NHS Continuing Healthcare A Personal Experience Roger Moreland

NHS Continuing Healthcare - A Personal Experience Roger Moreland

Today! � What today is and is not! � What is Continuing Healthcare? � The process � Personal reflections � Sources of Information � Conclusion

What this presentation is and is not! � Not financial, legal or medical advice! � You may want to consult a solicitor, independent financial adviser or health professional � Power of Attorney � A son doing his best!

Continuing Healthcare? - Definition � A well kept secret? � “NHS Continuing Healthcare means a package of ongoing care that is arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’. . . Such care is provided to an individual aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness. ” � This means there’s no means-testing, no top-up fees and no requirement to sell your home to pay for care or to use your pension or other money or assets. � “Eligibility for NHS Continuing Healthcare is not determined by the setting in which the package of support can be offered or on the type of service delivery. ” � In other words, it’s available whether your relative is at home, in a care home, in a hospice, in hospital or in another location.

Continuing Healthcare? – Key Points � An individual’s health needs are the primary driver � The £ 23 K myth! � Challenge any budget or financially based agenda! � NHS pays 100% of your costs or nothing! � Legal precedents

Continuing Healthcare? – Coughlan & Grogan � Pamela Coughlan � The principle of the ‘Primary Health Need Approach’: � “… where the primary need is a health need, then the responsibility is that of the NHS, even when the individual has been placed in a home by a local authority. ” � Remember, a legal precedent doesn’t mean it will happen! � Maureen Grogan

The Process NHS Continuing Healthcare • Preliminary screening tool • 11 care domains • Trained health and social care clinicians to carry it out • At least one from health and one from social care. • Trained on the framework. • MDT Co-Ordinator • 11 care domains & one more – ‘Other’ Day 1 -28 • After a positive Checklist, the full DST and eligibility decision should be made within 28 days of the Checklist being received by the CCG • The National Framework says it is mainly to see “whether the care plan or arrangements remain appropriate to meet the individual’s needs”. 3 mths 12 mths By Day 28 1 2 3 4 Initial checklist Decision Support Tool (Multi. Disciplinary Team) Decision within 28 days of the checklist stage NHS review

The Process - Checklist � 1. Breathing* � 2. Nutrition – food and drink � 3. Continence � 4. Skin integrity (including tissue viability) � 5. Mobility � 6. Communication � 7. Psychological/emotional needs � Each domain has three categories of need: A, B and C. � A is for high needs, B is somewhere in the middle and C represents relatively low needs. � Consideration for a comprehensive (full) assessment, requires a minimum ‘score’ in the Checklist: � 8. Cognition � 2 or more ‘A’s � 9. Behaviour* � 5 or more ‘B’s (or 1 A and 4 Bs) � 10. Drugs/medication/symptom control* � or at least 1 A in a domain with an asterisk* � 11. Altered states of consciousness*

The Process – Decision Support Tool � Carried out by a Multi-Disciplinary Team, including at least two professionals from health and social care � CCG appoints a Co-ordinator for the process � There should be no discussion about the person’s finances and no finance person present! � All the person’s needs and circumstances affecting eligibility should be taken into account � Reports, charts and notes relating to the person’s health and care needs � Your oral evidence and a written statement are important contributions � Challenge and check all information for accuracy � Know the process set out for DST meetings and make sure it’s followed!

The Process – Decision Support Tool

The Process – Decision Support Tool � A ‘Priority’ need in any of the domains where that’s possible (shown with an asterisk) � A total of two or more ‘Severe’ scores � If your relative has one ‘Severe’ score, together with needs in a number of other domains, or if they have a number of domains showing High and/or Moderate needs, this may also indicate a primary health need and therefore eligibility � The whole picture of need should be taken into account.

Reflections Based on Experience � Keep a diary to record everything related to your relative � Prepare an evidence based personal statement � There will be pressure to release a hospital bed – stand your ground if that’s the right thing to do! � Get to know the assessment and review process intimately! � Watch out for agendas and false information � Ensure discharge processes have been followed � Use evidence to optimise the scores in the multi-disciplinary meeting � Know the procedures for meetings

Reflections Based on Experience � Take someone into meetings with you as another pair of ears and to take notes � Check and challenge everything! � Paint the worst possible picture, supported by evidence � Check your points have been recorded � Be resilient and persevere!

Sources of Information � NHS https: //www. nhs. uk/condition s/social-care-and-supportguide/money-work-andbenefits/nhs-continuinghealthcare/

Sources of Information � NHS suggests the following site for independent advice https: //www. beaconchc. co. uk

Sources of Information � Care To Be Different https: //caretobedifferent. co. uk

Sources of Information

Conclusions � It will take a while, but keep at it! � The deciding factor is demonstrating your relative’s needs lie outside the local authority’s responsibilities – as outlined in the Coughlan Case � There is help and information out there – don’t give up!