When you’re short of time and energy it helps to focus on specific aspects of an appeal
Disputing the outcome of an Continuing Healthcare assessment can feel daunting, and so it helps to identify in advance what to focus on in an NHS Continuing Healthcare appeal.
When you start to pull apart assessment notes and care notes and put together an appeal, you quickly realise that the time and energy that needs to go into this can be substantial. Focusing predominantly on specific aspects of an appeal can help.
In a full NHS funding assessment for full time care (an NHS Continuing Healthcare assessment), the assessors will look at 12 different areas (domains) of health and give the person being assessed a particular score in each domain.
To be eligible for NHS funding, the person being assessed has to achieve a minimum combination of scores at the end. One such combination includes two ‘Severe’ scores; another such combination includes one ‘Priority’ score.
Here’s an example of how to decide what to focus on…
Typically, someone with advanced dementia will be given a ‘Severe’ score in the Cognition domain. The person may also have significant Behaviour challenges and ordinarily you would expect them to have a relatively high score in the Behaviour domain as well. However, increasingly assessors are declaring the person to have no Behaviour needs because they say it’s all to do with the person’s poor cognition.
This is despite the fact that the official Continuing Healthcare guidelines clearly state that health and care needs should be recorded in every relevant domain.
Assessors will also often say that someone with dementia cannot have any psychological needs or emotional needs, and yet this is of course completely wrong.
As in the above example, if you find yourself in that position where you have one Severe score and you believe at least one of the other domains should also attract a Severe score, when you come to appeal it’s a good idea to direct much of your time and energy into arguing the case for this additional domain. That’s how you are most likely to achieve the required scoring combination of two Severe scores.
With the other domains that perhaps have lower scores, you may decide not to spend so much time and energy focusing on these. Of course, where the assessment notes are wrong in these domains and contain misstatements of fact, or where the assessment has not been carried out properly and/or relevant evidence ignored, you’ll still want to make this point.
So remember to look at where you’re best directing your energy when you’re putting together an appeal, and look at the most likely way you could achieve an eligible combination of scores.