A flawed NHS continuing healthcare assessment with severe consequences, and how it was put right

Posted on: November 15th, 2016 by Tim Saunders

Yesterday The Continuing Healthcare Alliance published a report that highlighted the weaknesses in the NHS continuing healthcare (CHC) system, and called for improvements. The report flagged several problems, including with the assessment process. This process was clearly flawed in a case that came through our free Information and Advice Service recently…

Sarah’s elderly father, Eric, has challenging health and psychological problems and requires extensive one-to-one support. Despite this, a panel concluded he wasn’t eligible for NHS CHC funding, and Eric was threatened with eviction from his care home. But experts on our free information and advice service spotted problems with the assessment.

Sarah’s father has dementia, which has caused him to become very aggressive and obsessive. A stroke has also left Eric doubly incontinent and in a wheelchair. Caring for him is very challenging, especially as his behaviour can be unpredictable. At his first care home he was – unbeknown to Sarah – being heavily sedated. This made him unsteady on his feet, and was hospitalised following a fall. When this happened, the care home refused to have him back.

A desperate situation

At a new care home his behaviour again caused concern especially when, in December 2015, he attacked another resident. The care home threatened to issue him with a notice to leave if Social Services, who were part funding his care, refused to pay for six hours a day of one-to-one attention.

In January 2016 Eric received a full assessment for continuing healthcare (CHC) funding. He was declared not eligible and social services withdrew funding for his one-to-one care.

His behaviour immediately declined and the care home once again threatened to evict him. Sarah knew she had to challenge the CHC decision.

Expert advice

Sarah called our free Information and Advice Line, and told us about her father’s situation.

We arranged a free 30 minute phone consultation with her, during which we discussed her options and the grounds on which she could appeal.

We also suggested that she download our free Navigational Toolkit to help her understand the appeals process.

Our expert advisors highlighted to Sarah that Eric’s assessment had taken place after his behaviour had improved through extensive one-to-one care. But once this was removed he worsened significantly. The assessment had rated Eric’s psychological and emotional needs as low and had failed to include sufficient mention of Eric’s violent behaviour towards carers and other care home residents.

A successful appeal for funding

Following our advice, in September 2016 Sarah successfully challenged the eligibility decision.

The care home is now receiving continuing healthcare funding to pay for Eric’s one-to-one care needs, and he is being reimbursed more than £7,000 that had been paid out for care from his weekly pensions since December 2015.

Sarah says: “When I contacted Beacon I felt very vulnerable, very frightened and bewildered and I didn’t know which way to turn. All I knew was that I had to help my dad. Had I not had Beacon’s help, I think my dad would have been evicted from his care home and ended up who knows where.

“People in my Dad’s situation – and their loved ones – need as much help as possible to get the funding they’re entitled to. Beacon provided me with that expert help for free, and it made such a difference. I want everyone else in my situation to know about them.”

Do you need our help?

If you are preparing to appeal a continuing healthcare decision for yourself or a loved one, and need some help, call our free Information and Advice Line for support from independent experts.

Can you help to improve the system?

In Eric’s case, the consequences of a flawed assessment nearly pushed him over the edge. A report from the Continuing Healthcare Alliance has highlighted that the system is beset by problems that make it extremely difficult and stressful for vulnerable people to get the care funding they are entitled to.

Help us to change the system by sharing the report with your MP and local NHS. It’s easy to do, just follow the instructions at: www.continuinghealthcarealliance.co.uk

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