Whilst care providers still have restrictions in place to deter visitors and protect their vulnerable residents, it is inevitable that in time, those restrictions will continue to ease slowly. Indeed, some care homes are already allowing non-essential visitors. We know of one company which has been able to arrange for its external nurse assessors (wearing full PPE) to visit a patient at a care home and undertake a preliminary assessment as to their potential eligibility for NHS Continuing Healthcare (CHC).
Clearing the backlog: What is the future for Assessments?
NHS Clinical Commissioning Groups (CCGs) were already behind and flooded with pending assessments (and appeals) before coronavirus. How much more so will the backlog be felt once care homes can reopen their doors to facilitate CHC assessments and MDT hearings can fully resume face-to-face in due course?
CCGs are generally under-resourced and couldn’t cope before COVID, and in all likelihood, they will struggle again, but only to a greater degree. It is, of course, too early to predict the level of that degree until life returns to some sort of ‘normality’. However, we expect that most CCGs will take a long time to regain control and make inroads into clearing their huge backlogs and undertaking new patient assessments (as well as completing appeals).
Those whose CHC assessment is still on hold or else postponed by COVID, may well be feeling the financial strain of paying for their ongoing care. If savings or assets, such as a home, need to be sold to release funds, this is not the right financial market to do so. These are indeed worrying times.
Yet, knowing of the backlogs, some families may be feeling complacent, thinking that their relative’s existing CHC package of NHS fully-funded care (FREE) is ‘safe’ and going to remain in place indefinitely post-COVID.
Those waiting for an assessment or appeal which has been postponed by CCGs, can probably expect lengthy delays unless the NHS put their house in order to address the looming problem. It is expected that CCGs will be inundated and unable to cope as furloughed staff, and other key staff deployed to the frontline to fight COVID, return to their previous CHC duties. We would expect CCGs to recruit more staff to meet the increasing demand of an ageing population and clear the backlogs; but that will have a financial cost, too.
The alternative is for CCGs to outsource its backlog of CHC assessments as a quick fix to catch up, but again, this has a financial implication. Will the quality of the assessments be adversely affected? Does the CCG’s CHC Department have the time to check the quality and standard of assessments undertaken by their appointed outsourced provider? Just because an outsourced resource has been used before, it doesn’t necessarily follow that they are still up to the job, even if they have managed to retain their most experienced staff, post COVID. Will families lose out as a result of shoddy and inadequately prepared assessments?
Will stretched NHS Continuing Healthcare Departments have the time and resources to train new staff to an acceptable standard, such that both they and families can trust their decision-making process and outcome rationale?
Will the mistakes of previous poorly trained assessors and flawed NHS Local Resolution appeal outcomes be perpetuated post-COVID?
Will families be squeezed into rushed assessments merely to clear backlogs, but in doing so, create another long-term problem instead – making wrong decisions due to lack of time and careful consideration, just to tick a box and get the job done? The result may be to knock out lots of assessments quickly, and simply defer those found ineligible for reconsideration at appeal, should the family have the gumption and staying power to fight on.
We shall have to wait and see how all these ‘unknowns’ play out. The Government will have to make huge resources available to CCGs to deal with the backlog of assessments and help patch up a CHC system that some argue has not been fit for purpose for some time.
What is the future for Appeals?
There is no sign of any face-to-face appeals at Local Resolution Meetings, at present.
In the meantime, despite COVID restrictions, some CCGs have been resourceful and have successfully conducted local appeals by telephone hearing, albeit in reduced numbers. From what we hear, this seems to be working well for those families who have tried it. Perhaps it will become the norm in due course, and be offered more widely by all CCGs, as it is efficient and avoids the time and travelling costs of a face-to-face meeting.
Independent Review Panels conducted by NHS England have virtually ground to a complete halt, save for a handful of IRPs who have been proceeding by telephone appointment, again in small numbers. Whilst not ideal, it does have some advantages and appears to be working well.
4 Key areas for concern
However, when CCGs are able to resume business again on a full basis, there are some key areas for concern which families need to be alert to and need to start thinking about now, so that they are prepared:
1. The initial Checklist
The Checklist screening assessment is the usual starting point to see whether the individual is able to move forward to a full assessment – to determine their eligibility for NHS Continuing Healthcare Funding. However, if the Checklist assessment is delayed, then that will have a direct impact on the rest of the assessment process, and inevitably delay the chance of getting CHC Funding for your relative. When CCGs resume business in due course, we don’t anticipate that they will have a problem undertaking Checklists, as they can be carried out relatively quickly by a wide variety of different skill sets – so resources here shouldn’t be a problem. The bar to passing the Checklist assessment is set deliberately low to ensure all those who merit a full assessment (the next stage) are not deprived of that opportunity. However, this is where the backlog is likely to begin.
