NHS Continuing Care – the process

5 Jul

shutterstock_9022426 (20)To apply for NHS Continuing Care funding, the individual (or more likely their family) should contact their local NHS Trust (the shortly to be reduced in size Primary Care Trust).  If your not sure how to do this, speak to the District Nurse attached to the GP practise that covers the person in need of assessment.

The first stage may be a checklist stage or the assessor may go ahead with a Decision Support Tool.  The guidance recently issued by indicates that the assessment meeting should be arranged within 3 months of the request (this does not always happen on time!).

The checklist is a shortened version of the fuller Decision Support Tool, where an individuals needs are considered within 11 named domains (areas of need) and a 12th domain if there is something that has not already been covered by the first 11.  Mostly I find that people fit into the first 11 and it is not often that I use the 12th domain.

The Decision Support Tool and Checklist then considers the presentation in the various domains and attempt to score them.  This is a complex process of trying to put people into categories that they don’t necessarily easily fit into.  I’ve dealt with a lot of elderly clients and whilst some of them can have characteristics that are similar to other clients, I have never met 2 clients that are identical.  We are all people and we are all different.

If the Checklist is undertaken and is passed, then a Decision Support Tool process must be undertaken and whatever is the first stage (Checklist or Decision Support Tool) the decision should be made and communicated within 28 days (this does not always happen on time, some NHS Trusts are better than others).

There should be a full discussion of the individuals needs in all areas and it can be quite distressing going into the detail for the families.  Families should however be invited, as they know the individual well and for a long time, including when they were well (unless they were born learning disabled).

The individual is allowed an advocate and this is often a family member, but this is the role that I take when I attend assessments.  The advocate speaks for a person who is unable to speak for themselves.  The position of the indivual is the starting point in respect of the provision of their care and therefore if they are not able to speak for themselves, the position of their advocate is the starting point.

If the advocate and assessor disagree about a particular need, then the disagreement is recorded.  I always ask that the rationale for the disagreement is also recorded, as without it the disagreement does not necessarily make sense.

The recomendation of the assessing team is for the assessing team alone to make, but the advocate can disagree and appeal any unfavourable decision.  There are 2 grounds for appeal, one that the prcess has not been followed and the other that the clinical decision is wrong.  I would rarely appeal a decision where the sole grounds for doing so were procedural, as it will still lead to an unfavourable clinical decision and the funding would not be granted, which is the overall aim.

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