NHS Medical Assessor Ignores Medical Opinions – According To Workers


The Law Of…Access to NHS Continuing Healthcare Funding

The BBC has recently uncovered that Medical Assessors have been denying patients from receiving NHS Continuing Healthcare funding, despite the advice of medical professionals. Opinions of trained healthcare professions are reportedly being ignored in such instances.

George Johnston, legal expert from our specialist care homes team, examines the story.

Who Assesses The Patients Right To Care?

Clinical Commissioning Groups (CCG) are responsible for assessing individuals to establish whether or not to grant Continuing Healthcare Funding (CHC). These assessing bodies are expected to follow national guidelines and should take into consideration opinions of medical and social care professionals as well as family members.

Arden and Greater East Midlands CSU (Commissioning Support Unit) is an organisation which completes CHC assessments on behalf of a number of Clinical Commissioning Groups.

To give an idea of recent CCG activity, between 2016 and 2017 Birmingham South and Central rejected 75% of new assessments for CHC, Manchester CCG turned down 17% of new assessments, and Tameside and Glossop CCG only rejected 5% of those assessed.

While CCG and CSU claim to follow the same strict national guidelines, the disparity between rejections in different regions is clearly evident.

Allegations And Outcry Against CCG's

Three health workers told the BBC that Arden and greater East Midlands CSU had been ignoring the opinions of medical health professions when assessing patients and whether they should be granted CHC.

Mr Lamb, an MP of North Norfolk whose Liberal Democrat constituency includes the North Norfolk CCG, addressed the area's rejection of 73% of funding applications. He said the allegations of medical opinions being ignored was "very disturbing."

Why Are So Many Being Rejected?

An NHS England spokesman explained that taxpayers expect care to be taken before the public's money is handed out. He also stated: "It's a fact that the majority of people put through a continuing healthcare assessment turn out not to need it."

"While funding decisions on CHC cases are taken by local health bodies, there is now a far more consistent approach than ever before since the launch of the national eligibility framework," he said.

An example of this happening is the case of Diane Gallagher. Dianne, 77, was receiving CHC from the NHS by way of care home residency due to her Alzheimer's. Diane's husband, John, stated that funding was withdrawn on 3 separate occasions. Each time he had to argue with authorities until it was restored.

This put financial strain on the couple until the care was reinstated, not to mention the stress and frustration of going through the entire disputes process for a third time.

What Happens When Continuing Healthcare Funding Is Rejected?

If funding is not granted, an individual will be required to fund their care either independently or in conjunction with their local authority. Individuals and their relatives can dispute decisions in writing to obtain a reversal of the rejection. This requires voicing your complaint to the NHS in order to be seen by a review panel.

Like in the case of the Gallagher's above, this can be a frustrating and time-consuming process, with the patient potentially not receiving funding in the interim. The process requires a great deal of fact-checking, for example having the reviewing body look again through the patient's eligibility criteria. You must also state any errors that may have been made during your initial review, for instance, staff being intimidating or obstructive.

The entire process, especially for someone like Diane Gallagher with dementia, is very drawn out and difficult. Fortunately, Diane had her husband to dispute on her behalf. Other people in similar situations may not be so fortunate. The fact people in genuine need of care may be left without necessary funding unless they are able to complain is extremely unacceptable.

George Comments: “Continuing Healthcare funding is an incredibly valuable resource for individuals with complex health needs. The statistics revealed by the BBC are alarming and do indicate that availability of NHS funded care can depend upon where in the country an individual lives.”

Whilst national guidance has been issued there remains a need for detailed scrutiny of assessments to ensure that assessments are robust and criteria are consistently applied to all patients.”

If you or a relative has been denied Continuing Healthcare funding or had it withdrawn, then contact one of our Care Homes Legal Specialists today. You can get in touch either by our Freephone number or by completing our online enquiry form.

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