Council took too long to assess and to review changed needs.
Additionally it did not fund a care home placement whilst CHC
decisions were being made and financial assessments being completed.
CCG’s related fault was with completing CHC checklists and a
Decision Support Tool whilst delaying the reimbursement of care home
T’s Huntington’s disease caused him to deteriorate over time.
sister (Miss Q) contacted Essex County Council in August 2016
requesting support for her brother. Information about meals and aids
was provided as well as referring him to the equipment service.
However an assessment for equipment was declined by Mr T.
February 2017 a social worker visited and assessed Mr T’s needs and
referred Mr T for a CHC consideration. The CHC Checklist and consent
forms were completed and received by the CCG resulting in a positive
Checklist test in March 2017.
T attempted suicide twice and his mental health was apparently
declining. A specialist care home was discussed by Miss Q and the
Council for her brother but when one was identified there was a wait
for a vacancy to become available for Mr T. A respite placement was
refused by the Council who instead put in place an interim care
package at home until he was able to move into the care home in June
July 2017 Mr T was assessed as eligible for CHC funding by the CCG.
the care home fees already paid by Mr T to the care home whilst
awaiting the funding decision by Mr T totalling £8750 were delayed
in being reimbursed by the CCG.
August 2017 the Council agreed to fund ‘without prejudice’ the
care home placement whilst the issues with the CCG were resolved. The
CCG were provided with copies of the paperwork they required by Miss
Q on 26th
September 2017 to evidence the payments made to the care home, and
Miss Q accepted the CCG’s offer in writing on 7th
CCG authorised payment on 25th
October and made the payment to Miss Q on 9th
November 2017, by which point Mr T had died. The delays and issued
encountered by Mr T and his family caused them considerable upset, as
has the inconvenience trying to tackle the issues. Additionally the
CCG’s delayed care home fee reimbursement impacted on the family’s
ability to pay Mr T’s funeral costs.
The Council was found to
be at fault because:
of the length of time
taken to assess Mr T and put in place a care package for him;
there were delays in
T once it was apparent that there may be changes in his needs;
did not fund Mr T’s placement whilst CHC processes were being
completed (as to the reasons for which, there is nothing mentioned
in the LGO’s report, as it happens).
The Clinical Commissioning
Group was found to be at fault because:
and ambiguity regarding roles and responsibilities of professionals
involved in the completion of CHC Checklists and the Decision
Support Tool (DST)
reimbursement of care home fees to Mr T.
The Care Act 2014
places a duty on local authorities to carry out an assessment for any
adult who appears to require care and support, regardless of their
financial circumstances or likelihood of eligible needs. The
assessment must be of the adult’s needs and the subsequent impact
of those needs on the person’s wellbeing and the outcomes they wish
According to Essex County
Council’s own Key Performance Indicator ‘adults at risk’ should
be given priority for assessments within 28 days.
In public law terms, and
according to national guidance for the Care Act, the assessment
should be done timeously, which means within an ‘appropriate and
reasonable’ timeframe, considering also the urgency of needs, and
any change in needs.
Council staff are obliged by
regulation 7 of the assessment regulations to refer anyone who
appears to them might be someone who might qualify for NHS CHC to the
local clinical commissioning group.
assessments and funding decisions based on up-to-date assessments of
all the person’s relevant needs (social and personal as well) are
the responsibility of the individual’s local Clinical Commissioning
Group (CCG). However sometimes these responsibilities are delegated
to other NHS organisations to undertake on behalf of the CCG.
Initially a health or social
care professional will undertake a CHC Checklist (a screening tool
exercise indicating whether a person MIGHT qualify for full CHC –
set with a low threshold to be inclusive).
Each CCG and local authority
should have an agreement as to which professionals (within those
allowed by the rules) can complete the Checklist, but those involved
in regularly assessing the individual’s needs (e.g. social workers)
should be able to do this. The revised 2018 Framework for CHC makes
further provision to ensure that checklists are not done needlessly,
although there can be disputes about this and all that a professional
needs to do is disagree that none is needed.
Upon completion of a
‘positive’ CHC Checklist which indicates possible eligibility for
CHC, a full multi-disciplinary
eligibility decision-making process follows, which involves the
completion of a Decision Support Tool (DST) form which maps the
actual needs assessment evidence on a scoring chart, and records a
rationale for the MDT’s recommendation regarding the person’s
for CHC funding.
Useful paragraphs in the
Framework, to which the LGO could have referred, are here:
The DST is not an assessment of needs in itself. Rather, it is a way
of bringing together and applying evidence in a single practical
format, to facilitate consistent, evidence-based assessment regarding
recommendations for NHS Continuing Healthcare eligibility. The
evidence and rationale for the recommendation should be accurately
and fully recorded.
Assessment in this context is essentially the process of gathering
relevant, accurate and up-to-date information about an individual’s
health and social care needs, and applying professional judgement to
decide what this information signifies in relation to those needs.
Both information and judgement are required. Simply gathering
information will not provide the rationale for any eligibility
recommendation; a recommendation that simply provides a judgement
without the necessary information will not provide the evidence for
any subsequent decision. Assessment documentation should be obtained
from any professional involved in the individual’s care and should
be clear, well-recorded, factually accurate, up to date, signed and
The CCG’s designated
decision-maker (often a Panel, but not necessarily so – it can be
decided by any two people with the authority to take this next step)
is supposed to ratify the recommendation in all but exceptional
circumstances. This process should be completed within 28 calendar
days from the date of receipt of the positive CHC Checklist. Any
credibly unavoidable delays in the process should be explained and
confirmed in writing to the individual.
If the CHC Checklist indicates
the person is not even considered possibly to be eligible for CHC
funding, the CCG should, in writing, advise the individual of their
right to ask the CCG to reconsider. Once the CCG have reconsidered
the individual can complain to the CCG as the final right of appeal
if they are not happy with the decision. Most importantly any
disputes between CCGs and local authorities regarding funding
responsibility must not leave individuals without the support they
for Professionals in health and social care public bodies
efficient are your processes for completing healthcare/nursing needs
and Care Act assessments and a person’s right to a DST within a
reasonable time of appearing to be someone who might qualify for
there clear joint arrangements confirming roles and responsibilities
of professionals undertaking CHC checklists in light of the revised
framework in place since October 2018?
you aware of regulation 7 of the Assessment regulations, which
OBLIGE local authority staff to make referrals to the CCG based on
their own independent judgements?
you delaying the funding of Discharge To Assess placements whilst
awaiting CHC assessment processes to be completed? It would still be
the NHS’s function so to do, if the person has already been
positively checklisted. There is no justification for NOT
checklisting a person, just because they are not yet in the next
for Clients / Service Users
you faced delays when awaiting assessments or for care packages to
be put in place?
you been considered as someone who might be eligible for full NHS
continuing health care status and funding?
you experienced ambiguity or delays in CHC eligibility
considerations or funding? Interest is payable on reimbursements!
you been caught in a dispute between two statutory organisations,
neither of whom are willing to pay for care needs whilst they
resolve their dispute?
your CHC package been adequate, in your opinion? If not, HOW
inadequate has it been? CCGs are governed by public law principles
and the package must be rationally sufficient, transparent and
accountably defensibly capable of meeting needs, taking all other
legal principles into account, such as the one that says relatives
cannot be MADE to provide the necessary care!
so, please consider seeking advice from CASCAIDr via our referral
form on the top bar menu of the site.
full Local Government Ombudsman report can be found at