Prior to instructing Compass CHC, Mrs IB had been a resident in the care home for over 4 years. During which time, no Continuing Healthcare assessments had been completed, despite it being good practice for an assessment to be completed when somebody enters a care setting.
Compass were contacted by Mrs IB’s son and on receipt of instructions, were able to secure the care homes records in support of an application. Having reviewed the records we were able to draft a detailed letter of representations setting our why we were of the view that Mrs IB should be in receipt of full NHS Continuing Healthcare funding. These were then submitted to the CCG to instigate their assessment process.
On receipt of our letter, the CCG stated that we should contact the community nursing team, who would be able to complete the Checklist assessment, as the initial screening tool. The community nursing team denied responsibility and referred us back to the CCG, who in turn passed the responsibility on to the care home, who they stated needed to ask the District Nurses to complete the assessment. The care home initially refused to make such a request to the District Nurses, as they believed that they could meet IB’s needs and so a Checklist was not necessary. However, CHC funding is not about whether the patients’ needs can be met and so we persevered with our claim. Eventually, the CCG wrote to the District Nursing team requesting that they complete the Checklist. Despite this instruction from the CCG, the District Nurses claimed they could only complete the assessment if they received a referral from the GP. We therefore contacted the GP requesting the referral. The referral was eventually made and the District Nurses arranged the Checklist. However, they failed to inform the relevant parties until 10 days after the proposed date of completion. This clear lack of communication was unsatisfactory and so a request was made for a further date, to allow all those involved to attend. Despite their involvement so far and further correspondence from the District Nurses, they eventually and rather out of the blue, wrote to the CCG informing them that they were refusing to complete the Checklist assessment.
When we challenged the CCG on the above point, we were informed that they would accept a Checklist from either a nurse at the care home or a social worker. The issue was that the care home was residential only and so they had no registered nurses working at the home and the local authority confirmed they would only send a social worker for the final DST assessment and not the Checklist.
The above was clearly not acceptable and so we made a formal complaint to the CCG, setting out that under the National Framework for NHS Continuing Healthcare, they were the body with overall responsibility for ensuring that everybody who should be assessed, is. We also offered an alternative option at this point, which was for Compass to arrange for an independent nurse assessor to complete the Checklist assessment. The CCG eventually agreed to this plan and so the nurse, along with one of our advocates attended the care home.
IB passed the Checklist and this was duly submitted to the CCG, who in turn arranged for the final assessment, the Decision Support Tool (DST), to be completed. With the assistance of one of our expert advocates at the DST, Mrs IB was assessed as being eligible for full NHS continuing Healthcare.
This case illustrates the obvious complexities of the CHC process and the minefield that must be navigated even just to arrange the first assessment. Not one of the professionals involved in her care wanted to step up and take responsibility for completing the assessment. Neither did those professionals deemed responsible for the CHC process by the Department of Health, through the National Framework. This would have left IB in a veritable ‘no-man’s land’, whereby although she was clearly eligible for the funding, it would not have been put in place as the process was simply not completed. However, with our tenacious approach and knowledge of the National Framework, as well as the eligibility criteria, Compass were able to find a workable solution to the problem and secure full funding on an ongoing basis.
