The process of securing NHS continuing healthcare funding can be a long and protracted one, so it is always a pleasure for us to share success stories
Once we accept instructions to act on a patient’s behalf, our team of continuing healthcare experts, comprising lawyers (non-practising) and clinicians (including nurses, tissue viability specialists and pharmacists) work tirelessly to review and consider all the medical evidence from a clinical perspective before drafting reasoned arguments to the patient’s Clinical Commissioning Group identifying how the individual is entitled to NHS continuing healthcare funding. They do this by cross-referring the medical evidence to the National Framework for continuing healthcare criteria.
CASE STUDY: When Mr CF contacted Compass CHC to instigate the continuing healthcare funding process, Mrs JF (his mother) was living at home with agency carers attending 4 times a day. In 2016, Mrs JF suffered from ulcers on her leg which did not respond to treatment. Consequently, she required a leg amputation which brought with it many challenging needs. For example, Mrs JF is now unable to weight bear and refuses hoisting due to her level of pain and impaired cognition. Mrs JF suffers with severe pain which is not responding to medication. She is also allergic to antibiotics and some pain relieving medication which further complicates matters. Such a high level of pain and the inability to walk has had a direct impact on Mrs JF’s psychological and emotional status. Mrs JF has also lost a significant amount of weight. In addition, Mrs JF has a cognitive impairment which has an impact on her behaviour (due to lack of understanding) and her ability to reliably communicate her needs.
We gathered and reviewed the records in the case and drafted detailed representations to support our case for continuing healthcare funding. We then submitted representation to the CCG (Clinical Commissioning Group) and requested a date for the CHC Checklist (the first stage of the continuing healthcare process).
Our advocate, Natasha, attended the Checklist in January 2017. It was evident that the recent carer’s notes where not in sufficient detail at the Checklist stage, however, we were able to argue the levels of need. We obtained a positive Checklist which triggered for a full assessment. Natasha advised the care agency to re-write their Care Plan to ensure that it accurately reflects Mrs JF’s needs and asked carers to write in the daily notes when Mrs JF was suffering from pain, refusing care and when she was tearful and upset. Additionally, Natasha advised Mr CF (who also cared for his mother) to keep a detailed diary regarding his mother’s pain, behaviour and psychological and emotional state.
Due to our attendance at the Checklist, we were able to ensure that the levels of need were not underscored (which could put a halt on the entire process). Further, we could make sure that the supporting evidence was in place for the Decision Support Tool (DST) stage. Supporting evidence is crucial, as the DST is an evidence-based exercise. Natasha presented the case for funding at the DST in March 2017and secured continuing healthcare funding for Mrs JF.
Should you, or a relative, have any concerns regarding NHS Continuing Healthcare funding or you are thinking about starting the funding process, our expert advisors can assist by explaining the ins and outs of what can be a perplexing and complicated process. There is no time limit placed on this free, no obligation consultation. Should you wish to discuss matters further, do not hesitate to contact us directly on 0121 227 8940
Author: Tim Davies LLB