Status of CHC Funding whilst appealing against withdrawal of funding

[Blancr]

Hi Everyone,
I'm new here so bear with me! Also new to the nightmare world of Alzheimer's and its care funding.

I'm supporting a long term and dear friend who, back in July, was awarded CHC funding for which we were all very grateful. Despite her condition worsening, funding is to be withdrawn after her three month review.

The case for appeal is particularly strong so I will press ahead with that. Someone mentioned that if an appeal is lodged quickly, then CHC must continue to fund until the appeal is heard. However, I can find no mention of this anywhere and wondered if anyone had a definitive view on this?

Thanks for any thoughts and good luck with your challenges (this is one tough row to hoe!)
Blancr

 

[nitram]

If, at the time of referral for an NHS continuing healthcare assessment, the individual is already receiving an ongoing care package funded by the Board or a CCG, or an LA, or both, those arrangements should continue until the Board or CCG makes its decision on eligibility for NHS continuing healthcare

Appendix F clause 3 National Framework

https://www.gov.uk/government/uploa...al-Framework-for-NHS-CHC-NHS-FNC-Nov-2012.pdf

 

[jaymor]

I would say ring your local CCG and ask them. I always found them really helpful.

 

[Blancr]

Hi Nitram - exactly what I was looking for - thanks a lot!

Thanks Jaymor - tried that. They just brushed me off with "Funding stops until after the appeal".

Blancr

 

[Blancr]

Hi Nitram - exactly what I was looking for - thanks a lot!

Thanks Jaymor - tried that. They just brushed me off with "Funding stops until after the appeal".

Blancr

Hi Everyone,
Well - I tried Appendix F Clause 3 and got another brush off. The wording is a little ambiguous so if anyone has any experience of going into bat with it I would be grateful to know how you got on.

"those arrangements should continue until the Board or CCG makes its decision on eligibility for NHS continuing healthcare"

These words seem to be problematic to me. Are they saying that payment must continue until the appeal has been heard or, as in my case, are they saying "we have made our decision so funding stops but if you are successful in the appeal we will refund?"

Any thoughts or experience gratefully received.
Regards
Blancr

 

[nitram]

"...we have made our decision so funding stops but if you are successful in the appeal we will refund?"

That would be my interpretation, they have made a decision and CHC eligibility has ceased.

 

[Blancr]

"...we have made our decision so funding stops but if you are successful in the appeal we will refund?"

That would be my interpretation, they have made a decision and CHC eligibility has ceased.

Thanks Nitram.

That is certainly the view they are taking. But with regard to the Appendix itself - why include the word 'Disputed'? So in our case a continuing care package is in place. A decision to end funding on Jan 6th has been taken and we have lodged an appeal supported by a very strong written case i.e. we are disputing the decision in circumstances where a care package is in place.

If the CCG can simply take a decision to cease funding without regard to a dispute then the purpose of Appendix F is lost on me.

Perhaps I'm misunderstanding the purpose of Appendix F?

Thanks for any further thoughts.
Blancr

 

[nitram]

"But with regard to the Appendix itself - why include the word 'Disputed'?"

The appendix title is Guidance on responsibilities when a decision on NHS Continuing Healthcare eligibility is awaited or is disputed and as such it covers all cases whether or not there is a dispute and whether or not the assessment is an initial one or a review.

In your case where, as the result of a review, CHC funding has been withdrawn it says that if you launch a successful appeal funding will be renewed and backdated to the date of withdrawal. If CHC is reinstated there is no guarantee that the resultant care package will be the same.

 

[Blancr]

Ok Nitram - thanks - I get it now.

Thanks for the help
Regards
B

 

[Blancr]

Update on Appeal

Just in case this is of any interest to anyone:

We won our appeal (much to my surprise!) and I thought it might be worth setting out the points that seemed to make a difference (according to the Appeal Team).

Worth noting that the assessment quite clearly did not follow the prescribed procedure so we had quite strong grounds for the appeal.

