Should I use a solicitor for NHS Continuing Healthcare? …5 tips

Should I use a solicitor for NHS Continuing Healthcare? …5 tips

Using a solicitor for NHS Continuing HealthcareMany people consider using a solicitor for NHS Continuing Healthcare battles, because going through the Continuing Healthcare application and appeal process can be exhausting.

So what are the relative merits of using a solicitor vs. doing it yourself?

Having someone take the load off your shoulders and fight your corner on your behalf can be a huge relief. Solicitors can provide a very valuable service in this respect. Your decision whether or not to instruct one may depend on what stage you’re at in the funding application process.

In the early stages of the whole process you don’t really need to instruct a solicitor. Instead, get as far as you can yourself by being as well-informed as you can be.

Also, remember that a specialist Continuing Healthcare adviser can be just as good as a solicitor, especially if they have previously worked inside the Continuing Healthcare system.

Solicitors work in different ways: Some solicitors can help you through the process before the funding decision has been made. Others can help you appeal a funding decision afterwards – and many do that on a no-win-no-fee basis if there are care fees that can potentially be reclaimed. This can be a good option if you don’t have the energy to pursue it yourself, and you may be happy to pay whatever fees are involved to save you that stress and hassle.

Some NHS assessors can get very defensive if you take a solicitor along to an assessment – but that’s not to say you shouldn’t! People certainly do. Some assessors try to make you believe that a solicitor is not allowed to speak in an assessment. This is completely untrue.

Having an adviser or solicitor for NHS Continuing Healthcare assessments can help ‘encourage’ the assessors to stick to the assessment guidelines. Having someone in a legal capacity present, even if you do most of the talking, shows the assessors how serious you are – and that you’re unlikely to accept any nonsense. Many people find it beneficial, even if it doesn’t always work out that way.

5 things to remember if you do decide to instruct an adviser or solicitor for NHS Continuing Healthcare:

  1. Make sure they understand NHS Continuing Healthcare inside out and that they have an in-depth understanding not only of the established funding assessment guidelines (National Framework, Checklist, Decision Support Tool, etc – plus the Fast Track assessment process), but also the tactics the health and social care authorities use to try to avoid providing funding. Many solicitors may know a bit about it, but this may not be enough to fight your corner effectively. Make sure it’s a specialist.
  2. Keep in mind that you will know your relative better than anyone – and you will have vital (and unique) evidence of health needs and input for assessments and reviews that the solicitor will need to take into account.
  3. It’s a good idea to still attend funding assessments yourself even if you are using a solicitor. You will pick up on inaccuracies and misstatements of fact – plus any errors in the care home notes – much more easily.
  4. A solicitor can be a welcome sounding board when things happen along the way that you need a legal view on, and it’s often just good to know there’s someone on your side. It’s also good when that person is not afraid to ruffle a few feathers with the health and social care authorities to give you some extra legal clout.
  5. Only you will have the raw emotion that goes hand in hand with fighting for someone you love, and this can be a powerful thing. In addition (and similar to point 3 above), you will notice things about the Continuing Healthcare funding assessment process for your relative that a solicitor, working from more of a distance, may not. This is a important reason for staying closely involved in the process at all times, and supporting the work your solicitor is doing as much as possible.

You can get a long way through – indeed, all the way through – the Continuing Healthcare assessment and appeal process yourself, with good information and advice. At the same time an adviser or solicitor can be invaluable to ease the load when the going gets tough. (And it can get very tough.) Be sure to agree all fees up front.

Plus, of course, you may need legal help with other matters, for example, powers of attorney, Court of Protection matters, mental capacity assessments, local authority payments and disputes, care home contracts, making a Will, etc. As with any adviser, make sure the solicitor you choose is well-versed in the specific area of law you need help with.

44 Comments

  1. Trevor 2 weeks ago

    Can someone please help ? My mother in law has been in a care home for 5yrs . She is double incontinent has dysphagia and is given all food liquids and medication through a tube in her stomach I am told she has virtually no cognitive reaction to anything
    She has possible other problems , my wife finds it very difficult to talk about it.We have been refused full funding as we have been told she needs social care not medical we have appealed twice but lost. I just would like someone to tell me something I can show my wife so she can get the help we need.
    The cost so far to the family is someone laying in a bed who doesn’t recognise you at all never changing or reacting. It is immoral the government / council can behave like this.
    I saw another post saying his relative was costing £4000 pm. It is strange how costs are so similar everywhere that is what our costs are so we have spent £250,000 approx and we are now having to sell her house.
    Many thanks for any reply.

