CHC "appeals" Companies Heros or Villans? (or just money pits?)

[333pjb]

I know there is a lot of comment and post concerning this subject, and I appologise to break the thread.
However, it is now 59 pages long so much of the information is burried deep.
so I would like to invite any who have up-to-date experiences to comment...

We received the standard “didn’t find a primary healthcare need” but you can have the consolation prize of NHS funded healthcare (£233/wk). The assessors started to pack up and the social worker began the “it will need to go to brokerage” talk and, “it is likely that we will probably have to move Dad to a cheaper home.”

Process was flawed, predetermined outcome steered by NHS finance department.
So obviously unrepresentative and unfair you immediately look for who can help in this very niche area.

I looked at 2 offering with two different approaches:

• A proper solicitor who specialises in CHC appeals we’ll call ”FD”
• A “team” company prompted as 1st search hit on the web we’ll call “C”

FD solicitors will assist you in preparing an appeal document, go over it can strip out all that will not really make any difference. They will make sure what you supply has sufficient emphasis and uses the correct “terms” so you don’t undermine your own case.
They cannot "represent" you or if they do it's the £200/hr plus expenses

In summary you do a lot of the work, they oversee and help prepare. You do your own appeal (if it comes to that)

Cost for this £2K + VAT


“C” seems to have more direct approach, Reminiscent of PPI mis selling offers “we’ll do it all for you”. They talk about getting the "blows" in first, shocking the other side by demanding full patient records and medical documents immediately. They boast of “Fast Tracking” appeals and how they can create such pressure that sometimes the NHS CHC do “U turns” and change decisions. They state all they need is the next-of-kin’s consent and they can produce their responses in weeks so fast the CHC doesn’t have time to prepare.

Cost for this £6800 up front (before any work starts)

If they had to represent you that's another £7K


My questions:

Has anybody had direct experience of working with a “CHC appeal” company, and did your experience lead you to feel it was money worth spending?

Is doing most of it yourself easier (e.g. accessing documents), will they know enough about your case?

Do these “fast track” services actually work, or are they a method just to “bounce” the other side into not being able to respond within the timeframe, and as such win by default?

Are there any guarantees?

Is the knowledge of the “way things work” and the “short cuts” bragged about by “C” actually an advantage?

I have been told the system is deliberately complicated and contradictory so to confuse and without the involvement of one of these companies things will take much longer and possibly not conclude before the parent dies. Is this true by any bodies experience?

“C” indicated that THEY could get hold of Hospital records, GP Records, Care home files and the various NHS reports with no difficulty, is this true?


For many considering the loss of all assets their parents have saved over a lifetime this is a tempting prospect , but is there a way through without such expense?

 

[Jaded'n'faded]

No experience but I do have a few thoughts!

With the solicitor, can you ask how many cases they have taken on and what their success rate has been? Wouldn't be a bad idea to ask the C company either.

Do either do an initial assessment of everything first and advise you whether they think you have a good case before proceeding? This would hopefully be without incurring the full cost.

Is the knowledge of the “way things work” and the “short cuts” bragged about by “C” actually an advantage?

Yes, to an extent. Their plan to start by demanding all the notes/records is probably a good one because hospitals, SS, and others are notoriously bad at record keeping. Often the records are incomplete or inaccurate so your company can turn round and say, 'Aha! You didn't get this right so your decision to refuse CHC is flawed!' I think you're right that SS often get a bit scared when the professionals are brought in and also that cases are often overturned due to procedural errors.

Hopefully others can offer direct experience...

 

[pandion]

I know there is a lot of comment and post concerning this subject, and I appologise to break the thread.
However, it is now 59 pages long so much of the information is burried deep.
so I would like to invite any who have up-to-date experiences to comment...

We received the standard “didn’t find a primary healthcare need” but you can have the consolation prize of NHS funded healthcare (£233/wk). The assessors started to pack up and the social worker began the “it will need to go to brokerage” talk and, “it is likely that we will probably have to move Dad to a cheaper home.”

Process was flawed, predetermined outcome steered by NHS finance department.
So obviously unrepresentative and unfair you immediately look for who can help in this very niche area.

