Anyone who feels that they or a relative should receive NHS continuing care funding – now or in the past – due to an overriding health need should contact Cheselden immediately so that we can review your case.

The helpline FirstStop Advice has reported a large increase in calls from people enquiring about continuing care funding. Many callers are seeking refunds for care fees that have already been paid or want to find out if they are entitled to continuing care funding. This spate of enquiries is directly linked to the recent payout received from Pauline Hardinges from Cornwall and Isles of Scilly PCT for fees she had wrongly paid for her mother’s care. Despite being asked by the PCT to sign a confidentiality agreement, Mrs Hardinges decided to speak out to make others aware that they may be entitled to free care or to reclaim costs. Cheselden Managing Director, Colin Ball, comments: ‘It’s great that more people are finding out that they may be entitled to continuing care funding and that Mrs Hardinges’ experience is giving them the confidence to question their current or previous care arrangements. We urge anyone who thinks that they or a relative has wrongly paid, or is paying, for care that should be funded by the NHS to contact Cheselden straightaway so that we can review your case.’

To find out if you or a relative should be receiving continuing care funding, or if you are eligible for a refund of fees already paid, please complete Cheselden’s brief questionnaire so that we can assess your case free of charge and with no obligation to proceed. Or call us on 0845 659 1588.

posted by Cheselden Continuing Care at
17:40

The Government has asked 20 PCTs across England to undertake a three-year trial of personal health budgets for patients with long-term conditions. The scheme will involve GPs helping patients to decide on the best types of treatment and care that they can afford to buy with their own budget. As well as giving patients more power over their own care, the Government hopes that it will save money through patients not using up all the money allocated. Each of the PCTs involved in the trial will allocate personal budgets to a group of patients with specific long-term conditions, such as cardiac and stroke patients, or who have certain care requirements, for example, end of life care and continuing care. The success of the pilot schemes will be measured in a number of ways including patient feedback, improvements in care outcomes and whether the PCTs have saved money. Health minister Phil Hope commented on the trial during a visit to Devon to promote its launch at Torbay PCT: ‘The introduction of personal health budgets will support the cultural change needed to create a more personalised NHS. They have the potential to improve the quality of patient experience and the effectiveness of care by giving individuals as much control over their healthcare as is appropriate for them.’ However, the idea of personal health budgets has not proved to be universally popular amongst the GPs that will facilitate the scheme, with one commenting: ‘I’m worried that we could end up with patients claiming that they are being denied treatment because of how much it costs…and I can’t see how this scheme can fail to increase our workload.’ For more information about personal health budgets, please visit the Department of Health’s website.

posted by Cheselden Continuing Care at
11:01

The Northwich Guardian reports that local resident Philip Leather may have to move into a care home because he has qualified for NHS-funded continuing care and it is the cheapest option for funding his care. At present, he is cared for at home by three carers who provide 24 hour care, costing around £1,700 per week. A care home place would cost £700 and Central and Eastern Cheshire PCT are insisting that this is the only option for Mr Leather. But his two daughters are adamant that he should not move into a home. Mr Leather suffers from multiple sclerosis, diabetes and dementia and is totally dependent on carers. His daughters fear that he will not receive the one-to-one care that he currently receives if he moves into a care home and that this will cause his health to suffer. Tracy Philips told the Guardian: ‘I would remortgage my house and pay myself before he goes in a home…He needs one-to-one care. If he’s in his own bungalow he’s happy and keeps fighting – he’s quite strong-willed. Before he had 24-hour care he was in a home but he wouldn’t eat. He just goes downhill.’

This case highlights a recurring problem for some patients receiving continuing care. The National Framework for Continuing Care states that the current location of care should not be taken into account during the continuing care assessment process. However, if the patient is deemed eligible for funding then the NHS has the right to decide where care should be provided. The National Framework does recommend that the wishes of the patient and their family be taken into account where possible, but the PCT is not obliged to consider these. You can find out more about this issue in our factsheet: ‘When a patient has qualified for continuing care.’ You may also like to read about the 2003 Pointon case in our ‘Key court & Ombudsman cases’ factsheet where Malcolm Pointon was eventually (and unexpectedly) awarded NHS funding for care at home after a lengthy battle with his PCT on multiple issues surrounding his care and its funding.

