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Funding Reviews
If you are found eligible for Continuing Healthcare funding, your funding will be reviewed. Typically, the CCG will review your funding after an initial 6 months, and then reviews every 12 months or sooner if there has been a change in the funded person’s presentation that affects need.
The review process is designed to look at how the care the CCG has put into place is working. It is not an automatic reassessment although it may lead to a further Decision Support Tool being completed if it is apparent that needs have declined. All too often we have seen these reviews being used as a pretext for removing funding inappropriately. The NHS Continuing Healthcare National Framework Page 52, paragraph 183 states:
‘These reviews should primarily focus on whether the care plan or arrangements remain appropriate to meet the individual’s needs. It is expected that in the majority of cases there will be no need to reassess for eligibility.’
A reassessment (as opposed to a review) should only happen if you or your loved one has had material changes in the funded person’s health needs. The NHS Continuing Healthcare National Framework Page 52, paragraph 185 states:
‘Where reassessment of eligibility for NHS Continuing Healthcare is required, a new DST must be completed by a properly constituted multidisciplinary team (MDT), as set out in this National Framework. Where appropriate, comparison should be made to the information provided in the previous DST. CCGs are reminded that they must (in so far as is reasonably practicable) consult with the local authority before making an NHS Continuing Healthcare eligibility decision, including any re-assessment of eligibility. This duty is normally discharged by the involvement of the local authority in the MDT process, as set out in the Assessment of Eligibility section of this National Framework. CCGs should ensure an individual’s needs continue to be met during this reassessment of eligibility process.’
We emphasise the point as far too often we have come across cases where the NHS unilaterally and in breach of the National Framework withdraws funding following a review as opposed to a review, reassessment with a properly constituted Decision Support Tool panel.