  2. Karon Morrison 3 months ago

    Hello,
    Would like some advice regarding brother. He had a brain tumour when he was 16 years old (48 years ago) which resulted in many ongoing medical problems and including visual impairment. He was diagnosed as having organic brain syndrome early last year and in September he suffered a subdural hematoma, which resulted in his condition worsening and being assessed for mental capacity which he does not have. He has had previous TIA’s. Since his subdural hematoma (September 2016 to Dec 2016) he has had another two hospital admissions and three other visits to A & E (one of these was because he got up from his bed, missing the telecare pad, in place, and pulled the television on himself. Because he now lives in residential care rather than nursing I have had to be present, many of these calls are in the middle of the night. He has lost so much weight in a matter of weeks his trousers keep falling down.

    Before he left hospital in December 2016 the Multidisciplinary Team (MDT), myself and my daughter, who is a physiotherapist, went through the Continuing Healthcare (CHC) Checklist and a request for an assessment was actioned by the Social Worker.

    As far as I am aware, an assessment has not been done as I have not been invited to attend, only for the fact that I asked the Social Worker if it had, I found out that it had been refused. I have asked the Manager at the home to action another criteria and raise the request for another assessment.

    My brother clearly has complex medical issues for which medication needs administering morning and evening, is at risk of falls so needs assistance, has numerous UTI’s, is incontinent, blind and other medical issues, why would be be refused CHC and how can I secure this funding for him?

  3. Toni Purcell 3 months ago

    My mother has recently had a continuing care assessment carried out resulting in the necessity for a Decision Support Tool (DST) to be done in the coming weeks. Since the initial assessment we have received a call from the hospital inviting us back to go over a few things in the first report because they believe my mum’s medical condition has changed. Are they allowed to redo the initial assessment again?

  4. Fred Mullin 4 months ago

    Can an appeal for Continuing Healthcare (CHC) be rejected because the next of kin (wife) has neither a Power of Attorney or Deputyship? My brother in law had a stroke and doesn’t now have mental capacity and Deputyship will cost almost £2,700 (financial plus health needs). Is there any precedent establishing that an appeal can be heard without Deputyship? Surely the same situation would arise in the case of, say, a car accident and I understand CHC appeals may have been heard without Deputyship in such circumstances?

  5. SJ 6 months ago

    I am at a critical stage of the Continuing Healthcare (CHC) process – a recent Decision Support Tool (DST) wasn’t carried out correctly with serious flaws in the process so far – Dad is still in hospital and further assessments have now been carried out since the DST (which was rushed and panel rubber-stamped negative outcome within a week without factoring in all the prior evidence and my representations, etc, just before xmas shut down – so haven’t had chance to object, etc). DST only considered a few days’ worth of evidence from his time in this local hospital, ignoring evidence from neurological hospital where he had been week before and more than 3 months’ of evidence from interim placement at care home which couldn’t cope and refused to have him back because of his care needs. Now consultant has said halt discharge as Dad is not fit for medical discharge where as he was previously presumably, while further prognosis is needed – a referral has confirmed he is at high risk of feeding with dysphagia. Having continuous problems with unhelpful social services throughout, not evaluating if really social care needs as opposed to health needs etc – are keen to discharge him to any old interim placement which has a vacancy (there aren’t any at moment) without involving me or giving a choice or considering intermediate options, even though I am Lasting Power of Attorney (LPA). Discharge planning not being transparent – not telling me or showing Section 2 or 5 assessment notices previously or any of the assessment evidence used by assessor for DST, and I didn’t get to see any reports from this admission for myself (no proper discussion at DST, more a case of going through domains which seemed to have already been decided before meeting) – so if a DST reassessment is allowed (I will be appealing previous DST decision too). I feel I need help with a knowledgeable advocate in any Multidisciplinary Team (MDT) meeting. But it is difficult to find someone competent, knowledgeable and who is close enough to cover my area. I know it’s been explained before this website doesn’t usually give recommendations, but I am getting desperate for help, I don’t have much time and am already snowed under with all my other responsibilities; being single parent, work pressures, house moving and more, so need someone who can actually help and reduce the amount of legwork I am currently having to do alone. If someone can point me in right direction it would be a great help!

