Hello

I am new to this forum and have been reading many of the problems experienced by others in their battle to obtain continuity of healthcare for their family members. I have had that battle too in the past and now fear I will have to embark on another fight to retain my mother's funding. I am hoping that some members might be able to offer me advice regarding a recent demand to review my mother's qualification for CHC funding. I am seriously considering a flat refusal to comply with their demand.

What is written below is rather longer than I had intended and I hope it will not bore you......

Background Information:

My mother (aged 90) lives with me and I carry out most of her care alone, with the help of agency carers twice a day and visits from a district nurse once or twice per week for bowel management. In the past 2 years I have cut the amount of care provided by the agency considerably as it proved impossible to obtain continuity of carers and even more important, experienced carers. I felt my mother was being affected adversely (she has second stage dementia) and in her interests I began acting as the 'double up' at all visits. I have the absolute minimum of outside help necessary and in so doing I have saved the NHS many tens of thousands of pounds over the last few years.

Mum's carers have been funded by the NHS since late 2006 but only 'officially' since her 3rd assessment in late 2007, shortly after the new framework was introduced, when it was finally accepted that her primary need was for healthcare. Two earlier assessments, under the old PCT-defined criteria, were carried out whilst she was hospitalised. Because of my complaints regarding the quality of the assessments (double incontinence described as 'little accidents' by one assessor) she had to remain hospitalised for 10 months longer than necessary.

During this process there were threats to remove Mum to a nursing home against her wishes, accusations of 'bed blocking' and attempts to shame me into acquiescing. Although I had offered to have Mum home if they would fund carers (I could not longer manage her alone as I had previously) they tried to get me to agree to reimburse all care costs if, in the future, the SHA upheld their original decision to reject funding. All of this only stopped when I contacted the Health Commission for their assistance. I was told much of the information being supplied to relatives was incorrect or insufficient and following their intervention Mum came home with funding for a year prior to her next assessment in 2007 under the new guidelines.

Since that assessment I had heard nothing more from the PCT until about 12 months ago, when I received a 'phone call from a nurse assessor wanting to make an appointment for a review. I didn't initially understand what she intended as it was not explained this would include another full assessment – I thought they meant a review of the care arrangements with the agency!

Due to the problems I had experienced previously and the problems subsequently encountered by a friend I had helped with funding for her mother, I requested that they write and explain exactly what they intended to do, what documents would be involved, who would be invited to contribute to the assessment and who would be visiting. I also asked if my mother's GP would be invited to attend but was told they did not invite the GP, which I found surprising as he is the person most closely involved in my mother's healthcare – apart from me.

I heard nothing more until one morning when a district nurse and representative from the care agency (who had only ever seen my mother once before) arrived at my home and told me an assessment had been booked for that day! It was a complete farce as the letter sent by CHC advising me of the assessment had only been written 2 days previously, posted the day before and was delivered by the postman as everyone was arriving.

I never did see the assessors from CHC as they got lost on the way and refused to come to my home after I had spoken to them on their mobile and told them I was looking forward to meeting them and hearing their explanation of the situation.

They did not try to reschedule the appointment and on speaking to the District Nurse, she told me that the review does not always entail a visit and that they are sometimes contacted by telephone to check the situation of a CHC recipient. I also subsequently learned that the assessor had actually invited Mum's GP to the assessment, with only 3 days notice (but at least he got more than me!) Unsurprisingly he was unable to attend but did write to them confirming that my mother's condition was no better, she appeared frailer, there had been no sudden deterioration but that she was now no longer able to sit out in a wheelchair each day. He confirmed his opinion that her primary need was for healthcare.

With hindsight, I suspect the failure to provide any advance information and the late (too late) notification to me was deliberate, so I would have no time to prepare for Mum's re-assessment. The letter contained no information other than the names of those attending.

Present Problem:

Last week an administrator from the local CHC team telephoned again stating they wanted to 'review my mother's care needs.' Again, there would have been no further information provided if I had not questioned exactly what that meant. I declined their request to set a date during the call and told them I wanted to speak to someone before doing that. My intention was to contact my sister, who is a nurse, and establish her off duty for next month before agreeing to any dates. I want her here as a witness if I again have to submit Mum to this farcical process.

The following day I received a letter sent recorded delivery from a CHC team leader asking me to choose one of 2 dates in January (the first being the second working day in January) for a 'review assessment' of my mother and informing me that I must agree one of those dates by 21st December. I was then informed this is a mandatory requirement for PCT's under the Continuing Healthcare National Framework and I should be advised that 'any refusal of the assessment will result in funding ceasing from NHS XXXXXXX with immediate effect'.

Whilst writing this I have just been telephoned again (20th December) by the young administrator. She asked if I had decided a date and I said I hadn't decided anything yet and asked what date it was today? She then said that they were just trying to get everything organised before Xmas. I repeated that I hadn't decided anything to which she replied 'you do know the consequences don't you', to which I replied 'I know what you've told me'.

My questions:

Does a PCT review really have to include a full assessment by the MDT at least annually?

What, if any, information should the PCT collect before this assessment and can I demand a copy of this information in advance? In this area at least they do not appear to gather any 'evidence' prior to the MDT meeting and I have never yet seen a proper risk assessment.

Can they refuse to continue to pay for my mother's care if I decide not to subject her to what will be a cursory assessment by people who have never seen my mother before. I will have to remove her covers and describe in detail her physical condition. Given that her condition is chronic and will never improve it seems unfair on her (and me) to submit us to this each year.

Does any one else think that the letter and telephone call I have received is bordering on an attempt to bully me into complying? I have experienced this before with this PCT as described abovem - or am I being over sensitive?

Past Form of the CHC Department of this PCT:

I have no faith whatsoever that my mother will receive a rigorous and fair assessment because during the past 2 years I have been involved in trying to help two local families who had elderly relatives in need of continuing healthcare. In neither case was it evident that the CHC department understood the fundamentals of the framework – or perhaps they just ignored them.

This is a brief overview of their experience, which frankly beggars belief:

In 2009/10 the funding for a lady suffering in the final stages of severe Alzheimer's was withdrawn by this PCT at the first 'review':

-the daughter was given no prior information that a full assessment would be made or guidelines on what the 'review' would cover
-only one assessor, a mental health nurse, carried out the 'review', the lady was asleep for the whole assessment, which was simplistic in the extreme
-the mental health nurse concluded the lady was now 'very compliant to care, unlike when she first started on the funding' and 'the lady's behaviour has lessened enormously'
-a copy of the completed Decision Support Tool was sent to the daughter by e-mail only the evening before the Panel meeting
-the Panel found that her mother's needs were no longer complex, intense or unpredictable
-a review of the process that had been followed was supposedly ratified by a neighbouring PCT peer review
-written complaints that proper procedures had not been followed were simply ignored.

The lady was so poorly that she had to be hospitalised shortly after the assessment and she died before the end of the month. This at the same time that the PCT was informing the family that they would be withdrawing her funding at the end of that month.

The advisor on the Alzheimer's help line who provided us with outstanding help and advice in our efforts to reverse the decision wrote to me after her death: 'Sadly, I have found that a lot of PCTs demonstrate  the lack of professionalism you have encountered' 

In 2010/11 a man with Alzheimer's, hospitalised in the local community hospital run by the PCT was twice refused a full assessment for CHC funding and attempts were made to discharge him:

-the family were not invited to participate in a Check list for possible CHC funding, or informed it had taken place
-the initial check-list 'scores' recorded 4 As and 3 Bs – well above the threshold for automatic qualification for a full assessment - but the CHC department wrote saying he would not meet the criteria for CHC funding.
-attempts were made to discharge the gentleman to his family having organised 2 carers visiting 4 times per day for an hour at each visit and daily visits from the District Nurses. The family were told they had to fund this care.
-the family refused the discharge and complained to the Chief Executive of the PCT
-instead of carrying out a full assessment a second Check list was requested from the hospital (completed by a different member of the nursing staff) and this time the needs were more severe, 4 As and 4Bs.
-the CHC department again informed the community hospital staff that the gentleman had been 'screened out' by both the physical disability and mental healthcare teams and a full assessment was again refused.
-a second letter of complaint was sent to the Chief Executive of the PCT

The gentleman died in the community hospital before a reply had been received.

I have recently had a long conversation with a senior manager at the Spinal Injuries Association. He has submitted requests to many of the PCTs in this area under the freedom of information act in an attempt to determine how many people with spinal injuries are having their funding withdrawn. Most appear to have declined, citing the length of time it would take to correlate the information. He informs me that disabled people with spinal injuries are experiencing difficulty retaining their funding, as are those with MS and Alzheimer's. Apparently these organisations are engaging in dialogue with the Department of Health on this issue.

What shall I do? I am very inclined to refuse point blank to submit my mother to any further assessment by these idiots. I would be very interested to hear your views on the option's open to me.

Thank you for taking the time to read all this.

H

HS wrote:Hello

I am new to this forum and have been reading many of the problems experienced by others in their battle to obtain continuity of healthcare for their family members. I have had that battle too in the past and now fear I will have to embark on another fight to retain my mother's funding. I am hoping that some members might be able to offer me advice regarding a recent demand to review my mother's qualification for CHC funding. I am seriously considering a flat refusal to comply with their demand.

What is written below is rather longer than I had intended and I hope it will not bore you......

Background Information:

My mother (aged 90) lives with me and I carry out most of her care alone, with the help of agency carers twice a day and visits from a district nurse once or twice per week for bowel management. In the past 2 years I have cut the amount of care provided by the agency considerably as it proved impossible to obtain continuity of carers and even more important, experienced carers. I felt my mother was being affected adversely (she has second stage dementia) and in her interests I began acting as the 'double up' at all visits. I have the absolute minimum of outside help necessary and in so doing I have saved the NHS many tens of thousands of pounds over the last few years.

Mum's carers have been funded by the NHS since late 2006 but only 'officially' since her 3rd assessment in late 2007, shortly after the new framework was introduced, when it was finally accepted that her primary need was for healthcare. Two earlier assessments, under the old PCT-defined criteria, were carried out whilst she was hospitalised. Because of my complaints regarding the quality of the assessments (double incontinence described as 'little accidents' by one assessor) she had to remain hospitalised for 10 months longer than necessary.

During this process there were threats to remove Mum to a nursing home against her wishes, accusations of 'bed blocking' and attempts to shame me into acquiescing. Although I had offered to have Mum home if they would fund carers (I could not longer manage her alone as I had previously) they tried to get me to agree to reimburse all care costs if, in the future, the SHA upheld their original decision to reject funding. All of this only stopped when I contacted the Health Commission for their assistance. I was told much of the information being supplied to relatives was incorrect or insufficient and following their intervention Mum came home with funding for a year prior to her next assessment in 2007 under the new guidelines.

Since that assessment I had heard nothing more from the PCT until about 12 months ago, when I received a 'phone call from a nurse assessor wanting to make an appointment for a review. I didn't initially understand what she intended as it was not explained this would include another full assessment – I thought they meant a review of the care arrangements with the agency!

Due to the problems I had experienced previously and the problems subsequently encountered by a friend I had helped with funding for her mother, I requested that they write and explain exactly what they intended to do, what documents would be involved, who would be invited to contribute to the assessment and who would be visiting. I also asked if my mother's GP would be invited to attend but was told they did not invite the GP, which I found surprising as he is the person most closely involved in my mother's healthcare – apart from me.

I heard nothing more until one morning when a district nurse and representative from the care agency (who had only ever seen my mother once before) arrived at my home and told me an assessment had been booked for that day! It was a complete farce as the letter sent by CHC advising me of the assessment had only been written 2 days previously, posted the day before and was delivered by the postman as everyone was arriving.

I never did see the assessors from CHC as they got lost on the way and refused to come to my home after I had spoken to them on their mobile and told them I was looking forward to meeting them and hearing their explanation of the situation.

They did not try to reschedule the appointment and on speaking to the District Nurse, she told me that the review does not always entail a visit and that they are sometimes contacted by telephone to check the situation of a CHC recipient. I also subsequently learned that the assessor had actually invited Mum's GP to the assessment, with only 3 days notice (but at least he got more than me!) Unsurprisingly he was unable to attend but did write to them confirming that my mother's condition was no better, she appeared frailer, there had been no sudden deterioration but that she was now no longer able to sit out in a wheelchair each day. He confirmed his opinion that her primary need was for healthcare.

With hindsight, I suspect the failure to provide any advance information and the late (too late) notification to me was deliberate, so I would have no time to prepare for Mum's re-assessment. The letter contained no information other than the names of those attending.

Present Problem:

Last week an administrator from the local CHC team telephoned again stating they wanted to 'review my mother's care needs.' Again, there would have been no further information provided if I had not questioned exactly what that meant. I declined their request to set a date during the call and told them I wanted to speak to someone before doing that. My intention was to contact my sister, who is a nurse, and establish her off duty for next month before agreeing to any dates. I want her here as a witness if I again have to submit Mum to this farcical process.

The following day I received a letter sent recorded delivery from a CHC team leader asking me to choose one of 2 dates in January (the first being the second working day in January) for a 'review assessment' of my mother and informing me that I must agree one of those dates by 21st December. I was then informed this is a mandatory requirement for PCT's under the Continuing Healthcare National Framework and I should be advised that 'any refusal of the assessment will result in funding ceasing from NHS XXXXXXX with immediate effect'.

Whilst writing this I have just been telephoned again (20th December) by the young administrator. She asked if I had decided a date and I said I hadn't decided anything yet and asked what date it was today? She then said that they were just trying to get everything organised before Xmas. I repeated that I hadn't decided anything to which she replied 'you do know the consequences don't you', to which I replied 'I know what you've told me'.

My questions:

Does a PCT review really have to include a full assessment by the MDT at least annually?

What, if any, information should the PCT collect before this assessment and can I demand a copy of this information in advance? In this area at least they do not appear to gather any 'evidence' prior to the MDT meeting and I have never yet seen a proper risk assessment.

Can they refuse to continue to pay for my mother's care if I decide not to subject her to what will be a cursory assessment by people who have never seen my mother before. I will have to remove her covers and describe in detail her physical condition. Given that her condition is chronic and will never improve it seems unfair on her (and me) to submit us to this each year.

Does any one else think that the letter and telephone call I have received is bordering on an attempt to bully me into complying? I have experienced this before with this PCT as described abovem - or am I being over sensitive?

Past Form of the CHC Department of this PCT:

I have no faith whatsoever that my mother will receive a rigorous and fair assessment because during the past 2 years I have been involved in trying to help two local families who had elderly relatives in need of continuing healthcare. In neither case was it evident that the CHC department understood the fundamentals of the framework – or perhaps they just ignored them.

This is a brief overview of their experience, which frankly beggars belief:

In 2009/10 the funding for a lady suffering in the final stages of severe Alzheimer's was withdrawn by this PCT at the first 'review':

-the daughter was given no prior information that a full assessment would be made or guidelines on what the 'review' would cover
-only one assessor, a mental health nurse, carried out the 'review', the lady was asleep for the whole assessment, which was simplistic in the extreme
-the mental health nurse concluded the lady was now 'very compliant to care, unlike when she first started on the funding' and 'the lady's behaviour has lessened enormously'
-a copy of the completed Decision Support Tool was sent to the daughter by e-mail only the evening before the Panel meeting
-the Panel found that her mother's needs were no longer complex, intense or unpredictable
-a review of the process that had been followed was supposedly ratified by a neighbouring PCT peer review
-written complaints that proper procedures had not been followed were simply ignored.

The lady was so poorly that she had to be hospitalised shortly after the assessment and she died before the end of the month. This at the same time that the PCT was informing the family that they would be withdrawing her funding at the end of that month.

The advisor on the Alzheimer's help line who provided us with outstanding help and advice in our efforts to reverse the decision wrote to me after her death: 'Sadly, I have found that a lot of PCTs demonstrate  the lack of professionalism you have encountered' 

In 2010/11 a man with Alzheimer's, hospitalised in the local community hospital run by the PCT was twice refused a full assessment for CHC funding and attempts were made to discharge him:

-the family were not invited to participate in a Check list for possible CHC funding, or informed it had taken place
-the initial check-list 'scores' recorded 4 As and 3 Bs – well above the threshold for automatic qualification for a full assessment - but the CHC department wrote saying he would not meet the criteria for CHC funding.
-attempts were made to discharge the gentleman to his family having organised 2 carers visiting 4 times per day for an hour at each visit and daily visits from the District Nurses. The family were told they had to fund this care.
-the family refused the discharge and complained to the Chief Executive of the PCT
-instead of carrying out a full assessment a second Check list was requested from the hospital (completed by a different member of the nursing staff) and this time the needs were more severe, 4 As and 4Bs.
-the CHC department again informed the community hospital staff that the gentleman had been 'screened out' by both the physical disability and mental healthcare teams and a full assessment was again refused.
-a second letter of complaint was sent to the Chief Executive of the PCT

The gentleman died in the community hospital before a reply had been received.

I have recently had a long conversation with a senior manager at the Spinal Injuries Association. He has submitted requests to many of the PCTs in this area under the freedom of information act in an attempt to determine how many people with spinal injuries are having their funding withdrawn. Most appear to have declined, citing the length of time it would take to correlate the information. He informs me that disabled people with spinal injuries are experiencing difficulty retaining their funding, as are those with MS and Alzheimer's. Apparently these organisations are engaging in dialogue with the Department of Health on this issue.

