Your CHC Appeals support thread

luggy

Registered User
Jan 25, 2023
217
0
Oh and I did enjoy that being grabbed by the breast and scratched with dirty nails is apparently ‘normal working conditions and is not a risk’ 🤣🤣🤣 I knew that would be the response so enjoyed it …..apparently it woiod be v different if it happens to me tomorrow by someone with schizophrenia as opposed to someone with dementia …
…no wonder we have such a shortage of carers!
Hi @sdmhred well at least that's out of the way. You should receive a copy of the ratified DST soon. Have a good read of their take on the 4 Key Indicators, which is towards the end of the document. This is where the ICB show, or more usually they choose not to show, how the 12 domains interact with each other to prove a primary health need.
 

sdmhred

Registered User
Jan 26, 2022
2,317
0
Surrey
What I didn’t understand @luggy is that they didnt talk at all about primary health needs as opposed to social care needs ….this is what I was expecting.

They seemed to be talking about whether mum’s needs were usual for a nursing home in which case it would be FNC - almost as if CHC was if u were at nursing home plus type need.

maybe I misinterpreted?

The SW has emailed me so maybe I will go back and ask her for clarification as a learning point?
 

Spcc cat

Registered User
Jan 9, 2023
10
0
How successful are appeals?

We have a complicated issue. Mum in a nursing home after many years struggling. Both mum and dad own a small commercial property which they used rent for their income. Now council say that because the commercial property takes them over the threshold, they want full payment (and disregard the house). So dad will lose his small income.

What’s more, the commercial property has been run by my brother for 25 years, so if we sell the commercial, brother loses his income, in addition there’s a small studio above the commercial where someone with mental health needs is placed there by the local authority.

The council want this commercial property, even if three separate parties are affected and life changes for them, if we sell/equity release.

Lawyer tells us we have 50/50 chance but wants £5000 before he gets to work.

What is the chance of this? Anyone appealed and been successful? Any good lawyers you’d recommend?
 

Spcc cat

Registered User
Jan 9, 2023
10
0
How successful are appeals?

We have a complicated issue. Mum in a nursing home after many years struggling. Both mum and dad own a small commercial property which they used rent for their income. Now council say that because the commercial property takes them over the threshold, they want full payment (and disregard the house). So dad will lose his small income.

What’s more, the commercial property has been run by my brother for 25 years, so if we sell the commercial, brother loses his income, in addition there’s a small studio above the commercial where someone with mental health needs is placed there by the local authority.

The council want this commercial property, even if three separate parties are affected and life changes for them, if we sell/equity release.

Lawyer tells us we have 50/50 chance but wants £5000 before he gets to work.

What is the chance of this? Anyone appealed and been successful? Any good lawyers you’d recommend?
 

Camie93

New member
May 10, 2024
4
0
Hi,

Just under 2 weeks ago we had to put my Grandad in a Care Home, and he seems to be rapidly deteriorating since admission. I'm after some urgent advice. We had the Full Assessment for my Grandad 48 hours ago. His scores were 3 High, 6 Moderate, 2 Lows.

Behaviour was scored as High but I argued that the Behaviour domain should be Severe but the SW and Assessor didn't agree. He had been verbally aggressive, made inappropriate remarks on occasion, and kicked out at Care Home staff when it came to personal care (this has all happened in less than 2 weeks).

We had a call from the Assessor to say he wouldn't be eligible for CHC but would for FNC. The current Care Home does not have nursing services.

24 Hours later (yesterday), he grabbed another resident by the throat, threw a hot cup of tea over another resident, pushed another resident over who fell on the floor, and after the staff had managed to get him into the garden away from others, he grabbed a garden fork to use as a weapon and said he will not put it down until a family member goes to him.

Would you say we have a case to argue that his Behaviour should now be classed as Priority and pursue this? Can the Assessor change this score at this point or would we have to wait to appeal?

If you need any more info, please let me know.

Thank you.
 

Dave63

Registered User
Apr 13, 2022
451
0
Any disagreement with the outcome of the MDT would have to be dealt with via appeal. Your intention to appeal will need to be made withing six months of the date of the outcome letter. That timescale doesn't really help in your current situation though. Sadly, that's the only route available for disputing a decision.

