FUNDED CONTINUING HEALTHCARE
Observations and frustrations regarding my
several requests for an assessment for NHS Continuing healthcare.
Definition. Care extended over a
period of time to persons over 18 years of age as a result of
sickness/disability or accident.
I am an RAF veteran in my 90th year ill with motor neurone
disease, diagnosed by Professor Logue at Maida Vale in 1973. There will be many more frail, ill and vulnerable people,
similar to myself, some of whom were in
uniform, years before the perpertrators of the
dishonesty described in this article, were even born.
Understandably ill people must be assessed for this benefit (free
care) but before an assessment is granted he or she is screened using a
checklist and this checklist is the problem. It comprises 11 domains, 6 of
which I detail below the other 5 being not applicable in my case. It is the refusal to grant even
an assessment on the flimsy grounds of the outcome of this superficial
screening that is so unfair.
Let me list all 11 domains, they are:-
1. Behaviour. 2. Cognition. 3. Physological
and emotional needs. 4. Communication. 5.Mobility. 6.
Nutrition. 7. Continence. 8. Skin integrity. 9. Breathing. 10. Drug therapy.
11. Altered states of consciousness.
The checklist I maintain is a thoroughly dishonest and
inappropriate document, designed to deny the patient a proper assessment since, as in my case the
checklist revealed 'no primary health need' how perverse! Not only that, it dilutes, by dividing the
illness by 11 so 100% becomes a mere 9% . Read again
the 11 domains above, it reminds me of the ''small print'' a disreputable insurance company uses
to avoid paying.
The Primary Care Trust say, granting a proper assessment is not
about diagnosis or illness. Isn't it?, I would have thought that
would be the first consideration, but no, to add complications they say it is
about the nature, intensity, complexity and frequency of Health Care
Interventions, how anyone can possibly know these without first assessing beats
me. Let us look at these health care interventions.
Nutrition. Regardless of whether
fed by spoon or p.e.g. the result would be the same,
without food the patient would starve to death. So because of the patient's
underlying illness, another indivdual is required to intervene.
Likewise fluids, without which he or she would die of
thirst. Why do hospitals provide 3 meals and 4 drinks daily and use healthcare
assistants to feed patients who cannot feed
themselves?, surely a most basic
Continence. Unless properly managed,
water retention, an extremely uncomfortable experience could mean an ambulance
dash to A and E, a day in hospital and catheterization for 5 days...Dr. Habib of
Everybody knows the frequency varies with the individual
and his or her intake of fluids.
Drug therapy. Of what use is
medication the patient can only look at?
So the intervention of another person is again required.
Skin integrity. Another H.C,I. Who moves the patient's limbs at 1.a.m. 3.a.m. and
5.a.m. to relieve painful pressure sores, during the day as well. Why do
hospitals use the Pegasus No. 1 mattress?
Mobility. This is the whole illness
which spills over into several ''domains'' Take away the illness and the problem
is gone but what does the checklist reveal? It reveals the patient has no
primary health need! what then is an incurable, progressive motor neurone
condition resulting in tetraplegia ? secondary? The reality is, the patient cannot blow his or
her nose, remove spectacles and scratch that annoying itch and is
Cognition. If the house were on
fire at night I would be well aware but quite unable to get out of bed.
Using the Checklist.
A multidisciplinary team, sitting at table, carries out this
screening i.e. a nurse and a social worker who merely ask questions and tick
boxes, the patient is not examind in any way
whatsoever, (imagine issuing an M.O.T.
certificate without examining the car?) . The PCT assertion the qualifying
threshold is set low to ''include' 'is simply not true, the terminally ill
would have difficulty qualifying, not my words. Using this toolkit Pamela Coughlan of the 'Coughlan
Judgement' (a legal benchmark handed down by the Court of appeal in 1999) would
not remotely qualify, again not my words.
