No, unfortunately, your eligibility for CHC funding will undergo regular reviews
After what is often a complex, drawn-out and stressful assessment experience the knowledge that continuing healthcare funding is successfully in place is often tempered by the unwelcome news that it will be reviewed regularly and can – in some cases – be withdrawn.
If you have been awarded NHS continuing healthcare funding, your needs and support package will be reviewed within three months and at least annually thereafter. The review considers whether your existing care and support package still meets your assessed needs and – if your needs have changed – the review will consider whether you are still eligible for funding.
According to the CHC Alliance*, a group of 13 organisations who believe NHS continuing healthcare needs to improve, 44% of their respondents had gone through at least one reassessment and following reassessment one CCG had withdrawn funding from a staggering 241 people in a calendar year.
Can Removal of Funding Put Patients at Risk?
The worry here is that once assessed as having a primary health need it is, on the whole, unlikely that these individuals – who often have progressive illnesses – will have made any sort of recovery so the removal of continuing healthcare funding can actually be putting the patient at risk. The CHC Alliance found that:
People with dementia are commonly reassessed regularly. Despite having a progressive condition, funding is often removed when someone goes from having problem behaviour to being more withdrawn, or moves from being at risk of falls to being bed bound. This is despite other health needs emerging as a result of these changing circumstances. (page 20, CHC Alliance, Continuing to care? report)
The CHC Alliance also found that people with well managed needs are having their care withdrawn “with no acknowledgment to how their needs will progress without a suitable level of care in place.” A health complaint or condition being managed effectively doesn’t mean it has gone away, simply that the patient’s symptoms are being controlled more efficiently.
The CCG undertaking the reassessment must carry out a full DST assessment with a multi-disciplinary team (MDT) and the client (and advocates if required) must be present during the process. Worryingly, although in our experience, not surprisingly – the CHC Alliance report found that,
The National Framework states that when reassessing someone’s eligibility, MDTs must reference the previously completed DST and prove that things have changed. The alliance knows from speaking to people that this doesn’t happen. (page 21 Continuing to Care? report)
The CHC Alliance has put forward a number of suggestions to overcome the need for constant reassessment – which include CCGs showing that when regular reviews are undertaken, the need for review is not purely on the patient’s eligibility for CHC but as directed in the National Framework, “focused on whether the care package continues to be appropriate” (page 23, Continuing to Care report). The Alliance further recommends that NHS England introduce an option for ‘permanent eligibility’ where reviews are only carried out to assess if the individual needs additional support thus reducing the worry and stress felt by patients and families alike.
This is where Compass CHC can help. If you do not agree with the decision that has been reached by the review panel, then the decision can be appealed. This has to be backed by evidence, e.g. the decision reached was flawed. We can assist in this process. With our expert knowledge and experience of this complex area, we are able to determine whether you have a basis for an appeal by reviewing the evidence, and assisting you with the full appeals process. We have a strong success rate of securing funding after attending the panel hearings and arguing our client’s case.
More often than not, when a family is mentally exhausted and ready to throw in the towel, using a firm of experts allows the family to regroup and pass the burden on to a team dedicated to getting the correct continuing healthcare decision.
How can Compass Continuing Healthcare help?
At Compass CHC, our advocates are all (non-practising) lawyers specialising exclusively in continuing healthcare funding matters. Compass CHC does not undertake work in any other area which means we have accumulated vast experience attending assessments and appeal hearings at local and NHS England level and we are not distracted by work of other natures.
The key to success when taking on the NHS continuing healthcare professionals is to ensure that you have sufficient expertise in your corner to support you through the process so the correct outcome is reached.
Compass CHC has helped hundreds of individuals and their families understand and receive NHS continuing healthcare funding. Complete our free, confidential assessment today and an expert member of our team will contact you for a no obligation discussion to outline your options.
*source CHC Alliance’s report: Continuing to care? Is NHS continuing healthcare supporting the people who need it in England?
Author: Tim Davies LLB