It's not possible to give an opinion on individual levels of scoring as a lot depends on how each domain impacts on other domains. The assessor should not be looking at each domain in isolation.

Having said that, with 3 x High and 6 x Moderate you would normally have expected a positive decision for CHC. That's not me second guessing anything, it's actually stated in the governments guidance on how the Decision Support Tool should be used to assess people during an MDT.

The section I'm referring to is at para 35 and 36 of the guidance.

 

Camie93

New member
May 10, 2024
4
0
Any disagreement with the outcome of the MDT would have to be dealt with via appeal. Your intention to appeal will need to be made withing six months of the date of the outcome letter. That timescale doesn't really help in your current situation though. Sadly, that's the only route available for disputing a decision.

It's not possible to give an opinion on individual levels of scoring as a lot depends on how each domain impacts on other domains. The
Any disagreement with the outcome of the MDT would have to be dealt with via appeal. Your intention to appeal will need to be made withing six months of the date of the outcome letter. That timescale doesn't really help in your current situation though. Sadly, that's the only route available for disputing a decision.

It's not possible to give an opinion on individual levels of scoring as a lot depends on how each domain impacts on other domains. The assessor should not be looking at each domain in isolation.

Having said that, with 3 x High and 6 x Moderate you would normally have expected a positive decision for CHC. That's not me second guessing anything, it's actually stated in the governments guidance on how the Decision Support Tool should be used to assess people during an MDT.
 

Camie93

New member
May 10, 2024
4
0
Thank you for your reply.

I've done a lot of research and went into the meeting armed with information from the National Framework document itself etc, as well as creating a detailed report of each domain in relation to my Grandads needs, split under the 4 Key Indicators.

Unfortunately the Asssesor wasn't really interested at all in my points about any of it, barely took any notes down and just wrote down the scores for each domain based on our opinions of each (rather than how they are interrelated, the complexity etc). When I started to go into more detail, they cut me off and made a joke that I should work for them.

The SW at one point admitted to being sleepy and was slouched on the sofa looking at her phone at times, and the Assessor/SW also admitted that they knew each other well as they do these assessments together quite often. I found the whole thing very unprofessional.

Like you, based on those scores I would have expected my Grandad to have been eligible for funding (even without the Behaviour score now likely to be at least Severe) which is very frustrating. He was given a score of High in this domain.

I fully intend to appeal, but also questioning whether we should get a legal team involved. It's just not knowing how likely the decision will be overturned with/without an external company based on those scores.
 

Dave63

Registered User
Apr 13, 2022
451
0
I fully intend to appeal, but also questioning whether we should get a legal team involved. It's just not knowing how likely the decision will be overturned with/without an external company based on those scores.
Like you I researched the whole process to the point where I could have sat a flippin' exam on the subject. I was given the run around for a couple of years and was getting nothing but obstacles and dismissive responses. The assessor at mums MDT was extremely condescending, and not just to me, but also to the mental health nurse who was taking part.

After receiving the not eligible decision I almost felt like giving up and started to doubt my own ability to fight on. We instructed a specialist company who assessed mums chances of 50/50 of a succesful appeal and decided to go ahead as we thought the benefit of success outweighed the cost. It's an expensive option but I genuinely feel without their advocacy we would never have had the success that we achieved.
 

luggy

Registered User
Jan 25, 2023
217
0
Hi,

Just under 2 weeks ago we had to put my Grandad in a Care Home, and he seems to be rapidly deteriorating since admission. I'm after some urgent advice. We had the Full Assessment for my Grandad 48 hours ago. His scores were 3 High, 6 Moderate, 2 Lows.

Behaviour was scored as High but I argued that the Behaviour domain should be Severe but the SW and Assessor didn't agree. He had been verbally aggressive, made inappropriate remarks on occasion, and kicked out at Care Home staff when it came to personal care (this has all happened in less than 2 weeks).

We had a call from the Assessor to say he wouldn't be eligible for CHC but would for FNC. The current Care Home does not have nursing services.

24 Hours later (yesterday), he grabbed another resident by the throat, threw a hot cup of tea over another resident, pushed another resident over who fell on the floor, and after the staff had managed to get him into the garden away from others, he grabbed a garden fork to use as a weapon and said he will not put it down until a family member goes to him.

