PCTs facing more appeals against continuing care decisions

The NHS faced more appeals against decisions to deny people continuing healthcare funding last year and a greater proportion were successful, Community Care research shows. (Picture: Rex, posed by model)

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The NHS faced more appeals against decisions to deny people continuing healthcare funding last year and a greater proportion were successful, Community Care research shows.

The number of appeals rose by 9% from 2009-10 to 2010-11 while the proportion of successful completed challenges rose from 33% to 40%, a freedom of information survey of 49 primary care trusts or PCT clusters found.

The findings come amid concerns that funding shortages are increasing conflicts between councils and PCTs over eligibility for NHS continuing care, under which long-term care is provided free by the NHS for people with serious health conditions (see box).

Those found ineligible must fund care themselves or receive means-tested support from their council, with average costs of almost £40,000 per care package.

Community Care’s findings suggest some PCTs may not be implementing correctly the national framework for continuing care, warned Age UK charity director Michelle Mitchell.

“Many older people with primary health needs are being wrongly forced to pay for care when it should be free,” she said.

PCTs were reviewing continuing care cases more frequently because of funding pressures, said Jo Webber, deputy policy director at the NHS Confederation.

She said it did not surprise her that people were “moving in and out of continuing care” because clients often had fluctuating conditions.

“People think that if you have the right tick-box form in front of you you’ll get the right result, but it’s not like that. People aren’t stable,” said Webber.

One issue may be the quality of information PCTs receive, according to Clive Powell, a former civil servant who runs independent arbitration panels to resolve disputes over continuing care funding between councils and PCTs. He said PCTs are often having to decide eligibility on the basis of poor assessments by multi-disciplinary teams (MDTs) that may not include PCT staff.

“[PCTs] depend heavily on the quality of the MDT recommendation,” he said. “You can have acute trust or local authority staff on the MDT with more or less knowledge.”

NHS Manchester saw appeals rise from nine in 2009-10 to 33 in 2010-11. A spokesperson said it had a “robust system” for handling appeals but “specialist legal firms are now working on patients’ behalf”, which had increased numbers.

By contrast NHS Wirral saw appeal numbers drop from 32 to 13 between the two years. “Our evidence suggests that increased time is spent with relatives/advocates/representatives much earlier in the assessment process, providing relevant information both national and local, which in turn increases the level of understanding in the assessment process itself as well as increasing the understanding of the nature of the criteria associated with NHS continuing healthcare,” said a spokesperson.

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