How Clare English, Community Care Chartered Legal Executive, helped a Professional Deputy meet the Office of the Public Guardian Standards by advising on prospects of success at a NHS Continuing Healthcare appeal.
Jeremy is Thomas’s Professional Deputy. Thomas suffers from advanced Alzheimer’s and lives in Elm House, an Elderly Mentally Infirm (EMI) nursing home.
Thomas had previously been detained in psychiatric hospital under the Mental Health Act 1983. His challenging behaviour continued when he moved to Elm House.
He has received NHS Continuing Healthcare (CHC) funding since 2009. In 2018, the NHS Clinical Commissioning Group (CCG) reviewed Thomas’s eligibility for NHS CHC funding. Using the Decision Support Tool (DST), the Nurse Assessor recommended that Thomas was no longer eligible for fully-funded care.
Jeremy asked Martin Searle Solicitors to advise if he should appeal against this or pay Thomas’s care fees from Thomas’s income and savings.
Clare asked for a copy of the DST assessment and Thomas’s care records from Elm House.
She compared the description of Thomas’s care needs in the DST with the care notes from Elm House and Thomas’s medical records, to establish whether the DST provided an accurate account of his current care needs.
She advised Jeremy that the DST assessment was accurate and that Thomas no longer met the eligibility criteria for NHS CHC funding.
However, she also found that Elm House’s records were not detailed enough and didn’t document incidents when Thomas was not compliant and Clare provided advice about the standard of record keeping needed, to improve Thomas’s prospects of being found eligible at future reassessments.
Jeremy didn’t appeal against the withdrawal of Thomas’s NHS CHC funding because he was confident that in taking specialist advice, he had satisfied the OPG Standards and could justify his decision not to appeal.
Jeremy talked to Elm House about improving Thomas’s daily care notes so evidence of changes in his needs would be available for future assessments.
Jeremy also asked Clare to request Thomas’s mental health records so that she could advise on eligibility for other funding.
Clare established that Thomas may have the right to free after-care funding under section 117 Mental Health Act and Jeremy has now asked Clare to investigate this alternative.
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