Would you say we have a case to argue that his Behaviour should now be classed as Priority and pursue this? Can the Assessor change this score at this point or would we have to wait to appeal?

If you need any more info, please let me know.

Thank you.
Hi @Camie93 I'm sorry to hear that your Grandad is deteriorating. Like @Dave63, I've been battling with the ICB for the last 3 years for my mum, who has had 3 MDT's during that time. She was found ineligible at the first two, the second of which resulted in 1 Severe, 6 Highs, 3 Moderates and 2 No Needs and clear evidence of Intensity & Complexity. Using a legal firm, we took this to appeal which was successful.

My mum has always scored 'High' in the Behaviour domain which manifests itself as verbal aggression, abusive language, lashing out during personal care (causing minor injuries to herself and carers) and intractable noisiness (shrieking and screaming for hours on end and all through the night). I thought (and so did my legal caseworker) that 'high' was the correct score.

From what you have described, it sounds as though there has been an escalation in your Grandad's behaviour since the MDT. Now, if the ICB do their job properly (which is unlikely) your Grandad's DST and subsequent decision for ineligibility should be reviewed 3 months from the date of the MDT. At this review, if it is considered that there has been a change in needs, then the ICB must conduct another full assessment - your Grandad's behaviourial deterioration should trigger this.

It is likely that the 3 month review period will come and go and you won't hear from the ICB, in which case you may want to consider contacting them, explain that there has been a change in needs and ask them to please get on with the review. In the meantime, insist that the care home keep Behaviour Charts for your Grandad so that you have the necessary recorded evidence to prove your case at the review and/or appeal. Everything is evidence based and if it isn't recorded, it didn't happen. Make sure the care home keep comprehensive records - many of them don't.

You can still go ahead with the appeal. Some of the legal firms offer a free initial telephone consultation. That's how I got started on this CHC journey.

Good luck.
 

Camie93

New member
May 10, 2024
4
0
Thank you both for your advice.

Before I posted on this forum, I did email the Assessor from the ICB who attended the assessment and explained the new developments, and asked if this score could be reviewed based on this. She replied to say that she would speak to her Manager. I'm not sure if she's trying to fob us off or if that's a good thing to be honest!

I did say at the end of the email that I would like a copy of the DST and reasoning so that I can start preparing to appeal... It may be that as I've told her of my intentions that she responded in that way.

A bit of medical history for you- Rheumatoid Arthritis, COPD, Chronic Plueral Effusion (Fluid on Lung), Lung disease, Recurrent Chest Infections, 2 Cases of Skin Cancer previously in the last 5 years, Dementia, Severe Fall in Aug 23 resulting in a 2 month hospital stay (completely shattered his Knee which needed surgery, and fractured pelvis) but is now mobile again albeit unsteady so high risk of falls, Incontinent of urine since admission to the CH, completely deaf without hearing aids and you have to shout even when they're in, Hypertension and High Cholesterol. His weight has been gradually decreasing since his hospital stay (he is pretty frail as it is!) His 6/7 medications can have pretty bad side effects if not properly monitored. One of his medications require him to have blood tests every 3 months to check the impact from it.

It makes me so angry as he is not a well man at all and is rapidly deteriorating.

Can I ask you both roughly how much it cost to appeal with legal representation?

The CH have an online portal which shows detailed notes, behaviour charts etc so I'm being set up on this and will be reviewing everyday as well as taking my own general notes when I visit him.
 

Dave63

Registered User
Apr 13, 2022
451
0
She replied to say that she would speak to her Manager. I'm not sure if she's trying to fob us off or if that's a good thing to be honest!
Give it a week and if you've not heard anything email again for an update. I found them to be extremely lax at responding to any communications.

I did say at the end of the email that I would like a copy of the DST and reasoning so that I can start preparing to appeal...
A copy of the DST should be sent to you as a matter of course, they are obliged to do so and they can not refuse. If you don't receive a copy check with his care home as it may be emailed to them instead, this is what happened with my mums DST. The DST will detail each domain, notes on the level to which your grandad is impacted within that domain, any discussions which took place about the domain and any disagreements about scoring. At the end it will show the rationale for the eligible or ineligible decision.

A bit of medical history for you...
It makes you wonder what sort of lens the CHC assessors look through when determining what is and isn't a primary health need. You're going to find that the system is biased towards proving there isn't a primary health need and any health needs he does have can be dealt with by a FNC payment which is a much cheaper option for the ICB.

Can I ask you both roughly how much it cost to appeal with legal representation?
It'll differ company to company. In 2022 we had a free initial discussion, then the collation and review of medical records by a CHC trained nurse was £3k and the representaion at the LRM (appeal) was another £3k.

It's probably more than that now. We based our decision on the fact mums chances of success were 50/50 and if she were successful then that £6k in legal fees would be recouped in the saving of care home fees within six weeks. If her chances were less than 50/50 I'm not sure if we would have gone ahead.

I can not emphasise enough the importance of what @luggy has mentioned about accurate, up to date care records. It's fundamental to proving a primary health need and the complexities and intensities of those needs. My mum also scores highly in the behavioural domain and the fact the care home kept accurate records about mums behaviour by using ABC charts was a big help.
 

Dave63

Registered User
Apr 13, 2022
451
0
The following site is a brilliant resource for everything CHC. It began life as a private blog run by a lady who was fighting for CHC funding for her parents and is now owned and run by the solicitors who handled my mums case. It's not a recommendation as we're not allowed to make recommendations for individual companies but it is an invaluable A to Z resource of information.

 

luggy

Registered User
Jan 25, 2023
217
0
Thank you both for your advice.

Before I posted on this forum, I did email the Assessor from the ICB who attended the assessment and explained the new developments, and asked if this score could be reviewed based on this. She replied to say that she would speak to her Manager. I'm not sure if she's trying to fob us off or if that's a good thing to be honest!

I did say at the end of the email that I would like a copy of the DST and reasoning so that I can start preparing to appeal... It may be that as I've told her of my intentions that she responded in that way.

A bit of medical history for you- Rheumatoid Arthritis, COPD, Chronic Plueral Effusion (Fluid on Lung), Lung disease, Recurrent Chest Infections, 2 Cases of Skin Cancer previously in the last 5 years, Dementia, Severe Fall in Aug 23 resulting in a 2 month hospital stay (completely shattered his Knee which needed surgery, and fractured pelvis) but is now mobile again albeit unsteady so high risk of falls, Incontinent of urine since admission to the CH, completely deaf without hearing aids and you have to shout even when they're in, Hypertension and High Cholesterol. His weight has been gradually decreasing since his hospital stay (he is pretty frail as it is!) His 6/7 medications can have pretty bad side effects if not properly monitored. One of his medications require him to have blood tests every 3 months to check the impact from it.

It makes me so angry as he is not a well man at all and is rapidly deteriorating.

Can I ask you both roughly how much it cost to appeal with legal representation?

The CH have an online portal which shows detailed notes, behaviour charts etc so I'm being set up on this and will be reviewing everyday as well as taking my own general notes when I visit him.
Hi @Camie93

By sheer coincidence, I used the same legal firm as @Dave63, so the costs would have been very similar. I'm currently using them again to challenge a decision for another period of care.
 

Ruth32

Registered User
Oct 29, 2021
62
0
Hi All,

Has anyone taken their appeal to NHS England. After having failed with ICB, this what we are being advised to do next. Again it is a lot of money and I am not sure what to do. I am angry and frustrated and sadly we have now lost mum so 1/2 of me wants to still fight for her and the other 1/2 says just to give up. Below is a paragraph from the letter received from the company who is representing us at the appeals. Would love to hear your thoughts or experiences of taking it further to the NHS.

"Whilst they have taken into consideration the key evidential points raised and acknowledged the same, they have then simply discounted them from their conclusions. The only option available to us now is to advance matters to NHS England and we are firmly of the view there is an evidential basis to do so."

Many thanks
 

Collywobbles

Registered User
Feb 27, 2018
291
0
Hi All,

Has anyone taken their appeal to NHS England. After having failed with ICB, this what we are being advised to do next. Again it is a lot of money and I am not sure what to do. I am angry and frustrated and sadly we have now lost mum so 1/2 of me wants to still fight for her and the other 1/2 says just to give up. Below is a paragraph from the letter received from the company who is representing us at the appeals. Would love to hear your thoughts or experiences of taking it further to the NHS.

