My mum was recently CHC tested and the CCG assembled an MDT of two people, a nurse assessor (who happened to be a mental health nurse by background) and a speciality mental health nurse who has worked with mum and I for 2.5 years now and who had submitted the positive checklist to them. The assessment meeting was also attended by me as mum’s full time carer and representative and an Advocate working on mum’s behalf. Overtly and with the consent of all present, the entire assessment meeting was audio recorded by me.
The GGC also invited Social Services to attend but tell me they did not receive a reply from them or any reason for the no show although they had previously assessed mum twice and said that her needs were well outside the scope of their service. One of their social workers had taken part in the creation of the checklist and had agreed with it before it was submitted.
At the end of the decision letter (which, surprise, surprise turned mum down), it stated that the Recommendation to the CCG had been made by the Lead Assessor and another of their nurse assessors who they had appointed to replace the Speciality Nurse who was in the MDT. This person was not part of the MDT and had never met mum or ever been involved in her care. No reason was given for this.
Today, I spoke to a duty manager who stated that it was because “An MDT must consist or at least two health professionals from different health professions” so they appointed another who was a physical health specialist to help the lead assessor make the recommendation.
To any legal eagles or CHC experts out there, my questions are:-
Did Social Services have a legal duty under the Care Act and CHC Framework to attend when requested as they had information that was relevant regarding mum’s needs considerably exceeding the legal scope of their services?
Am I right in my view that what they have done re the MDT and recommendation is a complete breech of sections 119 to 123 of the CHC Framework becasue it stipulates that the MDT must be made up as a minimum of:-
120. In accordance with regulations an MDT in this context means a team consisting of at least:
• two professionals who are from different healthcare professions, or
• one professional who is from a healthcare profession and one person who is responsible for assessing persons who may have needs for care and support under part 1 of the Care Act 2014.
If they say they did this because the health professionals needed to be from different disciplines (which I feel is wrong anyway because one was the Nurse assessor and that is allowed under section 120), then surely they must have known that when they assembled the MDT. Why then, if they say that is not quorate, did they not invite another professional from another discipline?
Does “a healthcare professional” just mean medical health professional or can that include social care professionals.
Is this another example of CHC dirty tricks?
I would appreciate any comments on this. Thank you!
It’s very distressing. CHC assessment claimed that although my late husband’s needs hadn’t improved, they were now being met. A new tactic. If you can gather evidence, that needs are NOT being met, it possibly will help.
Ah, no. Sorry if i misled you there. It was the local authority that assessed her needs previously. This was the first and only CHC assessment she has had. Her condition has not improved, in fact quite the reverse with her suffering a complex mix of chronic physical and mental heath issues and is in rapid decline. This has resulted in her being placed on the Gold Standards Framework register and Community Matron supervison. Her agreed levels (I refrain to use the word “score” as it is not supposed to be used in that mechanistic way) in the CHC assessment (with the original nurse present) were 3 High (Cognition, Nutrition and Psychological/Emotional), 1 Moderate/borderline high (Mobility), 3 moderate (Continence, Skin, Mobility and Communictaion) and 2 low (Behaviour and ASC). There was only one domain with no needs at all (Breathing)
I have been living with with mum for 2.5 years as her 24/7 sole carer with my own house standing empty and my self-employed business in runis. I have to manage a complex set of contra-inidcating health conditions and medications. Mum now requires 2 to 1 handling by the mental health specialist care company who visit us but I have to handle her alone. I also have to manage her Nutritional needs in a background of her chronic anxiety related unintened weight loss and her severe backpain due to 4 osteoporotic spinal fractures which is about as intense as you could imaging.
Despite this, the verdict in the DST of the two Nurse Assessors, one of who was here for 3 hours (but never met mum as she had a cold) and the other who has never been here or met us is that “the care provided by the one carer who is her son is not significantly difficult to provide” and that “it is agreed that the care needs are still to be considered as ancilliary or incidental to that of the provision of accomodation under the Care Act 2014.”
This is just the most huge kick in the teeth and what really upsets me is that I know this is systemic and that we are very far from being the only ones suffering this. In fact, I am coming to believe from all I read and from talking to other carers that it is the norm.
