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mollysboy

Why would a Nursing Home want to promote CHC assessments?

35 posts in this topic

Mum has just been assessed as being eligible for NHS Continuing Healthcare, and I am very clear this may well not have happened if I had not insisted on a re-assessment, and had not fought her corner at every stage of the process. Her eligibility was assessed as "borderline."

I had always known that local authorities place a limit on fee scales for social care cases, but I had always thought NHS CHC was full funding of care fees. Not so, apparently.

The weekly charge at the Nursing Home has been £788, inclusive of FNC and allowance for continence products. The total amount the NHS will now be paying to the Nursing Home is £728. The NHS tell me they have "agreed rates which are lower than those charged to private clients."

So, the revenue for the NH will now fall by £60 per week.

Where is the motivation for Nursing Homes to push for NHS CHC funding for their residents?

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Frankly I think there is none, and that often care home staff are as much in the dark about CHC as some of the PCT and hospital staff either are, or like to remain.

I think Steve's line is that top up payments are unlawful because if CHC is awarded then the Coughlan j'ment states the NHS is responsible for all fees for care. From a logical stance that sounds right, but as we have discovered there is little logic (or fairness) about much of CHC!

Plenty of Judicial Reviews won and ongoing regarding the differing scales of fees charged to private clients as opposed to those paid by Local Authorities who block buy places at lower rates and in some cases are said to be driving down fees unreasonably, and so I suspect an answer is lurking in those actions and arguments for you.

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I know several care home proprietors who actively assist their patients to obtain NHS funded continuing care. Many are successful because they DO know how the system works - AND how to beat it!
At least that way they can be sure of getting paid and will also avoid the hassle and unpleasantness when families refuse to pay! Steve.

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I know several care home proprietors who actively assist their patients to obtain NHS funded continuing care. Many are successful because they DO know how the system works - AND how to beat it!

I must say that Mum's nursing home staff were extremely co-operative during the assessment meetings, but whether they would have initiated the process (e.g. in the absence of an informed relative) is uncertain.

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At least that way they can be sure of getting paid and will also avoid the hassle and unpleasantness when families refuse to pay! Steve.

Yes, I suppose CHC funding does remove default risk, but I do not subscribe to the notion of withholding funds from the nursing home while scrapping with the NHS. How would starving them of money help Mum's overall welfare?

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Your mum has already paid - through a lifetime of punitive taxation. The NHS is not free! Under the health act the NHS must pay ALL care costs for every resident British citizen having an illness, disability or injury and requires continuing care. As the LAW SOCIETY told the Commons select committee "The judgment in Coughlan clearly establishes that where a person's primary need is for health care, and that is why they are placed in nursing home accommodation, the NHS is responsible for the full cost of the package." 

In other words: 'Anyone who is so ill that they need to be in a care home is entitled to have ALL their care provided by the NHS' 'free at the point of need regardless of the ability to pay' THAT IS THE LAW!(Despite what the NHS and SS would like it to be!)
In fact anyone ill enough to require 24/7 access to nursing care is entitled to receive that care 'free at the point of need' and the venue where that care is provided is irrelevant as far as NHS liability is concerned! Send all care invoices to the Chief Executive of the primary care trust for settlement! Steve.

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Steve, you are clearly very passionate about the cause, and I respect you for this. I suspect writing in red text is commensurate with a rise in blood pressure when pressing your case.

I agree with most of what you say, but I'm sorry, in my opinion withholding fees based on a self-assessment of NHS-CHC would be totally unacceptable.

Cashflow is the lifeblood of any business. If every non-CHC resident suddenly referred invoices to the PCT, how long would it be before the nurses, carers and suppliers of goods and services cannot be paid? Withholding fees would be using these people as innocent pawns in the game.

I do not believe it should be rendered as general advice on forums such as this.

Chris

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Chris - the 2011/12 NHS budget is £106 Billion - of OUR money and paying their staff is their problem, not ours! We are entitled to receive that for which we have paid through a lifetime of punitive taxation and which is our statutory right. As highlighted in blue If a person is so ill that they need to be in a care home then they ARE entitled to receive NHS care free at the point of need! Patients are entitled to TAKE what is rightfully theirs just as you and I are entitled to walk out of Tesco's with the goods we have paid for! Steve.

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...the 2011/12 NHS budget is £106 Billion - of OUR money and paying their staff is their problem, not ours!...

Except that Mum is in a private sector nursing home. The staff are not NHS employees. They expect to be paid whether or not the NHS decides to allocate some of its budget.

Chris

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mollysboy: in my opinion (as also others but not Steve) you are totally correct. We need to pay whilst we fight our corner. Not to do so would, as you say, put innocent people under threat of losing their jobs; quite apart from other ethical questions. And it has cost some people a tremendous amount of money in the end.
But you are on a losing battle with Steve as this is his main argument on the Forum and he will not budge in my estimation. He sincererly believes it, apparently, but he is sincerely wrong.
maryjo

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No Maryjo - it is YOU who is completely WRONG! Our original legal advisor, Derek Cole, started the predecessor of our campaign known as the 'refusenics' where a group of claimants, including myself, refused to pay care home fees and persuaded the homes to invoice the NHS direct. We battled with the NHS and bogged them down by insisting that they followed their rules - and the law - to the letter. In my own case I proved that the health authority were ignoring their own rules and that the eligibility criteria they applied to my late father were 'more restrictive than national guidelines permitted'. I thus recovered all his care fees plus costs and interest. This, together with 'Coughlan' caused the DoH to issue their 'National Framework' in place of the myriad of different criteria produced by every individual health authority. This achieved nothing as each authority now interprets the rules differently and in any case theapplication of criteria which produces an unlawful result is unlawful. Steve.

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Steve, the world has moved on since those days. Things have changed. Not the law but the application of it. We are putting ourselves in grave danger if we refuse to pay (in normal circumstances).

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Indeed you are right Maryjo, Times have changed, The ombudsman today would not give the same result today that Steve got in the 90's, Thats why the Ombudsman was made to go jointly with the governments body,Corruption has compleaetly taken over, Such as Bent C.O.P Kangaroo courts, using the excuse it is outside of their courts remit to challenge the legality of the criteria N/F/T. Thus in the eye of the Bent courts the Criteria have been applied correctly, and they find in favour of the SS LA NHS, Because there is no legal challenge to the lawfullness of the 11 domains

no other Honest legal Bods to challenge, there all in it together Totaly ignoring the actual law 

Mick

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Esquires,

I'm sure, everyone would be interested to know Andrew Wells opinion on this ongoing conundrum of to pay or not to pay. Andrew does seem to provide an unbiased view of what is otherwise an emotive subject for many of us here on the forum. 

Would you mind asking him to give us his views please.

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No! No! Maryjo! Only due parliamentary process can amend or repeal law! As I said, if the NHS apply rules which produce an unlawful result, then application of the criteria is open to challenge. They cannot circumvent the law by substituting their own rules. Imagine the screams of anguish by care homes if thousands of patients refused to pay - Yet they have every right to do so! So far nobody has challenged the NHS under the 'supply of goods and services' act but if a service they have paid for is not delivered this is a legitimate remedy. Ask trading standards to intervene! The NHS have adopted a policy of 'those who CAN pay SHALL pay' but the 'Booker' judgement ruled that totally unlawful - even if you've got £2.9 Million in the bank! Steve

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Andrew Wells is a forum member so anyone can send him a PM! (and he won his own case!) Steve.

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