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Continuing healthcare claim, can we go to ombudsman?

(16 Posts)
Notretrojustold Thu 05-Jan-17 18:24:12

Mother has Alzheimer's and has been self funding in care for 5 years. Last year she deteriorated badly and was placed on end of life care after being discharged back to the care home from a short stay in hospital.
Due to the deterioration we asked the LHBS to carry out a continuing care assessment. The whole process was shambolic, the assessment described a woman about to go on a cruise rather than a bedbound, immobile, doubly incontinent woman with no communication or cognition at all.
We complained to the LHB and another assessment was done by the same nurse who was determined not to lose face and she minimised my mothers needs completely. We disagreed with the outcome again so the case went to an independent panel in September. Despite the chair finding issues with how the reviews were carried out my mother still did not qualify for CHC, scoring one 'severe' a few highs and moderates in the necessary domains.
We were told we couldn't appeal the decision just because we didn't like it but only if the process was carried out incorrectly so we have not taken further action. However, one of the recommendations of the IRP was that my mother be re assessed after 3 months, which should have been done in December - this hasn't been done. Could this now be seen as not following procedure? Does this mean we could now escalate our complaint to the public ombudsman?
Anyone who could advise I'd be really grateful, thanks.

Ginmakesitallok Thu 05-Jan-17 18:27:41

Have you asked for a reassessment or complained that one hasn't been done?

Lunde Thu 05-Jan-17 18:29:04

I'd push for reassessment

Notretrojustold Thu 05-Jan-17 18:46:28

I've not asked for a reassessment, I'm not sure I want them to know that they've messed up by not doing as the IRP has asked. I'm hoping it'll be a string to my bow that they are not following procedures and they'll be caught out on a technicality.

The reassessment will be a waste of time, they'll just say she's not eligible again. They minimise all of my mothers needs at every turn. She's basically a shell, fed pureed food, in nappies, can't walk, talk, make any decisions about her care etc but all they say is she needs help with activities of daily living.
Its all one big scam.

Ginmakesitallok Fri 06-Jan-17 08:41:34

They won't be caught out by a technicality. If you complain to the ombudsman they won't consider it until you have exhausted the board's complaints procedure. If you have your mum's best interests at heart you will ask for a reassessment rather than hoping the board gets caught through a technicality.

It does sound as though your mum has high daily living needs - but you haven't mentioned any ongoing health needs which she needs nhs care for?

Notretrojustold Fri 06-Jan-17 09:23:02

The health needs would very quickly emerge if she wasn't turned every two hours, didn't have her continence wear changed, wasn't hand fed and watered. Its the 'well managed needs' argument that comes time and time again. The panel always minimise her needs because they are managed yet I've been told that shouldnt happen, she should be assessed on if those needs weren't managed at all.

Ginmakesitallok Fri 06-Jan-17 09:58:09

If her needs can be managed without nhs continuing care then she isn't eligible for it.

Ginmakesitallok Fri 06-Jan-17 09:59:34

And none of the needs you mention need to be managed by nhs care?

Notretrojustold Fri 06-Jan-17 15:44:42

www.england.nhs.uk/wp-content/uploads/2015/04/qck-ref-guid-chc-nat-framwrk.pdf

I've copied this from the above link. We've been told time and time again that my mother isn't eligible due to not having a primary health need. Her health is totally at risk without intervention. She needs constant care to monitor her mood, whether she needs anything (everything needs to be anticipated for her as she cannot communicate or comprehend anything)

The care she recieves is due to the fact she is ill.

Notretrojustold Fri 06-Jan-17 16:07:03

What I just cannot understand is that she was asked to leave her last residential home in December 2015 due to them not being able to manage her needs. 'She needs nursing care' I was told, and she got FNC a as a result of this.
So, If she needs nursing care, I take that to mean she has health needs. If she only needs help with 'activities of daily living' then perhaps I'll see about getting her back into her previous home. She was quite happy there.

The whole system is a carve up, a disgusting betrayal of our old folk who deserve NHS care just like someone else who has a terminal illness. If she had all of her problems due to the fact she had brain cancer and not Alzheimer's then she'd get her care for free.

Ginmakesitallok Fri 06-Jan-17 16:17:48

But if she has nursing care why do you need chc? (I'm not an expert at all and don't understand why you need chc over and above what your mother is getting?) Also even if you did go straight to the ombudsman all they would do is get the reassessment done - they couldn't make the board give your mother chc.

hatgirl Fri 06-Jan-17 16:41:24

Your mum's needs sound like routine nursing care which is covered by the FNC contribution.

CHC is awarded when the nursing needs are particularly complex or unpredictable, or the nature of them is particularly severe meaning it requires input over and above what is already funded by the FNC.

What did the social worker at the assessment say? Did they disagree with the nurse assessor too?

Ginmakesitallok Fri 06-Jan-17 16:41:38

Sorry - that was a really stupid question.

Fayrazzled Fri 06-Jan-17 17:22:03

The system does indeed stink. I have been involved in the process twice- for my FIL and a great aunt. The trouble is that the people involved in carrying out the assessments and the CHC groups do not understand the law and apply their own criteria to the decision making process. It is truly a national scandal. There is a great website run by a MN-er that helps a lot with the legalities, have you seen it? (www.caretobedifferent.co.uk). I did loads of research before my FiL's assessment- and we were successful although he died shortly afterwards. This was a man who had suffered strokes, couldn't speak; couldn't eat, had a catheter that was perpetually infected; was disoriented etc etc and the social worker told us we had no chance (pre-judging the case, which of course she shouldn't). My dad has taken the case involving his aunt through the complaints process- the catalogue of errors is appalling. I don't think he'll get anywhere though unless he seeks a judicial review: the people involved just don't understand the law.

Fayrazzled Fri 06-Jan-17 17:23:08

Sorry- when I say CHC groups above I mean healthcare commissioning groups.

Blossomdeary Fri 06-Jan-17 17:34:20

I made use of this website and bought their ebook - caretobedifferent.co.uk/fighting-for-nhs-continuing-health-care-why-angela-sherman-set-up-care-to-be-different-2/

I succeeded in getting the funding for my Dad - I downloaded the assessment forms and filled them in myself with a commentary as to the reasons for my opinion for each item. I had a very detailed list of every small thing that might apply in each category. I think one of the things that swayed it in favour for him was that he needed so much attention at night - we had a live-in carer plus waking night care.

I had had a career as a social worker in elderly and disability care and could talk the talk - I do think that this made a difference, as they could see that they were not going to pull any wool over my eyes.

The whole system does indeed stink. Those who get it do so because their relatives are on the ball - it should not depend on this. So many people are fobbed of (I know many who were told you do not qualify if you are in a nursing home - not true) by people who have not had adequate training in administering this scheme and do not know what they are talking about.

Having said that, if everyone who qualified did get the payments, the NHS would collapse tomorrow. The whole system needs revisiting - at teh moment it is just a weird anomaly that you only get if you know the system - that is fundamentally wrong.

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