Many people consider use a solicitor for NHS Continuing Healthcare (‘CHC’) applications and appeals because the processes for both can be exhausting and bewildering.
What is NHS Continuing Healthcare (CHC)?
NHS CHC is a package of ongoing health and social care funded solely by the NHS where an individual aged 18 years or over has been assessed as having a primary health care need arising from disability, accident or illness.
Where an individual qualifies for CHC, the NHS has a duty under the NHS Act 2006 to provide it regardless of that individual’s wealth or savings. It can be provided in a hospital, a nursing home or at the individual’s home.
Where an individual’s primary need is a social care need and not a health care need, the Local Authority are responsible for providing for that need pursuant to the Care Act 2014.
Children receiving continuing care packages may become eligible for CHC when they reach 18 years old and should be referred for assessment when they are 16 years old so that a decision can be made before their 18th birthday.
Initial Telephone Consultation
Our highly skilled Private Client team are here to take the worry off your hands. We can provide an initial telephone consultation to see how we can assist in your case. For more information, please call Louise Kerr on 0808 1685550 or email firstname.lastname@example.org
Applying for NHS CHC
Where an individual has a rapidly deteriorating condition there is a fast track pathway to CHC.
In other cases, there is an initial screening stage using an NHS checklist. A multi disciplinary team (‘MDT’) consisting of representatives from health services and social services will then conduct an assessment using a Decision Support Tool (‘DST’). The NHS’s Clinical Commission Group (‘CCG’) decision maker will then use this DST to determine whether an individual has a primary health care need which qualifies them as eligible to receive CHC funding.
The CCG should reach its decision within 28 days of receiving a positive checklist.
A primary health care need is assessed according to its nature, intensity, complexity and unpredictability and whether the need is of a nature beyond which a social services authority could be expected to provide.
Where an individual does not qualify for CHC, they may qualify for NHS Funded Nursing Care (‘FNC’).
Eligibility Decisions According to the National Audit Office, around two-thirds of CCG assessments conclude that the person is not eligible for CHC funding.
Decisions not to fund these care packages can be a huge blow to patients and their families, and often come at a time in life that is already very difficult. Many people disagree with their eligibility decision and want to know if they should challenge it.
Should you Appeal?
Everybody has the right to appeal the CCG’s eligibility decisions and many people do. However, it can be a long, complex and stressful process. For this reason, we recommend pursuing an appeal only if you have clear and specific grounds that give you a chance of success.
How we can help
Cartwright King has experts in this field who can guide you through the process step by step and advise you on the likely prospects of success of your appeal.
We can assist in several ways:
- Assisting families/patients in putting together an application for CHC funding and/or reviewing and advising on proposed applications.
- Guiding families/patient representatives through the process of applying for CHC funding.
- Submitting and managing claims on behalf of patients and their representatives, which will include obtaining records, drafting and submitting a claim, managing correspondence with the CCG and driving the process through to conclusion.
- Reviewing cases that have been refused CHC funding and advising on the merits of making an appeal and on the appeal process.
- Advising on the merits of and assisting with the initial appeal stage, the Local Review Process (‘LRP’), managed by the CCG.
- Advising on the merits of and assisting with the next appeal stage, to the Independent Review Panel (‘IRP’) managed by NHS England.
- Dealing with the LRP and IRP appeals process in full including providing representation before the IRP.
- Advising on the merits of referring a decision to the Health Service Ombudsmen.
- Advising on the merits of and acting for patients in judicial review proceedings.
How to make contact
Our team at Cartwright King is on hand across the country to help you and can assist wherever you are based. Please call Louise Kerr on 07720 090 063 for a no obligation, initial discussion or email Louise at email@example.com.
Cartwright King has offices in: