The Continuing Healthcare Trap
By Max Duddles.
If someone is in a care home or nursing home because their mental or physical health needs mean that they cannot be looked after in their own accomodation, then the, often high, costs of that should be funded by the NHS Continuing Healthcare Scheme (CHC).
Approximately 450,000 people across the UK currently reside in care homes. It is estimated that approximately 40% of them entirely fund their own care and many more make contributions towards it. This raises the, obvious, concern that many people and their families could have been incorrectly asked to pay towards their own care, or towards the care of a loved one.
The problem is that the rules surrounding CHC funding are complex and very open to misinterpretation. CHC funding is reviewed once every 6 months and relatives who attend such reviews often report that they feel the person who is performing the review is under pressure to remove this funding, even when there is clearly a healthcare need.
At the heart of the issue is a document known as the “Decision Support Tool”, or DST. This is a 49 page document published by the Department of Health and Social Care and is used by all NHS Trusts.
The DST considers several “domains” which relate to a patient. These include such things as breathing, nutrition, continence, skin integrity, mobility, cognition and behaviour. Each domain is given a score, which ranges from “no needs” all the way up to “priority”. Each score has a number of descriptors, so, for example, a severe need for breathing needs means a,
“Difficulty in breathing, even through a tracheotomy, which requires suction to maintain airway.
OR
Demonstrates severe breathing difficulties at rest, in spite of maximum medical therapy
OR
A condition that requires management by a non-invasive device to both stimulate and maintain breathing (bi-level positive airway pressure, or non-invasive ventilation)”.
At the end of any CHC assessment, the scores are calculated and a decisions is made as to whether to refer the case to a Multi-Disciplinary Team (MDT) for a more thorough review. If that review decides that there is a Primary Healthcare Need, then funding is granted accordingly. Availability of funding can vary from area to area, but in general if a patient has 1 or more priority health need, or 3 or 4 severe health needs then CHC funding will be considered by the NHS funding commissioners.
The problem is that CHC assessors and funding commissioners often put a great deal of emphasis on the DST scores and treat the DST itself with far greater weight than it should have in law. The DST is supposed to be a tool in the shape of a form which helps decision makers to assess whether someone is legally entitled to CHC. It was never meant to take the place of a decision maker, neither is it a legal document itself. Unfortunately though, the way in which the form is completed at the outset can make all the difference as to whether someone is referred for an MDT review; or continues to get CHC funding; or has to pay for their own care.
This can often lead to very unfair and distressing situations. The wife of a man with dementia, who feels that he should be at home, but has been told that it is in his and her best interests for him to remain in a nursing or residential setting. She may be asked to use his pension to fund a care home placement. Sometimes property and belongings of value must be sold to make this happen.
What many people do not know is that they can ask solicitors and other legal professionals to attend CHC assessments and ensure that they are correctly and fairly carried out. We can argue in favour of continuing CHC funding and advise of the steps to take if such funding is unreasonably refused.
We can also review CHC funding decisions and advise on the prospects of successfully appealing them.
We firmly believe that everyone in such a position should be able to access quality legal advice at a fair and reasonable rate. To this end, we charge a fixed fee of £250 plus vat plus mileage for an initial meeting in our offices and to attend a CHC funding assessment in the Leicestershire area.
If a CHC assessment has already taken place and you disagree with the outcome, we charge a fixed fee of £200 plus vat for an initial meeting in our offices, an assessment of the completed documentation and a second meeting to advise on the merits of mounting a challenge.
If you have been asked to attend a CHC assessment, or feel that a CHC assessment has been conducted unfairly in the past please contact our team of specialists who can help you further on 0333 2029321.
