When a person with a rapidly deteriorating condition is nearing the end of their life, they can be fast-tracked and receive free health-funded care as quickly as possible. The person will have a care package arranged and this is increased as required. If they live alone, or family members don’t feel confident being on their own with the dying person, then 24-hour care is provided.
This is what should happen according to Continuing Healthcare guidelines, but it’s not always applied consistently. I have seen some people receive the support and live a lot longer than expected, but others die without ever being fast-tracked.
Unlike health professionals, social workers can’t complete a fast-track form. We have to complete an assessment – that can take up to three hours if it’s a complex case. We have to work out the annual and weekly cost of the plan and we then have to get authorisation, which can take up to three days. After this, we have to complete a support plan and get that authorised. Then brokerage has to find providers and increase the support plan for us – that can sometimes take days.
‘The first question is cost’
About 12 months ago, a ‘panel’ was set up. All cases have to go to that panel now. Some are rejected; others have to be reviewed weekly. We also have to answer a standard list of questions in the client’s case notes. The first question is ‘cost’. The provision of fast-tracked 24-hour home care has subsequently become extremely rare in adult services. The panel also often refuse nursing home placements for fast-tracked people, in favour of residential placements. I’ll give an example – but there are more.
One of my clients was near the end of his life and wanted to die at home. I requested home care support for him during the day and overnight. I sent in my assessment for authorisation but a manager questioned me about why this man needed carers overnight. I explained he needed assistance to go to the toilet, to be turned to prevent pressure sores and for reassurance as he lived alone and was aware he was dying.
He had been pressing his pendant alarm at night for help and reassurance.
When I continued to say this care was necessary, the manager asked another social worker to do a reassessment. This social worker upped the daily home care calls, but didn’t arrange overnight care. The man kept pressing her alarm and continued to get distressed at night. His daughter went away for a few days and, because there was no overnight care in place, my client went into the hospice for respite and died.
I am appalled by these cuts and delays, which have closely followed the introduction of the panel. These money-saving, paperwork heavy practices are failing to consider that social workers are working with people who are very sick, deteriorating quickly, and who are often very frightened. People are going through a lot of unnecessary distress and they are increasingly unable to die in their preferred place of care – their own home.
We are responsible for these terminally ill people – and adult social services should be responding in a timely and appropriate manner.
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I quite agree. The funding panel is merely a means of avoiding personal responsibility and accountability on the part of commissioners. It is always anonymous and faceless to outsiders, and, as this article points out, leads to delays and worse outcomes.
Commissioners should have the courage of their convictions and take individual responsibility for their decisions, hard though they might be. It is only the lack of accountability in local government as a whole that allows them to get away with such a destructive structure.
The Care Act does in effect provide a ‘fast-track’ option insofar as a local authority has the power to meet an adult’s care and support needs that appear to be urgent, as set out in section 19 (3). The statutory guidance states: “In this context, ‘urgent’ takes its everyday meaning, subject to interpretation by the courts, and may be related to, for example, time, severity etc” (paragraph 5.26). Urgency has not yet figured in any of the cases taken to the Local Government Ombudsman since the Care Act came into force – but it may only be a matter of time.
I’m confused with this article, it mentions Continuing Healthcare but then goes on to criticise Social Care processes. Why isn’t the Social Worker pushing for these individuals to get their ‘right’ for CHC instead of trying to jump the hoops of her own organisation. Perhaps she needs to highlight to her senior managers that they need to meet with the CCG to ensure it meet its responsibilities.
I’m just wondering why this person wasn’t eligible for fast track Continuing Health Care , a non chargeable service as well.
Great article.
Another example of how these budget cuts have gone on for far too long.
The social care sector deserve better funding and more focus on quality of care.
I entirely agree with Linda T. If health professionals are the only people who can fastrack then why did this social worker not contact GP, nurse etc to get the form/process completed and then the correct care package can be arranged as a matter of urgency. I was screaming ‘primary health need’
In some areas Adult Services and Health have a financial arrangement where people who are CHC fast tracked and already have a support plan have their free care arranged by adult services
This is, sadly, not an unusual case. People deserve to have a choice regarding where and how they receive care and especially those requiring support in their last weeks / months should have the option to be at home, in familiar surroundings and in many cases surrounded by a lifetime of memories. In reality as this article highlights people are not given any choice about where and how they receive care.
One of the problems is that those commissioning care packages are trying to use traditional “hourly” domiciliary care provider models to deliver 24 hour care packages. This is the most expensive way possible but the “systems” and culture drive commissioners down this route without looking at other available options, such as live in care.
As a former hospital social worker, if at a MDM it is recommended that a fast track assessment is needed – the social worker usually has written in hospital notes the social background of the person, details of any previous carers, family details. In the event of care at home this is the responsibility of the palliative care team and the hospital discharge coordinators to present it to CGG and they have specialist care agencies whom they can contact. If already in the community the palliative care nurses organise the fast track assessment taking into account medical details supplied by GP/District Nurses etc.
I think I’ll just make sure I never die…
My experience of panel is much more positive. The panel are able to recommend options I have not thought of myself and I find their questioning constructive. In my experience the consequences of not having a panel are much worse than the consequences of having one. I have taken onto my caseload clients who have care packages that were set up by a social worker without any checks in place from a panel. In one case the care package is far more supportive than required, putting an unnecessary financial burden on the council (which in turn affects the level of care that can be provided to other service users) and creating an unhealthy level of dependency in the service user; in other cases the care package has been supportive in the wrong way, leading to a deterioration in aspects of the service-user’s well-being.
The article is confusing and makes reference to what the National Framework states (which it doesn’t) and then proceeds to go into adult social care funding panel issues. If the author wishes to critically appraise CHC funding and it’s processes, then do it, rather than merge two systems which act largely in isolation with each other. Or, even better, critically evaluate and report on the continued lack of integration between these two service areas.