Can a CCG do a repeat Continuing Healthcare assessment?

Published 21/10/2017

Please note: This article was published prior to July 2022, and some information may be outdated.

Repeat Continuing Healthcare assessment: What happens when a CCG says it’s going to replace one assessment with another?

Let’s look at the following two scenarios – one of which involves a repeat Continuing Healthcare assessment:

Scenario 1:

Your relative has had a Checklist assessment for NHS Continuing Healthcare and is waiting for a full Multidisciplinary Team (MDT) assessment.

The MDT assessment takes place, a Decision Support Tool document is completed and the CCG decides that your relative is eligible for NHS Continuing Healthcare funding. This funding is then backdated to day 29 after the original Checklist document was received by the CCG.

This backdating point is vital to note, especially if the CCG has taken months and months to complete the assessment process.

Let’s now look at scenario 2:

Your relative has had a Checklist assessment for NHS Continuing Healthcare and is waiting for a full Multidisciplinary Team (MDT) assessment – just like in scenario 1.

The MDT assessment takes place, a Decision Support Tool document is completed – but then the CCG decides that your relative is not eligible for NHS Continuing Healthcare funding. You decide to appeal.

At some point after this, and during the appeal process, the CCG might say that it needs to do a repeat Checklist, i.e. a repeat Continuing Healthcare assessment.

This is when alarm bells should start ringing. Why? Because if a new Checklist is carried out, the CCG might try to backdate any subsequent funding only as far back as this new Checklist – instead of back to the original one.

In such a scenario, make sure the CCG knows you expect any subsequent Continuing Healthcare funding to be backdated correctly. i.e. to day 29 after the original Checklist was received by the CCG.

So there are 2 vital points here about repeat Continuing Healthcare assessments:

1. Where repeat assessments are carried out as part of an ongoing process prior to the final funding decision, the backdating of any subsequent Continuing Healthcare funding must be based on the original Checklist.

2. A similar principle applies if the CCG suggests repeating the DST/MDT during an ongoing process. If the original DST was flawed and incorrectly completed or ignored evidence, you may wat the CCG to repeat it. However, if the original DST showed you had a strong case for funding, it could be that the CCG, in suggesting a new one, is trying to reach a point where they can deny you funding by creating a weaker DST.

Note: If your relative’s needs actually decrease at some point during the appeal process, this does not make the original Checklist and Decision Support Tool invalid. They are still absolutely valid for the appeal process, as they reflect your relative’s needs and risks at the time they were drawn up.

Equally, just because your relative’ needs may have lessened some way into the appeal process, doesn’t mean they may not have been eligible for Continuing Healthcare when the original assessment(s)s were carried out.

While you are going through an appeal, you can also request a brand new Checklist – as part of a brand new process – if your relative has deteriorated in the meantime.

If you’ve come up against any of these issues, feel free to share your experience in the comments below.

Tagged Categories: CHC essentials, CHC funding, MDTs, NHS Continuing Healthcare, Requiring advocacy

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18 Comments

jo March 5, 2018 at 9:35 am

Jo
My father had a Decision Support Tool (DST) in Sept 2016, the outcome was that he was ineligible for NHS Continuing Healthcare (CHC) funding but received Funded Nursing Care (FNC) instead. He should have been reviewed Sept 2017 and is still waiting. Since then I have requested his case be reviewed. I didn't agreed with the outcome of the DST but at the time was grieving the death of my mother. Only read the DST last November by which time the appeal period had gone. I have written to the CCG recently explaining this, and that, I now believe the dst to be flawed for the following reasons. Assessor arrived at my father's nursing home earlier than the specified meeting time, met with my father and studied care plans. The way the DST was written was in consistant in that my father has verbal communication difficulties and hardly speaks so carer staff have to pre-empt his needs which can only be done when being tended by a carer who he is familiar with, but the assessor wrote " B asked for ..." or "B said..." which contradicts what was written in the communication domain. My question is should a new checklist be undertaken at a review stage? And, is it too late to appeal the DST carried out in Sept 2016? Your website is so full of useful information and has helped me to understand the system I only wish I'd been aware of it earlier at the time of my father's first DST in 2015. A big Thank you!

Cindy January 10, 2018 at 11:00 am

My mum has been funded under NHS Continuing Healthcare (CHC) since April 2010. During this time she has been resident in an authority closer to my home, but agreed when CHC was first agreed. There has been an ongoing dispute between the funding authority and the local authority regarding 'Ordinary Residence', together with a Decision Support Tool review in July which deemed she was no longer to be funded under CHC but reduced to Funded Nursing Care. The local authority, [not the funding CHC] has just informed me that they will undertake a Care Act Assessment. Can anyone explain what this is and how does it contribute to the ongoing dispute, or will there need to be a further assessment?

