What to Do if NHS Continuing Healthcare Funding is Denied

Author:
James Urquhart-Burton
Partner, Care Home Solicitor
Date:
12/08/2019

You or a loved one may have had a request for Continuing Healthcare Funding recently turned down, in which case, getting legal advice from an experienced Care Home Fees Solicitor may be the best course of action when seeking to appeal or complain.

We only want the best possible outcome for you and your loved ones, and to help you through the Continuing Healthcare Funding appeals process, a Solicitor can:

  • Prepare written statements for appeal/review
  • Analyse the Decisions Support Tool (DST) for any mistakes
  • Give a clear and honest assessment on prospects for a successful outcome

If you want to appeal an NHS Continuing Healthcare Funding (CHC funding) decision, get in touch with our Care Home Fees Solicitors for a free, no-obligation discussion. Ask if we can deal with your case on a No Win, No Fee basis.

Call us on 08002605010 or request a callback and we will help you.

Timeframes and Possible Outcomes from an Appeal

Negative Checklist

With a Negative Checklist, you have the right to make a complaint within 12 months. The first step in assessing a person’s eligibility for Continuing Healthcare Funding is to carry out a Checklist. This is a very basic tool that will consider whether the person requiring care has sufficient needs to justify a full assessment. For more information see What is a Primary Health Need?

If the Checklist indicates that a full review is not appropriate, then you will have a period of 12 months in which to submit a complaint to the responsible Clinical Commissioning Group (CCG). If your complaint is not upheld by the CCG then you will have a further right of complaint to the

If the Checklist indicates that a full review is not appropriate, then you will have a period of 12 months in which to submit a complaint to the responsible Clinical Commissioning Group (CCG). If your complaint is not upheld by the CCG then you will have a further right of complaint to the Ombudsman, but be careful about timescales here because the Ombudsman requires that your complaint is made within 12 months of the outcome.

It can often take the CCG several months in which to provide you with an outcome to your complaint, meaning that you are already at risk of missing the Ombudsman’s deadline.

Ineligible Outcome following a Full Assessment

If a Checklist indicates that a full assessment is required then a more in-depth review will be carried out. This will involve a Multidisciplinary Team considering the person’s needs across a number of different areas of care, such as mobility, nutrition and drug therapies.

A Decision Support Tool will be completed and this will assist the team to make a decision as to whether the person is eligible for funding. If the outcome is ineligible then you will have a period of 6 months from the date of the outcome in which to appeal the decision.

Tread Carefully

In both the above cases you should be mindful that the Clinical Commissioning Group (CCG) could seek to impose a shorter deadline to complain or appeal. Whilst this is contrary to the guidelines you should tread cautiously and get legal advice to ensure that you are not barred from challenging the decision.

Where Continuing Healthcare Funding is denied at either stage then you will need to know whether there are grounds to complain or appeal. The CCG should provide you with the details you need to take the matter further, should you disagree with the decision.

The CCG should also provide you with a copy of the decision papers, such as the Checklist or the Decision Support Tool, however, you may need to specifically request these. Consideration of the rationale for the ineligible decision will help you to assess the prospects to either complain or appeal.

Our Care Home Fees Solicitors have specialist expertise in Continuing Healthcare Funding assessments and appeals. We can guide you through the assessment and appeal processes, removing much of the stress involved and improving the chance of a successful outcome.

If you would like to discuss how we can help you please contact us for an informal, no-obligation chat.

For a discussion with no obligation call our Care Home Solicitors

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