1 - We made it clear that we understood the real challenges and constraints under which the CHC had to work.
2 - We were very calm in our manner and forensic in the evidence we submitted.
3 - We wrote as objective a report as we could (avoiding any hint of exaggeration) that evidenced all the key defects in the assessment.
4 - The Appeal team made the point that because they did not know the person in question, they relied upon the data provided by the Assessor, the nursing home notes and the routine care plan. This allowed us to make two key points a) The assessment was so defective as to render any data collected unreliable and b) we provided evidence to show that the nursing home notes and assessments were also unreliable. This notion seemed to come as something of a shock to the Appeal Team i.e. they just assumed any data put in front of them to be accurate. The realisation that it might not be (and clearly wasn't in this case) seemed to surprise them.

What I have learned from this experience is that CHCs are very skilled at deflecting any claims that lack clear objective evidence. More particularly the evidence must be presented in the correct manner. Getting angry (which is very easy to do!!) will achieve nothing even if you have good evidence.

Hope this helps - happy to chat if needed.
Blancr

 

[nitram]

Congratulations, your determination and hard work paid off!!

Your experience reinforces that, as I have often stated, well substantiated evidence is crucial.

 

[Shedrech]

well done Blancr
that must be such a relief
and your insight will be of interest to many
in fact may I be cheeky and ask if you could add this post (just copy and paste) onto the thread that is dedicated to CHC so that your hard earned experience will be available to an member looking on that thread; here
https://forum.alzheimers.org.uk/showthread.php?86059-CHC-(Continuing-Healthcare)-support-thread&p=1383494&highlight=continuing+HCH#post1383494
or I'd be happy to do it if you don't mind
very best wishes

 

[Toddleo]

Well played Blancr - please to hear of your success.

 

[Blancr]

Thanks for your kind words everyone.

Shedrech - by all means paste my post elsewhere if you think it will help. I'd do it myself but I find using these forums nearly as difficult as dealing with the CHC!!

I wondered if a suitably redacted copy of our appeal document (or relevant bits of it) might be of use to anyone?? If you think it might be helpful I'll figure out how to attach the file!

Best
Blancr

 

[LizK]

Thank you Blancr. It would certainly be useful to me!

Liz

 

[nitram]

The file may be too large, limits are:-
3.81MB PDF
293.4KB other files

If too large you could do a free upload to http://www.tinyupload.com/index.php and post a link.

 

[Blancr]

Here's the redacted file

Hope it helps

Blancr

 

[LizK]

Thank you so much Blancr for the file. I read it through and have now printed it so I can read it more carefully. Such incompetence from the assessor: it's almost unbelievable. It's very useful to me, but depressed me a little as I haven't the obvious injustice to fight against as you had.

Thank you once again for taking the trouble to publish the file, Liz

 

[Blancr]

Hi LizK,

Glad you found it of some help. If you have no obvious grounds for appeal then I guess you are stuck. However, I was surprised by the inaccuracy of the Nursing Home record keeping. The CHC will just take those records as 'Gospel'. We had to do quite a lot of digging to unearth 'the truth' and to get a complete picture of what was actually happening as opposed to what the records said.

I wish you well with your situation and let me know if you have any specific questions I might be able to help with.
Blancr

 

[LizK]

May I just say that of all the paperwork I have been sent regarding CHC funding, your file is the of the most use to me. I guess it's because paperwork is just words, but when the words relate to a person and their degree of deterioration, it's much easier to relate to your relative's situation. My assessment was only 2 weeks ago but the assessor said I wouldn't get funding for my husband as he wasn't into the next category since the last assessment 6 months ago. I must wait until I hear finally, but I find it difficult to accept, as at the last full assessment he wasn't on any medication. Since then he has been prescribed an anti psychotic drug due to his violence and agitation, which has been increased x 4 over the months since the last assessment. He is also given a sedative so that carers can approach him to wash and shave him. The GP said that he is dangerous and the psychiatrist said that he was in the severe category of AD. He is doubly incontinent, can't communicate or feed himself and has limited mobility. How ill do you have to be to qualify for funding?

Thanks once again to Blancr and I must say my admiration for such an articulate presentation of facts.

Liz