WE WON OUR APPEAL for Fully Funded NHS Continuing Health Care (CHC)!!!

[susankell]

Dear All

I just wanted to give you all the good news that our appeal for CHC was upheld by the Independent Review Panel (IRP) that met in November of last year. This was almost 2 and a half years after we first applied for CHC and almost a year after Dad passed away. The IRP concurred with our assessment of the DST Needs on 8/11 of the domains. They gave 1 Severe rating, 5 High and 5 Moderate in comparison to our PCT's ratings (which we knew were incorrect) of 3 High, 4 Moderate, 2 Low and 2 No Needs!!!

I would encourage anyone to persevere with an appeal if you feel an incorrect assessment has been made. Despite how long it took for us to get this result and the many hours/days/weeks/months I laboured over the initial appeal to the PCT and then the appeal to the IRP I feel vindicated!

I am not sure what the actual outcome means yet as the IRP sent their report to the Clinical Commissioning Group (CCG) and they were supposed to follow up with my brother (as I have returned to Australia) within a month. I have not had a chance to speak to my brother yet as he is overseas but I will keep this forum informed of the final outcome.

Thank you so much to those of you who supported me through this and especially to the Alz Soc volunteer who assisted me with the initial appeal.

Best wishes to everyone, Susan

 

[Wolfsgirl]

Well done Susan on keeping this battle up for so long t must have been very hard on you. It is great to have a benchmark too!

Dear All

I just wanted to give you all the good news that our appeal for CHC was upheld by the Independent Review Panel (IRP) that met in November of last year. This was almost 2 and a half years after we first applied for CHC and almost a year after Dad passed away. The IRP concurred with our assessment of the DST Needs on 8/11 of the domains. They gave 1 Severe rating, 5 High and 5 Moderate in comparison to our PCT's ratings (which we knew were incorrect) of 3 High, 4 Moderate, 2 Low and 2 No Needs!!!

I would encourage anyone to persevere with an appeal if you feel an incorrect assessment has been made. Despite how long it took for us to get this result and the many hours/days/weeks/months I laboured over the initial appeal to the PCT and then the appeal to the IRP I feel vindicated!

I am not sure what the actual outcome means yet as the IRP sent their report to the Clinical Commissioning Group (CCG) and they were supposed to follow up with my brother (as I have returned to Australia) within a month. I have not had a chance to speak to my brother yet as he is overseas but I will keep this forum informed of the final outcome.

Thank you so much to those of you who supported me through this and especially to the Alz Soc volunteer who assisted me with the initial appeal.

Best wishes to everyone, Susan

 

[carastro]

Well done, I have not heard of many people winning on this issue, they always seem to wriggle out of it even when it is blatantly obvious that CHC is needed.

It is also difficult battling with unfamiliar bureaucracy.

Carastro

 

[BeckyJan]

Good Having been through similar I know exactly how much hard work you have put into this. Also pleased the AS Volunteer Support Group were helpful - they did indeed guide me through it too.

Well done!

 

[Cornishman]

Hi Susan

Just to say I'm very pleased to hear of your success - well done on your perseverance.

We're in the midst of all this - my mother was granted CHC in 2009 (after we were self-funding for the previous 6 years), but after an assessment in August 2012, they told us 12 months later in August 2013 that her eligibility was being withdrawal the following month. The DST was contrived to ensure she was just on the wrong side of "not eligible". Scandalously they took a year to tell us, instead of doing what the NHS Framework document mandates which is assessment to decision should not exceed 28 days. For example, my mother became totally bed bound in that time, but when we complained they refused to recognise anything other than what they assessed in August 2012 - "talk to the hand" being their style for the most part.

An appeal was submitted last week. We've spent many many hours poring over care home notes etc etc, and our case is compelling to any right thinking person. And hopefully an IRP too if it gets to that.

I'm confident we'll succeed, and stories like yours give me heart and encouragement to keep fighting this injustice.

