Have you or a loved one had your care funding withdrawn following anNHS Continuing Healthcarereview? Here at Just Caring Legal, we are hearing of more and more cases like this. A review of NHS Continuing Healthcare takesplace after the first three months, then at least once a yearthereafter. Of course, there will be times when the withdrawal of funding is justified, if the intensity or complexity of care needs have genuinely reduced. However in some cases, even those with long-term, degenerative conditions such as Alzheimer’s, other forms of dementia and Parkinsons, are losing much needed support. This often means the loss of trusted and familiar carers, or even a move to a different (cheaper) care home.
However, you maybe able to challenge a decision to withdraw funding following an NHS Continuing Healthcare review. The key is whether the most recent assessment hasfollowed the correct procedures. Here are five key questions to ask.
How have care needs reduced since the previous assessment?
Before withdrawing funding following an NHS Continuing Healthcare reassessment, the Clinical Commissioning Group (CCG) should be able to demonstrate how care needs have reduced. This should be withreference to theprevious assessment based on theDecision Support Tool. But we know that this doesn’t always happen. In fact we find some people have never even seen their previous Decision Support Tool document. And it is never fully explained to themwhy they are no longer eligible for NHS Continuing Healthcare.
Who has given their input to the review?
The National Framework on NHS Continuing Healthcare is clear. Any reviewshould take place in consultation with the person receiving care and “any other relevant people who know the person who are present”. In short, an NHS Continuing Healthcarereassessment should never take place behind closed doors or by an unqualified member of staff.
Has the review followed the correct processes?
An NHS Continuing Healthcare review should not just look at previous care needs. Often as conditions progress, needs change. Each caseis unique and requires a thorough and detailed assessment. Has the review considered the full medical and care records? Has it taken into account the carers’ and family’s views?In short, has it examinedoverall care needs? Does it establish whether they are any less intense, complex or unpredictable than before? The review should give a complete picture across all theNHS Continuing Healthcare “domains”.
What would happen if current care was withdrawn?
A well-managed need is still a need. Nevertheless, we know people sometimes have their NHS Continuing Healthcare withdrawn on the grounds their condition has “improved” or “stabilised”, even though this is actually a reversible phenomenon purely down to the interventions of skilled carers. Ask what would happen if the same level of care was no longer provided? Would they remain stable or would they deteriorate?
Has the review also assessed whether current care is good enough?
The review should not just focus on continuing eligibility for NHS Continuing Healthcare. It should also address the question of whether the care provided is appropriate and adequate. If you have any concerns about the level of care provided, now is the time to raise it.
FAQs
The four key indicators are: Nature, Intensity, Complexity and Unpredictability. So, for example an individual diagnosed with Dementia is unlikely to be eligible for CHC Funding on that basis alone.
What are the 12 domains for CHC? ›
The 12 domains are Breathing, Nutrition – Food and Drink, Continence, Skin and tissue viability, Mobility, Communication, Psychological and emotional needs, Cognition, Behaviour, Drug therapies etc., Altered states of consciousness, and Other Significant care needs.
How do you win a CHC appeal? ›
Sending a written complaint to the CCG detailing the reasons you feel entitled to a full assessment and why you disagree with the Checklist outcome. You should provide as much evidence as possible and specify which areas of need (domains) you disagree with. (A PDF of an example checklist is available here).
What is CHC review? ›
If you're eligible for NHS continuing healthcare, your needs and support package will normally be reviewed within 3 months and thereafter at least annually. This review will consider whether your existing care and support package meets your assessed needs.
What are the 4 C's of healthcare? ›
Background: The four primary care (PC) core functions (the '4Cs', ie, first contact, comprehensiveness, coordination and continuity) are essential for good quality primary healthcare and their achievement leads to lower costs, less inequality and better population health.
What are the 4 domains of CHC? ›
NHS CHC Domains (areas of need)
- 1- Breathing. This domain considers whether the individual suffers from any breathing-related issues. ...
- 2- Nutrition. ...
- 3- Continence. ...
- 4- Skin. ...
- 5- Mobility. ...
- 6- Communication. ...
- 7- Psychological & emotional. ...
- 8- Cognition.
For quality health care to exist, care must be safe, effective, timely, efficient, equitable, and personcentered.
What is the 5 step framework NHS? ›
These will be used to indicate potential issues and prompt further investigation of support needs and align with the five national themes of the NHS oversight Framework: quality of care, access and outcomes; preventing ill health and reducing inequalities; people; finance and use of resources; and leadership and ...
What are the 7 domains of healthcare quality? ›
Seven attributes of health care define its quality: (1) efficacy: the ability of care, at its best, to improve health; (2) effectiveness: the degree to which attainable health improvements are realized; (3) efficiency: the ability to obtain the greatest health improvement at the lowest cost; (4) optimality: the most ...
What is the scoring for CHC? ›
The patient is assessed against various criteria, being graded either: no needs, low, moderate, high, severe or priority for each, based on the intensity, frequency and unpredictability of each of the criteria, or 'care domains'.
You or your representative must write to the CHC department at BLMK ICB notifying that you would like to appeal the decision. The letter can be sent to the BLMK ICB address shown on the decision letter, and it needs to be submitted within six months of date of the decision letter.
Who qualifies for NHS continuing healthcare? ›
To get NHS continuing healthcare you must: have ongoing significant physical and/or mental health needs, and having taken account of all your needs, it can be said that the main aspects or majority part of the care you need is focused on addressing and/or preventing health needs.
What does CHC mean in NHS? ›
NHS Continuing Healthcare (NHS CHC) is a package of care for adults aged 18 or over which is arranged and funded solely by the NHS.
What are the advantages of CHC? ›
Unlike Social Services Funded care it is not subject to means testing. In other words if you qualify for NHS Continuing Healthcare you will not have to make any contribution to the cost of your care irrespective of how much you have in savings or investments.
What are the benefits of CHC? ›
This form of NHS funding is used to pay for the personal nursing care of people living in either their own homes, or in a Residential Care or Nursing Home. Receiving continuing healthcare whilst still living in your own home does not affect any social security benefits that you may be able to claim.
What are the characteristics of community health nursing? ›
some characteristics of community health nursing are particularly salient to the practice of this specialty: (1) it is a field of nursing; (2) it combines public health with nursing; (3) It is population focused; (4) It emphasizes prevention, health promotion, and wellness; (5) It uses aggregate measurement and ...
What are the key characteristics of primary health care? ›
Certain principles were to underpin the PHC approach (PHCA), namely, universal accessibility and coverage on the basis of need; comprehensive care with the emphasis on disease prevention and health promotion; community and individual involvement and self-reliance; intersectoral action for health; and appropriate ...
What are the key defining characteristics of the US health care system? ›
Health services are provided by a loosely structured delivery system organized at the local level. Hospitals can open or close according to community resources, preferences, and the dictates of an open market for hospital services. Also, physicians are free to establish their practice where they choose.
What is the CHC model in community health nursing? ›
CHCs are sponsored and managed by community boards that involve members of the community and others who provide health and social services. Community governance enables health services to be more easily oriented towards what community members identify as their most important needs.
