Appealing an NHS CHC (Continuing Healthcare) decision can be a very cumbersome and time-consuming process. Not only is it distressing for the affected individuals and their families but people are also expected to wait months and even years before a decision is made.
Furthermore, you may not be happy with the decision, in which case, you can make a CHC funding appeal.
Understanding the CHC appeals process
If you or anyone you know is living with a disability, illness, or health condition, managing it and trying to live a normal life can be a very expensive proposition. This is where the NHS’s CHC funding can make a major difference, helping individuals manage health conditions by easing their financial burden.
Now, in the majority of cases, funding should run smoothly, where those eligible for it receive the necessary support without any hiccups or delays. Unfortunately, in a number of cases, people do not get the financial support they are entitled to, most likely due to mistakes or oversight on the NHS’s part. If not that, then many individuals are simply unaware of the fact that financial help is available to begin with.
Many people who should qualify for NHS funding get turned down by the NHS. Whether this is due to a general lack of understanding amongst the various healthcare professionals or the application form and process (which can get quite complex) – people who direly require funding for healthcare are missing out on the support that they rightfully entitled to.
A solicitor specialising in the NHS Continuing Care Appeal Process can work with you to secure funding and challenge the NHS’s decision as well, in case you do not receive the funding you are entitled or get less than what you should.
How does the NHS continuing care appeal process work?
If you believe that you or a loved one are eligible for CHC funding but have had the application rejected or, for some reason, you haven’t received the funding– you can claim back this entitlement, via successful appeals for NHS Continuing Care.
Appealing Continuing Health Care decisions means that you should work with a solicitor who understands the NHS CHC framework (including appeals) inside and out. Your solicitor will help you prove that you (or a loved one) is, in fact, eligible for CHC. After appealing the NHS Continuing Care decision, you can claim back payments, and also challenge any decisions where you (or your solicitor) believe that the funding has not being released according to your entitlement.
For most Continuing Healthcare appeals, you have approximately 6 months (starting from the date your claim got rejected) to begin the NHS Continuing Healthcare appeal process.
It’s worth noting that your medical records will be assessed and/or scrutinised, should you proceed with a CHC funding appeal. While all ‘appealing continuing health care’ decisions go through the NHS initially and not through the Courts, you can save yourself a lot of time, energy, and trouble by speaking to a solicitor who fully understands continuing healthcare appeals and can take care of matters on your behalf.
What happens when there are successful appeals for NHS continuing care?
When successful CHC appeals are made by eligible individuals, their healthcare needs are reassessed. If their funding needs are considered to be that of a primarily health-based nature, , then the NHS will fully fund their care, which also cover the cost of residential care – something which would otherwise have been paid out of your own pocket or your family’s personal bank account.
In addition, here are some key points to remember following successful appeals for NHS Continuing Care:
- After a successful Continuing Healthcare funding appeal, you will receive the necessary care services, such as personal care and support, nursing, accommodation, etc. all covered by the NHS which will significantly reduce your family’s financial burden.
- In certain appeals cases, if the appeal was granted after a period of self-funding care has transpired, you will be eligible to recover the care fees for that period or time frame.
- Even after a successful NHS Continuing Healthcare appeal, your care needs will be reviewed periodically so that the NHS can check that your needs are correctly being met.
Appealing a CHC decision: What you should know
When it comes appealing a CHC decision, you should know the following:
- Initially, a local resolution is sought to resolve funding issues through the ICB (Integrated Care Board), via a formal meeting or review process.
- If the initial attempt through the local resolution fails, an independent review of the case may be done by a panel.
- If the independent review panel supports the original decision, your case may be referred to the Parliamentary and Health Service Ombudsman so that it can investigated further or you can consider court proceedings.
CHC funding appeal: How to ensure it is successful
Certain factors can greatly contribute to the success of your CHC funding appeal, two of which are:
- Strong evidence which may include professional assessments, medical records, and statements from healthcare professionals and/or organisations, in order to serve as or support your complex health needs.
- Legal representation through a solicitor specialising in NHS CHC appeals.
At Hugh James, we have extensive experience in helping our clients appeal Continuing Health Care decisions. Our high success ratio and persistent efforts ensure that you get the complete funding you are eligible for. To date, we have helped affected individuals secure hundreds of thousands of pounds in continued CHC funding over the years, helping them cover all their complex health needs.
