As a result of the PCT review process assessment, it is very clear that Suffolk NHS set the bar extremely high for CHC health care funding. It would seem therefore from the Eligibility Criteria documentation that one has to demonstrate some combination of the following:-
•  requiring intervention for a psychiatric disorder
•  have intensive and frequent treatment for complex needs
•  demonstrate violent behaviour
•  demonstrate gross sexual behaviour
•  have an unpredictable medical condition
•  be prone to self harm
•  demonstrate anti-social behaviour
•  demonstrate inappropriate urination/defecation
So the obvious question is whether Pamela Coughlan's condition would have qualified for CHC funding when based on the above criteria. Answer is no it would not. Obvious conclusion therefore is that the Suffolk

eligibility criteria applied relevant to 2002 are not Coughlan compliant and therefore illegal. Presumably therefore, the above is basically what Suffolk NHS would define as 'nursing care'. This is somewhat of a paradox considering the number of times I asked the question of Suffolk Social Care services and got absolutely nowhere.

The Independant Review Panel, Norfolk, Suffolk and Cambridegshire SHA

Being quite dissatisfied with the Suffolk NHS Panel ruling, I sought to appeal the decision and subsequently an 'Independent' Review Panel was convened in August 2013 to consider the decision made by Suffolk PCT. Prior to this review I was sent a complete documentation package this time of my mother's care records which enabled me to obtain a more thorough understanding of her situation. The Review Panel procedural advice notes now gave me the opportunity to apply the National Framework assessment guidance in respect of my mother's care, which I had a far better insight into this time around. However, the advice notes revealed that the IRP procedure would be heavily constrained to the SHA CHC funding criteria as they were applied, NOT as to whether they were legal. I submitted documents in support of my case which I wanted the panel to consider. This documentation addresses the procedure followed by the NHS Suffolk Retrospective Continuing Care Panel on, and prior to, the 30th.May meeting. There are some questions about errors in their report, their decision making process and their non-transparency of their evaluation criteria. Additionally I questioned whether a) the evaluation procedure was aligned to the Couglan case in any way and b) was there any application of the National Framework and DOH Decision Support Tool? From the full documentation package sent me I was able to complete a DOH Decision Support Tool based on daily records etc. Unfortunately, as you might expect, the IRP Chairman shut me down twice when I started to talk about Coughlan. The decision of the IRP Panel was that my mother did not meet the Norfolk, Suffolk and Cambridgeshire SHA Adults with Physical and/or Sensory Disability criteria for CHC funding. The Panel Chair confirmed that the Norfolk, Suffolk and Cambridgeshire SHA criteria were used to consider the case as these were the criteria in place during this period, so in reality the fact that the PCT criteria were not Couglan compliant made no difference The Panel Chair explained that in 2003 all Strategic Health Authorities were requested to confirm to the Health Service Ombudsman that their criteria were Coughlan compliant (DID THEY?) and the Independent Review Panel worked on the basis that they were. The guidance they produced in 2003 did not even mention Coughlan! The National Framework had not come into force until 1 October 2007 and could not be applied to cases prior to this. The Panel Chair explained, however, that the Independent Review Panel would not only look at the Norfolk, Suffolk and Cambridgeshire SHA criteria but would also use the Decision Support Tool (DST) in the National Framework to ensure that all my mother's needs had been fully considered. This was in fact quite a thorough review, although I didn't agree with the findings. Their comparison of assessment domains and use of the DST is available HERE. It is very difficult to understand the simple tick box yes/no scenario of the SHA criteria but al least the National Framework DST gives a chance of a 'fairer' assessment by looking at the level of need, even though Coughlan wouldn't have passed this either. In considering my analysis of my mother's needs in the DST domains, the IRP essentially agreed with my findings except for two areas. I considered my mother's impaired mobility was severe, the IRP considered it high. I considered my mother's continence problems were high, the IRP considered them moderate. Even so, given the fact that the whole thing is subjective anyway, my mother scored one severe rating, two would would have been a clear recommendation for CHC funding. The panel could have exercised some discretion but they chose not to do that. As a final remark, I found the whole process of putting crosses in boxes to assess a clear and obvious illness as very demeaning and it is understandable why some relatives chose not to do that.
review data use panel justice? which way the law?