As well as the many things that go wrong in individual NHS Continuing Healthcare assessments, there are also serious and fundamental problems with NHS Continuing Healthcare – in terms of the actual processes that have been built around it.
It means that families are not only faced with a battle in the actual assessments, but the whole ‘culture’ around care funding for older people leaves a lot to be desired.
Here are 3 fundamental flaws in the system, and some links to help you…
1. The evidence used in Continuing Care assessments is unreliable
Continuing Healthcare assessors say that they base their funding recommendations primarily on the evidence of health needs available on paper at the time of an assessment. This evidence generally takes the form of daily care notes from the care provider.
However, generally speaking, care notes are kept to satisfy the requirements of the Care Quality Commission (CQC). Care staff have often never even heard of Continuing Healthcare, let alone understand how their often hastily scribbled end-of-the-day notes might be used in funding assessments. Some care companies even dictate what can and can’t be written in care notes. The NHS knows all this.
If the NHS is refusing someone the care funding they’re entitled to, and taking their personal assets to pay for that care, based on evidence that the NHS already knows to be unreliable, this surely constitutes fraud.
2. Ageism is alive and well in the NHS
Taking a chronically sick child to an NHS hospital or to an NHS doctor is unlikely to result in the parents being asked how much money they have. However, when an elderly person is chronically sick and needs nursing care, this is usually the first question they are asked – even when the extent of their nursing care needs is blindingly obvious.
Healthcare and nursing care in the UK are free, in law – unless you’re old, that is. When you get old, ageism in the NHS rears its very ugly head and a convoluted web of funding ‘assessments’ comes into play, carefully designed so that elderly people end up wrongly charged for care that the state should provide.
What’s even worse is that the notion of paying for care when we get older has become so engrained in our thinking (thanks to the health and social care authorities and the press telling us this) that few people realise the whole principle of paying for care is flawed.
3. NHS assessors and employees fail to comply with the law
The phrase ‘ignorance of the law is no defence’ is often quoted in legal matters. It’s interesting to observe, however, that health social care professionals and NHS funding assessors not only often seem unaware of the law but also seem to routinely ignore it – with seeming impunity.
For example, many fail to abide by the Mental Capacity Act and fail to carry out essential Mental Capacity Assessments. When this happens, vulnerable older people can find themselves in high-risk situations. Many NHS assessors seem ignorant of healthcare law and that healthcare and nursing care are free of charge in the UK – no matter how old someone is. Others admit they’ve never read the National Framework guidelines and/or have never heard of the landmark Coughlan case. Others twist the funding guidelines to suit their own budgetary agendas, instead of providing the state healthcare available to all.
Despite these fundamental problems, over 50,000 people do receive NHS Continuing Healthcare funding – but it’s clear to many people that many tens of thousands more should be receiving it. It can take determination and stamina to pursue the funding, and the better informed you are the easier it will be.