Summoned to the ward managers’ meeting to discuss continuing care applications again. This time one of our London PCTs has rejected a form as the wrong one, and when it faxed the right one it was the same form but with their logo on it.

Another wheeze, which the Greater London continuing care leads have apparently signed up to, is that only people being sent home to die within the next 48 hours should be allowed an assessment on the fast track form (in Greater London 7 pages, national 1 page; as opposed to the full glory of the 27 pages of the usual Greater London ‘delay by assessment’ form). This is a serious diminution of the quality of care for palliative care patients. The law has not changed, but under the previous system, virtually all palliative care patients (ie people who are dying) received the predecessor to fast track. It is also directly contrary to the National Framework document, which says:

45. Occasionally, individuals with a rapidly deteriorating condition, which may be entering a terminal phase, will require “fast-tracking” for immediate provision of NHS Continuing Healthcare because they need an urgent package of care. In this case, the “Fast Track Pathway” tool may be used by a senior clinician such as a ward sister, consultant or a GP to outline the reasons for the fast-tracking decision. This may be supported by a prognosis if available, but strict time limits are not relevant for end-of life cases and should not be imposed: it is the responsibility of the assessor to make a decision based on the relevant facts of the case. If possible and appropriate, the initial fast-tracking decision should be followed by a full assessment of need. Careful decision making is essential, to avoid undue distress that might result from a person moving in and out of NHS Continuing Healthcare eligibility within a very short period of time.

Where does this say ‘imminently dying’ or ‘48 hours’? Does it not say no time limits should be applied? Does it not say ‘rapidly deteriorating’ and ‘may be entering a terminal phase’? Fortunately, most of our continuing care people are not following this obnoxious policy. I can only advise relatives to appeal, and if necessary go to the Ombudsman or write to their MP.

The full Framework document:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_076288

To see my previous experiences of continuing care, click the link at the head of the blog.

Pics of the rebuilding at St Christopher’s, now under way, in solidarity with all colleagues working through a difficult time, to make things better in the future:
Revealed