I looked at 2 offering with two different approaches:

• A proper solicitor who specialises in CHC appeals we’ll call ”FD”
• A “team” company prompted as 1st search hit on the web we’ll call “C”

FD solicitors will assist you in preparing an appeal document, go over it can strip out all that will not really make any difference. They will make sure what you supply has sufficient emphasis and uses the correct “terms” so you don’t undermine your own case.
They cannot "represent" you or if they do it's the £200/hr plus expenses

In summary you do a lot of the work, they oversee and help prepare. You do your own appeal (if it comes to that)

Cost for this £2K + VAT


“C” seems to have more direct approach, Reminiscent of PPI mis selling offers “we’ll do it all for you”. They talk about getting the "blows" in first, shocking the other side by demanding full patient records and medical documents immediately. They boast of “Fast Tracking” appeals and how they can create such pressure that sometimes the NHS CHC do “U turns” and change decisions. They state all they need is the next-of-kin’s consent and they can produce their responses in weeks so fast the CHC doesn’t have time to prepare.

Cost for this £6800 up front (before any work starts)

If they had to represent you that's another £7K


My questions:

Has anybody had direct experience of working with a “CHC appeal” company, and did your experience lead you to feel it was money worth spending?

Is doing most of it yourself easier (e.g. accessing documents), will they know enough about your case?

Do these “fast track” services actually work, or are they a method just to “bounce” the other side into not being able to respond within the timeframe, and as such win by default?

Are there any guarantees?

Is the knowledge of the “way things work” and the “short cuts” bragged about by “C” actually an advantage?

I have been told the system is deliberately complicated and contradictory so to confuse and without the involvement of one of these companies things will take much longer and possibly not conclude before the parent dies. Is this true by any bodies experience?

“C” indicated that THEY could get hold of Hospital records, GP Records, Care home files and the various NHS reports with no difficulty, is this true?


For many considering the loss of all assets their parents have saved over a lifetime this is a tempting prospect , but is there a way through without such expense?

Hi @333pjb, have you looked up Beacon CHC?
https://beaconchc.co.uk/how-we-can-help/free-information-and-advice-on-nhs-continuing-healthcare/

I've not used them but was recommended to if appealing. They can give free information and advice. I would try them first before shelling out on solicitors and random companies...

 

[Jessbow]

in my eperience, they are money pits.
If your primary HEALTH need is obvious enough you'll get it.
your shouldnt need to pull out endless records and reports to prove anything

I got it for my Mother, without the need for any solicitor or advocate- she passed away 10 years ago now.

Have Just succeded again for my mother in law, who is cared for at home and doesnt have dementia

 

[Dave63]

Has anybody had direct experience of working with a “CHC appeal” company, and did your experience lead you to feel it was money worth spending?

We used the FD firm of solicitors. £3.5k for collation and review of medical records by a CHC qualified nurse and another £3.5k for representation at the appeal. This was over the period 2022/2023, so the pricing and services they provide may well have changed. We found them very open and transparent and never gave any guarantees about outcomes. If a company is providing guarantees I would steer well clear.

From checklist to appeal took just under four years with FD taking over for the last year. They knew their stuff and I don't believe we would have been successful without their help. As for money worth spending? £7k which paid for itself with six weeks of care home costs.

Is doing most of it yourself easier (e.g. accessing documents), will they know enough about your case?

The difficult bit is not acquiring the documents, it's ensuring the people responsible for care records are keeping them up to date and that they log everything. Some care homes/medical professionals are better than others. Poor record keeping will make or break your case.

One of my biggest gripes during the process was that they will only look at 6-8 weeks of records. Imagine looking at a painting through a straw, you'll never see the whole picture. That's basically what every CHC assessment does, so it's hardly surprising so many result in not eligible when the whole picture has not been considered.

Do these “fast track” services actually work, or are they a method just to “bounce” the other side into not being able to respond within the timeframe, and as such win by default?

If there are companies who can 'fast track' the process it's news to me. If they have given you the impression that a failure in process will lead to success they're lying. Failures in process have absolutely no impact on eligibility, the only thing which has an impact is proving a primary health need. Failures in process are dealt with seperately via the complaints procedure and will only result in an apology, not funding.

Are there any guarantees?

Never.

Is the knowledge of the “way things work” and the “short cuts” bragged about by “C” actually an advantage?

Knowledge is everything and everything you need to know is within the National Framework. As I mentioned before, if there are 'shortcuts' then it's news to me. I think I know who "C" is and I know nothing about them but my first thought is snake oil saleman.

“C” indicated that THEY could get hold of Hospital records, GP Records, Care home files and the various NHS reports with no difficulty, is this true?

I would imagine any legal representative who has been properly instructed can do this. It's not some secret sauce they alone have. Again, snake oil.

 

[Dave63]

If your primary HEALTH need is obvious enough you'll get it.

If only that were true.

 

[luggy]

I know there is a lot of comment and post concerning this subject, and I appologise to break the thread.
However, it is now 59 pages long so much of the information is burried deep.
so I would like to invite any who have up-to-date experiences to comment...

