No, unfortunately, your eligibility for continuing healthcare funding will undergo regular reviews.
After what is often a complex, drawn-out and stressful assessment the knowledge that continuing healthcare funding is successfully in place is often tempered by the unwelcome news that it will be reviewed regularly and can – in some cases – be withdrawn.
If you have been awarded NHS Continuing Healthcare funding, your needs and support package will be reviewed within three months and at least annually after that. The review considers whether your existing care and support package still meets your assessed needs and, if your needs have changed, the review will consider whether you are still eligible for funding.
Can removal of funding put patients at risk?
The worry is that once assessed as having a primary health need, it is unlikely that these individuals, who often have progressive illnesses will have made any sort of recovery, so the removal of continuing healthcare funding can actually be putting the patient at risk.
The CHC Alliance, a group of 20 charities and organisations who believe NHS Continuing Healthcare needs to improve, found that:
“People with dementia are commonly reassessed regularly. Despite having a progressive condition, funding is often removed when someone goes from having problem behaviour to being more withdrawn, or moves from being at risk of falls to being bed bound. This is despite other health needs emerging as a result of these changing circumstances.” (Page 20, CHC Alliance, Continuing to care? report)
The CHC Alliance also found that people with well managed needs are having their care withdrawn “with no acknowledgment to how their needs will progress without a suitable level of care in place.” A health condition being managed effectively doesn’t mean it has gone away, simply that the patient’s symptoms are being controlled more efficiently.
The Integrated Care Board (ICB) undertaking the reassessment must carry out a full DST assessment with a multidisciplinary team (MDT) and the client (and advocates if required) must be present during the process. Worryingly, the CHC Alliance report found that:
“The National Framework states that when reassessing someone’s eligibility, MDTs must reference the previously completed DST and prove that things have changed. The alliance knows from speaking to people that this doesn’t happen.” (Page 21 Continuing to Care? report)
The CHC Alliance has put forward a number of suggestions to overcome the need for constant reassessment, which include ICBs showing that when regular reviews are undertaken, the need for review is not purely on the patient’s eligibility for CHC but as directed in the National Framework, “focused on whether the care package continues to be appropriate” (page 23, Continuing to Care report). The Alliance further recommends that NHS England introduce an option for ‘permanent eligibility’ where reviews are only carried out to assess if the individual needs additional support thus reducing the worry and stress felt by patients and families alike.
How can we help?
If you do not agree with the decision reached by the review panel, then the decision can be appealed. This has to be backed by evidence, to argue the decision reached was flawed. With our expert knowledge and experience of this complex area, we can advise whether you have a basis for an appeal by reviewing the evidence, and assisting you with the full appeals process. We have a strong success rate of securing funding after attending the panel hearings and arguing our client’s case.
*source CHC Alliance’s report: Continuing to care? Is NHS continuing healthcare supporting the people who need it in England?
Unsure if you or a loved one qualifies?
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