NHS Continuing Healthcare Eligibility And Appeals Procedure Important information for patients, relatives and advocates
What is Care in the Community? Care in the community makes sure that people get the professional help and support they require to live in their own homes, or to settle into a Care Home, while also receiving the health care they need from Primary Care Services. What is NHS Continuing Healthcare? It is a package of inpatient healthcare arranged and fully funded by the NHS for those patients with high health needs as described below. Who can get NHS Continuing Healthcare? Only patients who require regular specialist clinical supervision (medical or nursing) as a result of: a) the complexity, nature or intensity of their health needs b) the need for frequent, unpredictable, clinical interventions c) the need for routine use of specialist health care equipment or treatments d) a rapidly degenerating or unstable condition 1
What information can I expect? Clear information about the assessment process and reasons for the decision. To be given clear written information about how the discharge procedure from hospital will operate to help you, your family, carers or advocate to make important decisions about your future care arrangements. To receive, from hospital and social work staff, written details of any care arranged for you including those aspects, which will be arranged and funded by the NHS. Be advised that you will be able to appeal against the decision about your eligibility for NHS Continuing Healthcare. Where is NHS Continuing Healthcare provided? Normally NHS Continuing Healthcare is provided in a hospital ward, hospice or a contracted inpatient bed with a care provider, outwith the NHS. 2
Who makes the decision about NHS Continuing Care? The consultant responsible for specialist care will make the decision, taking into account your views, the assessment carried out by other professional health and social work staff and your general practitioner (GP) as appropriate. Can I appeal against the Consultant s decision? Yes. If you do not agree with the decision then you can appeal or you may ask an advocate or relative to appeal on your behalf. Care in the community may not be appropriate for everybody. The appeal outcome will be binding to all parties. Who should you contact if you want to appeal? If you are told you are not eligible for NHS continuing healthcare and you want to appeal against this decision, you should let someone know as soon as possible. (This could be your key worker, ward manager, consultant or other doctor, carer, relative, GP or advocacy worker). 3
If you are an inpatient you should appeal in writing to your Consultant on page 6 of this booklet. What will happen? Your appeal will be fully investigated by another consultant who works in the same speciality appointed by the Associate Medical Director of the service. You, or your chosen representative, will then receive within 14 days a written response saying whether or not your appeal is supported. If the two Doctors disagree they will inform the NHS Greater Glasgow & Clyde s Medical Director who will review the case and make the final decision. If your appeal is not supported? You do not have the right to indefinitely occupy an NHS bed or receive NHS funding for your care. NHS staff will work with other agencies to provide you with appropriate support, accommodation and packages of care within the options and resources available. If you feel the process whereby the decision was made has not been correctly managed then you may use the Complaints Process. 4
(see attached document). This will not review eligibility or change the decision itself but if the complaint is upheld, the correct procedure will be followed to address your concerns. If you remain unhappy with the outcome, you can take your case to the Scottish Services Ombudsman, who will also review the process by which a decision has been reached. If following discharge you feel your care or health needs change and you are eligible for NHS Continuing Care, you may request a review of your case. This should be requested via your General Practitioner. If you need more help If you feel you need help with this process then you may wish to contact advocacy services (details overleaf). 5
Appeal against Not receiving NHS funded Continuing Care Name: Mr/Mrs/Miss/Ms I am in ward at hospital. I was informed by Dr on / / that I am not eligible to receive NHS funded continuing care. I wish to appeal against this decision. When complete, please return this form to the Consultant in charge of your care. Or you can give it to the Charge Nurse who will forward it. 6
Independent Advocacy Services in Greater Glasgow The Advocacy Project 15 Carlton Court, Glasgow, G5, Tel: 0845 0762262 E.mail: enquiry@theadvocacyproject.org.uk Ceartas Older People East Dunbarton 62 Townhead, Kirkintilloch, Glasgow, G66 1NZ, Tel: 0141 775 0433 E.mail: info@ceartas.org.uk Advocacy Matters Mental Health Advocacy Matters (Greater Glasgow Ltd) 5 th Floor, Merchants House, 30 George Square, Glasgow, G2 1EG, Tel: 0141 572 2850 Drumchapel Advocacy Project Unit 28, 42 Dalsetter Avenue, Drumchapel, Glasgow, G15 8TE Tel: 0141 944 0507 7
Ethnic Minority Advocacy Service 40 Wellington Street, Glasgow, G2 6HJ, Tel: 0141 427 7388 E.mail: emec40@aol.com Partners in Advocacy Netherton House, Anniesland Village Business Park, Netherton Road, Glasgow G13 1EU Tel: 0141 959 2525 E.mail: glasgow@partnershipadvocacy.org. ukwebsite: www.partnershipsinadvocacy.org.uk Independent Advocacy Services in Clyde ACUMEN (Argyll and Clyde United in Mental Health) Room 2016, Mile End Mill, 12 Seedhill Road, Paisley PA1 1JS Tel: 0141 887 9103 CARD Advocacy Renfrewshire Carers Centre Carers Centre, 16 Silk Street, Paisley PA1 1AG Tel: 0141 887 3643 E.mail: centre@card.carers.net 8
You First Advocacy Mental Health 47 Causewayside Street, Paisley, PA1 1YN, Tel: 0141 849 1229 Inverclyde Advocacy Service 21 Grey Place, Greenock, PA15 1YF, Tel: 01475 730797 Lomond and Argyll Advocacy Service 155 Glasgow Road, Dumbarton, G82 1RH, Tel: 01505 382632 E.mail: map@map126.freeserve.co.uk Scottish Public Services Ombudsman The Scottish Public Services Ombudsman can be contacted at: SPSO, Freepost EH641, Edinburgh EH3 OBR Tel: 0800 377 7330 Text: 0790 049 4372 Fax: 0800 377 7331 Email: ask@spso.org.uk www.spso.org.uk/contact/index.php 9
Further information on NHS Continuing Healthcare is available from the Scottish Government, please contact: The Scottish Government Partnerships Improvements & Outcomes Division www.scotland.gov.uk/about/haveyoursay or Scottish Health Department http://www.sehd.scot.nhs.uk/mels/cel2008_06.pdf. 10
Further copies of these leaflets are available from: perl@ggc.scot.nhs.uk NHS Continuing Healthcare: Some Basic Information NHS Continuing Healthcare: Eligibility and Appeals Procedure Email perl@ggc.scot.nhs.uk to ask for this information in another language or format. Produced by NHSGGC March 2010 Designed & Produced by Medical Illustration Services Tel.: 0141 211 4692 219649