NHS Clinical Commissioning Groups (CCGs) are incorrectly refusing to meet the cost of care for a significant number of people as a result of their ignoring medical opinions – according to a recent BBC documentary.
Under current national regulations, the NHS is responsible for covering the cost of long-term support and care if a person is deemed to have a ‘primary health need’.
However, revelations by the BBC’s Inside Out East programme suggest that medical opinions are being ignored when taking into account whether people should receive NHS funding for their care.
The programme’s makers found that although every CCG in England should follow the same criteria, in practice there were significant differences in the percentage of people who are refused funding following assessment for continuing health care (CHC) funding.
Between July 2016 and July 2017, Birmingham South and Central CCG rejected 75 per cent of its new CHC assessments, Manchester CCG turned down only 17 per cent of assessments, while Tameside and Glossop CCG only rejected 5 per cent of those assessed.
The documentary featured the accounts of three health workers, who each claimed that an assessor organisation discounted medical views, leading to some people being denied NHS care.
One health worker claimed: “There has been bullying at the meetings – attempts to ridicule people who are there who have a professional opinion.
“They ignored what professionals have said and changed what professionals have said. The concern is that this puts patients at risk.”
Following the revelations, the former health minister, Norman Lamb, MP, said: “[This] regional disparity amounts to an injustice between individuals with the same conditions which can’t begin to be justified.”
Lee McClellan, a Partner with Palmers who specialises in legal issues relating to the care of older clients, said: “Whilst the allegations made – including the bullying of professionals involved in the process – are shocking, the difficulty in obtaining CHC funding sadly comes as no surprise to those of us who regularly have to deal with a complex and often unfair assessment system for the provision of care for elderly and vulnerable patients.
“Applying CHC funding is a veritable minefield. To be frank, it is not in the interests of the CCG for anyone to be awarded CHC funding, as their budgets are constantly under pressure. We have also recently seen an increased number of cases where CCGs have withdrawn funding for care which they had previously been paying.”
The process of applying for CHC is a difficult one. There is an initial assessment of a person’s health needs and a checklist is completed. The second stage is a more detailed assessment with the level of a person’s health needs being judged against set criteria in 12 different areas.
To receive CHC funding a patient needs to be assessed as having a primary health need. In some instances this is clearly indicated by a person having the highest possible level of need within several of the assessed areas, but in most cases the position is not as clear cut.
“Anyone who is faced with a CHC funding assessment meeting or who has been turned down for the funding should consider seeking specialist legal help to ensure that they are properly represented,” said Lee.
“If an outcome goes against you, we can advise on whether an appeal would be worthwhile, as a refusal of CHC funding may not necessarily be the end of the road. We have had significant success in appealing against decisions to refuse funding”