Continuing Health Care

John Petters made this Freedom of Information request to NHS Castle Point and Rochford Clinical Commissioning Group

This request has been closed to new correspondence from the public body. Contact us if you think it ought be re-opened.

The request was partially successful.

Dear NHS Castle Point and Rochford Clinical Commissioning Group,

The Castlepoint and Rochford CCG appears to be in complete disarray concerning the provision and assessment of people requiring Continuing Healthcare, which is the little known legal provision of healthcare including accommodation for people who are ill.

My mother, who is 84 years old, suffers from severe dementia, first degree heart block, odeama, has recurrent UTIs, which result in regular falls, which have caused fractures. She cannot communicate any of her needs and care home staff are unable to predict when she will fall or have a seizure (she has a history of epilepsy). She is doubly incontinent and unusually for the care home, she is toileted every two hours during the day.

Senior Nurse assessor, Lynn Freeman was asked three times during a recent health needs assessment to confirm that the health assessment would be compliant with the Coughlan Judgement - the landmark appeal court judgement brought by Pamela Coughlan, which is the law of England. Ms Freeman refused to do so.

Lord Woolf the trial judge in the Coughlan case stated at Paragraph 48 of the judgement:

"It is for the Health Authority to decide what should be the eligibility criteria in its area in the co-operative framework envisaged by the circulars. In doing so it can take account of conditions in its area. We do not accept the argument that there cannot be variations between the services provided by the NHS in different areas. However the eligibility criteria cannot place a responsibility on the local authority which goes beyond the terms of section 21. This is what these criteria do. Cases where the health care element goes far beyond what the section permits were being placed upon the local authority as a result of the rigorous limits placed on what services can be considered to be NHS care services. That this is the position is confirmed by the result of the assessment of Miss Coughlan and her fellow occupants. Their disabilities are of a scale which are beyond the scope of local authority services".

The National Framework used for assessing whether patients can have free Continuing Healthcare and the Decision Support Tool are merely for guidance and do not trump the law as set out in the Coughlan Appeal Court decision, which is the law of England.

In Paragraph 118 (a) of the Coughlan judgement, Lord Woolf states,

"Whether it was unlawful depends, generally, on whether the nursing services are merely (i) incidental or ancillary to the provision of the accommodation which a local authority is under a duty to provide and (ii) of a nature which it can be expected that an authority whose primary responsibility is to provide social services can be expected to provide. Miss Coughlan needed services of a wholly different category".

Professor Luke Clements of Cardiff University, the acknowledged expert on Continuing Healthcare Law states,

"The DST is not, as the Department of Health emphasises, a decision making tool: it is merely a Decision Support Tool. In disputed cases, therefore, the ‘quality / quantity’ approach of the Court of Appeal should inform the decision making process and NHS CC eligibility should only be denied to those whose health care needs are marginal (or in the Court’s terms ‘merely incidental or ancillary’ to the provision of the social care) and quantitatively of a low level (or in the Court’s terms ‘of a nature which it can be expected that an authority whose primary responsibility is to provide social services can be expected to provide’)".

In a recent case settled by the NHS and reported in the Sunday Times, a payout of over £93,000 was made to Vicki Keiller who had wrongfully been denied Continuing Healthcare Funding by her local CCG. The reason for settlement was given as:-

"The Keillers claim that there was a potential conflict of interest at the time because (Sue) Jestice was listed as the “programme manager” who had to meet a “savings target” of £1.8m from CHC funding, detailed in the clinical commissioning group’s operational plan for 2014-16."

Sue Jestice, who was the head of complex case management, it was reported, resigned.

Castle Point and Rochford CCG produced an "Operational Positioning Report" in October 2013, a few months prior to refusing to fund my mother, which stated:

"Recent data provided by the CSU Continuing Healthcare team indicates that there will be an unexpectedly large overspend." This was submitted by Tricia D’Orsi, Director of Quality & Nursing, Castle Point & Rochford CCG.

Therefore I have to establish by way of a freedom of information application whether there might a conflict of interest similar to the Keiller case.

