Should Continuing Healthcare still be assessed prior to discharge from hospital?
One of our readers recently asked this question when his relative was about to be discharged from hospital.
So what’s the situation with Continuing Healthcare assessments in hospital?
On raising the issue of an NHS Continuing Healthcare assessment with the hospital discharge team, our reader was told that the government has now instructed hospitals to discharge patients first – before any Continuing Healthcare assessments are done.
The hospital team said that NHS Continuing Healthcare assessments should now take place ‘in the community’.
Is this correct?
NHS Continuing Healthcare assessments in hospital
In August 2017 NHS England sent a letter to CCGs saying that “less than 15% of all full NHS Continuing Healthcare assessments [should now] take place in an acute hospital setting”.
However, this does not mean that no Continuing Healthcare assessments should take place in hospital!
In addition, there are some vital things to remember if you’re told by a hospital discharge team that they ‘don’t do’ NHS Continuing Healthcare assessments.
We’ve outlined those here:
Typically, and in the experience of hundreds of families sharing their experiences on our website, a hospital will try to discharge a patient before an NHS Continuing Healthcare assessment is carried out. CCGs often call this ‘discharge to assess’.
However, many families call it ‘discharge to forget’, because people often have to wait months to be assessed outside hospital and some are never assessed at all once the hospital no longer has any responsibility.
Once a person has been discharged, families also lose the leverage of their relative occupying a hospital bed. It can be much more difficult to get an assessment done quickly as a result.
CCGs are responsible for paying for care in the interim
The Care Act stresses that people should be considered (i.e. assessed) for NHS Continuing Healthcare before they are are discharged from hospital, because that’s the only way to know who should pick up the care bill once they have actually been discharged.
If a person is discharged before being assessed for NHS Continuing Healthcare, the NHS must by default pick up the bill for ongoing care until the full NHS Continuing Healthcare process has been carried out.
What also often happens in practice is that many people are discharged and told that they’ll just have to start paying for care until the Continuing Healthcare assessment can be done.
This is completely flawed.
Why? Because it puts the responsibility for ongoing care onto the local authority – and local authorities means test people for care.
If a local authority does take on this responsibility before the Continuing Healthcare assessment process is complete, the local authority is in a potentially illegal position. It should never take on responsibility for care that is actually the responsibility of the NHS – or before a person has been assessed for Continuing Healthcare At this point it has yet to be decided who should be paying.
Additional false information that people in hospital (and elsewhere) are also often given is that they must pay care fees anyway if they have savings or a house. As we know, that is completely flawed.
So let’s go back to the letter that NHS England sent to CCGs – the one that told CCGs to reduce the number of NHS Continuing Healthcare assessments in hospital:
A letter from NHS England does not change the law. Nor does it change the principles of the Care Act.
In addition, the letter talked about ‘full’ NHS Continuing Healthcare assessments. Stage one of the process is the Checklist assessment; stage two is the full multidisciplinary team assessment.
Some families do allow their relatives to be discharged before the NHS Continuing Healthcare assessment process is complete. This is sometimes because being in hospital is proving detrimental to their relative’s health and wellbeing.
Others accept that their relative will be discharged, but (correctly) refuse to pay any care fees until the Continuing Healthcare assessment process has been carried out in the community (e.g. at home or in a care home).
Feedback and comments from many families also indicate that hospital discharge teams sometimes know very little about the proper NHS Continuing Healthcare process – and even less about the law. They are focused instead on managing and freeing up beds.
Stand firm when it comes to NHS Continuing Healthcare assessments in hospital
So if you’re told that an NHS Continuing Healthcare assessment can no longer be done in hospital, question this using the points outlined above. The person you are speaking to may be referring to the pressure from NHS England to free up beds or, alternatively, they may have been given incorrect information and may lack training in NHS Continuing Healthcare.
Ask them whether they have read and understood the Care Act, and if they tell you to start paying care fees, remind them that the NHS has a duty to cover the cost of ongoing care until the NHS Continuing Healthcare assessment process is complete.