Poppet January 2, 2018 at 1:57 pm

Could anyone point me to the relevant policy/legislation which would indicate whether there is a legal requirement for NHS Continuing Healthcare to carry out an annual Decision Support Tool (DST) which is to include a Checklist first? There is lots of interesting information out there but I can't find anything definitive that states that an annual DST preceded by a Checklist is a 'legal requirement'.

Taj February 10, 2020 at 7:18 pm

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/746063/20181001_National_Framework_for_CHC_and_FNC_-_October_2018_Revised.pdf

Page 52

Taj February 10, 2020 at 7:17 pm

The 2018 CHC Framework includes much improved guidance regarding annual or 3 month reviews of CHC eligibility.

In short a new DST should only be completed if there is "clear evidence" of a change in needs "to an extent that might impact on an individuals eligibility for CHC"

If there is no clear evidence of a significant reduction in healthcare needs then no new DST should be completed. The original DST still remains valid.

Eddy Burton December 11, 2017 at 4:45 pm

My Father of 97 was assessed without my knowledge and when I looked at the assessment they it had not been completed properly with his details or signed by him. I am not happy with the way this was carried out so can I request another assessment? I have power of Attorney and would have liked to have been present. He is in hospital after a stroke and they have advised he needs to go into a home which I am sourcing now. The Nurse I spoke to made a comment along the lines of' the NHS is under funded and we should be aware that funding is not for everyone!! Not really my fault and should I start collecting bottle tops for them!

Katrina November 16, 2017 at 2:21 pm

I wonder if anyone can help me. My mother had a checklist completed 26/10/17 and was recommended she should go through to the next stage the Multidisciplinary Team (MDT) assessment which was arranged for 15/11/17. On 14/11/17 a message was left on my answerphone that the MDT meeting for 15/11/17 had been cancelled due to assessor being ill and they would contact me to arrange another date.They didn't leave any contact details and haven't been back in touch two day's later. I have contacted the CCG via email to the only contact I had available to me and haven't heard anything back .My question is, is there a specified amount of time in which the MDT assessment has to take place after the completed Checklist.

Paul Speight November 6, 2017 at 9:59 pm

My Mother had a review (full Multidisciplinary Team - MDT meeting with completed Decision Support Tool - DST) that recommended to panel 'eligibility'. We received nothing from the CSU - or Continuing Healthcare (CHC) Team - but some weeks later were told by the care home (!) the review was to be repeated i.e.: a second MDT meeting would complete a second DST. My Mother was moved to a new care home (within the same group from Challenging Behaviour to EMI) between these two MDTs - the details of which we are uncertain of but think it was the home's decision and made before the first review.. but this didn't stop the Nurse Assessor/CHC Team citing this as part of the reason for another review. The second care home matron (Manager) told us the new Nurse Assessor from the CCG was "the big guns". It was an apt description as he was arrogant and passive aggressive and clearly arrived determined to get the 'right' recommendation passed up to panel this time. It won't surprise you that the Panel accepted this new 'correct' recommendation.. - yes, despite Para 91 and 92 of the Framework. The Social Worker was u-s-e-l-e-s-s.. I am finding the appeal process challenging but recommend Bernie Crean's article as ESSENTIAL reading: https://caretobedifferent.co.uk/care-act-2014-helps-you-with-nhs-continuing-healthcare/ Your appeal, if you undertake one, must be sharply focussed on relevant aspects.. the CCG is relying on it's knowledge of the regulations - yours must be better in supporting your case.

lance November 6, 2017 at 7:08 pm

Lance
My relative has been in a care home for six months. We have had two Checklists done but as they were done incorrectly by the social worker we are now onto our third one. My question is if she fails the Checklist will they back-date the care fees to when she arrived at the care home. I have so far refused to give the council any financial information but I'm a bit worried that if she fails the Checklist we will be hit with a huge bill.