What shall I do? I am very inclined to refuse point blank to submit my mother to any further assessment by these idiots. I would be very interested to hear your views on the option's open to me.

Thank you for taking the time to read all this.

H

Before anything else, take a look at thread "Just got home from the DST meeting! " by jonsmum, and read Esquires reply, and also look at the Stickies to see if there is information there which fits or helps your problems.

If there is nothing, or some of it only partially answers some of your questions then come back and post again. It may be a short haul, or a long haul, but solutions do exist - nearly everyone here has been where you are, so welcome to the club, and I really wish i didn't have to say that.

Hello HS.

I am sorry but you cant refuse to have an assessment done, it is a very standard process nowadays.

Everyone is supposed to have one assessment every year and with someone who has just won CHC for the first time it is usual for them to do a re-assessment with 3 months.

It doesnt however, always mean that they are going to take CHC away.

I am not aware that a PCT can withdraw funding because of a refusel for assessment. I dont think it would come to that because they would just go on and do an assessment without your agreement.

I could be wrong but I think once CHC funding has been given there cant be a withdrawal of funding because of dispute.

It is unacceptable to not let people know well in advance of a meeting. In those circumstances I would think you have a right to refuse to accept a meeting until you have prepared for it.

I would consider the telephone call and letter an attempt to bully or put pressure on to you.

Kind regards Ian

Hello HS from me too, and welcome to our sometimes happy forum.

It's the norm for reviews of CHC to take place, 3 months after first CHC agreement, then on an annual basis thereafter. Or more often, if the needs and the circumstances change. There's no defined timescale for reviews to take place - and relatives can also ask for reviews, if things change.

So the fact that your Mum hasn't been reviewed for years is possibly due to the quality of care that you are providing voluntarily, to her acknowledged-by-the-PCT health needs, to the fact that the PCT is comfortable with the 2 x daily carer visits, or perhaps due to inefficiency in their system. They're only human after all. So you may be worrying without need to worry.

You can't reallly refuse a review - all you could do is to refuse to take part yourself. Because the review will take place with or without your permission. In the best interests of your Mum, as they say. If you refused to let anyone enter the house to meet your Mum and to assess her, you may be faced with even more problems and questions.

I don't know if you have LPA for health and welfare, but if you do, and if you refuse for you or your Mum to have anything to do with CHC reviews/assessments/etc, then - as you are acting on behalf of your mother, and supposed to be acting in her best interests - it is possible that the PCT could just about consider that you wish to have nothing further to do with CHC.

If your Mum lives with you, and if you don't want the review to distress her, you could ask for the review to take place elsewhere, with you in attendance, and with carers looking after your Mum in your absence. There may still be a need for a brief visit to meet with your Mum, just to make sure that her living conditions are ok and not restricting her in any way, but the rest of the review can take place elsewhere, with your input and with input from your sister and your Mum's GP and so on. If you ask for that to happen.

The timescale you've been given is perhaps unacceptable, so if you're unhappy with the timescale, you should put that in writing and send it by recorded delivery asking for a more acceptable timescale, when your sister can also be present. Ask for a month's notice - or whatever suits your and your sister's circumstances - of all future requirements.

The cost to the PCT of providing 2 x daily carer visits is minimal. (Visiting District Nurses is fairly standard for anyone living at home with a need for DN visits. The basics of the NHS, if you like!!!) The PCT is unlikely to remove those funded visits, unless there is some extremely good reason. They may wish to increase the support that your Mum is entitled to, in order to take away some of your own need to provide care and to give you a break.

Put everything in writing, and ask for everything to be confirmed in writing. Pronto.

VM

Thank you for your replies. I am going to forget them over Christmas and complain about the tone and threats contained in the letter sent to me next week.

I cannot find any detailed definition of what is meant by 'review' in the recent framework. Does anyone know if such exists? For me, review and full assessment are not the same yet when they sent only one 'professional' to check the elderly lady I referred to in my original post it seemed that they were able (or thought they were) to decide her situation had improved and attempt to remove funding.

If I agreed with the process - which I don't - I could understand that they might carry out a less formal 'case review' and if the findings warranted it then engage in a full re-assessment. I do not understand why it is necessary for someone of my mother's age, whose condition is chronic and will never improve, to be subjected to full re-assessment when she is visited once or twice per week by professionals who are directly employed by the NHS.

