3 fundamental problems with NHS Continuing Healthcare
As well as the many things that go wrong in individual NHS Continuing Healthcare assessments, there are also serious and fundamental problems with NHS Continuing Healthcare – in terms of the actual processes that have been built around it.
It means that families are not only faced with a battle in the actual assessments, but the whole ‘culture’ around care funding for older people leaves a lot to be desired.
Here are 3 fundamental flaws in the system, and some links to help you…
1. The evidence used in Continuing Care assessments is unreliable
Continuing Healthcare assessors say that they base their funding recommendations primarily on the evidence of health needs available on paper at the time of an assessment. This evidence generally takes the form of daily care notes from the care provider.
However, generally speaking, care notes are kept to satisfy the requirements of the Care Quality Commission (CQC). Care staff have often never even heard of Continuing Healthcare, let alone understand how their often hastily scribbled end-of-the-day notes might be used in funding assessments. Some care companies even dictate what can and can’t be written in care notes. The NHS knows all this.
If the NHS is refusing someone the care funding they’re entitled to, and taking their personal assets to pay for that care, based on evidence that the NHS already knows to be unreliable, this surely constitutes fraud.
2. Ageism is alive and well in the NHS
Taking a chronically sick child to an NHS hospital or to an NHS doctor is unlikely to result in the parents being asked how much money they have. However, when an elderly person is chronically sick and needs nursing care, this is usually the first question they are asked – even when the extent of their nursing care needs is blindingly obvious.
Healthcare and nursing care in the UK are free, in law – unless you’re old, that is. When you get old, ageism in the NHS rears its very ugly head and a convoluted web of funding ‘assessments’ comes into play, carefully designed so that elderly people end up wrongly charged for care that the state should provide.
What’s even worse is that the notion of paying for care when we get older has become so engrained in our thinking (thanks to the health and social care authorities and the press telling us this) that few people realise the whole principle of paying for care is flawed.
3. NHS assessors and employees fail to comply with the law
The phrase ‘ignorance of the law is no defence’ is often quoted in legal matters. It’s interesting to observe, however, that health social care professionals and NHS funding assessors not only often seem unaware of the law but also seem to routinely ignore it – with seeming impunity.
For example, many fail to abide by the Mental Capacity Act and fail to carry out essential Mental Capacity Assessments. When this happens, vulnerable older people can find themselves in high-risk situations. Many NHS assessors seem ignorant of healthcare law and that healthcare and nursing care are free of charge in the UK – no matter how old someone is. Others admit they’ve never read the National Framework guidelines and/or have never heard of the landmark Coughlan case. Others twist the funding guidelines to suit their own budgetary agendas, instead of providing the state healthcare available to all.
Despite these fundamental problems, over 50,000 people do receive NHS Continuing Healthcare funding – but it’s clear to many people that many tens of thousands more should be receiving it. It can take determination and stamina to pursue the funding, and the better informed you are the easier it will be.
Read more about care fees and NHS Continuing Healthcare funding
Even when you manage on paper to get continuing care, getting care provided that is appropriate for the condition being managed, is extremely difficult. Families are expected to accept what they are given even when they know the staff allocated are not intelligent, & trained enough to deal with complex medical situations. Also there is no accountability for failure to provide the level of / type of care that has been agreed upon in a timely manner, putting family carers under intolerable strain. The NHS people who manage the system are only concerned about budgets and unlike the social services have no remit, or so it seems to ensure the general safety of the person being cared for. No pressure put on housing providers to ensure that severely disabled people are housed in appropriate housing for their need. My husband has been under this system since October 2009 and I do not think I have had 5 months of care cover since then adding it all up. I admit I am a tough customer because i will not accept my husband being looked after by just anyone, his safety is involved so I can not. Even though I persevere with the system, I have no confidence in the system what so ever and feel that the system has deprived me of my liberty to earn a living, affected my long term health and the health of my husband.
Some good points here – a pity the NHS cannot (make that “will not”) grasp these straightforward principles so easily.
The analogy of how we treat older people versus children is very true. As a society, we would never, quite rightly, tolerate the parents of Great Ormond Street patients being asked to pay for care. So how come it’s acceptable at the other end of a person’s life? It’s still the same person but with different needs. And the same NHS.
I have just send the CHC department a formal request for an assessment which properly reflects the judgement in the Coughlan case and the Grogan case – and I downloaded and sent the the full judgement which I found on another website. I’ve also sent them a copy of the submission made by the Law Society to the House of Commons Select Committee, just for good measure. I’ve found the video of Pam Coughlan, who was granted CHC by the High Court, and done a written comparison of Pam’s abilities, evident in the video, and mum’s abilities. It is clear that mum needs more care than Pam. This was posted Special Delivery to arrive at the CHC office last Friday. They denied receiving it, but last night I was phoned by a CCCG Complaints Officer, who is going to investigate further, because it was sent to her office, some 20 miles away from the CHC office, without being logged in, apparently. So mum has spent yet another week in hospital with nothing actually happening. All I want for Christmas is mum in a CHC funded nursing home bed. The bed is already reserved, and I’ve told everyone she can be gone in 24 hours once funding is granted. After 2 months in a rehab bed, she wants out and Matron is desperate to have the bed back. I’ve explained to all concerned that it’s not mum bed blocking, it’s the NHS bureaucracy. If they did everything properly first time, mum would have been out six weeks ago!
So much stress and distress is caused by the whole shoddy ‘system’ – failures to abide by regulations, guidelines and the law, the lack of knowledge of (or failure to take the time to find out about) care needs, one hand not having a clue (and perhaps not caring) what the other is doing, appalling and damaging protectionist behaviour when it comes to budgets… – it goes on. And at the centre of all this for every family is, of course, a vulnerable person needing care – the very person the health and social care system supposedly exists to help, and yet has entirely forgotten.
DST recommendation for 24 hour EMI Nursing care eligible for funding – denied by single decision-maker this week.
Unbelievable non-compliance with the framework.
Which bit of “24 hour EMI nursing care” is not eligible?
The fight is on.
Good luck Yvonne. Yes, the MDT recommendation should only be overturned in exceptional circumstances – and yet the rules are broken at every turn.