You may already know that in order to be eligible for the NHS’s CHC (Continuing Healthcare) funding, your care needs must be based on healthcare and not social. So, the need for funding must be primarily health related and not otherwise.
Many people, unfortunately, have been refused Continuing Healthcare, even though they went through the assessment and had primary care needs which qualify for funding. Over time, our solicitors at Hugh James have also observed how the CHC assessors have downplayed and underscored some very obvious health needs, re-categorising them as “social” needs.
People that we have worked with have spent many distressing hours in CHC assessment meetings, where assessors determined to prevent access to funding, have tried their best to dispute the difference between “health” care needs vs. “social” care needs.
If you have been refused Continuing Healthcare funding either due to not meeting the criteria (or so they say) or no explicable reason that you are aware of, here’s what your next steps should be:
When refused continuing healthcare – What to do
Establish grounds
The first thing you must do is establish grounds for an appeal.
For example, your grounds for appeal could be around an eligibility decision. Perhaps, the full assessment was not carried out correctly or you weren’t actively made a part of the assessment throughout each stage.
You might also establish grounds for an appeal based on the levels of care needs. For instance, the assessment of your care needs may not have been done and applied in the Decision Support Tool (DST) correctly or, perhaps, not all the relevant evidence was taken into account before reaching a funding decision.
Write to the relevant party
Once you have established grounds for an appeal, you need to write to the individual or organisation responsible for sending you the decision letter with six months of the decision letter. This is typically the ICB (Integrated Care Board) as they are responsible for making eligibility decisions. If not, then it is usually a third party commissioned to conduct the assessment.
While writing the letter, clearly outline reasons for requesting a review. A lot of care and caution must be exercised while writing the letter – ensure that you fully understand the decision letter and why you were categorised as ‘ineligible’.
Resolution process
Once you send a written appeal, the ICB will begin a local resolution process. Multiple resolution meetings may be scheduled where you’ll get a chance to talk about how your care needs are eligible, how the procedure was not carried out correctly, or other grounds for appeal you may have in mind.
Attending these meetings means being thoroughly prepared, including preparing notes, and having a clear mind map of the points you want to discuss.
How Hugh James can help
We have helped countless individuals across the UK get due funding after having been refused Continuing Healthcare by the NHS. Our solicitor would be happy to sit down with you and help you prepare fully if you are considering an appeal.