We received the standard “didn’t find a primary healthcare need” but you can have the consolation prize of NHS funded healthcare (£233/wk). The assessors started to pack up and the social worker began the “it will need to go to brokerage” talk and, “it is likely that we will probably have to move Dad to a cheaper home.”

Process was flawed, predetermined outcome steered by NHS finance department.
So obviously unrepresentative and unfair you immediately look for who can help in this very niche area.

I looked at 2 offering with two different approaches:

• A proper solicitor who specialises in CHC appeals we’ll call ”FD”
• A “team” company prompted as 1st search hit on the web we’ll call “C”

FD solicitors will assist you in preparing an appeal document, go over it can strip out all that will not really make any difference. They will make sure what you supply has sufficient emphasis and uses the correct “terms” so you don’t undermine your own case.
They cannot "represent" you or if they do it's the £200/hr plus expenses

In summary you do a lot of the work, they oversee and help prepare. You do your own appeal (if it comes to that)

Cost for this £2K + VAT


“C” seems to have more direct approach, Reminiscent of PPI mis selling offers “we’ll do it all for you”. They talk about getting the "blows" in first, shocking the other side by demanding full patient records and medical documents immediately. They boast of “Fast Tracking” appeals and how they can create such pressure that sometimes the NHS CHC do “U turns” and change decisions. They state all they need is the next-of-kin’s consent and they can produce their responses in weeks so fast the CHC doesn’t have time to prepare.

Cost for this £6800 up front (before any work starts)

If they had to represent you that's another £7K


My questions:

Has anybody had direct experience of working with a “CHC appeal” company, and did your experience lead you to feel it was money worth spending?

Is doing most of it yourself easier (e.g. accessing documents), will they know enough about your case?

Do these “fast track” services actually work, or are they a method just to “bounce” the other side into not being able to respond within the timeframe, and as such win by default?

Are there any guarantees?

Is the knowledge of the “way things work” and the “short cuts” bragged about by “C” actually an advantage?

I have been told the system is deliberately complicated and contradictory so to confuse and without the involvement of one of these companies things will take much longer and possibly not conclude before the parent dies. Is this true by any bodies experience?

“C” indicated that THEY could get hold of Hospital records, GP Records, Care home files and the various NHS reports with no difficulty, is this true?


For many considering the loss of all assets their parents have saved over a lifetime this is a tempting prospect , but is there a way through without such expense?

This is just my experience, other's may differ.

I represented my mum (and my dad, who didn't have dementia but had a massive stroke) at 3 MDT's with ineligible outcomes. I used a legal firm to appeal mum's last ineligible outcome and was successful at the first hurdle (Local Resolution). I think the firm I used may have been the one you refer to as FD. They were very professional and honest and the fees were on a par with what @Dave63 has quoted. The recompense in refunded care fees by far outweighed the legal costs. Before I instructed the legal firm, I spent months researching CHC, reading the National Framework and anything else I could get my hands on, so I knew that we had a good chance of a successful appeal. I had a good knowledge of the system, but what I couldn't do was interpret the nuances of medical and care records - the legal firm employ nurses to do that. Whilst I managed to access many care and medical records myself, the legal firm seemed to be able to access much more than I had been able to obtain. Despite opinions to the contrary, the information recorded on the Decision Support Tool at the MDT is evidence based. If you haven't got the evidence, i.e. medical and care records, you're sunk. The assessor may listen to your verbal evidence, but it won't count for much if it isn't supported with evidence - and this is where a good legal team will come into their own.

Having been present at the Local Resolution Meeting was immensely helpful. For reasons I won't go into here as they are far too complicated and long-winded, a few short weeks on from the successful appeal, mum had a review which triggered yet another MDT. Because of what I had previously learned from the legal firm, I was able and confident enough to represent mum's interests myself, arguing the case and debunking the myths. The outcome was eligible for CHC.

It's important to remember that a decision of eligibility is not infinite - there will be further reviews which may trigger MDT's and the assessors will always be looking to withdraw funding.

As I stated at the start, this is just my experience. It was with some trepidation that I engaged with a legal firm for some of the reasons you have recorded, but I'm pleased and relieved to say that it was a positive outcome. However, I'm sure that there are some sharks out there, making various promises.

 

[Jessbow]

If only that were true.

What I meant to say is, if you have a glaringly obvious medical condition aside from dementia, you shoud stand a better chance
My late mother ( registered blind, lewy bodies, insulin dependant diabetic) didnt qualify until an inoperable heart condition reared it head- she needed valve replacements- wasnt going to happen due to her dementia.
We had no behavior issues that qualified