posted by Cheselden Continuing Care at
13:55

The Times has discovered that £286 million of funding allocated by the Government to improve end of life care services has not been used for this purpose. 90% of PCTs surveyed by the charity Help the Hospices said that the money has been ‘lost on the NHS balance sheet’ or redirected to other areas. The funding, to be supplied over two years, was announced in July 2008 by the then health secretary Alan Johnson and was supposed to be used to help more people die at home rather than in hospital. 28 PCTs were surveyed and only three could prove that they had spent more money on palliative care this year than last year. Other Trusts stated that they had been unable to spend extra money on end of life care due to financial pressure, or that they could not identify a specific amount for this purpose on their annual allocation, or that they had not received any extra money. David Praill of Help the Hospices comments: ‘This is a tragic indictment of the system. PCTs have been given a substantial amount of money to improve end-of-life care, and it simply isn’t good enough that, one year on, many don’t know where it is.’

However, a Government review of end of life care published on 14 July tells a different story. It claims that the £286 million funding programme ‘..had made a good start and was set to deliver real service improvements’. The Department of Health has stated that it is using some of the funding ‘for national work’ as well as allocating money directly to PCTs.

At present, around 20% of people die at home in England, although it is a stated preference for almost 70% of those who die following a chronic illness. 58% of people die in hospital due to a lack of hospice beds and of the support and pain management services that would enable more of these people to die at home.

posted by Cheselden Continuing Care at
13:03

The Public Service sector website has published an article describing how using telehealth can save PCTs significant sums of money on the care of older people and those with long-term health conditions, whilst reducing the number of unnecessary and delayed hospital admissions. Telehealth involves the remote monitoring of patients at home by nurses. Information on the patient’s condition is transmitted daily, enabling nurses to pick up on any changes and prioritise the time that they spend on providing treatment. The approach has been shown to reduce acute hospital admissions as well as boosting recovery times for the patient. Telehealth is expected to play a major role in caring for the 17.5 million people in the UK who suffer from a long-term health condition. This group accounts for 80% of GP consultations, 60% of hospital bed use and 69% of the NHS’s primary and acute care budget. Sheffield PCT has recently trialled the use of telehealth for patients with chronic obstructive pulmonary disease. Community nurse visits were reduced by 80% and hospital visits by 50% – saving the PCT up to £40,000 which has been reinvested in more telehealth monitors. It is estimated that the wider use of telehealth could potentially save the PCT £1.2 million per year by dramatically reducing the number of hospital admissions.

posted by Cheselden Continuing Care at
14:08

Bristol councils, PCTs, the South West SHA and the Alzheimer’s Society have joined forces to dispel the taboos surrounding dementia and to work to improve dementia services in the south west of England. It is estimated that around 6,000 people in Bristol suffer from dementia and this figure is expected to increase by 33% over the next 20 years. However, at present only a third of sufferers are ever officially diagnosed and many others are unaware what support services are available and how to contact them. Key to the campaign is the local implementation of the National Dementia Strategy, which was launched earlier in 2009. The Strategy focuses on raising awareness of dementia and related issues, enabling earlier diagnosis and treatment and improving the standards of care provided to patients. One initiative that has already been launched in Bristol is the provision of a dementia support officer that GPs in the area can call on for specialist advice and help with patients. You can find out more about the campaign at the Bristol Evening Post website.

posted by Cheselden Continuing Care at
13:52

The King’s Fund for Enhancing the Healing Environment has awarded a £30,000 grant to 10 PCTs to enable nurse-led teams to improve living conditions for dementia sufferers. Niall Dickson of the King’s Fund comments: ‘We know that the physical environment in which we care for people affects the way they feel, and this is especially true for people with dementia and those caring for them.’ Projects that will benefit from the funding include an indoor garden at Macclesfield District General Hospital and a social area in Aintree hospital. Another project is the development of satellite navigation systems at the University of Newcastle, which it is hoped will help dementia sufferers avoid getting lost in public places.