The staff members that I know of involved in my mother's case are:
Patricia D'Orsi
Sarah Jane Ward
Matt Gillam
Nancy Muzondo
Lynn Freeman
Vicky Wood
Ian Stidston.

1.Please state if any of the above persons have been involved in any way with the CHC budget for the CCG and if any instructions have been issued to avoid an over spend on the budget to staff assessing CHC and if so, identify who gave those instructions and exactly what was the wording.

2.Please state what the overspend was in 2013.
3.Please state what the budget was in 2014, 2015 and 2016 and if the spending was within budget.
4. Please state who was responsible for the CHC budget in each year.
5.Identify all staff members involved in setting the budget and/or implementing the budget.
6. Please state the number of cases which have been recommended as ineligible for Continuing Healthcare by CHC's multidisciplinary teams, or agents operating on its behalf, at the Health Needs Assessment /Decision Support Tool level and at the local resolution and panel stages, which have been reconsidered by the CCG, overturned by the Independent Review Panel or the Parliamentary Health Ombudsman or Judicial Review and which as a result, the NHS has funded in the Years 2013, 2014, 2015 and 2016.

Yours faithfully,

John Petters

foi essexccgs (NHS BASILDON AND BRENTWOOD CCG), NHS Castle Point and Rochford Clinical Commissioning Group

FOI Request: CHC Budget and Overspend
Our Reference Number: 1617293

 

Dear Mr Petters,

 

I am writing to acknowledge receipt of your request under the Freedom of
Information Act 2000 to NHS Castle Point & Rochford CCG on 2^nd November
2016. The information is currently being collated and a response will be
sent to you no later than 20 working days. The deadline is calculated to
be 1^st December 2016.

 

If you have any queries regarding your request, please do not hesitate to
contact the FOI team on this email address.

 

Regards,

 

Iain Gear

Freedom of Information Lead

Tel: 01268 594515

Email: [1][email address]

Phoenix Place | Christopher Martin Road | Basildon | SS14 3HG

NHS Basildon and Brentwood Clinical Commissioning Group

 

Working on behalf of NHS Basildon & Brentwood CCG, NHS Castle Point &
Rochford CCG, NHS Mid Essex CCG, NHS North East Essex CCG, NHS Southend
CCG, NHS Thurrock CCG and NHS West Essex CCG.

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foi essexccgs (NHS BASILDON AND BRENTWOOD CCG), NHS Castle Point and Rochford Clinical Commissioning Group

1 Attachment

FOI Request: CHC Budget and Overspend
Our Reference Number: 1617293

 

Dear Mr Petters,

 

Further to your request under the Freedom Of Information Act, received on
2^nd November 2016, please find NHS Castle Point & Rochford CCG’s response
attached.

 

If you are dissatisfied with the response you have received, you have the
right to request a review of our decision or make a complaint about how
your request has been handled. Your request should be made within 40
working days of receipt of this letter, and we will reply within 20
working days of receipt. Any such request received after 40 working days
will only be considered at the discretion of the organisation.

If our decision is unchanged following a review and you remain
dissatisfied with this, you then have the right to make a formal complaint
to the Information Commissioner who can be contacted at:

Information Commissioners Office, Wycliffe House, Water Lane, Wilmslow,
Cheshire SK9 5AF.

Further information on your rights under FOI is available here:
[1]www.ico.gov.uk

 

To comply with The Re-use of Public Sector Information Regulations 2005,
this information is provided to you under the Open Government Licence.
Information on the OGL, together with conditions of use and exemptions,
can be found here:
[2]www.nationalarchives.gov.uk/doc/open-government-licence/

 

Should you require any further information, please do not hesitate to
contact the FOI team on this email address.

 

Regards,

 

Iain Gear

Freedom of Information Lead

Tel: 01268 594515

Email: [3][email address]

Phoenix Place | Christopher Martin Road | Basildon | SS14 3HG

NHS Basildon and Brentwood Clinical Commissioning Group

 

Working on behalf of NHS Basildon & Brentwood CCG, NHS Castle Point &
Rochford CCG, NHS Mid Essex CCG, NHS North East Essex CCG, NHS Southend
CCG, NHS Thurrock CCG and NHS West Essex CCG.

 

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References

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