Firstly, care homes will also need the administrative skill and resources available to facilitate access to patients for these full assessments, and also to make their records available. Some care homes will undoubtedly fare far better than others, with more available staff and administration to deal with the flood of pending assessments and requests for records.
Secondly, passing the Checklist is only the preliminary stage – to screen out those who aren’t eligible for a full assessment. The full assessment is conducted by a Multi-Disciplinary Team appointed by the CCG. We have raised our concerns above as to how the CCGs will be able to get back on track after months of inactivity. Given the existing backlogs of assessments already in the pipeline, whether pending or postponed, families can expect a lengthy wait. In the meantime, they will have to find alternative means of funding their relative’s care.
2. Interim funding
To encourage prompt discharge from hospital during the COVID-19 crisis period, under the COVID legislation the Government has provided emergency funds to support individuals who may be waiting for an initial Checklist assessment for CHC or other Funding, plus an enhancement to those with existing packages of care, post 19th March 2020. But beware! These interim measures may only be temporary, and you need to be giving thought as to what will happen when Covid Funding is removed, and how your relative will continue to fund their ongoing healthcare needs.
3. Three and twelve monthly reviews post-CHC award
If your relative has an existing package of care in place, you may well be feeling relieved that their CHC Funding is continuing, at least for now. But beware, as many may have their funding reviewed and removed once CHC assessments resume post-COVID. Don’t forget, an individual’s care needs will fluctuate and change over time. Some healthcare needs may become more challenging and complex, whilst others may become better managed and controlled and dissipate. Just because CHC funding is in place now, does not guarantee that it will remain in perpetuity and in certain situations it can justifiably be removed. Please speak to us if you are unsure.
Once CHC Funding is awarded, a CCG is supposed to carry out an initial review at 3 months, and thereafter every 12 months, to check that the current package of care in place remains adequate to meet the individual’s ongoing needs. However, since COVID these assessments have been placed on hold. Great news – if your relative has an existing care package which meets their needs and is continuing. Not so good, however, if that package is out of date and is actually inadequate to meet their increasing healthcare needs, and they are now underfunded.
But how will CCGs manage the review process? What additional resources will be needed to catch-up? Will the work be outsourced, and if so, how reliable are the outsourced providers?
From the CCG’s perspective, we anticipate they will try and make huge strides to play catch up and get as many reviews done as quickly as possible. There are two driving motives:
1) To help patients by ensuring that their care package is still sufficient to meet their needs; and
2) To save money and remove CHC where it is no longer appropriate! There will be many individuals who are in receipt of CHC Funding who are no longer eligible and have been left on CHC unchecked for too long at great expense to the NHS. Others who are legitimately in receipt of CHC Funding may face the worrying risk of having it arbitrarily withdrawn upon review.
Remember, the NHS are mandated to save £855m by 2021. So, it should be a matter of concern for those who already have CHC funding awarded and are expecting a review. If CHC Funding is removed, they will have other means to fund their care.
4. Fast Track Pathway Tool
Fast Track Funding is awarded to an individual who has a “rapidly deteriorating condition that may be entering a terminal phase in their life”. This Funding is typically awarded in an end-of-life scenario. However, to assist with speedy discharge from hospital and to release beds for more COVID patients, many individuals have been given Fast Track Funding. But beware! In many cases, Fast Track Funding has been provided a ‘sweetener’ just to get patients out of hospital quickly and prevent bed-blocking. If the patient survives, a review should ordinarily take place after 3 months. However, post-COVID these reviews have been postponed. Although, some may be fortunate enough to retain the benefit of their CHC package until a review takes place and indeed beyond, others may face the stark reality of having it withdrawn when it is found that their relative didn’t meet the eligibility criteria for CHC in the first place. Their relative may have placed in a more expensive care home based on that Fast Track award, only to find that they have to fund this cost themselves if CHC is subsequently removed. That can create a lot of anxiety both for the patient and their family, especially if they have to relocate their relative to a more affordable care home.
There is much uncertainty at present as to how CCGs will be able to manage their inevitable backlogs or how they will possibly cope with existing and new assessments and appeals. What resources will they have at their disposal and how will they be funded? What the state of play will be remains to be seen. However, we fear for families already in receipt of CHC and COVID Funding through different routes, who may be subjected to a curt review of their relative’s care package and potentially be at risk of having it removed and withdrawn.
Preparation is paramount. If you need advice, seek it early on and don’t leave it to the last minute as there could be many people in the same boat, all scrambling for the best advice and help they can get. If you need help, don’t forget to visit our one-to-one page or contact our Advice Line. If you have a query, email to: firstname.lastname@example.org
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