"Whilst they have taken into consideration the key evidential points raised and acknowledged the same, they have then simply discounted them from their conclusions. The only option available to us now is to advance matters to NHS England and we are firmly of the view there is an evidential basis to do so."

Many thanks
Unfortunately the firm advising you has money to make from taking it further. While they say that you have a case, I note they carefully avoid commenting on whether they think it actually stands a chance of succeeding. Sorry - I tend to be a bit cynical when it comes to protracted legal cases.
 

Dirge

Registered User
Dec 20, 2022
39
0
Hi All,

Has anyone taken their appeal to NHS England. After having failed with ICB, this what we are being advised to do next. Again it is a lot of money and I am not sure what to do. I am angry and frustrated and sadly we have now lost mum so 1/2 of me wants to still fight for her and the other 1/2 says just to give up. Below is a paragraph from the letter received from the company who is representing us at the appeals. Would love to hear your thoughts or experiences of taking it further to the NHS.

"Whilst they have taken into consideration the key evidential points raised and acknowledged the same, they have then simply discounted them from their conclusions. The only option available to us now is to advance matters to NHS England and we are firmly of the view there is an evidential basis to do so."

Many thanks
Hi @Ruth32 I am currently progressing an appeal directly to the NHS, having discussed it with my advocate I was given the same assurance that you were regarding having a strong case, however I also felt that the 1st appeal to the ICB was effectively them marking their own homework. In my case the ICB is once again dragging its feet and ignoring deadlines despite chasers from the NHS so no surprise there and the frustration continues.
 

Dave63

Registered User
Apr 13, 2022
451
0
Hi @Ruth32, I've no experience of IRP's but a couple of people on the forum have gone through that stage. @Palerider springs to mind but I haven't seen them posting for a while.

If your legal advocate is of the opinion that the evidence is absolutely biased towards an eligible decision, and if finances allow, I would be tempted to go ahead with the next stage. It's a risk/benefit decision at the end of the day but not everyone is willing, or able, to gamble a few thousand pounds. May be have an open conversation with your legal advocate about the process, how it's different from an LRM and what their history of success is with IRP's.

 

luggy

Registered User
Jan 25, 2023
217
0
Hi All,

Has anyone taken their appeal to NHS England. After having failed with ICB, this what we are being advised to do next. Again it is a lot of money and I am not sure what to do. I am angry and frustrated and sadly we have now lost mum so 1/2 of me wants to still fight for her and the other 1/2 says just to give up. Below is a paragraph from the letter received from the company who is representing us at the appeals. Would love to hear your thoughts or experiences of taking it further to the NHS.

"Whilst they have taken into consideration the key evidential points raised and acknowledged the same, they have then simply discounted them from their conclusions. The only option available to us now is to advance matters to NHS England and we are firmly of the view there is an evidential basis to do so."

Many thanks
Hello @Ruth32 I'm sorry to hear that your mum has passed.

I don't have experience of having to progress to the IRP stage. If I was in the same position as yourself, I'd be considering whether or not the redress would be worth the financial outlay, i.e. how many months/years of care fees would you expect to claim back if the appeal was successful.

I wonder if a long and protracted appeal process may also delay the resolution of your mum's estate?

I'm currently in the early stages of a retrospective appeal. If my mum passed away in the near future (which is quite possible), I would be very tempted to call it a day and get on with my own life.

My thoughts are probably not very helpful to you. We all have different circumstances to consider and I hope that you can find the best way forward for yourself.
 

Ruth32

Registered User
Oct 29, 2021
62
0
Unfortunately the firm advising you has money to make from taking it further. While they say that you have a case, I note they carefully avoid commenting on whether they think it actually stands a chance of succeeding. Sorry - I tend to be a bit cynical when it comes to protracted legal cases.
@Collywobbles Yes, I agree I am the same with being slightly cynical, especially as at the beginning they said we had one of the strongest cases they had seen, so if that was so, I thought we would have sailed through this. Saying that the work they have done was probably something I couldn't have done myself without having a nervous break down !