NHS Continuing Healthcare Funding is a free package of fully-funded care provided by the NHS for all of your relative’s healthcare needs and their accommodation. If your relative is eligible for this NHS Funding they should not have to pay a penny towards the cost of their care!
In order to obtain CHC Funding, your relative will ordinarily first undergo a screening Checklist assessment, and if successful, will then pass onto a Full Assessment carried out by a Multi-Disciplinary Team (MDT). The MDT use the Decision Support Tool as a means of assessing, whether or not, an individual’s healthcare needs meet the eligibility criteria for NHS Continuing Healthcare Funding.
If your relative is not successful at the Full Assessment meeting, but you believe that there are good grounds for appeal, then consider lodging your appeal as soon as possible. Don’t delay. Get your evidence together and prepare your written submissions. Remember you only have six months from the outcome Decision to lodge your appeal with the Clinical Commissioning Group.
However, the appeal process is not that quick, so the sooner you do it, the higher up the queue you’ll be. On average it takes about 3 to 6 months from to get an appeal hearing date before Local Resolution Meeting (LRM), and about another 4 to 6 months if you then want to appeal that decision to an Independent Review Panel (IRP). In the meantime, whilst going through the appeal’s process, your relative may be forced to pay for their care. Therefore, if your relative is still living, you need to stress this and actively chase the CCG in order to get through the appeal’s process quicker.
Note: In the meantime, there is nothing to stop you from requesting a fresh Checklist assessment if you believe that your relative’s needs have changed since their last one was done. This can take place even whilst you are awaiting the outcome of an appeal.
Unfortunately, if your relative has passed away and you are making a retrospective claim seeking reimbursement of care fees that were wrongly paid, then the CCG’s aren’t generally in any rush to prioritise these claims. In a retrospective claim, it can often take around a year until from the Local Resolution Panel outcome until an IRP is convened! You may be then be waiting another six to eight weeks for the IRP’s written Decision. So, you will need to keep chasing for regular updates as to progress.
If your appeal to the Independent Review Panel is unsuccessful, then your only and final recourse is to the Parliamentary and Health Service Ombudsman (PHSO). This is an independent organisation who will review the matter upon a formal written complaint.
We know from experience that the PHSO are generally very slow at dealing with complaints relating to CHC matters. Again, you will need to chase them regularly for updates.
However, whilst the PHSO might have intervened in the past to overturn ‘perverse’ decisions, for example, where the Local Resolution Panel or Independent Review Panel had erred, over the last few years, we have seen a substantial shift in policy. The PHSO are now only really interested in looking at whether there has been a clear and obvious abuse of process. For example, key documents weren’t considered by the appeal Panel, or the parties weren’t invited to attend the appeal, or the CCG‘s representatives made misleading comments to the appeal Panel. But if the appeal process has been carried out fairly and robustly, then however much you may disagree with the decision to refuse CHC Funding, the PHSO will be reluctant to interfere and overturn that outcome.
The PHSO are not infallible and can make mistakes, too. If you disagree with the PHSO’s decision, then there is often a right to challenge that within 12 months. But again, you will need to have very good grounds as to where they have erred.
Families going through the assessment or appeal’s process tell us how complex, difficult and overwhelming it is, battling against the NHS whilst trying to secure CHC Funded care for their relative. If you want help, visit our one-to-one page for expert legal advice and a free consultation.
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