We, at Care to Be Different, felt we had to share with you some worrying and startling first-hand insights from Nurse ‘Andrea’ (not her real name), a nurse advocate with a wealth of experience in all aspects of CHC assessments and appeals. She contacted us to let us know just what kind of antics she’s experienced with NHS Continuing Healthcare assessments, having previously worked as an NHS assessor and Lead Nurse, chaired Local Resolution Panels and sat on Independent Review Panels.
Andrea has since left the NHS, and for many years, has worked independently, providing professional assessments and advice to individuals, companies and care homes alike, to help them through the difficult and flawed CHC assessment process.
In 2007, the National Framework for NHS Continuing Healthcare Funding and NHS-funded Nursing Care was introduced. This laid out clearer guidelines and provided a Decision Support Tool (DST) to aid professionals make a decision in respect of eligibility for NHS Continuing Healthcare Funding (known colloquially as ‘CHC’). The National Framework was modified again in 2009 and 2012, and more recently in again in October 2018. The intention of these updates was for the CHC decision-making process to be more robust, fairer and consistent across the country.
Andrea: “After leaving the NHS and beginning to work independently, it was becoming very clear that there was a great deal of inconsistency across the UK as to who got CHC Funding and who missed out. This was because the National Framework was being interpreted in various ways by different CCGs across the country.” (This is often referred to as the ‘postcode lottery’.)
I have always argued that, whether an individual is born with a disability or health needs, or they has developed along the way, it should be the duty of those professionals involved in the care, to provide the family and the individual with as much support and direction as possible.
5th July 1948 – brought about the birth of the NHS and free Healthcare for all, from the ‘cradle to the grave’.
I feel from what I have witnessed that the Government and the NHS are still a long way from providing this.”
No:1 “If I broke my leg and was taken to hospital, I would be treated at no cost and would be kept there, free of charge, with all meals provided, until I was considered fit to be discharged home. However, if I was discharged into a care facility instead, I would have to pay for my accommodation, food and essentials – which could amount to thousands of pounds. Having paid taxes and National Insurance contributions all my life, why should I be penalised for being placed in a facility which is not my home, or else, having to pay for carers to come and deliver my care at my home?”
No:2 “I’ve witnessed CHC assessments whereby an individual who’s had a debilitating stroke and could no longer manage any of their own care, became unable to communicate, was incontinent of urine and faeces, unable to meet their nutritional needs, care for their own skin integrity, or able to identify or take their own medication – was assessed by the CCG as having no nursing needs. Yet, conversely, in another part of the country a CCG assessed an individual who was fully mobile, could make their own decisions, could choose from a written menu, assisted in their own care but required help to administer their medication (because they would forget whether they had taken it), was deemed to have nursing needs.”
No:3 “I have experience of professionals who have sent individuals back to their care facilities registered as a ‘residential only’ ie without further assessment or further consideration of their entitlement to either NHS-funded Nursing Care (FNC) or NHS Continuing Healthcare (CHC) when they have obvious ‘high’ levels of need. As most individuals do not understand the process, they don’t feel confident in questioning these decisions.”
No:4 “I have also read a comment made recently by a professional saying: If she [the patient] was in a care home she would be funded, but not while she’s at home.”
Statements like this are very worrying indeed, and show a lack of training and a fundamental misunderstanding, which goes to the very core of the National Framework!”
Andrea comments: “This in itself goes against the National Framework guidelines which very clearly state that NHS continuing Healthcare Funding can be delivered in any environment (ie whether in your own home, care or nursing home or other care facility).
No:5 “I have visited numerous care facilities to carry out eligibility assessments for CHC Funding, and one of the most common questions that staff ask is: ‘Why do they [the family] want an assessment for Continuing Healthcare?’ Some staff just don’t understand and think it’s because they want to move their mum or dad out of the care home.”
Again, this common scenario demonstrates that some care facilities have a basic misunderstanding of what NHS Continuing Healthcare is all about.
Andrea comments: “If an individual is already in a care facility receiving appropriate care, but then meets the eligibility criteria for NHS Continuing Healthcare Funding, it does not necessarily mean changing care facility. It merely means that money for funding for that individual’s care is now being paid for by the NHS rather than how it was previously being funded. An individual should not receive any different care (less or more) just because the method of funding has changed.”
No:6 “Care home managers have openly told me that, individuals who pay for their care privately (i.e ‘self-funding’) are being charged a higher rate for their stay at the care facility than those with NHS or local authority funding.”
NHS (and local authority) ‘bed’ rates generally tend to be far lower than the actual cost of keeping a resident in a care home. And so, whilst knowing that the NHS will meet the cost of the individual’s assessed CHC needs is helpful for budgeting and cash flow, it can still leave a significant shortfall in the actual cost of keeping that individual in the care home environment.
“Some care homes therefore do not find it in their best interests for an individual to be CHC Funded because of the lower rates paid. These self–funding individuals are effectively boosting the care home’s finances and subsidising their overheads and the care of others in the home.”
It’s shocking that there is such a poor understanding of the National Framework and such inconsistencies in its application. Nurse Andrea feels that these consistencies reflect the complex nature of NHS National Framework which desperately needs simplifying to become far more prescriptive.
However, we, at Care to Be Different, are not shocked by Nurse Andrea’s findings, but she does certainly help to highlight what we see time and time again happening up and down the country.
The conclusion we can draw from this is that you must always challenge decisions made by your Clinical Commissioning Group, and don’t ever assume that they are right 100% of the time. Fight for your relative’s rights!
Read more of Nurse Andrea’s insights in Part 2, coming soon…