Making sense of NHS Continuing Healthcare appeals
How to appeal against an initial decision by the NHS to refuse NHS Continuing Healthcare funding – how to start the NHS Continuing Healthcare appeals process…
You may have had a Checklist assessment for NHS Continuing Healthcare funding, and you may also have had a full multidisciplinary team assessment (using what’s known as the ‘Decision Support Tool’ or DST). At either stage, you may have been turned down for funding by the local NHS.
This decision can be hugely frustrating, especially when you know that your relative has significant health needs.
If you have been turned down, you can appeal. Make sure first that you’re familiar with the Continuing Healthcare eligibility criteria.
The NHS should have sent you information about the formal appeals process and how to proceed. Here’s what to do next:
- Write to the Manager or Coordinator of the NHS Continuing Healthcare team at the local NHS Clinical Commissioning Group (the local NHS). This is the team that made the decision and/or arranged the assessment(s).
- State that you disagree with the outcome. and why.
- If you’ve been turned down at the Checklist stage, ask for it to be done again
- If you’ve been turned down after the MDT meeting, confirm that you will be appealing. You can also ask for this stage to be repeated if you can show that it wasn’t done properly.
- State that you will be providing arguments and evidence to support your appeal in due course.
- The NHS may reply giving you just a very short time in which to do this. You can, however, remind them of the official timescales for Continuing Healthcare reviews.
- Then you need to start pulling together all the reasons why you disagree with their decision to deny funding and submit a written appeal to the same NHS Continuing Healthcare team.
The NHS should look at your reasoning and act on it, which may include a reassessment.
If you have already had a reassessment and you’ve still been turned down for Continuing Healthcare, you need to appeal through a different process: You now need to ask the NHS England (the NHS National Commissioning Board) for an Independent Review.
Read our frequently asked questions on NHS Continuing Healthcare. You’ll find some extra tips on putting together an appeal.