“Why is the NHS delaying my Continuing Care assessment?”
Frustrating delays seem to characterise most stages of the NHS Continuing Healthcare assessment and appeal process. Here’s what to do if you’re affected…
Delays in NHS Continuing Care assessments and reviews can be exasperating for families, and it’s not always easy to get answers from the NHS when you complain about this. It hardly inspires confidence in what is supposed to be a fair and transparent funding assessment process.
The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, issued by the Dept of Health, is the official set of guidelines about NHS Continuing Healthcare and all Continuing Care assessors have to follow these guidelines.
Initial Checklist assessment
The first stage of the assessment process is the Checklist assessment. This is supposed to be done within 14 days of an initial request. If you’re still waiting, take a look at the National Framework page 69-70, paragraph 25.1 and ask the local NHS Continuing Care Team why they have not adhered to this. (You’ll find the Continuing Care assessment team based at the local NHS Clinical Commissioning Group (CCG).
Full Continuing Care assessment
The next stage of the process is the full assessment involving a multidisciplinary team meeting/discussion and the completion of a document called the Decision Support Tool (DST). This DST is then passed to a CCG panel for an actual funding decision. From the time the NHS receives the completed Checklist to the time the funding decision is made should take no longer than 28 days. In practice it can take months! If you’re still waiting, look at the National Framework page 70, paragraph 26.2 and ask the NHS to give you specific reasons why they have not adhered to this.
Continuing Care appeals
If you are appealing a funding decision, new timescales for this were announced in 2012 and you can read more about timescales for Continuing Care reviews here. We hear of some CCGs issuing their own timescales, regardless of whether they comply with the official ones, and it’s a good idea to check with the local CCG what timescales they are working to – and if it doesn’t comply with the national guidelines, ask them why not.
Financial motives for Continuing Care delays
There may be various reasons for delays in the assessment and appeal process. The NHS is no doubt stretched in terms of resource, but many families also find that continual mistakes are made in the process, there’s a lack of response to communication, key points are ignored in correspondence, health needs are played down – to mention just a few of the things that go on. Funding is subsequently denied, thus forcing the family to appeal.
Budgetary issues should never play a part in the Continuing Care assessment process, and yet many families feel that this is exactly why the process is obstructed and delayed – perhaps also so that families will simply give up, go away and pay for care.
If you’re still waiting for the next stage in the assessment process, the delay could be an attempt to force your relative to pay for care.
If this is the first assessment process you’ve been though, and the delay is being caused by the NHS (and no actual decision has yet been made about funding), you can argue that your relative should not have to pay for care at this point. After all, the only way to decide who should be paying for care is for the full Continuing Care assessment and decision-making process to take place. Prior to that happening, there is no basis on which to make your relative pay.
The NHS can, however, wait until someone is in a permanent care location before they’ll go through the assessment process – for example, if someone is leaving hospital and going into a care home the NHS may say they won’t assess that person until they’ve left hospital, to give the real ongoing care needs a chance to emerge. However, it is the experience of many families that this is simply an excuse to get someone out of NHS responsibility and into means-tested care.
Put pressure on the hospital discharge team to assess your relative for Continuing Care funding before they’re discharged from hospital – before going into a care home – so that funding decisions can be made in good time. Attempts by the NHS attempts to delay this are often flawed and have no justification.
If you’ve already had one or more assessments and you’re still waiting for a satisfactory outcome, you could use the same argument as above – that the only way a decision can be made about who should pay for care is for the Continuing Care assessment and decision-making process to be properly complete and with the NHS adhering to all the national guidelines.
How long have you been waiting for an assessment or review?