Has anyone else heard that the qualifying life expectancy for fast tracking CHC application has reduced from 6 months to a matter of weeks?

[Willow_rob]

I am pushing for CHC funding for my wife. When I raised the matter of fast tracking her application because she has deteriorated very quickly (having originally been given a 2 to 6 months prognosis when she was in hospital 7 months ago). I was told by our district matron that the criteria had changed and that fast tracking now only applied to people with a matter of weeks left to live. This is not supported by any of the literature that I have read. Grateful if Kevin would also have a view on this. I suspect smoke and mirrors are being used to confuse applicants. Thank you. Rob

[Kevin_1]

Hi Rob

Saying hello and good to see you back

CHC absolutely has no time scale of any sort.

It is and always has been about clinical need.

It would help me if you could say who said that and what stage of applying for CHC you are at and is your loved one at home or in care.

I can be far more precise about the regulations and what steps to take given that information.

Sounds like you have been given one of the common rubbish statements and they are too common.

Easy to sort out though.

Best to you

Kevin

[Willow_rob in reply to Kevin_1]

Hi Kevin, I have had the check list submitted by our district Matron and it has been accepted and I am awaiting assessment (for which I am told there is at least a three month waiting period before they begin to gather evidence from such people as Mary's consultant and GP). It was this delay that caused me to query why she had not been fast tracked prior to discharge from hospital where she had the good news about her life expectancy! The Matron paid a house call this afternoon and observed that Mary's condition had indeed deteriorated (stricture, posture and cognition) and that I am having to exert all my strength to manage and move her because of this rigidity and I am concerned about injuring her. I am no spring chicken and have a long term condition (heart) which is not being helped by this exertion! I have read and followed all your advice hence we are at this stage in the normal application. I have also been steered towards Care Direct in order to get a Carers Assessment. I am a patient person but the CHC system seems to be full of loopholes designed to give reason to refuse. Thank you for your help. Rob

[Mcates in reply to Willow_rob]

Yes this is true now. Unfortunately if there is no specific nursing needs a fast track can still be refused. In this instance I would have fast tracked your wife and if refused gone on to do full assessment. I’m in Hertfordshire and the biggest issue is waiting for social worker input. I’m a community Matron and have had pts fast tracked that are still alive almost 2 years later. There are multiples of this which is why they are getting stricter. I hope you get her care sorted soon. X

[Willow_rob in reply to Mcates]

Thanks for your advice. I think our Matron is similarly frustrated by the process and she is resubmitting the DST to reflect Mary's deteriorating condition but cannot do this for two weeks due to other commitments. Rob

[Kevin_1 in reply to Willow_rob]

Adding

A carers assessment is always a good thing.

They may well be able to dome up with some funds for a carers respite break.

Thought when it comes to the Social Workers assessment for CHC you should really also ask for respite nursing home respite as well... even if you don't think you need it. The day may come when you might need a break for hospital treatment or other.

Back to the carers assessment: They should, as part of it, explain what carers resources are in you area as well.

It's good to get one.

Best to you

Kevin

[Kevin_1]

Hi Rob

As Mcates says even though fast track eligibility has not altered, it was used more generously in the past to expedite care in urgent cases, or to clear a blocked bed in a hospital where substantial care is needed at home. (Thanks Mcates - I had than one down in my head incorrectly).

Here is the guidance:

44.1 In Fast Track cases, Standing Rules state that it is the ‘appropriate clinician’ who determines that the individual has a primary health need. The CCG must therefore decide that the individual is entitled to NHS continuing healthcare and should respond promptly and positively to ensure that the appropriate funding and care arrangements are in place without delay.

44.2 The Fast Track Pathway Tool is used when the individual has a rapidly deteriorating condition and the condition may be entering a terminal phase. For the purposes of Fast Track eligibility this constitutes a primary health need. No other test is required. The completion of the Fast Track Tool is sufficient evidence to establish eligibility;...

You sound like you are doing a sterling job of caring for Mary under very difficult circumstances.

Though I love our NHS and though the staff generally do their very best the demands on them are very high now. That is an issue for government not for us who need their clinical input. With this in mind it is probably time for you to jump up and down a bit.