Anne Butler November 1, 2017 at 6:59 pm

I have been representing a close friend to help him through the process of applying for NHS Continuing Healthcare Funding. We have just got through the first stage...The Checklist...with 1 A and 8 B's. I decided that I would ask his permission to go through both his case files at the residential home where he lives, 5 days before the Checklist assessment. It took me 8 hours over 2 days to scrutinise them properly. But thank god I did! I found so many medical and surgical challenges that he had which had never been addressed by his social worker, the care home his GP or the District Nurses. These things were just lines of information written on his discharge notes from hospital after MRI and other scans, including colonoscopies. These things definitely altered the awarding marks for Cognition, Behaviour, Nutrition, Mobility, Emotional, Communication, and Continence. Do not believe everything the care home tell you, even though the patient might seem really settled there. Make sure you check EVERYTHING! There is now an 8 months waiting list for the next stage but I am going to try and be ready for it.

Pat October 23, 2017 at 10:29 pm

Isnt it about time there is a class action over NHS CHC misdemeanours?
Whats your view?

Poppet January 2, 2018 at 1:47 pm

I would say a resounding YES in answer to your question. My question is: who do we approach to get this off the ground and how do we all link up together to organise a class action?

Sue Collins October 23, 2017 at 12:04 pm

I have had this problem with a Decision Support Tool (DST) being "replaced." My mother had a DST in April 2014 and when it went to the panel they deferred it 4 times as they said that they could not make an eligibility decision as there was not enough information in the DST. I was at the time in contact with the Chair of our CCG as my mother's case had already been handled in such a bad way. I really got angry over this DST and because of this the Chair of the CCG ordered another DST be completed to override it. This was done in March 2015. Even this one was "revised" in June 2015 in certain domains whithout my knowledge. When we went to an Independent Review Panel (IRP) recently, the revised DST was not even in the file for use at the meeting, and this came to light during the meeting and the Chair of the IRP was not happy. He questioned the representative of the CCG who was squirming in her seat but eventually managed to convince all the panel that the "correct" DST with the revisions in had been used to decide that my mother was still social needs only, yet the only people with this revised copy were myself and my Advocate. I do not believe the CCG used the right one to make this decision. The Chair of the IRP admitted that my mother's case was one of the hardest he has ever chaired, there were so many faults and problems, we started the IRP at 10am and didn't come out until 3pm! Most distressing day for us. I never could get an answer as to why the 2014 DST was lacking information but I suspect my mother was probably on the verge of being awarded CHC funding and they were trying to side step it. In the following year or so my mother did deteriorate but not enough to fast track but as she got worse in a sense her needs became less as she became more of a shell. Does that make sense? She had the DST in March 2015 which was the last one before she passed away in December 2016. I am still fighting, it has been decided that the decision of Social Care only was sound. I am gutted. The whole case is so flawed. I am taking my complaint back to The Ombudsman but I don't have much faith as they don't seem to be on the side of the people.

Jeannette October 23, 2017 at 11:24 am

Can you please include any link (ie from official guidance or legal requirements) for your statement: "...the final funding decision, the backdating of any subsequent Continuing Healthcare funding must be based on the original Checklist." It may be that CCG would deny this is a requirement and you would need to prove it.

Angela Sherman October 23, 2017 at 11:48 am

It's in the National Framework. Use these tips to find whatever you need in any document: http://caretobedifferent.co.uk/find-what-you-need-in-continuing-healthcare-guidelines/ I believe the point about the Checklist is around p.133.

Cindy Spencer October 23, 2017 at 9:37 am

Currently waitng for social care assessment as part of annual review where CCG reduced full NHS Continuing Healthcare (CHC) funding to Funded Nursing Care (FNC). Should there be a new Decision Support Tool (DST) completed when Social care involved or do they contribute to the one I am disputing.?

I know there is 6 month time limit to appealing and disputing DST but currently two social departments disputing 'ordinarily residence' so where do we stand regarding this time limit.

NB. CCG have continued to pay full funding until this is resolved.

Pat October 23, 2017 at 9:22 am

Regarding... NHS Continuing Healthcare funding at home with NHS contracted agencies.
Has anyone experienced a case of someone being kept in bed when no medical reason to do so.
Not even allowed out of bed for the toilet due to unpredictability in moving and handling issues as the person has dementia. This continued for over 3 months. Anyone encountered similar neglect in care?

Pearl Baker October 23, 2017 at 9:22 am

My father-in-laws NHS Continuing Healthcare (CHC) was stopped and started three times he was in various Hospital, each time he moved the process started again.

My final request in Hospital was met with a comment from his doctor? He would NOT qualify? I explained it was not for him to decide. Eventually he passed the first stage, discharged into Care Home, where the next two stages took months. He died soon after the successful result. (Backdated payment was made ignoring the first 29 days from the Checklist.)

I had to continually remind them they were well over time.