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'Medical opinions ignored' by NHS payment assessor, workers say

From BBC - September 9, 2017

Medical opinions have been ignored in the assessment of NHS payments to patients receiving care, it is claimed.

Three health workers said an assessor organisation discounted medical views so some patients were denied NHS care.

Norman Lamb MP said England-wide data obtained by the BBC showed a "regional disparity" and was "an injustice".

However the assessor organisation, Arden and Greater East Midlands CSU, says it follows national guidelines to decide on payments.

Under national criteria, the NHS pays for long-term support and care if a patient's condition is severe enough.

However, BBC Inside Out East has found a wide difference among clinical commissioning groups (CCGs) in England in the percentage of patients rejected following assessment for continuing health care (CHC).

Between July 2016 and July 2017,Birmingham South and Central CCG rejected 75% of its new CHC assessments, Manchester CCG turned down only 17% of assessments, while Tameside and Glossop CCG only rejected 5% of those assessed.

All assessors - of which there about half a dozen covering England - should use the same criteria.

Three health workers told the BBC that one of the main assessor organisations, Arden and Greater East Midlands CSU (Commissioning Support Unit), sometimes ignored medical opinions in assessments so patients could not obtain NHS care.

One worker told the BBC: "There has been bullying at the meetings - attempts to ridicule people who are there who have a professional opinion.

"They ignored what professionals have said and changed what professionals have said. The concern is that this puts patients at risk."

North Norfolk MP Mr Lamb, whose Liberal Democrat constituency includes North Norfolk CCG where 73% of cases assessed were turned down, said the disparity and the allegations of medical opinions being ignored were "very disturbing".

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