  6. Robert Brewer 7 months ago

    Thanks Mike we are determined to pursue this through to a satisfactory conclusion.

  7. Mike Clark 7 months ago

    Both my father and father in law have 24/7 Live In Care to manage their health needs. I have been through the CHC process three times now and eventually gained full CHC funding and Shared Care funding for them both. It is a long and difficult battle. In both cases, I emphasised that Dad and father in law’s condition would be much worse without the professional care of the dedicated Live In Nurse/Carer using the principle ‘ a well managed need is still a need’. The NHS Assessors really don’t get it – despite normally being qualified nurses. It is incredibly difficult to get them to think ‘outside the box’ and imagine what an individuals health would be like without this care in place. They are determined to follow ‘the framework’ at all costs and tend to review the patient in real time and what they see when they conduct the assessment. What you will need to do I think is to continue to be resolute and to link the complexity and intensity of your mother in laws health needs and show how the unpredictability and intensity of these needs are being well managed by 24/7 care – describing how the carers ‘anticipate’ these through close attention and dedicated care. It is a long process and time consuming, frustrating and stressful process but don’t give up!

  8. Ali Fox 7 months ago

    Good evening, we are in the process of applying for my mother-in-law to receive Continuing Care Funding. This has been going on for a long time and we have just recently found out that the checklist meeting has already taken place without us being present. We have requested that this is carried out again (with the help of the nursing home). My question is – on the Checklist notes it states under para 20. ‘Where the extent of a need may appear to be less because good care and treatment is reducing the effect of a condition, the need should be recorded in the Checklist as if that care and treatment was not being provided’. As we were not present at the meeting, the nursing home could only give notes on the present conditions which are obviously ‘with care.’ My mother-in-law was previously in hospital and before that at home in a much worse state that she is now due to lack of care. She was not offered the checklist in the hospital and we only found out about this funding by chance. When we attend the meeting to revise the checklist should we be pointing out what her condition is like without good quality 24/7 care?

    • Author
      Angela Sherman 7 months ago

      Ali – yes, it should always be about the underlying needs, as if no care were in place. This is made clear in the National Framework guidance. Even if the care notes show daily needs with care in place, the assessors must take account of what those needs would be like without that care. This may help regarding managed needs vs. underlying needs: http://caretobedifferent.co.uk/continuing-care-assessments-2-frequent-mistakes-part-1/

  9. Robert Brewer 8 months ago

    My sister and I both live in Canada. 2 years ago I had my mother over for 6 months with the plan to get her to stay with me permanently. My mother insisted that she wanted to go home so reluctantly we accompanied her home where we approached Social Services to have home help for my mother as she was in early stages of dementia. It was not long after that she took a couple of falls, the last one resulting in a bad shoulder injury requiring surgery. She was held for some time in hospital as she was unable to use her arm and it was then determined that a care home would be required as her dementia increased resulting in aggressive behaviour in the hospital. She has been in the care home for 2 years with funding by the NHS, during which time, she has lost the ability to walk, dress or feed herself. Now, without notification to us, another assessment was carried out, resulting in the NHS funding being removed. I did visit my mother earlier this year but she did not recognise me and did not want to talk to me. My daughter, who is an Occupational Therapist, visited my mother as she lives in the UK and confirms that the report is completely deficient. As I understand it the NHS must inform you before assessment and allow you to appoint a representative if you cannot be there. To me if they don’t do this then the assessment is invalid. Your thoughts on this please.

  10. Paul Dennis 9 months ago

    Good evening, please can you recommend a solicitor to help our case for Continuing Healthcare funding please. It’s for my dad who the PPA logopenic variant of dementia. We have been going through the process for over 4 years.

