CHC Assessment - Second Stage - Senior Nurse?

[MillieMoggie]

Hello all

My Mum is currently resident in a care home with mixed dementia and seems to be deteriorating fairly rapidly and has many other medical issues. The home have referred her for the CHC assessment as her needs are very quickly going beyond what they can provide. Sadly she 'passed' the first assessment, the checklist, with 'flying colours' scoring 5 As and the next stage assessment is booked for a couple of weeks away.

However, the ICB contact called me earlier today to confirm the date/time and gave me the name of the 'senior nurse' who will be doing the assessment with a social worker. But when I check the NMC website the nurses - there are 2 with the exact same name - both only qualified in late 2023. My understanding is that a 'senior nurse' would usually be Band 6 or above with significant experience. Does this sound right? I'm just conscious that the ICB will do all it can to pass her care needs back to the local authority and her, as she's self funding, rather than likely agreeing that she has clearly obvious nursing needs. I just don't know whether I should ask questions/challenge this.

I guess there are two ways of looking at it. A very experienced senior nurse working for the ICB might push back harder saying that the care home have just got to deal with it or a very inexperienced senior nurse might also push back as she doesn't fully understand all my Mum's needs.

Any advice/thoughts/shared experiences would be very welcome.

In my area, the senior nurses are called nurse practitoners. Experience alone, doesn't mean they are more likely to advocate for your mum. All professionals involved will be looking at the evidence provided by the home.

You certainly will not have a say in who the nurse assessor (NA) will be from the ICB, if you complained this would actually make you look difficult to the assigned NA. However, you can influence who represents your mum from the care home, it needs to be someone who knows your mum well and understands the CHC process.

The CHC checklist is a low bar to pass to meet the threshold for a full CHC assesment.

Why do you think your mum eligble?

You can get Band 6 nurses who are relatively newly qualified, especially if they’ve gone straight into a role like nurse assessor.
I’m a bit confused - if she’s self funding wouldn’t the ICB/ home be more willing to keep her there, as it means more money?
What is it that they can’t manage at the home she’s currently staying in?

I think you should probably spend your energy on articulating why your mother meets the threshold for CHC rather than become personal about a specific nurse.

Im amazed you felt the need to check the nurse was on NMC register and I am a nurse! Surely if she is Band 6 she was considered by those who interviewed her and gave her the job to be quite suitable..are you questioning the judgement of those on the interview panel.

@crazycadetmum respectfully, 30 years ago my hv was 23. She may have been qualified and clever but she did not have the clinical or life experience to do the job well. And yes I would check NMC registers nowadays as so often a healthcare assistant is referred to as a nurse. Bearing in mind the uproar about PA'S being mistaken for Dr's I'm not sure there isn't more uproar about HCA's trotting about in what look like nurses uniforms to the public and being referred to as nurses.

I agree with a pp. It will mostly be about advocacy from the carers and would suggest that the op is furnished with a full copy of the report/paperwork or is present.

I've been present at an ICB CHC assessment as the representative of the patient. It was done over teams and lasted 4 hours. I was sent a blank copy of the DST (decision support tool) beforehand which is used for every patient who is assessed by the ICB. I filled it in and wrote loads of notes on it. After 4 hours the nurse assessor had completed her assessment and her conclusions were the same as mine (she had very detailed reports from the hospital, GP and the care homes care plan). A copy of the full report was sent to me a couple of weeks later. Although exhausting I'm glad I took part. My opinions and thoughts were taken into consideration. The ICB are completely independent and there is no sense that they are trying to fob anyone off or pass the buck to someone else. A social worker (not present at the assessment but who works for the LA) tried to have the decision overturned (it's extra workload for her so she wanted the decision downgraded) but the ICB told her to back off as their decision based on medical facts stands for 1 year until the next assessment (and she has no medical training.....) Good luck OP - make sure you are present to advocate for your Mum.

