When NHS Continuing Healthcare is refused, families are often left wondering what to do.
Many people ask us whether it’s worth appealing a Continuing Care funding decision, and this is one of the most frequent questions people ask us in enquiries.
The short answer is: We can’t say – at least, not without looking in detail at your relative’s health and care needs and risks.
However, there are several things you can do yourself to decide whether it’s worth taking the matter further with the NHS.
5 things to help you decide whether it’s worth appealing a Continuing Care decision:
- Is one or more of the assessment scores clearly wrong? If so, look at the scores you believe your relative should have been given, and evaluate how that combination of scores compares with the Continuing Healthcare eligibility criteria. (You’ll find the main assessment ‘tools’ via this link. They contain the criteria.) If your view of the correct scores matches the minimum eligibility criteria, and you can show why the scores those scores are appropriate, it may well be worth appealing.
- Did the assessors look at all the relevant care notes, plus information and input from all relevant clinicians, physicians, therapists, carers, consultants, doctors, etc? If they didn’t, you can argue that the assessment was not a proper review of your relative’s needs, and so you may well have good grounds for appeal.
- Are the daily care notes from the care provider up to date, and do they represent a full and accurate picture of all your relative’s health needs? If they don’t, you can argue that the assessment could not have been safe or reliable, and so you may have good grounds for appeal.
- Did the NHS involve a proper multidisciplinary team at a full assessment? Did they involve you fully in the process? Did they note your comments and input? Did they ignore or gloss over certain key health needs? If the assessment process itself was flawed and assessors did not follow their own Continuing Healthcare National Framework guidelines, you have grounds for appeal.
- Do you have the energy to pursue it? This might sound like a strange question and rather defeatist, but it’s just important to keep in mind. We’re not saying don’t do it – in fact, we’d encouraging everyone to pursue it if they can and if they believe their relative should have been eligible – but it’s just something to be aware of.
Read the NHS Continuing Healthcare guidelines – the National Framework, the Checklist, the Decision Support Tool, the Fast Track. They will help you identify what has and hasn’t been done correctly by assessors and decision makers.
If you’re fairly new to NHS Continuing Care matters, and your relative has been refused funding but without you really knowing much about what went on – or what should have been done – you may find our guide helpful: How To Get The NHS To Pay For Care.
The guide will also stand you in good stead in evaluating to what degree you have grounds for appeal.