    • Author
      Angela Sherman 9 months ago

      Paul – we don’t recommend any one firm of solicitors over another, and the best thing to do is actually to Google “continuing healthcare solicitor” or “continuing healthcare adviser”. Make sure that whoever you speak to is a specialist in Continuing Healthcare and not just someone who ‘knows a bit’ about care fees. Wishing you well.

  11. Alison Gibbon 10 months ago

    My husband has advanced MS with complex care needs. He has received NHS funding for care at home for many years and 2 Nursing Agencies were employed to provide a registered nurse and carer each morning for 2 hours 7 days a week. I provide all other care, but was also allowed 11 hrs to use for sitting time (to give me a break as he is not left alone) and 1 hr for feeding him at a Day Centre.
    As time went on it became hard to find nurses so the last agency sent very good carers who could meet this need in part. I am regarded as a carer with basic nursing skills iro bowel management – including anal irrigation, catheter care (including changing his supra-pubic catheter, skin and wound management. In June the agency ceased care stating it could not maintain the number of carers we had since it was complex.
    At very short notice I managed to find a Care Agency, much cheaper than the previous one as the carers are not up to the same standard. Their insurance does not allow them to do the full range of duties as before and I have to be the lead carer.
    Continuing Care said an NHS budget was the answer for me (I had been asking for this for years and it was ignored).
    However nearly 3 months on the extra tasks have fallen to me and the process for the budget is slow. I can employ the old carers I had but the pay is only £8 per hour when their skills (close to a registered nurse) meant they had been getting £15 an hour. I am not supposed to use other carers that I pay, but to cope I do or I would be ill.
    I feel very stuck – it is the NHS who should be meeting my husband’s needs but they rely on me. Their answer was emergency respite care in a home which has proven dangerous previously in similar homes.
    I found a Nursing Agency who had vacancies but was told the minimum care duty was 4 hrs they had for a nurse was more than the 2 hrs Continuing Care had assessed for. My care is now virtually 24 hrs and the only way I can proceed is for it to be reviewed with the implication that the award might then stop. A no win. We both have lump sum pensions so fall outside the scope for Local Authority Support although our income is not that high.
    How can I enforce adequate care at home from the NHS without them relying on me? If he is assessed for 2hrs a day and they can only find a minimum of 4 hrs then they should use them until a solution is found?

    • Author
      Angela Sherman 9 months ago

      Alison – that sounds very stressful, to say the least. The NHS should most certainly be providing all the care your husband needs, and they should not automatically assume you will be there 100% of the time. Write an urgent letter suggest to them that this is wilful neglect and puts your husband at risk. Use the phrase ‘carer breakdown’.

  12. Jean wright 1 year ago

    I have court of protection for my father who is 97 and in a care home. Trying to get CHC has been a real struggle. He has been in 3 care homes since the 5th November 2014, and now has one to one for 6hours a day. He is high risk falls, unpredictable behaviour. In February this year he was sent into hospital by the previous care home and when he was ready to be discharged the home refused to have him back. I should say at this point Dad is self funding. I had to look around again for a suitable care home for him. The hospital at first said he needed an EMI unit but I couldn’t find anywhere that had a place for him, so they downgraded him to a nursing home which I found a nice for him.
    When they assessed him 4weeks after his discharge for CHC they said he didn’t screen in. Bear in mind I been trying to a CHC assessment done from Christmas but I was kept being given excuses why it couldn’t be done. A few weeks after the initial CHC was done and he didn’t screen in, I asked for it to be done again. This time I was told they would go straight to the DST (by this time I think they had got fed up of me). I did ask for a copy of the CHC but I never got one. Anyway on the 26 April they did the DST and was told they would not reccomend him for funding even though he scored a severe on cognition and a high on behaviour which I said he was in between a severe and a priority. I then told them I was going to commission a professional to take up the case. They came back with they would not speak to any one other than me because of data protection. Now whether this disturbed them or not I then got a phone call to say they were funding Dad for up to 3 months then there was to be a review. Then I got a letter say the review would be 6weeks from the 26th April. I now have a date for the 23rd of June for the review. Is it worth my while to take a professional with me as they have said they will not speak to them? Dad condition has really deteriorated he has lost a lot of weight was in hospital for the day after a really bad fall where he cut open his forehead. Behaviour is very bad without the one to one. The care home couldn’t handle him. And now they say he too frail for an EMI unit, he would at risk. I know that my Dad’s care is now far beyond just mere social care but how do I put this across to people.

