What to include in an NHS Continuing Healthcare appeal
Tip no. 23 in our series of 27 top tips on NHS Continuing Healthcare
If you’ve been told your relative is not eligible for NHS Continuing Healthcare, you may be wondering what to do next.
The NHS Continuing Healthcare team at the CCG should have provided you with the funding decision in writing. In addition they should have given you a copy of the assessment notes (e.g. the Checklist and/or the Decision Support Tool).
You should also be given information how to appeal.
If you’ve been turned down at the full assessment stage, after a multidisciplinary team meeting, the CCG should give you a written rational for the funding decision. Your next task is to decide whether to appeal.
If you do decide to appeal, you need to pull together various types of information. You may already have done much of this for the full assessment meeting.
If you weren’t able to prepare properly for the full assessment, read more here about that here – it will help you with the appeal.
Here’s what to include when you write an appeal for NHS Continuing Healthcare
Essentially it will be a document that pulls together all the reasons why you believe the funding decision is wrong:
- Make sure you’re familiar with the stages of the appeal process. If the CCG hasn’t given you any information about that, ask them for it.
- Make sure you read the National Framework guidelines. The more informed you are, the better your chances with the appeal.
- Highlight everything in the assessment notes that is incorrect, misleading or missing.
- Pull together information about your relative’s care needs in every care domain, and suggest the correct scores. (A care domain is an ‘aspect’ of care, e.g. Mobiity, Behaviour, etc., and these are set out in the Checklist document and the Decision Support Tool.)
- Familiarise yourself with the Coughlan case.
- Make sure the local authority legal limit has been properly considered.
- Check the care notes that are kept by the care provider. Do they let your relative down? It’s not unusual for care notes to be incomplete, inaccurate and lacking in detail. If this is the case, say so in your appeal and also take it up with the care provider; a failure to keep proper notes can put your relative at risk.
- Consider what evidence should have been reviewed by the assessors, but wasn’t.
- Refer to your own diaries and general notes about your relative’s care.
- Highlight any actions or statements on the part of assessors that have been unacceptable, intimidating, unprofessional or that shows ignorance of how the assessment process is supposed to work.
- And finally, pull together anything else that supports your case that has not been properly considered.
Once you’ve done all of that, send it to the NHS Continuing Healthcare team at the CCG. You may need to chase them regularly about your appeal. In all your dealings with them,be prepared to stand your ground.
Tip no. 24: What is a joint package of care?
You don’t have to fight this battle alone
Fighting a Continuing Healthcare funding battle alone can feel daunting. If you need to talk to someone about your case, read more here.