How to Make An Appeal against a NHS Continuing Care Assessment Decision

What Is NHS Continuing Health Care?

In England, NHS Continuing Health Care (NHSCHC) is care funded by the NHS. It is available for people aged 18 and above and is provided to meet physical or mental health care needs that have arisen through disability, accident or illness. NHSCHC is care that takes place away from a hospital.NHSCHC funding is non-means tested. 

Care can be provided in your home or in residential accommodation. For more information on NHSCHC funding see my article here. For much more information go to the website of Care to Be Different. This is an absolutely outstanding resource for anyone having to deal with the arcane complexities of Continuing Health Care Funding.

How to Appeal Against a NHSCHC Assessment Decision

Following your full needs assessment for NHSCHC you should be sent a written explanation of the decision. If you are assessed as being not eligible, you should also be told how you can make an appeal. In short, there are three appeal opportunities.

1. Review by the Local Clinical Commissioning Group (CCG)

Your first appeal is to ask the CCG to review the decision. Each CCG may adopt a different procedure. However, details of each CCG's procedure should be publicly available, a copy of which you can request from your CCG. CCG's should deal with all requests for reviews promptly, but, sadly, you will find many stories of delays.

2. Review by an Independent Review Panel

If you are unsuccessful in your local review, your next step is to appeal to an independent panel. To do this you need to appeal in writing to NHS England. The review panel will meet locally.

3. Appeal to the Ombudsman

If you are unsuccessful at the independent review, you can refer your case to the  Parliamentary and Health Service Ombudsman (PHSO). The letter you receive informing you of the independent review panel's decision should explain how your can refer the matter to the Ombudsman.

Further Information

The information in this article is deliberately brief. You can find more details in this document produced by Age UK. Also, the Care to Be Different website is excellent.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.