    • Author
      Angela Sherman 1 year ago

      Sounds like unacceptable delays and obstruction by the Continuing Healthcare people, Jean. You are perfectly entitled to have someone helping you through this and you’re entitled to take someone with you to assessments. This is made very clear in the National Framework and elsewhere. The CHC people will still be communicating with you, but that doesn’t stop you having an advocate, adviser or solicitor yourself – to support you. Also, go through the National Framework and the Decision Support Tool in detail – plus the assessment notes (you are entitled to a copy) – and list/summarise everything that has been done incorrectly.

  13. Mike Clark 1 year ago

    I agree about the positive aspects of using a CHC specialist solicitor. My experiences though is that the NHS don’t like it – though not a reason itself for not using one – and can also bring out their legal team from nowhere too to fight the case (certainly this happens with Local Councils and Social Care). This then becomes very expensive, more stressful and time consuming. If you have the energy and desire to keep this going, you will pick up the knowledge and experience your self, and has been already stated, you know your family member the best.

    • Author
      Angela Sherman 1 year ago

      Thanks for your comment, Mike.

  14. Lynda Lester 1 year ago

    Help required to appeal against CHC funding being stopped

  15. Richard Terrell 1 year ago

    Concerning NHS CHC, the authorities have – and are still – refusing to complete assessment as is in law required, fragmenting procedure and in last case refusing on grounds of not ill enough. I had to find it out myself and they never told me, then even denied it was applicable, including mental health. I now have firm evidence that the authority is relentless in doing a financial assessment, regardless. The authority uses agency care throughout. Some carers cannot make a bed or even understand how to make a cup of tea, have no idea of the complexity of their clients needs. The so called Care Plan is a worksheet for the Carers coming in.
    There is no Care Plan or Carer’s Assessment completed, as is required in law. Departments will not co-ordinate. I have even had to get food from a local cafe. The Carers support, councillors including chief Councillor, and MP will not answer my plea of this endless insanity.
    There is something chronic, as it is evident it is assumed Financial Assessment for Social Care is the order, and if you are dying shortly you might quality for NHS CHC otherwise everyone is to be automatically disregarded.
    This is a national scandal that clearly needs sorting out. Carers should have an appropriate standard to work to regardless of who is paying for care.

    • Author
      Angela Sherman 1 year ago

      Many families would I’m sure agree with you, Richard, about what goes on in the care funding system being a national scandal. In your situation it sounds as though this may also be a safeguarding case for the local authority to investigate, especially if there are no proper care plans. In addition, if no Continuing Healthcare assessment has taken place, this may help: http://caretobedifferent.co.uk/getting-the-nhs-continuing-healthcare-assessment-process-started/

    • Pandora13 1 year ago

      I have very similar dodging tactics like this with my father. He was discharged from hospital with a positive checklist and placed in a nursing home. During the following weeks, instead of following through with the DST and to apply for funding he was instead underscored by lesser, so called professionals. I queried the greatly differing results to those of the hospitals and refused to sign the underscored checklist. i’e he was initially given 4 ‘A’ scores and this was underscored to just 1 with no change in his needs.I asked to see his Nursing home’s notes which weren’t available, blood tests..(Again none available) and an explanation of how they arrived at this decision..I’m still waiting! I have complained but everyone passes the buck and the top person from social services who really shouldn’t be involved, denied I even attended the meeting!. Scandalous and incompetent just doesn’t cut it. What next?

  16. Lesley 1 year ago

    Hi. I am about to instruct a private company to undertake CHC – it will cost over £1000 – is there any advice please?

    • Author
      Angela Sherman 1 year ago

      It depends what they’re going to do, Lesley. If they’re taking on the whole case for you, then £1000 actually seems very little because it can take a lot of time. It’s always worth getting some comparable quotes – but make sure you know exactly what they are quoting for.

