Frustrations and obstacles leave many at their wit’s end in NHS Continuing Healthcare assessments and appeals
Some options for you…
Even just a quick glance at the comments and questions on our blog reveals the huge number of obstacles and frustrations many families experience with the NHS Continuing Healthcare funding system.
It can be hard to know what to do when it seems as though you’ve exhausted all avenues to achieve justice in Continuing Healthcare for your relative.
If you’re finding that your local Clinical Commissioning Group (CCG) and/or NHS Continuing Healthcare team won’t listen to you, won’t reply to you, won’t abide by the Continuing Healthcare assessment guidelines and/or are ignoring the law (for example the Couglan case and the Care Act), you may find the suggestions below helpful.
The usefulness of each option will depend on which stage of the assessment and appeal process you’re at:
Write to your MP
Many people write to their local Member of Parliament (MP) about the maladministration in Continuing Healthcare. We hear mixed reports about the effectiveness of doing this, but it is one way to exert some pressure, and some families do find that it leads to a faster response from their Continuing Healthcare team and/or Clinical Commissioning Group (CCG).
Contact the press or media
It’s not everyone’s preferred option, but some families have shared their stories with local newspapers and local radio/TV. The resulting negative publicity for the local CCG can make a positive difference in individual Continuing Healthcare cases. Equally, you could approach some of the national current affairs programmes or ‘magazine’ style programmes in national radio and TV. If you do this, always be aware that you will generally have no control over what is actually broadcast or printed, but if the newspaper or media station is on your side and is perhaps looking to cover this as a wider issue anyway, it may be a good option.
Contact NHS England
If you’ve exhausted the local assessment and appeal process and the local CCG is still not handling your case properly, you can approach NHS England. This may be for an independent review or it may be to raise other concerns about Continuing Healthcare.
Alternatively, or in addition, write a letter of complaint to Simon Stevens and copy it to the press and/or other relevant organisations. Simon Stevens is Chief Executive of NHS England and is accountable to Parliament.
Contact the Head of Adult Care at your local authority/council
The local authority/council has a legal duty to evaluate whether your relative’s care is beyond the local authority’s own legal remit. If it is, the NHS has responsibility for funding your care through NHS Continuing Healthcare. For this reason the local authority MUST be involved in the Continuing Healthcare assessment and appeal process. If a person’s care needs are beyond the local authority’s legal remit, and yet the person needing care is paying for their care, the local authority will be acting illegally because it will, effectively, have taken responsibility for that care.
If the local authority has been remiss in this legal duty in your Continuing Healthcare case, contact the local authority’s Head of Adult Care and make it clear that the local authority are potentially in an illegal position, as they haven’t adhered to the Care Act.
In addition, write to the leader of your local authority/council stating that they should be asking questions, because their tax payers are picking up the tab for those people rejected unlawfully for Continuing Healthcare by the CCG.
Make a complaint about specific individuals who have broken the law or failed to follow procedure
If relevant, make a formal complaint about specific social workers and/or CHC assessors. Remember that all those working in health and social care must follow their own professional codes of conduct. Here’s an example from the Nursing & Midwifery Council.
Contact the Local Government Ombudsman (social care only)
This is not strictly to do with NHS Continuing Healthcare, but it may be useful nevertheless for social care matters. If you have concerns or complaints about the way your social care is being charged, write to the Local Government Ombudsman (LGO) and outline your case. (Note: The LGO is not the same as the Health Service Ombudsman – see below.)
Contact the Parliamentary and Health Service Ombudsman
If you’ve already taken your Continuing Healthcare case to an Independent Review Panel at NHS England and you’re still unhappy with the outcome, write to the Parliamentary and Health Service Ombudsman (PHSO). We hear mixed reports about the PHSO service, but it is an option to consider.
Use a Continuing Healthcare adviser or solicitor
This is worth thinking about if you need to offload things onto someone else. There are, of course, costs to consider, but if you’re acting as power of attorney for your relative, the fees for advice could potentially come from your relative’s funds. Always double check this though, before you use funds for that purpose.
Consider going to court
The potential legal costs involved in going to court understandably put many people off, but it may be appropriate in some cases.
It’s useful to know what options other families may have used to prompt some response from local CCGs and Continuing Healthcare teams – to try to make progress with funding assessments and appeals.
If you have additional suggestions that might help other families – especially if they have made a positive difference to you – please share them here.