I think the whole CHC assessment is an absolute con! My stepfather scored maximum in the first assessment, but it was determined that his health needs weren’t complex enough to qualify for CHC. This was a 3 hour assessment via Teams much like the pp above. The irony is that he was severely enough to be under a DOLs, so even if I had wanted he wouldn’t have been able to be removed from his care home, and yet he had to pay for the privilege of being deprived of his liberty.
The focus is on the complexity of their needs. So someone like my SF, who needed 24 hour care for feeding, toileting, was immobile so needed hoisting, could not communicate and needed lots of medication didn’t meet the criteria because all of that could be carried out by a HCA who didn’t need nursing experience.

I attended a CHC assessment last week as a professional and the social worker was in her first year of practice. Only found out when we were chatting afterwards and I told her how impressed I was (it was a tricky family situation).

My experience of these is that they go pretty rigidly through the Decision Support Tool and everything has to be evidenced for them to allow it. The categories on the Tool are also very clear.

I suggest you stop investigating the assessors and get yourself very familiar with the DST and the scores needed for funding. It should be fairly obvious before you start then if funding will be awarded - beware just scoring on the checklist by no means guarantees scoring on the DST.

@Soontobe60 this is what seems to happen all over. I’m an experienced nurse and CHC funding is getting harder and harder to get. My grandfather had Alzheimer’s for 12 years. Towards the end stage of Alzheimer’s (for the last 4-5 years of his life) he required 24 hour care, toileting, feeding assistance with mobilising, had a complex medical history, requiring timely medication, DOLs etc and it was only when he was declared to have 6 months to live then he had CHC funding as prior all of his needs could be met by carers/HCAs.
The NMC register also won’t show you how experienced some nurses are.

@SleepingisanArt I’m not sure why you think the ICB are independent, CHC funding comes from them, so it’s in their interest for patients not to qualify, therefore passing care needs back to the LA.

@MillieMoggie I understand you looking for the nurse’s credentials but as PP have said, rather than spending time on that, you really need to be looking at the DST.

This will be a rigorous 4 hours. You need to make sure you have plenty of evidence for the 12 domains to show unpredictably, intensity and frequency.

You have a battle on your hands, only 1 in 5 people are eligible for funding after a DST. Good luck.

@Anewuser - the funding is from the NHS not the LA so they are independent from the LA. After the SW sticking her nose in I had a call from the person in charge of the ICB in the area in which my parent is a resident. He was very clear that CHC funding comes from a central NHS pot and is not from the LA (who spend their money on people who can't afford care home fees which is separate from the CHC funding). The purpose of the DST is to ensure a level playing field regardless of where you are in the country - it is available on the government website:
https://www.gov.uk/government/publications/nhs-continuing-healthcare-decision-support-tool

I agree I wouldn't concentrate too much on the assessor's nursing experience, it's a rigid, bureaucratic set of criteria that you can become 'expert' in quickly, so broader nursing experience not so much relevant in my opinion. Depends more on their personality, I have sat in a few as a sw and some more amenable than others. I also got it for my dad. Agree focus on the criteria and how to challenge if needed. Look at the 4 key indicators:Nature/Intensity/Complexity/
Unpredictability as they can be the most important deciders. My LA sent sw's in to advocate strongly for a positive decision because if CHC granted it saves the LA money...

Thanks everyone. I didn't think it was odd to look at the NMC register as that's something I would do with any registered professional who is providing a service to me or my family. And as a registered professional myself, it's something I encourage those I am working for to feel free to check. However, I've received the appointment letter today and it's a different named nurse who will be carrying out the assessment and I have not checked her registration details.

I am making myself very familiar with the DST and am fully aware that this funding is very difficult to get. It's interesting that a number of posters have said that recent assessments they have attended took about 4 hours. The appointment letter says this should only take about 1 hour, which looking at the DST and the detail required would seem to be less than ideal. I'll take that up with the ICB to check timings.

Thanks again for everyone for sharing your thoughts and experiences. Much appreciated. Apologies as I know I haven't answered some questions but it's been a nightmare day at work and then I went to visit my Mum, who has now been diagnosed with Strep B infected ulcerated legs along with everything else.

Thoughts with everyone also going through this with loved ones. It's horrible.

