From the Decision Support Tool ... 12.
Even where an individual has not elected for a family member to advocate for them,
the views and knowledge of family members may be taken into account,
where consent has been given to seek these views.

15. If the person lacks the mental capacity to either to refuse or to consent,
a ‘best interests’ decision should be taken (and recorded)
as to whether or not to proceed with assessment of eligibility for NHS continuing healthcare.
Those making this decision should bear in mind the expectation
that all who are potentially eligible for NHS continuing healthcare
should have the opportunity to be considered for eligibility.

... but capacity in schizophrenia is not a cut and dried thing and generally
if they try acting for themselves loses them out when the illness thinking, and the thinking 'shortage'
denies them the awareness of what they 'really' need,
and denies them the ability to manage and cope with the snags on the way.
They give up.

The centre of drive for this interminable Rules, seems to be about old age dementia and
general health. the argument [ was ] between forgetfulness which is normal - Local Authority takes your assets to pay for what they deliver
and Alzheimers - an illness which was a Health budgeting matter.

Case law is that it is 'free' to the recipient, whoever pays ... not quite; still which budget pays is there.

The language of the Rules is impenetrable, and, as usual mitigate
against continuing schizophrenia being able to get 'it's' head round it,
to obtain healthcare led occupational and supported housing in aftercare .

The other 'get out' is that the Care programme Approach is pointed to as the guidance for supplying CHC like aftercare.

The two stools process:-

A.
section 17 aftercare ( where either Health or Local Authority may take the lead in provision )

and B.
Continuing Health Care [ CHC ] which is that aftercare provision should be a Health lead matter

... " Given the new guidance regarding not using continuing care assessments
as a means to determine health and local authority funding split,
I wondered if anyone in the group knew any tried and tested tools for deciding the split?"

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The perplexity in these Rules makes it even more important that carers intervene at the Needs Assessment of the Care Programme Approach , and use their intervention to have put into the Care Plan what comes out of that ssessment , that there is the Need for Health to lead on aftercare - the illness does continue, hidden from awareness by 'lay' eyes.
Health professionals are not so blinkered, or should not be so. To deliver an approraite serice to schizophrenia Health must always be there to intervene, and so must always be in the position to be updated abiut the progress and circumstances of th continuing illness liability.

Experience shows that if secondary specialist health service is not actively available, schizophrenia goes wrong. Section 117 was meant to do this. In effect social supervison o provision goes to 'Welfare' budgeting, and health professional drop out, lose up-to-date information on what the illness is doing, find it difficult to regain contact, and take the easy route out. There is nothing further that we can do. And don't do it.

Schizophrenia is unlike other serious illnesses, always impossible for those engaged with it to know what is or is not going on in the mind of those with the condition.
What it is that is sometimes taking over in their minds.
And those who claim differently do not live with the illness.

Lay people can get some idea of the other serious illness from their own identification.
Depression as a lowering condition different in that it can get stuck and be severe:
obsessional states can be seen into, as habits and anxieties taking charge:
anorexia that is an overvalued worrying about figure, and dieting one way and another:
anxieties, as something we all experience but can be recognised
as persisting and disabling in some people and in some particular situations.

Jaspers made the point to diagnosis, the lack of any way for ordinary experience to see into the duration and sense of the mind of someone affected by schizophrenia.

Schizophrenia requires, but doesn't get, a service of it's own.

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Health Professionals still consider aftercare is a social need
rather than that it is an aftercare Health treatment to prevent relapse - that is to provide a regular routine for them
of continuing interest and work substitute activities in a weekly programme.

They do not put it in the Needs assessment of th Care programme Approach as a continuing Health need and obligation.

Family carers know that the domestic routine at home going on around them allows family sufferers to have that routine.
It simplifies the demands on people in residual ilness,
protecting them from what are to others unchallenging personal necessities,
and allows sufferer to be able to manage, even if they do not progress.
Many have been at home with this limited life for years -
without relapsing, saving admission aaand substantial cost of NHS provsion.
Preventing relapse is a Health treatment continuing care need.
If professional NHS service at the beginning provided assistance into outside activities
that they could take part in, that routine added to the family domestic one
enables sufferer to have a better life, helping also by giving families breaks in the week' for their own lives

The illness disrupts the use of essential internal brain associations in hauling up background experience - the foundation for taking part in outside 'goings on'.
Those affected by schizophrenia NEED a stable external 'anchoring' framework, onto which, by regular participation,
the internally loosened mental association systems and enfeebled brain 'will' , forms an internal 'map' to match the outside programme, can catch up, and regain control over 'intending'.

