Continuing Health Care
The National Audit Office has published a report highlighting its concerns about misinterpretation of the rules and how CCGs need to improve their processes when assessing people for CHC. Click here
What is CHC funding? click here to find out more
Continuing Health Care funding is given to people who meet certain criteria which means that the NHS pays for all their healthcare needs.
It's supposed to be a straightforward process with clear instruction on how a person qualifies and the time scale between making an application and a decision being reached.
People who should qualify usually have life changing, life long, life limiting conditions but we're very concerned that some CCGs appear to be making their own rules and even breaking the law National Health Service Act 2006.
Here in Gtr Manchester CCGs are working to ensure that all applications are processed within the national framework IE the rules.
Click here to see what Gtr Manchester CCGs do when considering a person for CHC (using information from NHS Bolton CCG website)
So why are things still not working?
We're hearing from people that :
The criteria and the process isn't clear enough - even for professionals
They're not being kept updated or even informed
Important clinical evidence is not being submitted to panel and supporting documents are being altered
Panels are financially driven and made up of people who know little or nothing about the person being discussed, they very often have no neurological experience or knowledge
Brokers are being included in CHC checklist and Decision Support Tool meetings without the agreement of the patient or their representative/ supporters
They're being 'encouraged' to choose Care Advocates even when a patient's carer or supporter has been evidenced as able to speak for them and they are happy for the carer/representative to do so
Click here to find out what a Care Advocate does
Mental capacity is being used to suggest a person isn't able to communicate their wishes - even patients who haven't had an assessment
Assessments are incomplete and/or factually incorrect
Queries and appeals are being referred to complaints teams that take too long to respond or action
People are getting worse and sometimes dying, waiting for help
Vexation orders are issued against people who repeatedly ask questions or have to challenge decisions
Click here to see peoples experiences
Click here to see what the NHS Constitution says about this
So how should it work?
Click here for more information
So what can you do if your application is rejected?
You must understand the language used to reject an application for CHC.
EG : we're hearing from people that their health needs are considered "stable and predictable". This means that in panel's opinion a person is able to cope with their health needs and does not require support under CHC. However you must ask what would happen to that person if support was withdrawn IE would they remain stable and predictable. For the majority of people living with neuro the answer is no.
You can challenge any process or decision that isn't in line with the national framework. Do this by contacting the CHC Lead for your CCG click here
You can appeal a decision if you believe it is wrong. This is a formal process and you need to write to the Chief Operating Officer of your CCG to express your dis-satisfaction at the decision. Make clear that you wish to appeal and ask that you be able to provide medical evidence to support your appeal. Insist that the CCG updates and corrects any old or false information that it has on documents relating to you. This make take several attempts.
Ask the CCG if the person applying for CHC was deemed to have mental capacity
Click here to download a sample appeal letter
Click here to read more about Mental Capacity Assessments
If you are ignored or refused make a formal complaint.
You can speak to a solicitor dealing in Public Law but you may not qualify for Legal Aid or Legal Help as you may not have a case and the powers of a solicitor are limited. They cannot insist that a CCG act outside of a judicial review and this is very rare. However they should be able to provide you with enough information to take the next step.
Ask a solicitor about whether or not your situation might be considered a 'deprivation of liberty' subject to
Liberty Protection Safeguards (LPS): In July 2018, the Government published a Mental Capacity (Amendment) Bill which will see DoLS replaced by the Liberty Protection Safeguards (LPS). Under LPS, there will be a streamlined process for authorising deprivations of liberty. Read more: Liberty Protection Safeguards
Make a complaint to the PHSO click here
The NHS Constitution is clear on CHC and its position is not open to interpretation.