NHS Continuing Healthcare
What is NHS Continuing Healthcare?
NHS Continuing Healthcare is a package of care arranged and funded solely by the NHS. A person may be eligible for this if their needs are primarily related to their health rather than their social needs. This could include if a person’s medical condition is unstable or unpredictable and means that they need constant round the clock specialist care.
What are the rules that govern NHS Continuing Healthcare?
There is a National framework based on best practice principals where a person’s needs are assessed over twelve different domains.
Who is assessed for Continuing Healthcare (CHC)?
Before being discharged from hospital everyone should have an assessment carried out by the hospital staff using a checklist. The checklist will determine whether a full CHC Assessment should be carried out or not. If a full CHC assessment is thought to be needed a Decision Support Tool Assessment will be undertaken assessing the person’s needs over the twelve different domains with input from people providing the person’s care and the family.
Am I entitled to see the decision?
A copy of the assessment together with the decision and the reasons for arriving at that decision should be made available to the person who is the subject of the decision and/or their legal representatives.
Can I appeal the decision of the Clinical Commissioning Group?
Yes, the person who needs the care or someone on their behalf at any stage can appeal the decision of the Clinical Commissioning Group. Here at Norton Peskett we have a specialist team who can assist you if you decide to appeal the decision of the Clinical Commissioning Group. You can challenge in the following circumstances:-
- The person has been denied NHS Continuing Healthcare funding but you believe the decision is wrong and you wish to appeal this.
- The person was receiving NHS Continuing Healthcare funding and has now been assessed as no longer being eligible.
All appeals must be submitted within 6 months of the date of non-eligibility.
What if the person should have been receiving NHS Continuing Care but was never assessed?
You can apply to the Clinical Commissioning Group for a retrospective review if someone has not been assessed for NHS CHC before. You can also do this if the person in question has since died. However, such a claim can now only be made back to 31 March 2012.
A specialist from Norton Peskett will meet with you as soon as possible to discuss the matter and offer their opinion on whether or not we believe the person should qualify for NHS Continuing Healthcare Funding. If you decide to proceed we can arrange for our own expert to visit the person requiring care to carry out a reassessment. Once this has been carried out our expert will prepare a full report on how to proceed. We can also arrange for our expert to represent you at any future independent review panel, if you wish.
How much will it cost?
In some cases, for example where the person or estate has suffered a loss because they were told that they were not eligible to CHC funding, we will be able to act for you on a no win no fee basis. In other cases where we might act for you on a recent appeal we would act for you on a fixed fee basis. We will discuss the fees with you before commencement as each case is dealt with individually.
Why use a solicitor?
We have a team of trained specialists dealing with these cases on a daily basis who have an in-depth knowledge of the process and the law in this area. We will be able to tell you, from the information that you give us initially whether you should proceed with an appeal or a retrospective review. If we agree to proceed we will guide you through the process and collate any necessary evidence to support our argument before sending this to the Clinical Commissioning Group. We will ensure that you are fully supported throughout the process.