  17. Jan Allen 1 year ago

    We’ve now received notice that my MIL is no longer eligible for NHS funding. (See my earlier posting about her assessment ) . We are certainly going to appeal.
    Over 7 years ago we started appealing against an earlier decision and eventually 4 plus years ago were successful in achieving a retrospective payment. But it appears that now the CCG are determined to turn it all around. We are due to go to an IRP in a couple of weeks to consider another retrospective period. We are also providing evidence with respect to the enforced sale of her home to find her care in 2005 at a time which was decided retrospectively that she was indeed eligible for CHC funding .
    The whole thing is a mess as the CCG are tactically denying, defending and delaying. We will not be giving in or be worn down by all of this . We continue to provide a voice for someone unable to speak, coherently, for herself. We are also not going to employ a solicitor . Meanwhile the Ombudsman is waiting for the whole process to go through local resolution (to date 7 and 5 months of it ) before being prepared to review the CCG’s practice .
    Meanwhile she has had a stage 3 pressure ulce r for over 6 months which apparently does not merit a Severe in the domain.

    • Author
      Angela Sherman 1 year ago

      I can empathise with your experience of the delays and denials, Jan. It really is appalling, isn’t it? I wish you well as you continue.

  18. Carolyn allsop 1 year ago

    Any advice about to complete a whole new DST today in hospital setting after 1 week this will be 5th DST over last 2 1/2 years all rejected, even tho 5 consultants wrote full supporting letters requesting support for CHC. All ignored.
    I have found a nursing home to take mum on tomorrow DASS have offered £420 per week towards the home I have selected and I will pay the top up of extra £400 per week. So desperate to get mum the care she so desperately needs. Now at 94 she is an Insulin diabetic with Altzheimers/vascular dementia .. No short term memory apart from all of her other co-morbidities however the NHS always reject all supporting evidence and state her needs are not primarily health!! Any help or advice? I am just going on the hospital now to start the DST completion!!
    I must now engage some legal assistance because without it we will fail again if that I am confident although I could wallpaper my hone with all of apology letters I have from our CCG regarding their processes not having been adhered to previously, none of which altered Mums needs but completely altered the outcome !!

  19. Jan Allen 2 years ago

    My mother-in-law with dementia has had CHC funding for some years but a recent MDT determined that she was no longer eligible. We were not aware of any improvement in her condition.
    She continued to be deemed to have a Severe level of need in the Cognition domain but the main disagreement was that it was decided that despite having had a stage 3 non healing pressure ulcer since July that it didn’t warrant a Severe level of need for the skin domain. A community matron present at the meeting said initially that it wasn’t healing (she is monitoring the ulcer on a regular basis and advising the home nurses on how to manage it). After a lively discussion it was decided that as a swab had been taken to determine whether it was infected that if the sample showed that it was infected that it would not warrant a Severe level of need as the argument was that if infected the prescribed antibiotics would enable the wound to heal. If the swab determined that the wound was not infected (but still red looking) then a Severe would be awarded for level of need.
    As unprofessionals we struggled to understand such logic. We were left wondering if such “logic “was a desperate attempt to not allow her continued eligibility, as 2 Severes would have made it very difficult for the MDT and CCG to refuse continued funding .

    • Author
      Angela Sherman 2 years ago

      I think you’re right to wonder where the logic in that is, Jan – and to me it sounds like a tactic to deny funding. From experience I know that when there’s one clear Severe score (in your mother-in-law’s case with Cognition), many assessors seem to try anything they can think of to avoid awarding further Severe scores.