As much as I agree with your thoughts, there are a lot of nurses these days that qualify and get senior posts within a year or 2. This doesn’t mean they aren’t suitable for the job as life experience can count a lot for the type of nurse you are (I swear the older I’ve got and especially post child I’m a better nurse than I ever was!) that being said I wasn’t (I hope 🤣) a bad nurse, but I’m of the age where you stayed a band 5 generally for a good few years before even considering a higher band. Let it happen, any concerns raise it with chc manager. Wishing you all the best xxxx

Thank you. And I can absolutely understand and acknowledge that my words were not well chosen at all. I'm sure you are a brilliant nurse!

I guess I was just comparing it to my own regulated profession where I have seen junior colleagues promoted far too soon, the minute after qualifying, before they have built up any real levels of experience actually working with clients and us 'veterans' have to deal with the fall out, smooth things over and lead on learning opportunities. I guess that is nothing unusual for many professions to be honest.

But thank you very much for your best wishes. I really do appreciate it! xxxx

I'd say the ones I have done without patient or family present take an hour, and the most recent one with both patient and family took 2 hours.

In the 2 hour one it was obviously going to be successful before we even started but they were very careful to make sure patient and family were able to have their say and agreed with each category.

I can imagine that if family are not familiar with the DST already, or it starts becoming clear it won't be awarded, the whole assessment could rapidly get very heated and easily take 4 hours.

Nope, where I work, every nurse is a senior nurse, regardless of experience. Try not to worry, the care home will know the right answers to the questions and push for it

I equally agree with you and (I’ll be scorned for this but….) I do think some nurses ARE promoted too soon, but then again, even at 39 and only (only 🤣) 21years in the NHS, healthcare then qualified at 23, training has changed dramatically and some nurses, dare I say it, are ‘too posh to wash’ but they are trained to such a high level, a level that would have made it impossible for me to be a nurse when I trained when I did. I’ve since gone on to be a very senior nurse but only recently, and gained skills I never thought I would, or needed! The recent death of a relative who was very close to me affected me no end, and having a child at 35, gave me so much more confidence as a nurse.
but I digress, that’s my beef 🤣
for you and your loved ones I beg you to speak up if your not happy with anything, sometimes shouting and screaming at NHS professionals is the only way you get heard, and yes I’ve been at the receiving end and it’s horrible, but equally I wouldn’t be as healthy as I am today and my daughter could have died when I was in labour - shout, scream stamp your feet if your not happy with anything, sadly it’s the only way xxx

You must have misunderstood something somewhere. There is absolutely no way a SW working on behalf of a local authority would attempt to get a positive CHC decision overturned, it makes no sense! As for increasing workload a positive CHC decision would usually substantially decrease a SW workload not increase it.

The ICB absolutely are NOT independent.

This is such a weird post it's like the SW and the Nurse Assessor have had their roles swapped in it.

The DoLS is irrelevant to severity of needs.

Absolutely anyone who lacks capacity around their placement in a care home should be under a DoLS whether they are sitting happily in a corner knitting and getting 8 hrs sleep a night or if they are trying to bash their way out through secure doors with a fire extinguisher and require 1:1 support during their waking hours which are all the time bar the odd 40 minute catnap several times a day.

The DoLS is a legal framework allowing the state to legally evidence their justification for placing someone in an institution and nothing at all to do with with how complex a person's care need are.

Good luck OP in getting the CHC.
My late mum couldn't talk, walk, feed herself or dress.
Was being fed through a tube.
Got A's for the first 5 questions then drew a halt to the assessment as they said mum was too ill. Of course it was rejected. Mum died a week later.

Ours took 2 hours, 4 of us there and the nurse assessor who was quite ignorant but followed the rules. They're meant to offer it in person so press for that if you want. And it's quite locally specific in my experience despite the national system. Good luck.

I am so very sorry. That's awful. It seems to be such a brutal process. I'm sorry you had to experience that💐

The ICB have responded to say that the '1 hour' timescale is just for family to be consulted but the rest of the assessment will likely take much longer. Which is fine now I understand the process more. I will be ready and prepared thanks to the advice you have all kindly shared, thank you.

Thank you. I'm so sorry you had to go through that but it seems like you definitely came through stronger after it! Even so, nobody should have to.

And I absolutely will kick up a fuss if I need to. I'm not worried about making myself unpopular to get the best care for my loved ones. I've done it before and I'll do it again.