By Rosalind Hughes, founder, Just Caring Legal
Despite repeated requests, the government has failed to confirm whether it will continue the “discharge-to-assess” funding that has been in place since the start of the pandemic. This currently guarantees four weeks (reduced from six weeks in July) of funding for each hospital-leaver needing new or additional care. It means they leave the wards as soon as they are medically ready, freeing up vital capacity. Patients and their families then have four weeks to finalise longer-term care arrangements and sort out who should pay. For those with a potential ongoing “primary health need“, this will include an assessment for NHS Continuing Healthcare. If the local Clinical Commissioning Group (CCG) does not complete the CHC assessment within four weeks, it must continue funding the care until it does.
Has discharge-to-assess been a success?
Experts say this policy has significantly reduced the average length of hospital stays and facilitated patient flows from acute to community settings. Data from NHS England and NHS Improvement shows a 28% reduction in patients staying over 21 days in hospital between winter 2019/20 and winter 2020/21. As a result, many believe the discharge-to-assess policy should become a permanent fixture. Our view is that if this happens, it must be with the six weeks’ rather than four weeks’ post-discharge funding.
We are hearing daily of the myriad ways that CCGs are attempting to take shortcuts and rush through NHS Continuing Healthcare assessments. The reduction from a six- to a four-week deadline has only made this worse. CCGs are already under immense pressure to clear the backlog in assessments from the pandemic. Adding in a financial penalty for failing to meet the four-week deadline just increases the incentive to cut corners.
CCGs appear to be thinking up new ways to rush through NHS Continuing Healthcare assessments
One of the common ways they do this is to cut family representatives out of the multi-disciplinary team (MDT) meeting. The MDT is where health and social care professionals come together to decide on whether the person has a primary health need. They use a standardised tool called the Decision Support Tool to help them assess the nature, intensity, complexity and unpredictability of care needs.
The National Framework for NHS Continuing Healthcare says the individual and their representative(s) should be fully involved in this. They should give their views on care needs and say whether they agree with the MDT’s assessments. The MDT should then give these views due weight and discuss them fully. Instead, we are hearing that increasingly MDTs are completing the DST behind closed doors. Then they present the decision – most often a negative one – as a fait accompli.
We are also hearing of families not receiving sufficient notice that the MDT is taking place. CCGs may give a take-it-or-leave-it date, without attempting to accommodate families’ schedules and commitments. Another common tactic is to cut the evidence-gathering short, instead relying almost completely on the verbal testimony of a single care home staff member. This will often be a manager, who does not know the individual particularly well. It is a recipe for under-assessing needs and failing to give people the funding – and the care – they need and deserve.
It is our job at Just Caring Legal to take on the corner-cutters
Has your NHS Continuing Healthcare assessment been rushed? Has the CCG failed to inform and involve you? If so, you may well have grounds for an appeal. The CCG is bound by law to have regard to the National Framework in all its decision-making processes. If it has failed to do so, then the decision is ripe for challenge. That is where we come in. We can do as much or as little as you require, from giving an expert opinion on your case to undertaking the appeal on your behalf. So call or email us today for a free initial assessment of your case. Still within the four-week window? Call us anyway for advice on how to maximise your chances of success.