That is a treatment NEED.... [ key question - this is better - letter in the British Journal of Psychiatry ]

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Aftercare Issues ... when is aftercare a Health lead issue { continuing health care ] and when is it a Section 117 issue.
A section 117 follows a MHAct section 3 admission, and places an obligation on NHS and Local Authority to work together ! to deliver what is needed in health and social aftercare
- the two stools battle - that leaves sufferer on the floor

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_103161.pdf July 2009 (revised)

Section 117 services [ follow Mental Health Act Section 3 inpatient admission to aftercare assessments, and hence those going on to Community Treatment Orders ]

25. To assist in deciding which treatment and other health services
it is appropriate for the NHS to provide under the National Health Service Act 2006,
and to distinguish between those and the services that LAs may provide under section 21 of the National Assistance Act 1948,
the Secretary of State has developed the concept of a 'primary health need'

Where a person's primary need is a health need, they are eligible for NHS continuing healthcare.
Deciding whether this is the case involves looking at the totality of the relevant needs.
Where an individual has a primary health need and is therefore eligible for NHS continuing healthcare,
the NHS is responsible for providing all of that individual's assessed needs - including accommodation, if that is part of the overall need.

57. In order to address this issue and ensure that unnecessary stays on acute wards are avoided,
there should be consideration of whether the provision of further NHS-funded services is appropriate.
This might include therapy and/or rehabilitation, if that could make a difference to the potential of the individual in the following few months.
It might also include intermediate care or an interim package of support in an individual's own home or in a care home.
In such situations, assessment of eligibility for NHS continuing healthcare should usually be deferred until an accurate assessment of future needs can be made.
The interim services (or appropriate alternative interim services if needs change) should continue in place
until the determination of eligibility for NHS continuing healthcare has taken place.
There must be no gap in the provision of appropriate support to meet the individual's needs.

26. There should be no gap in the provision of care.
People should not find themselves in a situation where neither the NHS nor the relevant LA
(subject to the person meeting the relevant means test
and having needs that fall within the appropriate local Fair Access to Care bandings) will fund care, either separately or together.
Therefore, the 'primary health need' test should be applied, so that a decision of ineligibility for NHS continuing healthcare
is only possible where, taken as a whole, the nursing or other health services required by the individual:
a) are no more than incidental or ancillary to the provision of accommodation
which LA social services are, or would be but for a person's means, under a duty to provide; and
b) are not of a nature beyond which an LA whose primary responsibility it is to provide social services could be expected to provide

47. .... Eligibility for NHS continuing healthcare is, therefore, not determined or influenced either by the setting
where the care is provided or by the characteristics of the person who delivers the care.
The decision-making rationale should not marginalise
a need just because it is successfully managed: well-managed needs are still needs.
Only where the successful management of a healthcare need has permanently reduced or removed an ongoing need will this have a bearing on NHS continuing healthcare eligibility.

53. Local assessment arrangements and processes differ around the country,
though a number of models have formed the basis for assessment and care and support planning processes.
The Single Assessment Process for older people9 has been extended in many areas to cover all adults, and the Care Programme Approach10 is more widely used in mental health.

114. Responsibility for the provision of section 117 services lies jointly with LAs and the NHS.
The specific arrangements for how responsibilities are shared are determined locally.
The absence of a local policy agreed between PCTs and LAs on section 117 responsibilities
is not a reason for awarding eligibility for NHS continuing healthcare as a substitute for the use of section 117 powers.
Some PCTs may use a common budget to fund both section 117 and NHS continuing healthcare,
but this does not mean that those in receipt of section 117 support
are eligible for NHS continuing healthcare.
It is important for PCTs to be clear in each case whether the individual is being funded under section 117, NHS continuing healthcare or any other powers.

115. There are no powers to charge for services provided under section 117,
regardless of whether they are provided by the NHS or LAs.
Accordingly, the question of whether services should be `free' NHS services (rather than potentially charged-for social services) does not arise.
It is not, therefore, necessary to assess eligibility for NHS continuing healthcare
if all the services in question are to be provided as after-care services under section 117.