And as far as I know a common tactic! Obviously I don’t know yoiur specific circumstances but that sounds like a classic case of a well managed need that should still be classed as a need. My understanding is that you should only consider a need in this way if it has been permanent mitigated by a particular intervention, i.e. you can now take the care away. You do have to take into account that this refers to needs that would be require care that is above the normal baseline provision but I cannot see this would be the case if a qualifing level of need had previously been establised.
Sadly my husband passed away a few weeks after the last assessment. He was in hospital and the nursing home refused to take him back because they would no longer manage his needs!! Broke my heart, as he had been with them for 3¾ years
You probably won’t be surprised how much of a fight many families had for their loved ones. It’s a nursing home for complex needs.
My comfort was that he was well cared for in the hospital. He was in and out over a long period and they grew find of him, even in his dementia aggression.
The words severe and unpredictability are key, and if you can find evidence for them it may help. It’s a dreadful fight, and makes family members feel their loved one is nothing but a nusiance to the powers that be.
My Dad yo-yed in and out of CHC funding for 2 years. Assessment after assessment, appeal after appeal, meeting after meeting. We were often told at meetings that “yes, he will absolutely get funding” - only to be turned down once the decision was reviewed back at head office. It was AWFUL. We were told that it “wasn’t unusual” for people with long term conditions to be in and out of funding. Like this made it OK? We just appealed every time we were turned down and did win 2 out of the 3 times we appealed. My opinion is that the system is full of dirty tricks, they don’t want to pay and will turn most people down as a matter of course in the hope that they give up and go home, which I am sure that most people do.
I can’t answer your specific questions. But if procedure isn’t by the book and the MDT wasn’t of the right make-up then absolutely make a fuss. I would 100% appeal the decision if you feel she should be granted funding.
The system absolutely stinks. Sorry you and your Mum are having to go through this.
I am so sorry to hear that. My heart goes out to you. I do wonder now with my mum deteriorating if she will ever get the appropriate, coordinated care she needs after being in limbo between health and social services for the last three years.
I most certainly will challenge it and sing what has happened from the treetops. I’m already collecting evidence of the various dodgy dealing during and after the assessement and am turning up some real shockers:-
The say they contacted mum’s GP for a report but they have no record of any contact from them and there is no report on file.
They claim there is no report, letter or record for an OT visit which they were told about during the assessment and which heavily supported mum’s needs as being over and above the scope of Social Care packages. However, I have been to the GP and they confirm there is a substantial report on the visit. They are getting me a copy and also, I have an audio recording of both the OT visit and of the assessment where we told them about it.
I have now spoken to the health professional who was part of the MDT and who insisted that 3 of the domains should be recorded at a higher level. It seems what the CCG did was to telephone her with the decision already made and without involving her is the process or giving her a copy of the DST and asked her if she would sign and endorse it. She refused saying she didn’t agree with it so they went away and replaced her with another nurse assessor who was not in the MDT, did not attend the assessment, has never met mum or been involved in her care and then the two of them downgraded the disputed domains and recommended against the award.
I shall now place a GDPR subject access request on the CCG for of of the complete case file and call their bluff on the above.
Even if your loved one clearly qualifies they will down score the DST document. They will delay and refuse to budge. I never got a decision letter on any occasion from them. The social worker did his uttermost to rid his department of my son’s package and got nowhere with CHC. They stood firm and refused full continuing health care wrongly and unfairly. My son qualified for it and was given a dis-service from these people. They will do anything not to pay in full. However, they did have to fund night care at 9 pounds an hour, in the hope it would be too difficult to find someone to do it. Generally, they are not trustworthy, in the slightest, and that’s going on my experiences with them.
It sounds as if the dirty tricks brigade are alive and kicking. I quite recently helped someone to a hearing after their partner was turned down for funding. The frustrating thing was that at the hearing, they didn’t really care that guidelines had been breached. Instead, they were more concerned with running the lady through the domains and giving her 5 minutes per domain. However, you do have a trump card and that is Pamela Coughlan caselaw. It is as relevant now as it was then. They cannot circumvent the law, no matter how hard they try. I suggest you find a tech savvy person and get him/her to write down each domain with your partner’s descriptive needs next to it whilst also doing the same with Coughlan’s needs for each domain. If your partner is found to have needs at least on a par with Coughlan, then you should be given CHC. The sad thing is that you may have to go all the way to the IRP hearing before this will be recognised. A long fight ahead, but that is the best way of beating them. For all their bluff and ignorance, they simply cannot ignore caselaw. Remember, the framework is guidance. The law is the law.