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Important information for NHS CHC applicants

It has come to SIA’s attention that some of our members, who are being assessed or reviewed for NHS Continuing Healthcare eligibility, are being denied access to the completed Decision Support Tool (DST) prior to it being submitted to the ratification panel of the Clinical Commissioning Group (CCG) at which a decision on eligibility is made.

Whilst this does not contravene the letter of the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care (National Framework), SIA feel that it is not in the spirit of the statutory guidance which promotes a ‘person centred’ assessment process. On a number of occasions where the individual has been allowed to see the DST, prior to it going to panel, we have had to correct factual inaccuracies and/or input a substantial amount of important detail which had been missed out from or misstated in the DST assessment document, thereby prejudicing the person’s chances of securing a determination of eligibility for CHC funding, and despite this having been discussed at the multidisciplinary team meeting. This clearly demonstrates the vital importance of the individual having the opportunity to review and if necessary challenge the information beforehand.

In order to try and prevent this happening, we are now advising our members to apply the following caveat when asked for written consent to be assessed – which is a prerequisite to the completion of the DST:

I am willing to consent to the completion of the DST provided I am given a copy of the DST, to check for errors and omissions in a timely manner before the DST is submitted to the ratification panel and before a final decision on eligibility is made’.

We hope that this will then encourage CCGs to incorporate the person centred and transparent approach which is promoted within the National Framework and will potentially reduce the number of ineligibility decisions resulting from inaccurate and/or incomplete recording of information by (usually) Nurse assessors in DST documents and consequential appeals.

It is also worth noting that you have a right to access your medical notes and information held about you by a public body (CCG) or its proxy such as a Commissioning Support Unit that carries out an assessment of eligibility for CHC.