Local protocols in NHS Continuing Healthcare
Have you been told by your Clinical Commissioning Group that they can override national Continuing Healthcare guidelines?
Families report being given all sorts of incorrect information by the care authorities about what happens during the Continuing Healthcare assessment process.
We also know of cases where families have been told that:
- the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (the national guidelines) doesn’t apply in their area
- that their Clinical Commissioning Group (CCG) – the NHS – has ‘opted out’ of the National Framework
- and that the local CCG has replaced the National Framework with guidelines of their own.
So can a Clinical Commissioning Group override national Continuing Healthcare guidelines and case law?
No. The National Framework does make provision for CCGs to draft their own local protocols, BUT this is simply about applying the National Framework locally. It does not give a local CCG a means to replace the national guidelines.
So if you’re told that in your local area the Continuing Healthcare rules are different, challenge this immediately.
Page 137 of the National Framework looks at Local NHS Continuing Healthcare Protocols (Annex G), and it’s interesting to note the following:
- Nowhere does it say that local protocols replace national guidelines or case law.
- Any local protocols must still transparent and lawful. This includes providing access to Continuing Healthcare based on need, not on financial considerations. This means there can be no cap on Continuing Healthcare payments; Continuing Healthcare covers all assessed care needs.
- You must be kept informed and involved at every stage of the NHS Continuing Healthcare assessment process.
- Any local protocol must uphold the principles of consent and compliance in relation to the Mental Capacity Act.
- CCGs must show you how to access advocacy, advice and information.
- You should be informed of the outcome of Continuing Healthcare assessments in writing and given a copy of the assessment notes, e.g. the Checklist
- CCGs must act on a Fast Track assessment without delay.
- If your relative is being discharged from hospital, CCG remains responsible for funding care during the Continuing Healthcare assessment and decision making process.
- The CCG must make arrangements for the local authority to be involved. (Indeed, the local authority has a vital role to play in the Continuing Healthcare process.)
- There should be a dispute resolution process in cases where you are unhappy with the outcome of an assessment .
There are of course many additional points mentioned in Annex G than we’ve listed here, but it’s worth keeping the above in mind, as you may be given incorrect information by your local CCG.
We also know that there are CCGs currently promoting the following:
- That patients in hospital only need a Continuing Healthcare assessment if their needs have a clinical origin. (Note: the National Framework actually states very clearly that needs do not depend on any specific diagnosis; it’s the day-to-day needs that count – regardless of how they arose.)
- That patients often improve considerably once discharged from hospital and so assessing for Continuing Healthcare in hospital results in costs to the CCG that could otherwise be saved. (Note: It’s difficult to see how many older people going into care will improve considerably.)
- That people should be means tested on discharge from hospital and assessed for NHS Continuing Healthcare later, when they are ‘in the community’, as this will save the CCG money.
- That the Checklist is ‘unreliable’ so shouldn’t be carried out in hospital.
…amongst other things!
Needless to say, this flies in the face of the Care Act and the whole principle of looking properly at who is actually responsible for paying for care from the start.