Neither is their assertion
the checklist is 'Coughlan compliant', when it
clearly is not.The
fact is, it gave no indication of a health need when it is blindingly
obvious to the layman or 'the man in the street', the patient has a major
health problem. Note number 20 accompanying the checklist says ''There
may be circumstances where a full assessment for NHS Continuing
healthcare is considered necessary, even though the individual does not
apparently meet the indicated threshold.'' but ignored.
Driven by the financial incentive, a proper assessment is denied
so the risk of finding the individual is sick, is
avoided. The individual is then left with the Local Authority for what in
reality is asset stripping. They in turn say, that care
charged for, is 'domiciliary care', which I do not receive and never
have received. Domiciliary Care according to Collins is provided by Mrs.
Adams through 24 hours.
Comments on the checklist from three independent
1. ''....highlights the absurdity of the decision support tool and
2. ''....bizarrely and totally misconceived...''
3. ''....I doubt if the checklist is lawful as for instance
it doesn't cover the section 21 test...''
Yet the PCT, The Complaints Dept., the SHA, all use the outcome of this very
doubtful, tick-box exercise, for all their decisions in the matter of
eligibility for free care. Even the Ombudsman's office use the checklist result
in their decision to come down on the side of the Suffolk PCT, after 'liaising
with them' and 'using data supplied by them'. The Ombudsman's
assessor used over 3 pages of foolscap just to say the PCT had used the
checklist correctly and that comparison with Coughlan
is inadmissible with the words '
stressing that each case must be viewed in its own right' strange!!! when according to the
Court of Appeal judgement, anyone whose health condition is equal to or
worse than Pamela Coughlan is entitled to NHS free
care. The judge said care needs more than ''merely incidental or ancillary''
are the responsibility of the NHS.
The review team,
of the Ombudsman's office hardly comes up 'smelling of roses'
when their 'Director of Outcomes and Learning ' ''undertakes to reply within 16
weeks, (4 months), brilliant!, should have been a plumber!. To be fair a reply
arrived after only 3 months, the reply, after all that wait, "the case
remains closed". This, after I had
supplied the 3 minute Coughlan video explaining how
she feeds herself, demonstrates how she signs her name, dexterity using hands
in the kitchen and opening the outside door. I can do none of these
things. Pamela Coughlan receives free care, I do
not!, how fair and reasonable is that?. I have
Pamela Coughlan's permission to mention this.
The 3 core principals of the 1948 Health Act.
1. That it meets the needs of everyone. 2.
That it be free at the point of delivery. 3. That it be based on clinical need, not the
ability to pay.
Quote from The Health Select Committee.
17. We are shocked to hear some patients and their relatives are
not offered any form of assessment for continuing care and subsequently do not receive assessments because they are
simply unaware that continuing care funding
exists and that they might be entitled to it. We do not think the onus
should be on the patients or their families or carers to request an assessment
for continuing care; all patients with continuing care needs should be offered
an assessment automatically before leave hospital. Needless to say I was
offered no such assessment on discharge from hospital.
Quote from the Law Society.
''Unless the legal position is fully understood and consistently
applied, the core problems will continue and many vulnerable people and their
families will continue to pay for healthcare which should be the responsibility
of the NHS and free at the point of delivery''.
I first asked for an assessment in September 2009 but find I am up
against a 'brick wall' of official intransigence. The reality, as I experience
it, is grossly unfair, if it were not for my 83 year old wife, who is ill
herself, struggling on, providing 24 hour care, I would need a care home and
then who pays?, who cares?. The NHS officials, public servants, deliberately
blind to what is reasonable and obvious, hiding behind 'guidance' of the
''National Framework'', which is just another excuse for failing to do their
job as it should be done, that is, the care of sick people in a positive way
and not wriggling out of their responsibilities.
None of us have immortality, my year of birth was 1921, so by using delay, after delay, after delay, sooner or later
the problem of granting an assessment will surely solve itself.
I find it sad that anyone be a party to this deception and
injustice to an older generation of many frail, ill and vulnerable citizens,
who created the NHS in the first place and are now treated so badly.
23rd January 2011.