  20. Shirley Hurley 2 years ago

    5 years ago my mother (then 78 years old) had a stroke and while she was in hospital she was diagnosed with mixed Dementia (Vascular and Alzheimers), along with high blood pressure, high cholesterol, heart failure and atrial fibrillation. She is approx 5’1″ and slim build. While she had some capacity her ability to care for herself ie everyday things like being able to shop, organise her banking, paying bills, showering and dressing, physically she could do but was mentally challenged on doing these things and without me looking after her for the last 5 years she wouldn’t have been able to do. Upon discharge from hospital they refused to release her until a care package was put in place because they recognised there was a problem. This care package was 2 half hour visits per day, one am and one pm. At the time we felt this was inadequate but deferred to social services knowledge. We were never made aware of the CHC package or NHS care of any description. A CHC assessment was never done, all that was done was a social (financial) assessment which we were unaware of until after she came out of hospital and was back at home and in receipt of her care package. Firstly, was this legal and the fact that we were not made aware of the CHC? At first there was no contribution from my mother as she was not in receipt of all her benefits. In 2012 another financial assessment was done (no CHC assessment) and it was deemed then that she had to make a contribution towards her care package. We can get proof from the neighbours that the care visitors were here no longer than 5-10 minutes at the most, in fact some times less than that and she was paying for a full half hour visit. Because of her condition and not being able to be on her own during the day we managed to get her into a day centre so that someone could keep an eye on her during the day and ensure she was eating. Over the 5 years her dementia deteriorated and her heart condition (to the point where she had to have a pacemaker fitted) until finally in May 2015 we all decided (as a family) that the care she was getting was not sufficient for her needs ( ie the care workers were not feeding her or showering her) and we moved in to look after her. Even then we saw there was a big deterioration. Finally in July there was a big drop in her dementia (vascular episode) and she started to attack myself and my husband physically. Upon calling the police and ambulance she was Sectioned under Section 2 of the Mental Health Act. She was kept in hospital for 28 days assessment and then upon her “appealing – saying she wanted to go home” a meeting was held for which I was present and she was then taken off from Section 2 and was staying “voluntarily”. The assessment of the Doctor was that she could not be released back home. She has now been found a place after 2 months in a secure ward a home in a secure care home and cannot be allowed out of the home without accompaniment. At the end of a 4 week trial period the social services are then going to do see if the care home is suitable for her needs and if so will be doing a financial assessment again to see if she needs to pay towards her placement in the care home. At no time in the last 5 years have social services ever done, and still haven’t done, a CHC assessment. It was only through some research on the 30th September by ourselves that we even found out about the possibility of CHC help. Now whilst she may not need to pay anything anyway we do feel that potentially the council are at fault for not doing a full CHC assessment 5 years ago or since. They seem to be more interested in her financial state than her well being and health needs. When we mentioned about CHC to her senior care worker he didn’t believe that she would be entitled to it and has never been entitled to a CHC assessment. Is this correct and how and where do we stand?
    Many thanks, Shirley

  21. Rachel Idle 2 years ago

    I am in the throws of fighting for NHS Continuing Healthcare funding for my father-in-law, Peter. Briefly, Peter was NHS Rapid Responsed into NHS Respite Care in a Care Home, as an emergency, following an emergency referral by his GP in June. After a couple of weeks, following intensive support from doctors, Physios, District Nurses etc. at the care home, an MDT Meeting was held and it was decided between the NHS Rapid Response, Social Worker, and Occupational Therapists and Physio that Peter required 24 hour Care in a Care Home, with his complex health needs being met via community-based nursing teams – via twice daily visits from a District Nurse, and additional visits as required from Diabetic Nursing Specialists, Physiotherapists, his GP and hospital liaison nurses. Basically, his complex and unstable range of health needs, which had brought him into the care and nursing system in the first place and which were the cause of his need for sare, were being sidelined in favour of a focus on his resulting basic care needs. After a few days of being discharged by NHS Rapid Response into a new Care Home, under Social Services (SS) 6 weeks Respite rules and pending an SS Financial Assessment, due to further serious and life-threatening health issues, Peter was emergency admitted to hospital. After 23 days in hospital and prior to him returning to the Respite place, an NHS Continuing Healthcare Checklist was carried out by hospital staff on 21st August. This Checklist triggered a full DST Assessment with a date to be fixed once my father-in-law had been discharged back to the care home. The first DST Assessment Meeting took place on 17th September and a further Assessment Meeting is still to be held, as the CHC Assessor required additional expert medical information to complete the Assessment. I am concerned as there seems to be confusion as to who covers the interim costs for Peter’s care pending completion of the NHS CHC Assessment. Basically, SS have requested financial information so that they can provisionally do their assessment for SS funding costs (as they think we are unlikely to succeed with our claim for NHS CHC Funding. But my understanding of the National Framework is that it is the NHS/CCG who should take responsibility for these interim Care costs (less any Top-Up Fees). The period in question is between the NHS CHC Checklist completion date on 21st August (when my father-in-law was still in hospital) up to the date of completion of the NHS CHC Assessment. My interpretation of paragraph 74 and 75 of the National Framework for NHS Continuing Healthcare and NHS Nursing Care is that the relevant CCG should cover these care costs. I suggested this to the CHC Assessor who responded, “Oh, well, we don’t do that in Barnsley!!” I have since had a phone call from the CHC Assessor’s superior who says that paragraph 74 is possibly being misinterpreted by me (though he needs to check for sure as he didn’t know for definite!!). Reading between the lines, he implied that the words ‘appropriate setting’ within paragraph 74 might be the get-out clause for the CCG being able to shirk its financial responsibility to Peter. The suggestion was that perhaps I would be unable to prove that Peter’s current 24/7 care home setting (as had been agreed and confirmed via NHS Rapid Response and SS) was an ‘appropriate setting’ for purposes of enforcing paragraph 74.

