for ‘The Council’s policy on reablement says it will not accept referrals from people “needing long term support with no potential for improvement in their level of independence”.
    So the decision is no wrong doing by the council. I did point out the clause in the 2014 Care Act but to no avail. So it seems the Council decide not the Care Act. I am in disbelief.

  3. Peter Wiltshire 4 weeks ago

    If the National Director of Operations and Information of the NHS, Matthew Swindells issues an instruction or an advice to the Clinical Commissioning Groups that demands or advocates illegal activity (https://www.england.nhs.uk/wp-content/uploads/2017/08/letter-improve-nhs-continuing-healthcare-assessment-processes.pdf ) by denying people who need nursing care access to those who are familiar with their condition, i.e. the nursing staff who have been dealing with them in hospital, surely anyone can take out an action against him. I’m game for setting up a fighting fund. Anyone feel the same?

  4. Cecilia Toole 1 month ago

    Thank you for this new information, it is invaluable.

  5. Chris-G 1 month ago

    Furthermore, to last comment….. This is a CCG ‘Rubber Stamper’s’ charter.
    The hurry up is more important than health care and observation of and provision of care needs.
    I am also mystified as to the role of government in this, having apparently taken managerial responsibility for the NHS from the Secretary Of State some time ago, when it was restated that his role was only to provide an environment in which the NHS could function……. It appeared at the time to be a vehicle to enable the Sec’ to avoid blame by not being seen to actively manage the NHS. If so then why does this report mention his involvement?
    Angela Sherman’s point about Continuing Healthcare checklist and Multidisciplinary Team assessments and the documentation forming part of the care plan is entirely and centrally relevant. To circumvent or to avoid such processes is to risk the healthcare of patients just at the time that it is transferred to social workers………
    Imagine if you will what would happen if the Atomic Energy people circumvented rules and/or rubber stamped the recommendations regarding who would continue in custody of used nuclear fuel once they no longer have a use for it……….. would the fuel remain safe and secure? Would they be allowed to mess about with the laws and rules in such cavalier manner….. I sincerely doubt it.

    • Andrew 1 month ago

      Chris

      Neither Her Majesty’s Secretary of State for Health nor Her Majesty’s Government have had day to day managerial or operational responsibility for the National Health Service since the Health and Social Care Act 2012 came into force, mainly on 1 April 2013.

      Since 1 April 2013, in England day to day decision making concerning the National Health Service rests with the Chief Executive of NHS England and to those within NHS England to whom the Chief Executive delegates responsibility.

      And following the coming into force of the Care Act 2014 and secondary legislation The Care and Support (Discharge of Hospital Patients) Regulations 2014 (which secondary legislation has not been debated nor scrutinised by our MPs), are worded in such a manner that it seems NHS England is entitled to issue directives to CCGs like the one issued on 17 August 2017.

      An online article on 21 August 2017 suggests English local councils have also been contacted by the Department of Health. In summary, the article alleges the Department of Health has told local councils if they do not assist CCGs in speeding up hospital discharges they (local councils) may have their social care budgets further cut!

      Local council’s initial response is that what they are being asked to do is “undeliverable.”

      http://www.independent.co.uk/news/uk/home-news/nhs-beds-blocking-targets-councils-social-care-funding-threat-a7900271.html

      Secondary legislation without proper oversight is an extremely bad way of implementing policy. Perhaps now only Her Majesty’s judges will be able to overturn this policy if it is affecting patients adversely. But who is going to be willing to take the Department of Health and/or NHS England to court?

      Angela is absolutely right. Those fighting to ensure that a proper and comprehensive assessment of their loved one’s needs for NHS Continuing Healthcare is conducted should follow Angela’s advice above and fight for what they believe is right.

      • Chris-G 1 week ago

        As you say Andrew, secondary legislation without oversight………. That is the entire NHS Continuing Healthcare process in a nutshell. The standing rules regulations are among the most recent of single minister created laws that Parliament does not read and vote upon……..

  6. Chris-G 1 month ago

    A good article based upon yet more cynical cost and service cutting. Interesting to see that my CCG has completed only 48% of Continuing Healthcare assessments within the mandated 28 days.
    Assuming that the Professor of Nursing is a Registered Nurse; what I wonder, would be the Nursing And Midwifery Council’s response to a complaint that a Nurse has signed off this document, much of it apparently ignoring the National Framework Guidance and the in so doing, ignoring law.

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