Appealing A CHC Funding Decision, Not To Grant Or To Withdraw Funding

Appealing A CHC Funding Decision, Not To Grant Or To Withdraw Funding

How to write an appeal for NHS Continuing Healthcare

You may be looking to find information on appealing a CHC funding decision. This article looks into this subject and explores the various options available to you.

Following an MDT, a recommendation will be made to the Clinical Commissioning Group with regard to eligibility for funding and the panel will decide whether to adopt that recommendation.

Once a decision has been reached this should be communicated in writing to the patient or to the family member with Lasting Power of Attorney and you should be given 6 months in which to appeal that decision.

We are coming across an increasing number of cases where letters are sent out from the CCG advising that any comments should be submitted within 28 days. This is wrong and unenforceable. It serves no purpose other than to pressurise family members to rush to reply without having an opportunity to consider the evidence and will possibly lead to the wrong decisions being made. Do not make this mistake.

The best thing to do is to seek independent advice about the likelihood of successfully overturning the decision and advise the CCG that you are doing so and that you will revert to them within 6 months.

This will then allow you the time to consider your options and if necessary instruct some professional support. Alternatively, obtain the records from the care home and GP yourself and carry out a thorough review with the assistance of someone with clinical expertise and make sure that your appeal submissions cover every detail and address every issue raised in the Decision Support Tool which you believe are capable of being challenged – it is important to make sure that all of your arguments are supported by evidence from the care records!

Remember that there are two possible stages for the appeal so if you fail at local level there is still the option to appeal to Independent Review Panel with NHS England. Again you are allowed 6 months from the communication of a negative decision to lodge your appeal with them. This is effectively your last chance so make sure that all evidence is included in your arguments and if you have not already done so consider seeking professional advice at this stage.

Summary:

  1. Time for lodging appeals is 6 months and not 28 days or any other period
  2. Make sure that you gather all necessary evidence including a copy of the DST which is not always sent out – if not request it from the CCG.
  3. Back up your arguments with evidence from the records and ensure that your written appeal submission covers everything you want to say.
  4. Don’t forget that there are 2 stages of appeal
  5. Consider using professional help with all stages of appeal.

6 Comments

  1. Ali Horner 4 weeks ago

    I have a friend who has come to me with the following question as I’ve been through the CHC process with her CCG. She has an LRM organised very soon. CHC have allocated 1 hour for the appeal and 30 mins for the panel to make a decision there and then. The case is complex and she is appealing on both grounds of process and evidence. she fears that, as with the MDT things will be rushed and time pressures will be used to dismiss her information. What should she say if at the end of the hour the meeting time is called and she feels she hasn’t been heard or she hasn’t had time to present her whole case. Is there anything in the NF or otherwise that says that the meeting should not be rushed etc. She is very clued up and strong about what she has to say and if she had this information I feel she would be able to deliver her case more calmly and without rushing. An early answer would really be appreciated as time is of the essence before the meeting. Thank you.

    • Care to be Different 4 weeks ago

      Hi Ali – sadly not but if it doesn’t go to plan please feel free to call us and we will happily chat it through with you. 0161 979 0430 Kind regards

      • Ali Horner 4 weeks ago

        Thank you so much. Brilliant telephone advice. Much appreciated.

  2. Joy Elizabeth Reardon 1 year ago

    What is an MBT Please

    • Care to be Different 1 year ago

      Hi Joy – it should be MDT – Multi Disciplinary Team. Regards

  3. Stephen Reeve 1 year ago

    The letter I received stated 14 days – whch was immaterial because they telephoned on day one stating that the withdrawal decision had been upheld but they assumed I would appeal so sent copy of my MDT notes to the relevant individuals in the CCG / Adult Care. So many folks are appealing that it was five months before the LRM was held. That was adjourned after thirty minutes because they had not provided written guidelines as required and the individuals who were at the validation meeting were not in attendance so could not be questioned ! The LRM reconvenes on Nov 15th – 8 months after the original MDT ! They still have not published appeal guidelines. Chaos abounds !

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