    The above only scratches the surface of the complexity of our current situation and the difficulties we are coming across in trying to obtain comprehensive and straight forward answers to care/health-related funding queries. We basically can’t get a straight answer from anyone, and no-one seems to truly understand the National Framework. Where do we go from here?

    Any advice and clarification of the correct interpretation paragraph 74 would be wonderful.

    • Author
      Angela Sherman 2 years ago

      Hi Rachel – a few points to help:

      A six-week intermediate care period should be funded, and your father-in-law should not have to pay for this. Regarding the pending full assessment for CHC, it’s not possible for anyone to tell Peter to pay for care until it’s been properly shown that he is a local authority responsibility – is indeed he is. If he’s told to pay before the local authority (as part of the CHC Multidisciplinary Team) has looked at whether his care needs are beyond simply social care, this potentially puts the local authority in an unlawful position. It also sounds as though the local authority and the CHC assessor are trying to put you off. No one should be asking for financial information at this point. It sounds as though the ‘professionals’ involved could be either incompetent, ignorant of the law or deliberately trying to make Peter pay. It doesn’t matter where the CHC assessment is carried out, and it doesn’t matter what the care setting is, the NHS still has a duty to assess promptly – and neither the local authority nor the NHS can tell Peter to pay until a lawful CHC decision has been made.

  22. S. Wagstaff 2 years ago

    My mother is currently in hospital due to a variety of severe needs and difficulties.

    I attended a meeting at the hospital a couple of weeks ago where the attendees were; a Junior Registrar, a Social Worker, an Occupational Therapist and a Senior Nurse. This took the structure of an informal meeting in a small anteroom at which the Registrar took charge and informed me that my mother was seriously ill and, fundamentally would not be able to return home. At no time was a Checklist mentioned or the fact that this was a meeting concerning NHS Continuing Healthcare. No notes were taken to my knowledge and, as far as I knew it was a courtesy meeting to explain that she did not have long but would need a nursing home after discharge and to prepare for that.

    Yesterday, on visiting the hospital, I was presented with a Continuing Care Report/Checklist which claimed to have been filled in at various times. The majority of the information in the Checklist is seriously inaccurate and not a true reflection of my mother’s condition.

    Can I refuse to sign it and issue a covering letter why?

    • Author
      Angela Sherman 2 years ago

      This is very common, unfortunately, and we receive many, many accounts from families who report the same things happening. The Checklist and any further Continuing Healthcare funding assessment should be carried out with your knowledge and involvement. Yes, refuse to sign it – and insist they do the whole thing again. Also, you can make it clear that your mother is not obliged to pay any care fees until it has been properly decided who is actually responsible for paying. This article may help: http://caretobedifferent.co.uk/vital-information-about-paying-for-care/

  23. Tracey Glendinning-Smith 2 years ago

    My father has recently been assessed for CHC following a request from us when he was approaching discharge. This was completed very quickly without our involvement and the MDT did recommend him for CHC but this was not validated by the CCG, who said there was not enough supporting evidence. Would this indicate a good case for appeal given the MDT recommended him? There doesn’t seem to be much info about this kind of scenario as most focuses on disagreeing with the assesment itself. Any advice appreciated.

  24. Angela 3 years ago

    Hi Claire – could you complete our contact form below in the first instance with a few details about your situation. Many thanks.

  25. Claire 3 years ago

    Hello

    Could someone please contact me regarding the CHC process ?

    Thank you

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