As fully expected the Panel refused CHC..so am sounding off... but also any advice on appeals?

Hi Again

My late father's PCT have just under taken a retrospective review for the last period of his care....

My father was actually granted CHC near the end of his life but not due to him being fast tracked. They back dated it to the date of his MDT which happened to be only six weeks before he died. I have been asking the PCT to review his whole time in care but they will only go back from 2009 to mid 2007 when they believe they have proof he was not eligible...that being an RNCC and tick box checklist for CHC....Anyway the basis of my argument is that the PCT have sent me a Needs portrayal document ( more on that load of rubbish later!) basically stating that they did not think he deteriorated during the period under review which to be honest is true as he was always exhibiting a PHN! On the last day of the period they have just reviewed retrospectively the PCT actually did a full assessment of my dad at the time in 2009 and he was found to have needs that would qualify him in at least six domains...his subsequent DST found One severe, 3 high's and four moderates and two low and this lead to him being given CHC and the council asking the PCT why did this person not have a PHN in the first place? So my argument to them was how could he be at level for CHC on the last day of the retrospective review period as seen by a nurse assessor at the time and 3 days after that be found at a level for CHC by an MDT who actually met him and not be during the review period...especially as no significant deterioration took place on the evening before his Full CHC assessment or MDT....ie he was awarded CHC in 2009 even though no deterioration took place therefore meaning his needs were of the same level prior to this and in fact were entirely caused by a massive Brain hemorrhage in 2003.

I obviously didn't just argue this point...I wrote a comprehensive document ( 90 pages of evidence plus notes) covering my response to the PCT in a Needs Portrayal and DST format....we were not allowed to attend this panel...I wrote this with the knowledge that it will end up going to the SHA and poss Ombudsman as it was clear to me from the beginning that the PCT would do anything to thwart my claim... I included under each domain hundreds of statements from notes, I included a needs overlap diagram, I showed overlap in the notes, I included lots of reference to intensity and complexity, I gave case studies showing my fathers level of need as judged in 2009 against others who have publicly been referenced by the ombudsman...and yet they have as I expected refused his eligibility.

They have even downgraded his level of need in breathing believe it or not from High to No Needs!!!!....in his 2009 MDT he was found to be high this is due to the fact that at that time frequent chest infection was included in the description under high. Last weeks panel found him to have no need...this even though I requested that they review him under the eligibility criteria of the time...it was after 2007 and so NF...they have ignored this but also decided to use criteria used at the time for the period May 07 - Oct 07 and not NF.....aaagh!!!

I also pointed out in my response to their Needs Portrayal document that the PCT has written two NPD's for my dad...for the same period of time, by the same assessor and using the same notes..he is dead so their could be no changes and both of these NPD's were done in the last year or so in response to my family's request for a review.....The first showing almost no needs was done when my mum (83 years) initiated the review...the second done for me after I halted the process and asked for his notes and started asking more searching questions...the second NPD has more information...ie NPD 1 has on average 4 entries per page showing no needs or health issue's...NPD 2 has 30 entries showing a little more but still masked. Why would the PCT have the need to prepare a second document....I wonder!!! If my document had gone up against the first NPD it would have wiped the floor with it....it should have done it with the second but including more information gave them a bit more room to wriggle

The second NPD is also very questionable as it is a highly edited version of my dads notes...I have obviously cross referenced as much as possible...difficult as they refused to send me copies of notes they paginated. I did find masses of stuff left out which I obviously included in mine but worse than that was the editing of notes and entries ie 'Deteriorating and of low mood and Citalopram not working' is edited to ' Citalopram not working' there are masses of examples of this and of really important evidence being left out. They don't seem to take notice under cognition of entries like 'unaware of any danger' and yet pay plenty of notice things like " able to make eye contact' and 'able to move slightly to assist when we are washing his back in bed' apparently this shows cognition and that he was able to indicate his needs...how could he ask for his wife or a an extra blanket...Tosh!!! I obviously highlighted this but they just ignore it ....It's so predictable that I'm not even annoyed and will just keep plugging on...I honestly believe in the health service right to try to save money but not by employing nurses to edit and hash notes together to give an entirely wrong picture of a persons needs...It clearly show's the PCT are partial from the get go....and I do intend to make another formal complaint about this editing of notes and question why there was a need for a second NPD as no fresh evidence was made available for them to include!

