Can NHS Continuing Healthcare retrospective reviews be fair if the reviewers have never met the person being assessed?
It’s a big question. And an important one. It cropped up recently on our blog and we’re expanding on it here.
In many NHS Continuing Healthcare retrospective reviews, families will be pursuing a review for a relative who is still in care, but who has not been properly assessed for NHS Continuing Healthcare funding.
In other cases, however, the person being assessed will already have died. Their family will be questioning whether the person should have actually been charged for their care – and a retrospective review may follow.
Let’s look first at some of the problems that occur in NHS Continuing Healthcare retrospective reviews.
This is not an exhaustive list, but it highlight some of the things families mention the most:
- Many people feel that if they are pursuing a retrospective review for a relative who has already died, their Continuing Healthcare funding case is already compromised. Why? Because the whole thing hinges purely on the quality of historical care notes and written evidence about care needs.
- What’s more, those notes may have been written by health and social care people who no longer work in this field, and indeed the care provider may no longer exist.
- It’s also not unusual for the quality of care notes to be very poor.
- Some families find that notes and reports and letters from therapists, medical consultants and other clinicians are written in very conservative terms – and sometimes with what seem like stock phrases. It means that information may fail to reflect the actual practical, hands-on, day-to-day needs of a person in care.
- Also, many health professionals do not seem to understand what their notes and reports might be used for. It means that, sadly, many medical reports and notes do nothing to support a Continuing Healthcare funding case – even when it’s obvious the person in care is/was eligible.
- It’s a similar problem with the seeming lack of understanding by many health and social care professionals of the difference between social care and healthcare.
- Once a retrospective review is underway, the reviewer will produce a Needs Portrayal Document (NPD). This is supposed to capture a full picture of all care needs for the period of time being reviewed. However, many families report that their NPD has been full of inaccuracies, that the information has been cherry-picked from the care notes to give an unduly positive picture of need, and that whole periods of care have been missed out.
So what can you do?
7 tips to help you with NHS Continuing Healthcare retrospective reviews
Again, this is not an exhaustive list of everything you need to keep in mind, but it addresses some of the most common issues.
1. Just because a person may have died, it doesn’t mean that mistakes potentially made by the Clinical Commissioning Group (CCG) assessors in the past no longer count. Such mistakes could be, for example, the CCG failing to follow the correct procedure in a previous Continuing Healthcare assessment – or failing to even carry out an assessment at all. The CCG is answerable for these mistakes and the impact they have had.
2. Remember that in any retrospective review, just as in any current assessment, it must be clearly shown whether a person’s needs were within the local authority’s legal remit for care or whether they were outside that remit. If they were within it, the person would have been means tested. If their care needs were beyond that local authority legal remit, the NHS should have paid for care through NHS Continuing Healthcare funding.
3. If the evidence and/or care notes are inadequate, the CCG cannot simply conclude that a person did not warrant Continuing Healthcare funding. It is not the fault of the person being retrospectively assessed that evidence lacks integrity. Read more here about care notes being inadequate.
4. In an NHS Continuing Healthcare retrospective review, you should (as the family) be asked for your input – just as you would be in a current assessment. This may take the form of a Family Statement of Needs – a written account from you about your relatives care needs and why you believe they should have been receiving NHS Continuing Healthcare funding. It’s vital to make this as detailed and comprehensive as possible. Go through each care domain (Behaviour, Cognition, etc.) and build a case for the score you believe your relative should have been given. Also highlight every aspect of intensity, complexity and unpredictability in their care needs. Find links to the Continuing Healthcare eligibility criteria here.
5. If you ask a consultant or doctor or therapist or other clinical to write something in support of your case, make sure they understand what exactly this will be used for. Vague opinions about your relative’s health are pretty worthless in the Continuing Healthcare process; instead, you need something that highlights the severity of their specific care needs and that positively supports your case. Otherwise they may inadvertently write something that actually weakens your case, for example a phrase such as “Mrs X is has advanced Parkinson’s and is unlikely to recover.” It says nothing about the actual care needs.
6. Make sure you understand the difference between social care and healthcare needs – and make sure that anyone supplying evidence on your behalf also understands this. It is shocking to read how often health and social care professionals don’t seem to grasp this – and yet it’s fundamental to every single NHS Continuing Healthcare retrospective review.
7. When you receive the Needs Portrayal Document from the retrospective reviewer, go through it meticulously. Challenge anything that is incorrect, misleading (including the language used) or missing.
What other tips would you give families in this situation from your own experience?