Fast Track Tool Success Story

In February 2018, a Fast Track Tool was completed by a CHC Nurse Coordinator, which found Mrs X (to protect her identity) was eligible for Fast Track funding. This decision was reached following discussion with the GP and staff at the Nursing Home. The Nursing Home records indicated a rapid decline in her condition and identified ‘end of life’. The GP’s prognosis was less than 6 weeks, as Mrs X was suffering advanced dementia and was not taking diet and fluids.

For reasons which are unclear, rather than reviewing Mrs X after 3 months – which is usual following an award of Fast Track Funding – the CCG reviewed her healthcare needs within a shorter period of only 6 weeks (in March 2018), without involving the family in the review. A clear abuse of process. Mrs X’s niece received a telephone call from the CCG’s Assessor to advise that she was at the nursing home, had reviewed Mrs X and had assessed her aunt as no longer qualifying for CHC funding – despite poor prognostic indicators, no significant change in Mrs X’s condition or life expectancy, or indeed any justification for this further assessment!

After raising concern about the assessment, the Assessor subsequently confirmed that CHC funding would be reinstated and a further assessment would take place in two weeks’ time (still within the usual 3 month period under the National Framework).

In April 2018, Mrs X was formally assessed at a Multi-Disciplinary Team Meeting (MDT) and following consideration of the evidence, the CCG’s representative and the Local Authority representative disagreed on the appropriate level of need in the ’Behaviour’ domain of the Decision Support Tool, and moreover, her overall eligibility for CHC funding . The CCG’s representative concluded that Mrs X was no longer eligible for funding, but the Local Authority Social Worker disagreed, and felt that she was eligible and said so, both at the MDT and when the matter then came back before the CCG’s Panel for ratification of the MDT’s recommendation for funding.

However, CCG ultimately unilaterally decided that Mrs X was not eligible for CHC funding. When Farley Dwek called upon the CCG to provide frank disclosure, the documents gave insufficient reasoning why, or how, the ratification Panel had reached this outcome. There was a complete lack of transparency as to what was evidence had been considered, what the arguments were between the CCG’s two appointed representatives attending both the MDT and CCG’s ratification Panel, and what was the rationale for refusing Mrs X’s CHC funding.

Farley Dwek Solicitors were instructed to lodge to an appeal to the CCG’s Local Resolution Panel and were successful in recovering nearly £60,000 for Mrs X in wrongly paid care fees during the period her CHC funding was incorrectly withdrawn by the CCG.