116. However, a person in receipt of after-care services under section 117 may also have needs for continuing care
that are not related to their mental disorder and that may, therefore, not fall within the scope of section 117.
An obvious example would be a person who was already receiving continuing care for physical health problems
before they were detained under the 1983 Act and whose physical health problems remain on discharge.
Where such needs exist, it may be necessary to carry out an assessment for NHS continuing healthcare
that looks at whether the individual has a primary health need on the basis of the needs arising from their physical problems.
Any mental health after-care needs that fall within section 117 responsibilities would not be taken into account in considering NHS continuing healthcare eligibility in such circumstances.

Complexity: This is concerned with how the needs present and interact to increase the skill required to monitor the symptoms,
treat the condition(s) and/ or manage the care.
This may arise with a single condition, or it could include the presence of multiple conditions
or the interaction between two or more conditions.
It may also include situations where an individual’s response to their own condition has an impact on their overall needs,
such as where a physical health need results in the individual developing a mental health need. [ Ed :- ? ]

?] Unpredictability: This describes the degree to which needs fluctuate
and thereby create challenges in managing them.
It also relates to the level of risk to the person’s health
if adequate and timely care is not provided.
Someone with an unpredictable healthcare need is likely to have
either a fluctuating, unstable or rapidly deteriorating condition.
Each of these characteristics may, alone or in combination, demonstrate a primary health need,
because of the quality and/or quantity of care that is required to meet the individual’s needs.
The totality of the overall needs and the effects of the interaction of needs should be carefully considered.

It is also important that deterioration is taken into account when considering eligibility,
including circumstances where deterioration might reasonably be regarded as likely in the near future.
This can be reflected in several ways:

• Where it is considered that deterioration can reasonably be anticipated to occur before the next planned review,
this should be documented and taken into account.
This could result in immediate eligibility for NHS continuing healthcare
(i.e. before the deterioration has actually occurred).
The anticipated deterioration could be indicative of complex or unpredictable needs.

? Where eligibility is not established at the present time,
the likely deterioration could be reflected in a recommendation for an early review,
in order to establish whether the individual then satisfies the eligibility criteria

[ But this encourages professional NHS assessment at the Needs Assessment stage of the CPA
to not bother to put in that aftercare occupational routines are an essential health need to prevent relpase in schizophrenia
However, a person in receipt of after-care services under section 117 may also have needs for continuing care
that are not related to their mental disorder and that may, therefore, not fall within the scope of section 117.
Where physical needs exist, it may be necessary to carry out an assessment for NHS continuing healthcare that looks at whether the individual has a primary health need on the basis of the needs arising from their physical problems.
Any mental health after-care needs that fall within section 117 responsibilities would not be taken into account in considering NHS continuing healthcare eligibility in such circumstances.

At the Needs assessment of the CPA it's rare to see aftercare weekly occupational activities
as a necessity to prevent relapse in schizophrenia.
But without it as a routine, high EE [ situations of unresolved continuing anxiety and frustration ]challenges always arises
between sufferer and lay people, between famiiy and cared for, between sufferer and others.

Taking part in activities is necessary to make up for the specific defect in schizophrenia
– a mental illness difficulty in assembling the relevant experience and intention to find and keep on with a routine for themselves

If it is not in the Care Plan it is never put in place, it is never registered as an unmet need,

and the absence of it , means relapse.

Social services are difficult or impossible to get to act..

Preventing relapse is Treatment. It is a continuing Health care need.

NHS mental health professionals do not put it into Needs and Care Plan – a continuing care health requirement
– because they – like you - are lazily content to see it as a social need which will be provided by LASS.
LASS don't know enough about schizophrenia, don't own th condition. to find suitable and sustainable domestic situations where intervention is required. [ They place them in flats next to drug users ]
Nor is their influence convincing enough to protect patients in continuing care from the hassle of 'back to work' judgements.
Nor how to go with participants into afterare occupational ned top protect the entry from the stress of that .

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It instructs the local PCT and Social Services to jointly agree (not necessarily jointly provide) an aftercare plan and to do so until they jointly agree that it is no longer necessary. In effect it is a a life long eligibility. It is unlawful [ Stennet ] for any charge (including prescription charges) to be made for any aspect of the aftercare plan.

CHC is the system whereby it is decided whether the person has a primary health need and therefore the NHS must fund all of their care including accommodation.
There is a national framework for deciding whether CHC applied
Link to DoH rules for contining health care
It is very difficult to establish a CHC right if the primary health need is mental health.

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