posted by Cheselden Continuing Care at
12:27

The British Journal of Healthcare Computing and Information Management (BJHC & IM) reports that the Rotherham Health and Social Economy Partnership is pioneering a new information system that will enable better decision-making about patient care. The Interqual system is designed to help health and social care professionals make decisions about patient admissions, care provision and discharge from hospitals. It is already widely used in the USA. The Rotherham Partnership, which consists of the Rotherham NHS Foundation Trust, Rotherham PCT and Rotherham Social Services, plans to use Interqual across three areas: healthcare for the elderly, orthopaedics and emergency admissions. The Partnership was established to provide Rotherham residents with quick and fair access to local services that cover all their health and social care needs whilst remaining personalised and of high-quality. Brian James, Chief Executive of the NHS Foundation Trust, explains how Interqual will help NHS and Social Services staff make more effective and appropriate decisions about care. ‘Using the same tool to help determine whether an individual patient requires admission or not, whether they are at the right level of care, and when it is appropriate to discharge, creates a win-win situation. The PCT avoids the cost of an “avoidable admission” and the Foundation Trust can reduce the cost of inpatient stays.’ To find out more about Interqual and the Rotherham Partnership, visit the BJHC & IM website.

posted by Cheselden Continuing Care at
16:53

The Department of Health has launched new legislation that will protect people who lack capacity and who live in hospitals and care homes. The Deprivation of Liberty Safeguards came into force on 1 April 2009 and will help protect these vulnerable people against abuse and poor care. Introduced as part of the Mental Health Act 2005, the Safeguards mean that if a care home or hospital has to deprive a patient of their liberty for their own safety and wellbeing, they must now apply for permission to their local authority or PCT.

Deprivation of liberty can now only take place further to a new, standardised assessment and authorisation process that hospitals and care homes are obliged to implement. The process gives the patient the following rights:

• To challenge the decision to deprive them of their liberty
• To appoint a representative to act for them and protect their interests
• To have their status regularly reviewed and monitored.

Care minister Phil Hope explains how the change in the law will benefit patients: ’Before this law came in, care homes or hospitals were able to lock someone up or sedate them without their consent, without that person having any kind of right to appeal or protest…The safeguards will flush out poor care and prevent people being deprived of their liberty…unless it is absolutely necessary for their own safety.’

The move has been welcomed by a number of charities working to protect the rights of people suffering from mental health problems. Neil Hunt of the Alzheimer’s Society gives his view: ‘Two thirds of people with dementia live in care homes and up to one quarter of hospital beds are taken up by people with dementia. It is essential that people in these settings be supported to live their lives in a way that recognises their human rights.’

Around 21,000 applications for deprivation of liberty are expected in the first year of the new scheme and it is anticipated that a quarter of these will be authorised. Read more about the Deprivation of Liberty Safeguards at the Department of Health’s website.

posted by Cheselden Continuing Care at
16:33

Suffolk PCT has unveiled its plans to develop the county’s community healthcare services by converting the existing Suffolk Community Healthcare (SCH) body into an ‘arms length trading organisation’ by April 2009. Felixstowe TV [link to ] reports that, by April 2010, the organisation will be recognised as an independent legal entity. Along with private providers, SCH will then be invited to submit tenders to supply community health services such as the management of community hospitals, district nursing, health visiting, community dentistry and podiatry. NHS Suffolk has stated that their actions are in line with guidance issued by their Strategic Health Authority and that the creation of competition amongst service providers will lead to a better standard of care for the county’s patients. A spokesperson commented that the Trust has ‘…identified 12 strategic initiatives to deliver progress over the next 5 years on its main 5 goals. Several of these require significant improvements to, and investment in, community health services.’

NHS Suffolk has undertaken extensive research and project work to help staff understand how to commission services that will result in high standards of care, patient experience, integration with other services and value for money. It has announced that it is organising a series of events for patients, GPs and other stakeholders to explain to them the agenda for changing Suffolk’s community health services and the benefits that will result.

posted by Cheselden Continuing Care at
13:56

The Westcountry’s local news website reports that PCTs in Devon and Cornwall will receive 4% less funding over the next two years than is recommended by the Government’s ‘fair funding’ formula. The shortfall across the Westcountry totals £200 million, leading to concerns over quality of care and the continued provision of services. The Department of Health (DoH) claims that the general increase in funding across the country outweighs shortages in certain areas, but Teignbridge MP Richard Younger-Ross disagrees and warns that local people will suffer if a lack of funds leads to staff and care services being ‘rationed’. The news is a blow to a long-running campaign to secure additional funds for Devon and Cornwall to cover the extra costs of providing services in rural areas, with Falmouth and Camborne MP Julia Goldsworthy commenting that the figures are ‘overwhelming evidence which demonstrate how far behind rural areas are falling.’ The pattern recurs across the southwest, with PCTs in Somerset and Dorset also receiving less than expected.

