Potential investigations into NHS Continuing Healthcare…
Some of you have previously sent complaints and concerns about NHS Continuing Healthcare to the National Audit Office (NAO). The NAO is now moving Continuing Healthcare up their agenda and is going ahead with some scoping work on the problems in the Continuing Healthcare process in England.
This work, which is likely to start early in 2017, will help them decide whether to publish a later investigation on the topic.
NHS Continuing Healthcare investigations
As in many bodies like the NAO, researchers will draw on information that is available relating to problems in the system. There can be few people who know more about problems in Continuing Healthcare than the families of people in care – and of course individuals who need care themselves.
It’s vital, therefore, that not only does the experience of these families get into the hands of those who can investigate, but also that the information actually makes an impact.
We’ve had several requests for guidance on what exactly you should send in such an instance, so here are some tips:
Sending concerns about Continuing Healthcare to public bodies
If you’re sending your concerns and complaints in this respect to a public sector body (for example the NAO), keep in mind the bigger picture.
For example, an organisation like the NAO may not want all the intricate details about your own relative’s specific care needs. Instead, they can probably make better use of information that helps paint a bigger national picture, e.g. examples of maladministration in the assessment and appeal process that are likely to affect many other families too.
If they receive lots of correspondence from many different people who are highlighting the same or similar problems, the impact is likely to be greater.
Make it as easy as possible for the person at the organisation who will be reading your correspondence to grasp the severity of the national situation.
Continuing Healthcare process
So if the context is a national one, i.e. it’s the wider Continuing Healthcare system that is being scrutinised, rather than your relative’s own individual case, consider including examples of the following (if they apply to you):
- failure by assessors to follow Dept. of Health guidance (National Framework, etc.)
- failure to uphold case law (e.g. the Coughlan case)
- failure to follow individual points in Continuing Healthcare guidance, e.g. incorrectly focusing on managed needs instead of underlying needs, failing to involve the family, using incorrect assessment forms, altering assessment scores behind closed doors, ignoring evidence, intimidation, threats and obstruction of the process – the kinds of things that many, many families report, and which many families share on our blog
- failure to provide adequate information to the family about the process
- failure to carry out any assessmnt at all and/or attempts to put the family off right at the start
- attempts to force a person to pay care fees before the proper assessment process has been followed
- lack of appropriate knowledge and training on the part of assessors
- …and so on
- …and so on.
There are often many issues to highlight, as the articles and comments on this website show. (Of course, only highlight those relevant to you.)
So keep in mind that, whilst you’re using your relative’s case as the basis for what you’re sending (which is important), the points you’re making are for the greater good, rather than for getting your relative’s own individual case resolved at this point in time.
Interpretation of eligibility criteria
You might also want to highlight how assessors have failed to correctly interpret the Continuing Healthcare eligibility criteria. Again, make it as relevant as possible to the bigger picture.
For example, if the score in any given care domain in an assessment is obviously far too low, you may want to highlight a seeming deliberate attempt to play down care needs and deny funding – rather than including a long detailed account of all of your relative’s care needs in that domain.
In addition, if you have a combination of scores where it’s pretty obvious that Continuing Healthcare funding should be awarded and yet it’s not, highlight the failure by assessors to properly interpret those scores – rather than writing a detailed account of the conversation that took place in the assessment meeting.
Remember that researchers are busy people and they have a lot to read, so make the information you send as impactful as possible.
The difference between information that highlights the bigger picture and information that highlights your specific case is a subtle one, of course – and both are important – but keep in mind always the primary purpose of the information you’re sending.
If you have any further tips to share about how you’ve put together information in this context, please do add a comment, as it could help many other families.
Note: National Audit Office – Although there’s no firm guarantee about an investigation into Continuing Healthcare, the more information they receive now the more likley they are to take this forward with concrete action. Contact Jenny George, Director, Health value for money studies, Email: Jenny.George@nao.gsi.gov.uk (Please don’t send your correspondence to Care To Be Different; instead, send it to the NAO.)