This article appeared in the daily Telegraph on Tuesday, 22 October 2019.
The article stated that, “The number of over 85s in the UK is set to double within the next 25 years, data suggests, amid fears it could worsen an escalating social care crisis.
The Office for National statistics (ONS) yesterday revealed that the UK population is set to rise by 3million (or 4.5%) in the next decade, from around 66.4 million in mid 2018 to around 69.4million in mid 2028.
The new figures reveal that numbers of over 85s could hit 3 million by 2043 – double today’s number of 1.6 million – as people live longer.”
With an ever-increasing ageing population and people living longer, you would naturally think that more individuals would qualify for NHS Continuing Healthcare Funding (CHC) across the country.
However, that does not appear to be the case, and indeed statistics suggest that over the last 4 years the numbers of people being found eligible for CHC Funding has declined significantly.
The reason for this drop in numbers is unclear, and could be due to several factors:
Firstly, there is very little mention in the public domain about the availability of CHC Funding or how you go about applying for it. Indeed, many GP and consultant medical practitioners don’t even understand what NHS Continuing Healthcare Funding is all about, or how you apply for it.
We can understand why the NHS don’t advertise this widely, because it comes out of their allocated budget!
Unless you happen to chance upon NHS Continue Healthcare Funding or come across our website, many families are totally unaware of its existence and the fact that NHS funds could be available to pay for ALL of their relative’s assessed healthcare needs and accommodation if they have a ‘primary healthcare need’.
Read our blog: BBC Drama, “Care”, Shines A Spotlight On NHS Continuing Healthcare as this is exactly what was portrayed in this moving contemporary BBC drama.
Remember: CHC Funding is FREE and is not means–tested.
According to Paragraph 180 the National Framework for NHS Healthcare Funding and NHS–funded Nursing Care (revised 2018), the whole raison d’être of CHC Funding is that it is “free at the point of need” – irrespective of the setting where the care is provided and regardless of wealth. So, if your relative meets the eligibility criteria, then all their assessed healthcare needs should be met in full by the NHS.
Secondly, we know that the NHS is under financial pressure and has to save £855 million by 2020/21. One theory is that there has been a deliberate shift in NHS policy over time, causing the reduction in those being found eligible for CHC Funding. From what many of our contributors post on the Care To Be Different website and our Facebook page, it could be inferred that there is a deliberate, but unofficial, ‘conspiracy’ to find individuals ineligible and fail them for CHC Funding – when they clearly should be entitled to it. The assessment process is supposed to be ‘person centric’, but in practice, given the large numbers being found ineligible for CHC Funding, families could be forgiven for thinking that some CCGs are operating concerted policies to withhold or withdraw this vital funding.
You can read the numerous personal, heart-rending, angry and frustrated first-hand accounts of inadequate and flawed assessments; inappropriate comments made by CCG assessors to families to put them off pursuing a CHC assessment; flawed appeals at CCG Local Resolution Panels; and testimonies where the CCG’s assessors have told families that they will be recommending CHC Funding only to find that it has been arbitrarily or unilaterally rejected when the matter is passed over to the Clinical Commissioning Group for ratification. The latter is, of course, contrary to paragraph 153 of the National Framework 2018 which sets out that, “Only in exceptional circumstances, and for clearly articulated reasons, should the multidisciplinary team’s recommendation not be followed.”
If an individual has been assessed in person by the appointed CCG’s assessors and considered eligible for CHC Funding, then it is hard to think of any really ‘exceptional circumstances’ whereby a separate panel sitting behind a desk could then suggest that the recommended funding is inappropriate. Yet it still happens far too often!
Thirdly, we accept that the bar to obtaining NHS Continuing Healthcare Funding is set very high, and the criteria for eligibility need to be subjectively matched against the descriptors in the 12 Care Domains set out in the Decision Support Tool (DST). However, it does seem to buck the trend that the numbers of individuals obtaining CHC Funding is decreasing, whilst the population is ageing and increasing! This subjectivity leads to inconsistent results as the eligibility criteria are not being applied consistently throughout the country – often referred to as the “postcode lottery”. The result means that many people who could and should be entitled to CHC for their relative are either missing out or being denied this vital source of free funding – much depending on the CCG’s policy where they live.
Fourthly, families are at a huge disadvantage when battling the CCG’s assessors for CHC Funding for their relative. It is not a level playing field. The CCG’s assessors are (supposed to be) trained in the National Framework in order to carry out a fair, proper and robust assessment when determining eligibility for CHC Funding. The National Framework 2018 currently consists of 167 pages of detailed narrative and Practice Guidance Notes relating to the assessment and appeals processes. You need to have the stamina, patience and perseverance to wade through The National Framework. Unfortunately, many individuals seeking CHC Funding have struggled to get to grips with the Framework and fully understand it, which often leads to misconceptions and poor outcomes when fighting for their relative’s rights for funding.
As many contributors to our website will also testify, the problem is exacerbated by the fact that many professionals, as well as CCG assessors, don’t actually understand the National Framework either. This leads incorrect interpretation and application, and inevitably to wrong decisions being reached. Hopefully, now you’ve found our Care To Be Different website you will find lots of free information and resources to help you at whatever stage of the assessment or appeals process you are at.
Use our website to share your experiences or look to see how others in your position have handled a similar situation. Don’t forget you can also call us on 0161 979 0430 if you prefer.
We’re interested to hear from other families who have also experienced flawed assessment or appeals and what they have done to address the injustice suffered. Share your experiences below, but please avoid mentioning any specific names of CCGs for local areas.
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