It will come as no surprise to many families to read that in NHS Continuing Healthcare conflicts of interest are commonplace.
Many things go wrong in the Continuing Healthcare assessment process, and we’ve listed some of the most frequent here:
- Families are not told about Continuing Healthcare when a relative first needs care and so do not know that their relatives may need to be assessed for this funding.
- There seems to be a lack of training on Continuing Healthcare for health and social care employees and assessors, including those working in hospitals. It means that many do not seem to understand the vital difference between healthcare and social care and how each is funded. Families, also, are often unaware of this difference and therefore do not always know when things are being done incorrectly and when a relative is being illegally means tested.
- Many assessors seem to have been thrown in at the deep end with assessments. Some have admitted they’ve never have read the National Framework assessment guidelines, and/or they don’t understand the Continuing Healthcare eligibility criteria themselves, and/or they fail to understand the local authority legal limit when coming up with their eligibility recommendation.
- Families are frequently put off applying or pursuing Continuing Healthcare funding by some health and social care staff who say, “it’s not worth it” or “you won’t qualify” or “you have to be in a coma” or “paralysed” or “at end of life” – or other such nonsense. None of these things are true. This seems to be compounded by the ‘system’ making it as difficult as possible for people to pursue and secure the funding.
- Assessments often happen behind a family’s back, i.e. the family is not told an assessment is taking place and therefore they can’t input evidence or monitor what’s going on. This goes hand in hand with poor quality care notes in many instances, which can render a person ineligible for funding even though a person clearly has significant care needs that warrant the provision of Continuing Healthcare. In such instances it is even more vital that the family is involved, to argue the case for their relative and to point out the flaws and inadequacies in the care notes and in the process being followed (or not followed) by assessors.
NHS Continuing Healthcare – conflicts of interest
There are some clear conflicts of interest that underpin these flaws. If you’re contacting your MP or other advocate to support you in your funding application or appeal, it’s worth highlighting the following points:
- The Continuing Healthcare guidelines published by the Dept of Health stress the need for transparency and openness throughout the funding assessment and appeal process. However, the reports we receive from many families suggest that such transparency is sady lacking. Instead, other agendas seem to be at play (e.g. budgetary influences, protectionist and defensive attitudes, etc).
- The people who conduct Continuing Healthcare assessments work for CCGs, who hold the purse strings. Continuing Healthcare assessors make a funding recommendation that goes to a CCG decision making panel; this panel is comprised of people who ultimately hold the purse strings.
- A care home manager we spoke to told us that the CCG in her area is removing all Continuing Healthcare funding from people almost as routine, and making families fight to get it back. This is despite the NHS having a legal duty to fund people with a certain level of care needs. It would seem a cynical move, to say the least: it often comes at a time when the person needing care is dying; in addition, it takes energy, stamina and knowledge to pull together a detailed and coherent appeal case, and many families just aren’t in a position to do that.
- Care homes, generally speaking, receive the most money from people who pay for their own care (so-called ‘self-funders’). It means there is often little incentive for a care home to help a family through the assessment process. Indeed, some families report care providers actively sabotaging funding cases.
- We were involved in a Continuing Healthcare assessment where the assessor stated that the CCG gives training to all care homes in their area to show care home staff how to keep the kind of care notes needed to support a Continuing Healthcare funding application. This turned out to be untrue. Many care home staff who keep care notes have no idea about Continuing Healthcare and so cannot possibly be recording the things needed to support a case. Carers are also very busy. Families rely on care notes as the main form of evidence in funding assessments, and yet these care notes frequently let the family down.
- Hospitals want to get people out and free up beds – and yet this may be before anyone has actioned a Continuing Healthcare assessment. It means vulnerable people are moved into long term care facilities and just told to pay the care fees; however these are care fees that the NHS may, in fact, have a legal duty to pay instead.
3 things need to happen to reduce these conflicts of interest:
- the whole process needs to be taken out of the hands of those with vested interests in the outcome
- all those involved need to be impartial
- care staff (and carers at home) need to be properly trained to understand the importance of every single thing they write in care notes
The greater the number of people who know about Continuing Healthcare the better – and families need to know how to argue their case in an assessment or appeal and know the potential pitfalls to watch out for.
If you’ve come across additional conflicts of interest in your own Continuing Healthcare case, please add a comment below.