Stable and predictable needs in Continuing Healthcare
We continue our two-part article about frequent mistakes made in Continuing Care assessments.
In Part 1 we looked at how your relative may be wrongly given low scores in assessments because they are receiving care and their needs are being managed. However, it’s always the underlying need that should be assessed, not the managed need.
Part 2 now looks at health needs that are ‘stable and predictable’ – and what you can do to make sure these needs are given due consideration in an assessment…
As part of a full assessment for Continuing Care the assessors look at the nature, intensity, complexity and unpredictability of your relative’s needs – and this is where the problems often start. A common argument used by NHS assessors to deny funding is to say that someone’s needs are stable and predictable, and therefore they’re not eligible for Continuing Care funding.
However, this argument is flawed.
The official guidelines the NHS has to follow when assessing for Continuing Care are embodied in the National Framework for NHS Continuing Healthcare and NHS funded Care (2012), which describes ‘unpredictability’ as:
“…the degree to which needs fluctuate and thereby create challenges in managing them. It also relates to the level of risk to the person’s health if adequate and timely care is not provided. Someone with an unpredictable healthcare need is likely to have either a fluctuating, unstable or rapidly deteriorating condition.” (page 16, paragraph 35)
Assessors are often quick to latch on to the phrase “rapidly deteriorating condition” when looking at unpredictability. However, a need can also be considered unpredictable if it requires daily monitoring (“adequate and timely care”).
- If your relative is taking a range of medication, the side effects of that mix of medication could potentially be problematic. This can be considered unpredictable.
- If your relative is immobile, cognitively impaired and also unaware of their immobility, they may try to get up out of their chair and walk. Their needs in this respect may be considered unpredictable.
Your relative does not have to be at death’s door or display wildly challenging behaviour that poses an immediate risk to life and limb.
The NHS seems generally much less interested in patients with chronic conditions than acute ones, and many people report that this is often the reason given for denying NHS funding. However, always keep in mind that if your relative has chronic yet stable health needs, they may well still qualify for Continuing Care funding.
The Coughlan case demonstrates this: Pamela Coughlan’s needs were chronic, yet stable, and her landmark case regarding NHS Continuing Care funding was upheld at the Court of Appeal. Any assessor who is unaware of the Couglan judgment – and who carries out an assessment without understanding the National Framework guidelines – is negligent.
Discrimination almost certainly plays a role here too. People with chronic conditions are often elderly people, and the National Framework states that:
“Access to assessment, decision making and [care] provision should be fair and consistent. There should be no discrimination on the grounds of… age…” (page 17, paragraph 43)
If you feel that Continuing Care assessors are assessing your relative unfairly on account of their ‘stable’ needs, you can challenge this: Remind the assessors of their duty to adhere to the law and to their own Department of Health guidelines – and make sure they’re aware that you know the rules and that you fully intend to see they’re followed.
It’s unacceptable that, 13 years after the well-known Coughlan case and 6 years after the Grogan case – two cases that contributed to the establishment of the National Framework – the legal framework surrounding Continuing Care funding is still ignored by many assessors and, as a result, many vulnerable and chronically ill elderly people are being denied the care funding they’re entitled to in law.
Remember, just because a need appears to be stable, does not mean it can be ignored. A need that appears stable is likely to still need careful management and care intervention. Without that intervention, the need is likely not to be stable at all!
Assessors are also required to wait until ongoing care needs are clear before they assess, i.e. there must be some kind of stability of needs in order that assessors can make an accurate assessment of both current and future needs.