If you find that your Local Clinical Commissioning Group are delaying matters, then you need to be pro-active and complain. Don’t just sit back and accept it.
This is the NHS service which we are all paying for…
The general perception is that most CCGs tend to be more pro-active when it suits them, for example: if someone has been receiving NHS Continuing Healthcare Funding for a year or so, but their health needs have not been reviewed. A regular review could save the NHS thousands of pounds in unnecessary care home fees where the individual’s health needs have improved or even disappeared. That is fair enough!
But, what about those individuals going through the assessment process to obtain NHS Continuing Healthcare Funding, or are stuck in the system waiting an appeal, or seeking a retrospective claim for care fees already paid? Whilst live patient assessments tend to be prioritised over retrospective claims for deceased claimants, when you need the NHS process to work for you, there are often inordinate delays. Sounds familiar?
We know of retrospective appeals for NHS Continuing Healthcare Funding against one particular CCG, that have been outsourced to a different provider just to deal with the appeal element only. These cases have then been transferred around the country from office to office, and then person to person, only to end up back with the same CCG where they stated 2 years earlier – with absolutely no progress having been made by the CCG in the meantime to move the matters forward. Hugely disappointing and frustrating!
This is your relative’s funding which is at stake. They could be paying needless funds out of hard earned savings in order to fund care which should be reimbursed.
So, what can you do?
Here’s some helpful suggestions as to how to complain…
- Remember you are complaining, not moaning…
- “Strike whilst the iron is hot”. You have to take prompt action and decisive steps to make progress, even if complaining does not come naturally to you. If you leave the issue to resolve itself, unfortunately in our experience, you could be waiting a long time!
- You are perfectly entitled to complain if the system is failing you and your relative. Indeed, it is your ‘right’ to complain and you must do so if you want to see some progress of your claim for NHS Continuing Healthcare Funding.
- Do regularly chase the CCG either by telephone and/or in writing by email or letter for progress. Don’t be fobbed off!
- It is useful to keep a log of who you spoke to, time and date – as you may be passed from ‘pillar to post’, and department to department. A record of your attempts to contact the CCG may become useful if you have to lodge a formal complaint in due course.
- Diarise forward to issue frequent reminders or chasers.
- Be assertive. Write forcibly and with purpose, expressing your complete dissatisfaction with the way this matter is being handled and explain your frustration.
- It can be helpful to set out a chronology of events and your attempts to progress matters – which again, is why a log can be handy record.
- If you receive no response or no satisfactory response, do not be afraid to now send a formal Letter of Complaint to the CCG. Go onto the CCGs website to find details of their Complaints Department and complaints procedure.
- Make your Letter of Complaint concise and to the point, and do not ramble. You have to get the CCGs attention and make an impact. Set out the facts clearly and succinctly. Once you get going, you will probably find it a cathartic exercise.
- We suggest you copy in the Chief Executive, Chairman and Head of NHS Continuing Healthcare into your correspondence to make sure your letter receives attention at the highest level and won’t be put to one side.
- It is a good idea to send your Letter of Complaint by way of Recorded Delivery, so you can trace that it has been received. Allow a reasonable time (say 14 days) for the CCG to acknowledge your complaint letter. They should give you a timescale by which they will respond to you formally.
- Remember to keep a copy of your letter – just in case you need to send a reminder chasing a response, or need it to resume battle…
- We suggest you write to the CCG acknowledging receipt of their holding letter and that you intend to keep them to their own proposed timescales for responding to your complaint. If, however, no timescale is provided, insist on one – otherwise, your complaint may end up taking as long as the subject of your complaint!
- If there are insufficient Nurse Assessors available to review the records, then suggest the CCG re-allocates its budget to provide more resources to move these cases through the ‘pipeline’.
- For retrospective claims, you can remind the CCG that the longer they delay in processing their review of the matter (and any appeal), the more interest is racking up on any monies found due for repayment – at the taxpayer’s expense!
- You may also want to get your local MP involved to add weight to your complaint if the CCGs conduct is really appalling or the delay is totally inexcusable. Unfortunately, most MPs have very little experience in this particular field, and so it would be a good opportunity for you to educate them as to NHS Continuing Healthcare Funding and get them to help spread the message that the system is under-resourced and that families are suffering as a result of delays.
And Some Don’ts
- Don’t put the matter off and pretend the delay doesn’t exist, or think that the situation will somehow improve on its own if you ignore it. It won’t!
- Don’t be fobbed off and keep persevering! The fact that the NHS are delaying matters or are woefully behind due to a lack of resources, is not your problem. You just want fairness and justice for your relative, and for the CCG to respond quickly. So press for action, and timescales for the matter to be actioned.
- Don’t be hysterical, get emotional or rant in your Letter of Complaint. Although the CCG’s may be slow in processing claims, their staff still deserve your respect too and are only trying to do a job to the best of their ability with the resources available.
- Don’t be rude or be unnecessarily aggressive in the tone of your letter – it won’t necessarily help your cause. “Firm but fair” is the motto here.
- ‘Shouting’ or using lots of exclamation marks in your Letter of Complaint won’t help your case get to the top of the pile. On the contrary, whilst it might work for some, it can often have the reverse effect – so take care to moderate your language. Quite understandably, most CCG’s do not respond to being bullied into action or threatened – however frustrated you may feel by the way the NHS CHC Funding system works.
- Don’t be surprised though if you have to chase a response to your Letter of Complaint as well!
- Don’t be fobbed off with a holding letter of ‘acknowledgement’ to your complaint – which gives no positive steps as to the proposed course of action the CCG are going to take to investigate your complaint, or timescales for doing so. You have to push for a formal reply and time-frame as to when your claim will be actioned. To say that, “the matter is in a queue awaiting allocation and we can’t tell you how long this will take…” is simply not good enough. Go back and ask:
- How long is the queue?
- Where is the case in the queue?
- What steps are being taken to move it up the queue?
- What is the timescale for it to be reviewed?
- Is it usual for a case of this nature to take xxx months/years, and what is being done to move it forward more quickly?
The CCGs response, if unsatisfactory, will formulate your next response…
- Most importantly… don’t give up!