NHS Continuing Healthcare Funding (CHC) – The process
Now that CHC has been imbedded with the National Framework for some years now, the CCGs understand much more about the process, but that does not mean that everyone who works in the CHC process does. The various CCGs have also worked out how they choose to do it and even though it is roughly in line with the National Framework, each area can be slightly different. I’ve also come across more than one CCG where their process is a long way from compliant to the National Framework. One of the issues with that, is that although you can point this out to the person you are working with on the assessment, they are doing what they have been told, so unless you can get the CCG to change their process, the assessment is not going to go as it should. I’ve usually reported those issues to NHS England or the Ombudsman and where leave it to them to advise the CCGs to change their processes.
So what should it be? The first thing is that Social Services have a duty under the Care Act 2014 to put forward a person for an assessment if they think that they may be eligible for CHC. However this relies on that particular Social Worker knowing that they have that duty and secondly understanding the criteria for CHC. So assuming that no-one else has asked for an assessment, how do you go about doing it? The first thing is to contact your local CCG and ask them to undertake an assessment.
There is usually a waiting list, so it may be some weeks before the assessment takes place. But you should ensure that you get confirmation of the request and ask them how long they think that it is likely to take before you get an assessment date.
Once the assessment date comes around, it should take place at the venue where the person lives, if they are cognitively impaired, then it is appropriate that the person / team (Multi disciplinary Team – MDT) undertaking the assessment meets the person, but if it is going to cause them distress to take part, then they should not be actively involved themselves. Just because the person is not involved, doesn’t mean their family shouldn’t be. Although the carers in the care home have a good knowledge of the person, no-one is going to know them as well as their family, so they should be involved. I am often involved to support the family as advocate, as although I don’t know the person as well as their family do, I do understand CHC and together we make a great team. If the person is not cognitively impaired, then they should take part in this assessment.
The MDT then should look through the notes to get some background information and then the meeting can begin to discuss the person, this meeting should include the family and carers, as well as the MDT. There are 11 named domains to talk about and these should be discussed in detail, it can take 90+ minutes, if it takes much less, it is unlikely to be a thorough enough job to make a good decision. Each of the domains is scored, the family have input into this, a recommendation is made by the MDT, and the paperwork sent to the CCG to go to Panel and the Panel should accept the recommendation, except in exceptional circumstances. The Panel do not accept the recommendation far more often than they should and then an appeal can be made if the person is not found eligible, which can take many more months and adds more stress to the family, so family’s often drop out, but as advocate I can take some of that stress away to support through the appeal.
Sometimes the Panel will defer a decision for more information, so if they need just a little bit more information, then this can be sent in and the matter goes back to Panel and they can find the person eligible. If they need more information, they will ask for which area they feel they need more information, so the research is very focussed. This is less time consuming and saves having to go through a whole appeal process, which is far less distressing for the family. It is therefore useful to stay in touch with the MDT, who will advise if this happens.
The family’s who instruct me find it very helpful to have someone on their side, who understands the process to support them, check the paperwork and ask the right questions to get a good result – hopefully!
I am very grateful to you for the help you gave me. It is very sad that even if a Social worker is aware of the system and criteria they might make a judgement about the home of the ‘patient’ and decide that on the surface they have enough comfort that any help should not be for them by just stretching the criteria beyond that stated. I persisted and got there in the end.
I am glad that I was able to help Carol.