Continuing Health Care – the grim reality – Part two

In our last blog we explained why applying for Continuing Health Care is not an easy process.

In the second of our two-part blog we examine what happens when you make an application for free Continuing Health Care funding and more importantly we tell you how you can “tip the scales” in your favour.

If you read last week’s blog you will know that a diagnosis of dementia alone is not in itself sufficient to obtain Continuing Health Care (CHC).

Whether your relative qualifies for CHC, depends on their primary health need.

Sadly, many people with dementia also become ill in other ways. So, someone who was initially turned down for CHC, might go on to develop other health problems which do qualify for free funding.

If their condition has changed for the worse recently, you should definitely reapply for CHC.

What happens during the CHC application process?

When you apply for CHC, your local NHS, known as the Clinical Commissioning Group (CCG) will send someone out to complete a document called a Decision Support Tool.

So far so good, you may think.

BUT – even if your loved one is eligible to be considered for CHC, you may be in for a further shock. An unfair and illegal postcode lottery exists between the various Clinical Commissioning Groups across the country.

That means that you are around 18 times less likely to get CHC funding if you lived in Luton compared with someone who lives in in Salford. You can check our postcode lottery guide here.

If you think that’s unfair – we agree! It’s completely wrong that applications are treated differently just because of where you live. 

How long does the process of applying for CHC take?

According to the NHS’ own rules, there should be a maximum period of 28 days from the first stage (the Checklist) to the second stage (the Decision Support Tool or ‘DST’) being completed.

However, in practice it sometimes takes in excess of six months. We have discovered some truly shocking examples, where people have waited in excess of six months for a decision. 

A shocking example of a CHC delay

During a bank holiday weekend, ‘Joan’* was admitted to her local hospital in Darlington. This lady was subsequently discharged into a care home. In addition to a diagnosis of dementia, Joan had a number of additional distressing health problems. She was initially told that she would not be eligible for Continuing Health Care but her family were determined to have her assessed for CHC nevertheless.

Time passed and a family member made a call to Steene Law to ask if they should be waiting six months for Joan to be assessed for CHC, because when they called Social Services their response was: “everyone is very busy, you’ll have to wait your turn”.

We were able to advise the family that the first stage, known as the Checklist, is normally completed whilst mum is still in hospital. If it is not, then until she is assessed, the NHS has to pay for all her care.

And, guess what, we also discovered that Joan had in fact successfully negotiated all the hurdles the CHC process put in her way. She was entitled to FREE NHS CHC care but the local authority had dragged their feet for six months and had delayed making the decision.

 When we did a little more digging, we found out that in Darlington, per 50,000 members of the population, 12 vulnerable people with health problems are left waiting in excess of six months for something that should be completed within one month!

As a result of the family making a call to Steene Law, Joan is no longer one of those statistics.

* We have changed the client’s name to protect her identity

The moral of the story is this: if your relative’s application for CHC is taking longer than it should, call the team at Steene Law for advice – our intervention and an official ‘legal letter’ can often help to speed things up.

Sadly, Joan’s situation is, by no means, a one-off case. Upon further digging, we have discovered backlogs of six months or longer in most areas of the United Kingdom, with some of the worst occurring in the North of England.