Watch out for more pressure on families to get relatives out of hospital
If you have a relative in hospital and they need ongoing care, you may soon come under even greater pressure to get them out before the proper NHS Continuing Healthcare assessments in hospital have taken place.
NHS England has issued new guidance to CCGs regarding hospital discharge and Continuing Healthcare assessments. It means that CCGs may now do whatever they can to avoid assessing people while they’re still in hospital.
The new guidance comes in the form of a letter sent by NHS England to CCGs. It’s dated 17th August 2017 and you can read it here.
We’ve pulled out a few points from the letter and added our comments and words of caution below. The focus of the letter is, on the surface, about making the NHS Continuing Healthcare assessment process more efficient. However, it may make things even more difficult for families.
Here’s what the letter says about NHS Continuing Healthcare assessments in hospital:
“1. CCGs must ensure that less than 15% of all full NHS CHC assessments take place in an acute hospital setting;”
“These CCGs are required to submit a plan for improving this to less than 15% by March 2018…”
There are some crucial things to watch out for here:
- You may come under enormous pressure to get your relative out of hospital. If you can stand firm and insist that the NHS Continuing Healthcare assessment process takes place while they are still in hospital, you will have more leverage to get it done quickly.
- If/when your relative is discharged, they may be offered intermediate care (rehab) – if that’s appropriate for them. Your relative should not be charged for this. At the end of the period of rehab, and if your relative still has ongoing care needs, there should be an NHS Continuing Healthcare assessment. Again, your relative should not be charged a penny for any care until this process is complete – even if they have left rehab.
- If intermediate care is not appropriate and, for example, your relative is going straight into a care home or having ongoing care at home, you do not have to pay a penny in care fees until the NHS Continuing Healthcare assessment process is complete. It doesn’t matter whether the assessment process takes place inside or outside hospital, the NHS has a legal duty to cover all the costs of care until it is complete. Guidelines do not negate the law.
The NHS England letter also states:
“2. CCGs must ensure that in more than 80% of cases with a positive NHS CHC Checklist, the NHS CHC eligibility decision is made by the CCG within 28 days from receipt of the Checklist (or other notification of potential eligibility). CCGs are expected to ensure that full assessments are only undertaken when required, for example, assessments are not required for people who are going on to NHS rehabilitation services or do not have long-term care needs;”
The last few words here contradict existing guidance and are, frankly, alarming: NHS Continuing Healthcare funding is for any stage of life. It doesn’t have to be ongoing; instead, it can be provided during those times when a person’s care needs meet the criteria, and then cease if/when the person no longer needs it.
So, saying that people who don’t have long term care needs shouldn’t be assessed at all would seem to mean that anyone recovering from illness or accident (and who is actually recovering) would never get the funding. This must surely be in conflict with the whole legal basis on which the NHS operates, i.e. to provide healthcare.
Be alert also for the following:
- CCGs may be more reluctant to do Checklist assessments in the first place. Stand firm. Read about the typical mistakes made with NHS Continuing Healthcare Checklists.
- The scores in Checklist assessments may be lower than they should be, essentially to avoid the need for the CCG to do full multidisciplinary team (MDT) assessments.
“NHS CHC assessments should only be undertaken when an individual has recovered after an acute period of care and when their long term care needs can be more clearly identified.”
This is essentially the same as before. However, remember that part of the purpose of the NHS Continuing Healthcare assessment process is to inform the kind of care that is required. If people are being shunted out of hospital without a clear ongoing care plan in place, this presents a huge risk to patients.
“CCGs must ensure that decisions can be made swiftly throughout the week, as soon as patients are ready for discharge. Verification of MDT recommendations should take no more than 2 working days.”
Whilst it’s good news that funding decisions will be made more quickly, be alert for the following potential scenarios:
- NHS Continuing Healthcare full MDT assessments being arranged in haste without families being informed.
- NHS Continuing Healthcare full MDT assessments being carried out so quickly that they do not reflect the true picture of need of the individual being assessed.
- A lack of proper evidence at assessments, because the time it takes to pull it together may mean the CCG does not complete the process in the required time.
This may all sound cynical, but there is already a huge amount of impropriety in the way NHS Continuing Healthcare assessments take place (or don’t take place); these extra requirements placed on CCGs risk making this even worse.
Remember always 3 crucial things:
- Guidelines are just guidelines; they are not the law.
- Whether or not a person pays for care has nothing to do with their money, house or assets; it’s about their care needs only – and the decision about who does actually pay can ONLY be made once the NHS Continuing Healthcare assessment process is complete and a finding decision has been made, in writing, and with a full rationale.
- The local authority has a vital role to play in the NHS Continuing Healthcare assessment process.
So be vigilant, stand your ground and don’t be afraid to dig your heels in and get the Checklist carried out while your relative is still in hospital.