Appeal Panel Format

[Cornishman]

Hello everyone

Just a quick request for feedback from anyone familiar with a CHC Appeal Panel.

We've just had notification of our Appeal Panel date with the CCG following my mum's withdrawal of eligibility for CHC. It'll take place later this month.

I think we're reasonably well prepared in terms of our challenge to the DST markings and the general conduct of the process (for instance, they took a full year after assessment to make a decision to withdraw mum's CHC funding).

The letter from the CCG doesn't provide any additional information other than date / time and a map of the venue - nothing about composition of the panel, how much time we're allocated or how the panel is run.

So my questions to the forum are as follows please:

Likely composition of the panel (who / how many people etc?) Is it fairly formal or informal? (Although in either case, I intend to be very "businesslike" - been there before, caught out by "smiling hyenas"!)

Whether it's a passive or active engagement? (do they usually just take a "the floor is yours approach" or adopt a more "interactive" discussion?)

Anything else / your top-tips

I appreciate these things must vary by CCG, so recognise any info provided will not necessarily apply. Indeed, I think with some CCG's, we wouldn't even be in this position, but this CCG are particularly obtuse and think they're above the NHS' own framework document. For that reason, I don't hold out a lot of hope at this stage, so if necessary we will battle on towards IRP, the Ombudsman and even legal action.

Many thanks as ever.

 

[Cornishman]

Bumped to the top please

Is there really no one out there who's been to a CHC appeal panel?

Would be grateful for any info, even if only a partial answer to my original questions please.

In the last couple of days I've asked the CCG for this information, but based on previous experience, they are not overly helpful over anything very much.

Many thanks as ever.

 

[2jays]

I'm sorry I don't have experience of this, but did wonder if you had read CRAIG which sets out the legal responsibilities that they have to follow whether they want to or not.

It's a huge document and does take some reading, but I know that it has been suggested so many times on here when others have had problems getting chc

Sorry I can't be more help

 

[nitram]

Not what you asked but maybe helpful and will give you a bump!!

From a FOI request

9. How many people sit on your CHC panel? How many are health staff
(e.g. nurses) and how many are social care staff (e.g. social
workers)?

Two NHS and two Local Authority representatives.

https://www.whatdotheyknow.com/request/chc_applications_9

 

[sue38]

Have you tried the CHC Volunteer Support Group?

 

[nitram]

Terms of reference for Somerset PCT
http://www.somerset.nhs.uk/EasysiteWeb/getresource.axd?AssetID=522&type=full&servicetype=Attachment

 

[2jays]

Have you read NHS continuing care thread by Busterpen? Maybe that will help answer some questions

 

[Cornishman]

Thank-you everyone.

I'll check out the references - I think the 2xCCG and 2xLA SS is likely as indicated - even that seems a bit OTT given we're limited to 2.

Just over 2 weeks away now - I think we've a compelling case which builds upon the extensive evidence we presented in response to the draft DST just prior to their decision to withdraw Mum's CHC eligibility. Although most of our very detailed response was ignored, it doesn't alter it's validity. Indeed, the very fact most was ignored serves to strengthen our case, if anything.

Grateful for all your kind responses.

Many thanks

 

[Egeon]

Cornishman,
Be aware: They can't take away funding up to IRP and not before, until that full process has been completed as long as you keep the dispute process going

 

[Cornishman]

Egeon

Thank you for your response.

Your advice was correct at one time, but sadly that is no longer the case. Individual have to pay while the appeals process continues.

The CCG just wrote to us last August saying funding would be removed 28 days later and any invoices received would be sent on to me.

With indecent haste the care home sent me a bill for the first month the next day: £5565.

Oh - and another invoice for £3 for toiletries not included in above.

Of course, we've been paying £5565 per month since - no choice really.

Not forgetting we'd already paid out as self-funders some £180,000 in the period 2003 (first admission to CH) to 2009 (granted CHC funding).

They took CHC eligibility away from my mother in August 2013 based on an assessment they undertook in August 2012 (yes - a full year - supposed to be 28 days).

Appeal panel next Wednesday.

Thanks for your input. VERY happy to be corrected re not paying while appeal progresses, but I'd need a current and authoritative source please.

 

[Egeon]

Egeon

Thank you for your response.

Your advice was correct at one time, but sadly that is no longer the case. Individual have to pay while the appeals process continues.

The CCG just wrote to us last August saying funding would be removed 28 days later and any invoices received would be sent on to me.

With indecent haste the care home sent me a bill for the first month the next day: £5565.

Oh - and another invoice for £3 for toiletries not included in above.

Of course, we've been paying £5565 per month since - no choice really.

Not forgetting we'd already paid out as self-funders some £180,000 in the period 2003 (first admission to CH) to 2009 (granted CHC funding).

They took CHC eligibility away from my mother in August 2013 based on an assessment they undertook in August 2012 (yes - a full year - supposed to be 28 days).

Appeal panel next Wednesday.

Thanks for your input. VERY happy to be corrected re not paying while appeal progresses, but I'd need a current and authoritative source please.

If the NHS were paying at the time you put in the appeal/dispute, then they should be still paying. They will fob you off and mislead you but that is the case
NF 2012 Page 140
"Arrangements to ensure individuals get the care/support they need whilst disputes are being resolved, bearing in mind the principle of ‘no unilateral withdrawal of funding’."

This is from Sheffield Dispute Resolution procedure 2008
"4.2 Pending resolution of a Dispute, there should be no delay to the provision of appropriate care for the individual Service User. At no point during the process may either the PCT or the Local Authority unilaterally withdraw from an existing funding agreement.
4.3 Where a Dispute arises, the Partner Organisation funding the arrangements in place at the time that the Service User is assessed by the MDT will continue with the funding on an interim basis (and without prejudice to their position) until the Final Resolution Date."

