Let’s assume your relative has got through an assessment for NHS Continuing Healthcare. The assessors recommend funding. Great news.
Then you receive a letter in the post from the local CCG saying funding has been refused. Can CCGs overturn NHS Continuing Healthcare eligibility recommendations?
(CCGs are local Clinical Commissioning Groups, formerly Primary Care Trusts.)
Reading that your relative’s NHS Continuing Healthcare funding has been declined can be bewildering, frustrating and downright maddening, especially when you know the original Continuing Healthcare recommendation of eligibility was correct.
If you don’t know any different, you may take the outcome at face value and assume the letter is right. But be careful. Look carefully at who has actually made this decision.
NHS Continuing Healthcare is NHS funding for full time care and it covers all care fees. A full assessment for NHS Continuing Healthcare funding involves a multi-disciplinary team, and the lead assessor will make a recommendation about eligibility. This recommendation is then put to a CCG panel, who make the final decision.
This also happens in retrospective claims for care fees previously wrongly charged.
Can CCGs overturn NHS Continuing Healthcare eligibility recommendations?
The National Framework for NHS Continuing Healthcare – the formal guidelines for Continuing Healthcare assessments – sets out in black and white that CCG panels can only overturn an eligibility recommendation in exceptional circumstances. There are clear guidelines to this effect – and about what should happen next.
Needless to say, a CCG panel cannot arbitrarily throw out a recommendation of eligibility without following these rules and without being able to justify their actions. Predictably, reports from families show that this is exactly what some CCG panels try to do.
If this happens to you, be sure to read the guidelines. The blog http://chcfunding.wordpress.com contains a useful page of information about what the guidelines actually say in this respect. It will help you appeal, should you need to.