Discharged from hospital without a Continuing Healthcare assessment?

Hi all
Wondering if anyone can assist here. The hospital are refusing to carry out an assessment of my aunt until they discharge first. They calling it discharge to assess and say its is done after discharge.
We are refusing and saying we want an assessment carried out first before she moves.

Thanks for your comment, Iain. Yes, my understanding of this is that once a Checklist has been undertaken in hospital and the person being assessed then has to wait for a full MDT assessment to be arranged, the NHS is responsible for paying for care in the meantime - no matter where that care is delivered.

Reading the National Framework Guidelines Paragraph 74 states the following.....

74. Where the Checklist has been used as part of the process of discharge from an acute hospital, and has indicated a need for full assessment of eligibility (or where a Checklist is not used, a full assessment of eligibility would otherwise take place), a decision may be made at this stage first to provide other services and then to carry out a full assessment of eligibility at a later stage. This should be recorded. The relevant CCG should ensure that full assessment of eligibility is carried out once it is possible to make a reasonable judgement about the individual’s ongoing needs. This full consideration should be completed in the most appropriate setting – whether another NHS institution, the individual’s home or some other care setting. In the interim, the relevant CCG retains responsibility for funding appropriate care.


my reading of this is that until a CHC Assessment finds against ineligibility funding should be provided by the CCG. So if there is a massive delay between discharge and assessment there is no way the individual should have had to pay for their own care.

Is that your understanding of the meaning of this paragraph?

Previous comments:

September 29, 2014
Edwina Smart wrote…

As soon as we were told by the Consultant that my mother needed 24 hour nursing care we were immediately visited by a social worker. At my mother’s bedside we were asked all about her finances and at no time were we told of a CHC assessment. It was just assumed that we would pay for care (despite my mother having had 2 strokes, nearly dying of aspiration/pneumonia and being immobile since 1997). In fact, this was in 2011 and I had not heard of CHC. We did attend a ‘planning meeting’ regarding future treatment which I now understand was a MDT meeting. I wonder if it was a bogus CHC assessment?

We were threatened to move my mother from hospital and were given a date whereby if we had not found her a home the hospital would evict her presumably to a home anywhere. We begged for a place in a (private) respite bed at the local rehab hospital and then she eventually moved to a permanent nursing home. At no time were we offered a CHC assessment, not even by the social worker that was assigned to us when my mother moved. So far, we have spent in the region of £150,000 in care fees. I first put in for an assessment in 2012 and we are still fighting it!

October 01, 2104
Chris G wrote…

Just had this happen to my father-in-law. Three times in the space of about six weeks. Every time we tried to get a discharge date from hospital they would not even estimate. Then twice we arrived to find him returned to his Nursing Home for recovery at his own cost and not the NHS’s.

On the first occasion he almost died from two separate seizures: He had refused his medication because he believed that he had already had it. He was adamant in his angry refusal and so the hospital staff took him at his word and simply left him to collapse, with the risk of death as a result. Simple covert medication would have solved the problem if the CSU that assessed his needs had actually properly reported that his judgement is faulty and not to be relied upon in an unalterable situation. E.g.. He can refuse a meal but he should not be able to randomly take or refuse medication that is not simple analgesia. It is also the case that he refuses meals because he believes that he has just had it. We have watched him refuse a meal and then eat it seconds later. So much for him having full cognition!

One the second occasion they sent him home with inches of his amputated thigh bone poking through the destroyed and diseased end of his stump. They did not understand that he continually refused corrective surgery because he believed every time he awoke that he had had surgery all over again and it had again failed. Then he got angry and petulant and the refusal began all over again.

I asked a Surgeon if he would be allowed to operate if he was suffering infections and taking large doses of morphine. He said of course not! He still did not get it that a patient with a brain injury in the same circumstances cannot be relied upon to refuse or accept the need for medication or surgery.
A CCG Director told me that their CSU would liaise with the hospital from the outset. It never once happened. So a proper discharge process was never undertaken.

Of course he has had two CHC assessments this year, before the operations mentioned above, by that same CSU; one to remove his CHC funding and another for intractable pain, neither of which took the slightest note of his two year old amputation failure and the MRSA treatment along with opiate pain relief. Instead, the local appeal insisted that they could not accept photographs of his wound dated on the days of the assessments because they could not verify the dates, locations or even if they were of my father-in-law. The decisions were made safe in the false knowledge that “His amputation wounds had healed fully”. Just a pity that neither CHC assessor actually looked at them.

To be called a liar by way of ducking the appeal is reprehensible. Especially as I cannot verify if any of the evidence they did present was in fact true or the within the dates it alleges to include etc.

There has been action to artificially lower the local CHC funding budget. It is the case that nationally mandated needs assessments that match the eligibility criteria are no longer being used to establish Primary Health Needs.

So even preparing for the discharge process with some knowledge of it, was thwarted by a Hospital that well knew the consequences of allowing a family to intervene and delay the discharge.