Department of Health and regional NHS directors have defended the funding decisions, focusing on the increase in actual funding rather than the percentage distance from the Government’s ‘fair funding’ target. A DoH spokesman points out that ‘Cornwall is in the top 10 per cent of PCTs in the country in terms of the size of its increase. A greater distance from the targets – which move – is an advantage for a PCT because it means bigger increases in funding in future years.’ Click here to read the full story.

posted by Cheselden Continuing Care at
11:50

Further details have emerged on our recent story about the direct payments case being brought by two disabled people. Valerie Garnham from North London is in her 60s and has been disabled and in a wheelchair all her life. She needs help with all aspects of daily care which is provided mainly by her husband but also by six other carers who were previously funded by direct payments from the London Borough of Islington. Despite being assessed as eligible for continuing care in 2002, the direct payments continued until February 2008, with the Borough reclaiming the cost from the NHS. Mrs Garnham’s PCT then wrote to her advising that the payments had to stop as they were against NHS policy. The PCT offered to provide its own agency carers and care plan instead. Mrs Garnham claims that this has robbed her of her ‘dignity and autonomy’ and has left her feeling like a ‘useless cabbage’. Her barrister will argue in court that the PCT’s actions amount to ‘discrimination’ and result from an ‘erroneous interpretation’ of the 2006 NHS Act.

Steven Harrison, aged 41, from Wakefield has been tetraplegic since a diving accident in 1998. He uses a wheelchair and needs assistance with most day to day tasks such as bathing and dressing. He also suffers from Autonomic Dysreflexia, a serious condition resulting from his spinal injury, and must be watched at night when he is most likely to suffer an attack. Mr Harrison’s barrister commented that it is especially important that Mr Harrison retains control over choosing his own carers because ‘He finds the delivery of personal extremely intrusive and…it is important for Mr Harrison to work with carers whom he trusts and with whom he is comfortable.’

The case continues.

posted by Cheselden Continuing Care at
10:55

Care services minister Phil Hope reveals that the National Framework for continuing care, introduced in October 2007, has not achieved its goal of abolishing the ‘postcode lottery’ of care in England. There is still widespread variation in the proportion of people who receive funding for long-term care. Figures released by Mr Hope show that numbers receiving funding vary from 8.9 per 50,000 population in South East Essex PCT to 105.8 per 50,000 in Ashton, Leigh and Wigan PCT. The average figure for the country is 40 people per 50,000 population. The charity Age Concern has responded to Mr Hope’s figures by calling for closer monitoring of those PCTs with unusually low or high levels of funding. It also urges trusts to check that health professionals in their area have been trained in using the Framework.

This news comes as the Government undertakes a review of the Framework, which was designed to end the ‘postcode lottery’ of care funding by introducing a single national standard to be followed by all PCTs. Although this effect has yet to take place, the National Framework has achieved one of its aims, as there has been an overall increase in the numbers of people receiving fully-funded care in 2008-9.

posted by Cheselden Continuing Care at
16:21

The Nursing Times reports that the Government’s cancer director, Professor Mike Richards, wants PCTs to fund 24 hour community nursing services to allow terminally-ill patients to die in their own homes or in a care home. The Government’s End of Life Care Strategy for England is to include the setting-up of fast-response nurse teams to undertake this care. With these measures, Professor Richards hopes that both patient suffering and unnecessary hospital admissions will be minimized. Click here to view the story on the Nursing Times website.

In a related story in the Manchester Evening News, Trafford GPs have called for long-term, chronically-ill patients to be given electronic monitors in their own homes to alert surgery staff to any changes in their condition, reducing the patient’s stay in hospital. Read more about this and other plans to improve health services in the Trafford area on the MEN website.

posted by Cheselden Continuing Care at
17:30

The Daily Mail draws attention to the widespread cuts in NHS care that are affecting Alzheimer’s patients all over the UK, with almost a third of PCTs reducing community services such as district nurses due to lack of funds. 40% of Trusts do not currently provide any dementia services at all. Launched in response to these findings, the Mail’s Action on Alzheimer’s Appeal aims to raise funds for the 700,000 people in Britain affected by all forms of dementia. The Appeal has already attracted celebrity backing from names like Angela Rippon and Sir Cliff Richard and is supported by the Alzheimer’s Society. Read the full story on the Daily Mail website

In a related article, the Daily Mail also reveals that spending on Alzheimer’s research in the UK is far lower than most other Western countries at 14p per person, representing 3% of the Government’s medical research spending.

posted by Cheselden Continuing Care at
13:49