This won't be the most up to date one and probably not your area! But if you search for a Dispute Resolution Procedure for where you are, you should find the most up to date one with very similar words in it.

 

[Cornishman]

Thanks Egeon - Only just caught up with your message. Been doing appeal preps.

I'll check it out.

Many thanks

 

[BeckyJan]

Sorry not to have replied earlier.
On your initial question I can only answer on my own experience. I had no idea what the format would be other than the SW opted out at last minute and one of the Senior Care Assistants at the Home would be there. So it consisted of two peer group assessors (from another area), plus the CH Asst and myself.

I went fairly businesslike clutching brief case with relevant papers.
The two nurses were lovely and very friendly but not 'giving' too much. I had no idea of the time scale but everything was discussed in great detail. The Asst gave wrong information about number of falls which I questioned so he was sent off to get relevant paperwork - his 8 falls in a month was in fact 28!

I did get them on 'if in doubt take the higher score' - my knowledge on that surprised them.

After 5-1/2 hrs they agreed that there was likely to be a case and it would go the Panel (I was not allowed there). The result came back after about 5 weeks.

I did not argue on every point, only when it mattered.

I wish you luck.

 

[FifiMo]

In case there is some confusion, I'd like to point out that the dispute resolution process that Egeon (post 11 above) is talking about when quoting the Sheffield doc, is when there is a dispute between the NHS/PCT-as-was and a Local Authority. For example, when someone is refused CHC by the NHS - BUT the LA feels that that person should be receiving CHC, the LA is obliged to enter into a dispute with the NHS. That’s the one that the Sheffield doc is all about. Paragraph 4.2 and 4.3 which Egean has quoted explain this particular dispute procedure when there is a difference of opinion between the NHS and the Local Authority. Under those circumstances, provision of care MUST continue - for obvious reasons.

This is totally different to the kind of dispute that most people who are refused CHC by the NHS are involved in.

If the LA agrees with the NHS decision to refuse CHC, the applicant can dispute that, but he/she will need to enter into a completely separate and different dispute procedure. As written into the National Framework - that dispute procedure does not involve the Local Authority as such, because the individual is disputing the decision made by the NHS.

Hope this helps clear up any potential misunderstandings.

Fiona

 

[Cornishman]

Thank you for your input Fiona.

Given we had self-funded my mother 2003 to 2009 (when she was at last deemed eligible for CHC) but have since started paying again after the completely unjust removal of CHC through totally dysfunctional processes, this is a subject I take a close interest in.

My research and understanding is that you are absolutely correct. In addresses the situation where, had the LA disagreed with my mother's withdrawal of funding, not least as one day they'll finish up paying, there should be no unilateral withdrawal by the NHS.

Where they are in collusion and "agree", then the individual has to pay, even through the appeals process.

As probably others have found, there's a "conspiracy of cooperation" between the NHS and LA, because they both know in many cases, neither will be paying. Which explains why, in our case, the LA just rolled over and signed the Joint Decision letter put in front of them by the NHS, even though they were using evidence over 12 months old. They should have refused to sign it, but of course are more keen to have a nice working relationship with their pals with whom they share an office, than worry about a poor person in a CH, even where in doing so they are acting unlawfully and not acting in the person's best interests.

 

[Egeon]

In case there is some confusion, I'd like to point out that the dispute resolution process that Egeon (post 11 above) is talking about when quoting the Sheffield doc, is when there is a dispute between the NHS/PCT-as-was and a Local Authority. For example, when someone is refused CHC by the NHS - BUT the LA feels that that person should be receiving CHC, the LA is obliged to enter into a dispute with the NHS. That’s the one that the Sheffield doc is all about. Paragraph 2.3 and 2.4 which Egean has quoted explain this particular dispute procedure when there is a difference of opinion between the NHS and the Local Authority. Under those circumstances, provision of care MUST continue - for obvious reasons.

This is totally different to the kind of dispute that most people who are refused CHC by the NHS are involved in.

If the LA agrees with the NHS decision to refuse CHC, the applicant can dispute that, but he/she will need to enter into a completely separate and different dispute procedure. As written into the National Framework - that dispute procedure does not involve the Local Authority as such, because the individual is disputing the decision made by the NHS.

Hope this helps clear up any potential misunderstandings.

Fiona

Yes, my mistake, that Sheffield doc is re dispute between NHS and SS. But the same applies to disputes between individuals and the NHS. The funding that was in place at the time of the dispute continues. I think it may be under the Local Policy protocols but it is there to be found and used.

 

[Cornishman]

Egeon

As somebody who has had to start paying CH fees again after 4 years of CHC eligibility being taken away, I'd love you to be right.

But sadly I think the former arrangement of not having to pay while in dispute and going through appeal etc no longer applies.

I can't find anything to confirm your belief the NHS shouldn't have withdrawn funding in this circumstance, so would really appreciate a definitive source document please.

Many thanks.

 

[Egeon]

Egeon

As somebody who has had to start paying CH fees again after 4 years of CHC eligibility being taken away, I'd love you to be right.

But sadly I think the former arrangement of not having to pay while in dispute and going through appeal etc no longer applies.

I can't find anything to confirm your belief the NHS shouldn't have withdrawn funding in this circumstance, so would really appreciate a definitive source document please.

Many thanks.

What area are you in, I might possibly be able to find one for you?

 

[Cornishman]

Hi Egeon

I've sent you a PM.

Regards

 

[Brodie]

cornishman - I think your appeal is tomorrow?? - so just wanted to wish you all the best for tomorrow.

please let us all know who you get on.

regards
brodie.