Make a move. If you need professional help with the CHC Funding Process – don’t leave it too late!
Good preparation and early planning are the main keys to presenting a well-constructed case for your relative’s claim for Continuing Healthcare Funding (CHC).
Many families get into difficulty because they embark upon this CHC funding process, but don’t really understand the mechanics of what is involved and the complexities of the NHS funding system. They become frustrated and disappointed when the process takes far longer than ever expected, and when funding is refused, understandably flounder because of the plethora of detailed information they have to absorb, in an unfamiliar territory.
The CHC funding process is set out in the National Framework for NHS Continuing Healthcare and NHS-funded care (2018), which runs to some 167 pages, excluding additional documents such as the NHS Continuing Healthcare Checklist (2018), NHS Continuing Healthcare Decision Support Tool (2018) and NHS Continuing Healthcare Fast Track Pathway Tool (2018).
The NHS National Framework is supposed to be an all-inclusive, comprehensive document as to each step of the process to assist CCG practitioners and members of the public alike, to be able to work their way through the CHC funding system, so as to get a robust decision as to whether or not an individual qualifies for CHC funding.
Unfortunately, we know from experience, that the CHC assessment process is not straightforward, and families have to work incredibly hard, pursuing an uphill struggle to obtain funding for their relative – sometimes in circumstances where it should be plainly obvious to the Clinical Commissioning Group (CCG) that they should qualify for funding – no questions asked.
Although people carrying out the assessments are supposed to be fully trained in the National Framework, the Framework can be open to subjective interpretation, hence the results can vary from one CCG to another around the country. Inconsistency promotes frustration.
If you have started claiming CHC Funding and have got bogged down with it, or do not really fully understand what it is you must do to obtain the best results, then we recommend that you seek early professional help. Emotions run high, and there can be so much information to digest. Unfortunately, if people do seek help, it is often in the eleventh hour when it can be far too late to get any meaningful assistance. But failure to secure free funding for your relative can be the difference between paying nothing for their care or many thousands of pounds per month.
Early planning and preparation are the keys to securing CHC funding and giving any appeal your best shot.
GP, hospital and care home records need to be obtained, categorised and sorted, paginated and key entries records in your submissions appeal document to be presented to the CCG in writing. This is a considerably administrative heavy burden which cannot be done at the last moment. Firstly, it takes time to get hold of all these records, collate and process them. Each line in the records may have a particular relevance to one or more of the twelve Care Domains. Knowing what to look for and how the Domains interact will undoubtedly improve your scoring and chance of success. Leave this overwhelming task to the last minute at your peril! You may be doing your relative a huge disservice, as there may be lots of ‘golden nuggets’ of information and entries in the care records that would boost your relative’s outcome, if only you had time to consider them holistically.
However, if you are rushing to do the job, or do not even know what entries to look for, or how they relate to the other Care Domains, then your relative could potentially be missing out on thousands of pounds every year in free funded NHS care.
Rest assured, that it is not in the CCG’s interest to make the CHC case for you, nor point out all the entries that would support your relative’s claim for CHC funding.
Furthermore, the CCG’s representatives at any Local Resolution Appeal Meeting or Independent Review Panel appeal, will not make life easy for you. So, you must prepare your case and know it extremely well, if you want to try and persuade the Appeal Panel as to the merits of your relative’s claim for eligibility for CHC Funding. If you cannot present your case, then don’t expect the CCG’s advocate to do it for you!
Recommendation: If you are stuck in the CHC system and don’t know where to turn, consider getting early professional help. Don’t leave it to the last minute. Otherwise, it may be too late and the opportunity will have gone.
For further reading on appeals, “Can the MDT Panel refuse to proceed if I have an Advocate?”.