Sorry for the ramble but obviously now have to go through the appeals process....apparently we can go back to PCT and attend the appeal but don't really see the point in that as they definitely won't change their minds....Partly they won't give in because they know if they do they will have to keep going back to the previous years as the supposed evidence that he was not eligible in May 2007 will have been proved wrong. So How many times can you go to SHA for the same period and then is it Ombudsman? Also will the appeal be based on evidence already seen or can I include comment on their Retrospective Review Panel Findings. I will keep on going with this but I may decide to contact Hugh James as I think I have a clear picture of our case now...I spoke to them a while ago but was in a bit of a muddle so decided to put off and I do want to stick with it myself but it just takes over your life!
Thanks and any pointers will be appreciated.

KW

So so sorry to hear the latest after I know you have sweated blood over this over the past weeks. After all the toil you have put in I was rooting for you that they may see sense this time (I must be going daft) but their response is just what we have come to expect - they cherry pick the bits that support them in their denial, and ignore everything else! You rant away as much as you want to!

Next stage is to ask the SHA for an 'Independent Review' - (which isn't independent at all) This you can attend and you can put your case to the panel on the day on everything that has been done (or not done) to date, including this latest review. The PCT SHOULD forward to the IRP everything in their file so far, including your submissions to date. Following that, once you have the IRP's full report, their decision, and their 'rationale' for that decision, the next stage is to the Ombudsman, however, we found that the O'man would only look at the IRP stage, even though we complained about the actions of the PCT - they said that the IRP 'would have' reviewed thoroughly everything the PCT had done - load of cobblers!

May be others on here who are more up to date than me, -it's nearly 3 years now since our own IRP.
In your shoes, and knowing what I know now, I wish we had contacted Hugh James 2 or 3 years ago. From recent contact with them I know they will not take anything pre-2004 at the present time, which most of our case was, but as most of your case is after that date then you should be o.k. with that.

Good Luck and keep us posted
regards HK

Thanks for your support Helkat...think I probably will contact Hugh James as really don't want to have another month like the last one when you do all this hard work and it is just ignored....Really can't understand their logic of how my dad can be according to last weeks panel High in one domain, moderate in eight and none in two and then without deterioration and again according to the panel in 2009 on literally the day after the retrospective review period.... be Severe in one domain, high in three and moderate in four with two lows and eligible for CHC as found by the PCT....Utter madness.

This seems to be their MO recently. The IRP's over riding the PCT's scores or in our case ' overstating ' Mum's needs. The Ombudsman found in the IRP's favour so I have just sent them an appeal for a review. So to re cap = 3 separate DST's done in 2007, 2009, 2011 [ gradually being downscored on each occasion ] 2 IRP's - 1 appeal to Ombudsman when they told the SHA / PCT to do a review of their decision and the 2nd appeal to the Ombudsman failed us. I should at this point advise you that our Solicitor dropped our case at the recent Ombudsman decision. So we are on our own again since 2008.

"they cherry pick the bits that support them in their denial, and ignore everything else!"
ABSOLUTELY. The Nurse Assessor on each of Mum's appeals made a point of saying she'd tried to be fair but reality is that whilst negative behaviours were included, comments like "Happy Today", "Good Day Today" were included to negate the negative ones - question: why would a note be made of good things if they were anything other than unusual!


"[i]Next stage is to ask the SHA for an 'Independent Review' - (which isn't independent at all)"
My advice would be to attend (that is if you don't go down HJ route). I really regret taking advice of an Advocate not to attend an IRP that now I know to have been crucial to the whole case. May have proven to be a waste of time to have attended but I will never know now will I?

In your shoes, and knowing what I know now, I wish we had contacted Hugh James 2 or 3 years ago.
I've just passed all of my documents to HJ for them to assess - will take 2-3 weeks. IF they think there's a case, will need to negotiate on their NoWin/NoFee deal they've indicated. I've taken this route because I just cannot do this any more.
We all know we are right but we just don't have their might.
Only you know how much more you can take - but please please don't let this destroy you if there's an alternative way. By the way, HJ charge £1,000 + VAT to do the assessment, plus costs for obtaining care home/hospital/GP etc notes - if you don't already have them.
MissPiggie
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