Best Wishes

 

[blandford516]

Hi Susan ,

Well done and congratulations . You have given me hope to carry on with my mums appeal for CHC . We are the Independent Panel stage . brilliant news but also sad that we all have to fight !!
Best Wishes x

 

[susankell]

CHC Appeal - Good Luck!

Hi Cornishman

You would know then that one of the issues we had was the total failure of the PCT to adhere to the Guidelines! They treated our appeal as if it wasn't worth bothering with and they were taken to task over that by the IRP. The IRP also advised us to put in a retrospective claim for the 2012 period as what we didn't know was that the appeal only covered the period Aug - Dec 11. They have basically said we will win if we claim retrospectively. It is such a relief to discover the members of the Panel are true professionals who listened to what we had to say and agreed with us! In stark contrast, I found those dealing with the original assessment and appeal incompetent, unprofessional and clearly didn't understand the guidelines themselves!

I wish you the best of luck with your appeal and I am sure you will win!

Regards,
Susan

Hi Susan

Just to say I'm very pleased to hear of your success - well done on your perseverance.

We're in the midst of all this - my mother was granted CHC in 2009 (after we were self-funding for the previous 6 years), but after an assessment in August 2012, they told us 12 months later in August 2013 that her eligibility was being withdrawal the following month. The DST was contrived to ensure she was just on the wrong side of "not eligible". Scandalously they took a year to tell us, instead of doing what the NHS Framework document mandates which is assessment to decision should not exceed 28 days. For example, my mother became totally bed bound in that time, but when we complained they refused to recognise anything other than what they assessed in August 2012 - "talk to the hand" being their style for the most part.

An appeal was submitted last week. We've spent many many hours poring over care home notes etc etc, and our case is compelling to any right thinking person. And hopefully an IRP too if it gets to that.

I'm confident we'll succeed, and stories like yours give me heart and encouragement to keep fighting this injustice.

Best Wishes

 

[susankell]

Chc

Thank you all for your kind comments.

I hope it helps others to continue the battle although it grieves me to say it is a BATTLE. This should not be the case. The CHC Guidelines were developed to assist the process NOT hinder it which sadly seems to happen all too often.

Good luck to all who have to appeal against unjust and, often, unfounded decisions by people not competent enough to make the correct decision.

Susan

 

[Saffie]

That is good news so well done for your perseverance. It paid off in the end.
You must feel totally vindicated. I hope that now you can relax a little!

 

[Izzy]

Great news!


Sent from my iPad using Talking Point mobile app

 

[Austinsmum]

That's fantastic news Susan. Very, very, well done for persevering.

 

[Brodie]

that is really fantastic - even though it took you 2 years and alot of hard work it is so great to hear about a positive outcome out of this truly awful process.

clare

 

[Rheme]

Congratulations on a good result.

 

[littlegem]

Well done, so good to hear of someone getting what is truly deserved.

 

[geum123]

Congratulations Susan.

I used specialist solicitors to make a retrospective claim for my Dads Nursing Home fees
and was successful.

It's good to let people know that it is possible, no matter what the so called professionals say.

 

[grove]

Well done & many Congratulations Susan ! , I'm so pleased you & your Brother 's hard work paid off & its good to hear somebody getting what they truly deserve


Grove x

 

[Cornishman]

Hi Susan

Thanks for that additional info - even more encouraging.

The whole episode has dragged along for almost 18 months now, and my constant thought in the background whilst we've been dealing with the people in the CHC team of the CCG has been along the lines of "if only we could get somebody sensible to look into this - it would take them 1 minute to see how non-compliant and devious the CCG are being, and how unjustly my mother is being treated..."

Coincidentally I had an acknowledgement of receipt of our appeal letter today. The letter also offers a pre-appeal "conciliation" meeting with a senior member of the CHC team, but based on our experiences to date of arrogance, lies and flagrant disregard for the NHS' own guidelines, we're likely to decline.

I anticipate we might get "knocked back" at appeal (they did nothing about our complaint, even though they were clearly in breach of the framework document), so with an attitude like that, I'm not expecting them to change during the appeal process.

Thanks again for the update.

Best Regards