In part 1 we looked at the legal position surrounding healthcare provision in the UK, and why it is inappropriate for the NHS to ask people to pay care fees during an appeal for NHS Continuing Healthcare.
We now look at some of the practical things you can do first if you’ve been turned down for Continuing Care funding and you’re ask to pay care fees – and yet you want to appeal.
- Ask for a full copy of the Checklist and/or Decision Support Tool assessment notes.
- Go through them in fine detail and make a note of anything that is incorrect, misleading or unduly positive in terms of portraying your relative’s health needs.
- Make a note of anything that is missing from the notes or any points that have been overlooked.
- Make a note of flaws in the assessment process used, such as excluding you from the process, verbal or written intimidation by the assessment team, unprofessional behaviour by staff (who may have stated in advance that you ‘won’t qualify’), misinterpretation of the eligibility criteria, (e.g. saying that someone who is immobile has ‘no risk’), assessors refusing to acknowledge that your relative’s combination of scores does indeed match the eligibility criteria, assessors having no knowledge of your relative’s day-to-day health and care needs, things just seem plain wrong, etc.
- All these points will be invaluable later on.
- Write to the local NHS Continuing Care Dept and inform them that you will be appealing their decision not to provide funding – and cite just a few (not all) of the strongest reasons you’ve pulled out.
- State that you will be submitting a full Continuing Care appeal in due course.
- Use the arguments in Part 1 of this article to highlight that your relative cannot be found ‘ineligible’ for Continuing Care funding when the assessment was not carried out properly in the first place.
All the things you pick up from the assessment notes and assessment process render the assessment itself flawed, and therefore no decision about who is responsible for funding can possibly have been made at this point.
Plus, given that healthcare in the UK is free of charge by default, the NHS must clearly show without any doubt that a person is not eligible for care/funding before it refuses to provide care.
If your relative is in hospital and being pressured to go into a care home and to start paying care fees, remind the discharge team of their obligation to follow proper hospital discharge procedures. 5 things to check before your relative is discharged from hospital
It is the responsibility of the NHS to conduct proper and full assessments, not the job of a family to have to pick up the pieces of maladministration and be forced to pay for the NHS’s mistakes.
For the same reasons, the NHS should fund care in any temporary home in which they place your relative, especially of course given that it will be their choice to send your relative there.
A patient cannot possibly be moved into self-funded care (healthcare) without the full and proper extent of his or her health needs being made clear through appeal against maladministration and misinterpretation of the eligibility criteria by the NHS. Attempting to force someone with a primary health need to pay for ongoing healthcare in a care home before the full process has been completed is serious financial abuse.
So, in a nutshell, if the NHS tries to force your relative to pay for care during appeal, the key arguments to use here are that:
- No proper or safe assessment has yet been carried out, nor has the proper process been followed.
- No safe decision can be made based on what has been done so far.
- It is the responsibility of the NHS to pay for healthcare for people who live in the UK, and there is as yet no safe evidence to conclude that your relative is not entitled to that.
- The attempts by the NHS and/or the local authority to make your relative pay for care at this point (for all the above reasons) constitute serious financial abuse, and those attempting to defraud your relative in this way may personally be in breach of the law.
And of course, just because the flawed NHS practice of telling families to start paying for care has become so entrenched, and just because most families do so, doesn’t mean the NHS has any right to do this.
Read more about refusing to pay care fees – including when Continuing Care funding is withdrawn.