Does anyone know if any document exists, that I have missed, that defines the periodic review process in more detail?

Hello HS

As far as I am aware it will be a full CHC assessment ie; MDT/DST. All the rules relating to that will apply to this re-assessment. I am not aware of any separate document with guidance for this.

It is just the same if you are dealing with SS and benefits, you will be further assessed every year automatically, or if your circumstances change. It doesnt matter if you are visited by NHS professionals every week they still need to do a re-assessment of your case.

Be aware of the situation but dont assume that the outcome will be negative.

The advice that VM gave you was very good and I would just add to it over the POA/LPOA ETC issue; if you hold one of these and say you refused entry to a health care professional over this assessment. Then they could ask the Court of Protection to end your POA etc, because by refusing entry you are not acting in the best interests of the person. This very situation is one reason for them doing so. So dont go down that road.

Keep positive. Just one thing I would add though, if say the re-assessment went against you and they had not consulted with your GP or other health care professionals involved in the care. Then you can appeal against their decision on that very fact and I would think stand a very good chance of turning it around.

Very kind regards Ian.

Hi Ian

This is not the same as a SS review - not that I've ever had one - they are looking at monetised criteria and the reviews that people whose primary need is for healthcare are submitted too is far from that.

I do not share your faith in the assessment system for the reasons I have clearly outlined in my original post.

If you have already read all the information relevant to your question (in the 'Links to Useful Information' sticky), your best bet is to send an email to the DoH with your specific questions. Mark it urgent and see how you go. They will be able to point you towards the specifics you're concerned about.

Meanwhile, this may help:

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_115477.pdf

A review of a care package has to involve an assessment. No two people are the same, so no two assessments will ever be the same. What happened to one person, may not happen to another person. So the only people who can give you chapter and verse on what the DoH says should form part of a 'review' etc are the people at the DoH.

VM

Hello HS

I think you misunderstood the point I was making is about the process of yearly reviews of both CHC and SS Benefit reviews and not the content of them. No matter what department you deal with your case will always be reviewed every year.

You should have had a review every year since 2007. I know of a number of people who have been refused CHC funded care at home and in one instance where a lady was told that CHC wasnt possible for someone at home. More usually you will find that it is the social services/local authorities who will fund care at home rather than the NHS. That was certainly the position with my Mother. But she did not suffer from Dementia.

But a lady in Morecamb whose mother did have dementia ( first stage ) was refused CHC at home on the grounds that it wasnt possible. Which was incorrect has shown by the Pointon case.


I think you need to understand that the biggest problem with CHC assessment is the assessors themselves rather than the guidance they work to ( or are supposed to work to ).

Yes the National Framework criteria is over-restrictive but never lose sight of the fact that people are successfull sometimes outright in MDT/DST assessments, or upon challenge.
You could have a look at a topic in the Debating Chamber, one of mine regarding extracts from an actual submission by a solicitor ( Hugh James ), in a case I am involved with.
Which outlines the best way of attack is against their own criteria and interpretation.

To hopefully put your mind at ease do what VM has suggested and contact the DOH directly.

Very kind regards Ian

Hi Ian

Thank you for your reply. I do understand the system and I quite agree that the problem is often with the assessors.

They are not however the only problem as in this area they do not follow the DofH guidelines (as I described, only 1 professional at a review that resulted in the PCT removing fuding and the attempt to refuse an assessment and discharge the elderly gentleman despite 2 Check Lists indicating an assessment must be carried out).

In this area at least it is all still a problem despite the new instructions and guidelines to PCTs. I am concerned about the lack of information still be provided to relatives - including me. I am just trying to find out if I have missed something as when I make a complaint I like to include the directions issued by the DofH but in the case or 'reviews' I can find none.

Anyway things have now moved on with another registered letter today. Have to deal with Mum now but will try to post the latest development later.

The next letter they sent was addressed to me but did not say Dear Anyone at the top just a title as follows:

Multi disciplinary Team CHC Review of xxxxxxxx (Mum)

Further to our letter dated xxxxx, we write to inform you that a review has been arranged as detailed below for xxxxxxx (Mum). I have enclosed a personal statement for you to complete and return regarding your mothers care needs so that your opinions can be taken into account at the meeting.

Date
Time
Location (15 miles from my home)

We have invited the following agencies to attend the review, SS Care Manager, D Nurse and XXXX (agency providing recent v poor service to assist me) along with 2 of our assessors.