As I said before CHC is definitely not only for end of life care. The key criteria is having a Primary Health need and that is a key part of the DST assessment.

The only changes that have been made in recent years are in the new National Service Framework which CCG's have to implement by October of this year. For your purposes there are no significant changes. It clarifies a few points and the guidance is clearer, the DST has better guidance notes.

The National Service Framework has to be followed it is a requirement of the NHS to do so.

The NSF states that from checklist to Care Commissioning Group decision should be within 28 days and that the CCG should normally respond to the Multidisciplinary Assessment Team within two working days. In English the latter part means that the CCG should respond to the DST and the recommendations based on it within two working days of it being submitted.

So the 'sorry three months queue' does not cut it.

In your shoes I would politely mention the 28 day requirement and also address risk.

Risk is a major guide stone for the NHS. Whatever a clinician does or does not do they must pay full heed to properly assessed risk.

Examples of risk are:

* Insufficient care support which means the patient is left vulnerable for periods of the day.

* Risk of care / carer breakdown due to insufficient care/clinical support.

* Inadequate monitoring of patient leaving them vulnerable to accidents or other such incidents.

* Risks involved in transfers and moving and handling because of the need for two carers and the carer cannot safely manage that on their own.

* Risks to your own health in attempting to provide care with inadequate care support.

So if you were to write to them in this vein you might get a more timely response.

The funding should be backdated to the date the Check List screening tool was undertaken.

This is a good quick reads to get yourself up to speed:

england.nhs.uk/wp-content/u...

I do hope this helps a bit.

Do come back if you want clarification or more info.

Best to you both

Kevin

[Willow_rob]

Thanks Kevin for your advice. I will start banging the table. My problem is that I am mitigating the risks, particularly with handling and ensuring Mary is left in safe places but it is taking its toll on my health and I am now having to take pain relief in order to get moving in the morning. It's a damn shame we get old! Thanks again to you and Mcates. Rob

[Kevin_1]

Hi Rob

Yes, of course your mitigating the risks... but you need to be clear with them that your efforts are perhaps not safe and you are concerned. You need to lay it on the line truthfully, but worst case scenario.

Yeah, I'm feeling my age a lot now... sometimes frustrating, but look at the wisdom we accrue eh?

You must look after yourself as much as you can. Caring is exhausting and if you go down so does the home care. Please... no bravery.

Best to you.

Kevin

[Willow_rob in reply to Kevin_1]

Hopefully youth and vigour will be overcome by experience and cunning!! Cheers Kevin

[Kevin_1 in reply to Willow_rob]

Big chuckles at that here

Your more than welcome

[wheelrace]

have just gone through all this one week ago they said you must be dying within six weeks the question to them was who can say that only god they then said they can refer for continuous care funding but not fast track unless my husband was dying which he now unfortunately is ask your district nurse to ask for an assessment or find out where your ccg who provide funding is and request an assessment they cannot refuse I followed kevins advice to the letter but my husband was in hospital and I don't know your circumstances but everything was put in place on the day he came home and believe me they suddenly cant offer enough for his care carers as often as I want district nurses macmillan and marie curie I stood my ground with help from the forum and family they try everything to put you off so keep stamping your feet youll get there best wishes doreen

[Willow_rob]

Thanks Doreen I shall keep trying. Rob

[Mcates]

Hi, whichever route you go down please keep a very detailed diary of absolutely everything you do for your wife. Get one of those large a4 ones that have the times down the side. I did Yvonne’s husband George’s and it was definitely Yvonne’s evidence that swung it. She even provided video evidence of nighttime behaviours. Good luck. Hope you manage to sort it. Xxx

[Willow_rob]

Thanks for this advice I have already chronicled my/her worst days on advice from our district Matron. Trouble is you run out of time. I am awaiting a carers assessment because I have been told that this is also good evidence. Rob

[Marie_14]

Rob it is, and don't downplay things! Lay it on thick how ill this is making you etc. It's true anyway! If this doesn't make carers ill I don't know what does!

Good luck.

Marie x

[Willow_rob]

Thanks Marie, I second that, it's the lack of proper sleep that I find very trying. Not particularly caused by Mary but my fretting about her. This and frequently bursting into tears when I face the enormity of losing my best friend. Thanks for your advice. Rob