Continuing health care review update

We want to update our clients on the Retrospective Continuing Healthcare (CHC) cases we are currently processing; there have been considerable delays with this process and understandably many of our clients are frustrated at the length of time this takes. At EAD Solicitors we have taken several steps to try and expedite the cases and are continuing to do so, these include:

Contacting the Parliamentary and Health Service Ombudsman, contacting Members of Parliament and speaking with the Department of Health.

In order to try and keep our clients informed, we would like you to read the following information, which although may not make this wait any less frustrating, may go some way to explain the reasons behind the delays.

Prior to the Department of Health (DoH) issuing a claim registration deadline of 30th September 2012 for periods of care between 01/04/2004 and 31/03/2011, the Continuing Healthcare Departments dealt with very few cases for referral, in one particular department this was as little as 15 cases per year.

As a result of the deadline being introduced, there was an influx of claims being registered with the CHC departments nationwide the volume of which was far beyond that the DoH was expecting. With each case, the CHC department has to follow the below process (some deviation may occur due to the specific cases and local processes).

The Retrospective Continuing Healthcare Claim process:

– Register the claim prior to the 30th September 2012 deadline

– Complete and submit the assessment application, some of these were not provided to us until mid-way through 2013

– The case is then ‘screened’ by the CCG to ensure they have all required documentation

– The CCG completes a ‘checklist’ (this may be confusing as the checklist is usually referred to as the ‘screening tool’)

– The checklist is an initial ‘assessment’ which has a lower threshold and is less time consuming than the full assessment, this helps the CCG determine if the case should be referred for a full assessment

– If the checklist determines that a full review/assessment is needed, the CCG will then apply for health records from the GP, care home(s) and any other relevant organisations. If the checklist does not indicate a full assessment is required, we can appeal this decision

– Once these notes are received (this often takes a while), a full retrospective assessment will be carried out using the notes and what the NHS call a ‘decision support tool’.

– The results of the full assessment will be presented to the ‘Continuing Healthcare Panel’ (sometimes referred to by another name) who will make a decision based upon those recommendations

– If they decide the patient doesn’t qualify for funding, we will be notified in writing and may appeal to the ‘INDEPENDENT review panel’ (IRP)

– The IRP’s decision is final as far as the Continuing Healthcare Process is concerned, however with any NHS department, complaints can be made to ‘NHS Complaints’ and should they not change their decision, we can complain about the NHS to the Parliamentary and Health Service Ombudsman

– Clearly with each complaint step, we will be required to hold evidence which supports the complaint

This process is done at varying speeds by the different CHC departments around the country, whilst we have had several cases now complete – the vast majority of our clients are in the same position. The majority of the CHC departments have taken the view that they will assess patients who are still living first and deal with the retrospective cases afterward. This means that the majority of our cases, which are Retrospective, are still waiting to be dealt with properly.

We do understand the frustrations of clients and can appreciate it seems as though their case isn’t being dealt with from our side, but we are reliant on the NHS to conduct the assessments, and if there aren’t staff available to do so then we have little option, but to wait.

We know from our conversations that the vast majority of the Continuing Healthcare teams have either, or are in the process of, appointing new staff to help clear the backlog. Most of the teams who have set themselves deadlines are aiming to complete these cases in the next 12 months; however some have warned it may be longer.

 

What others say about us

Extremely happy with the outcome of my Personal Injury Claim and can only thank Paul McCarthy and his team at EAD Solicitors and also Tim Trotman my barrister arranged by EAD, for all their work and efforts on my behalf. As such I would highly recommend EAD to anyone in need of their service. Once again thanks to all involved.
Brodie Martin, Merseyside
Excellent, very professional, approachable when I needed advice. I would just like to say thank you to your staff.
Robert Adams, West Midlands

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