Your CHC Appeals support thread

Ruth32

Registered User
Oct 29, 2021
62
0
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.
@Dirge,

Thanks for the reply, yes the ICB do seem to drag their feet a lot, this has been going on for over a year now ! I am surprised they are ignoring the NHS. Can I ask, are your appealing directly yourself or using an advocate ? And so does the NHS step in as judge as such and asks the reasoning from both sides ? My outcome also mentions

"It was agreed by the panel members that the care Mrs xxxxx required was no more than ancillary or incidental to that of the provision of accommodation and was not over and above what social care has a duty to provide under the Care Act 2014."

If this means she would just need her accommodation provided for, it is a load of rubbish as she was in an EMI unit, because she got thrown out of her last home because they couldn't cope with her, although they said they had a special unit for dementia guests and could cope with anything.
 

Ruth32

Registered User
Oct 29, 2021
62
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.


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.

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.


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.

@Dave63 Thanks for your reply and the link is really appreciated and has lots of good information. My advocate is phoning me in a few days. After speaking to my brother who is also part of this, he is of the opinion of we have gone this far, so lets go on and do the final part. If you look a one of my reply's above it mentions that about mum just being required accommodation, or at least to me that how it looks like. Do you read the same. I know all the stuff about primary health care etc. But as know one explains exactly what this is it is difficult to argue the case. Also I think as they still haven't said why mum needed another mdc this is something to note. Thanks again.
 

Dave63

Registered User
Apr 13, 2022
480
0
If you look a one of my reply's above it mentions that about mum just being required accommodation, or at least to me that how it looks like.
What they're basically saying is the health care your mum received was of such a low level that it wouldn't be unreasonable for a local authority to provide it. It's the measuring stick they use to determine whether care should be funded by LA's or NHS and the rules are set out within the Care Act 2014. The problem is, the Care Act 2014 doesn't define what the levels of care are, nor where the line in the sand is between LA and NHS responsibility. It's not beyond the realms of possibilty that NHS use this vagueness to their advantage.

Your legal advocate will have much better knowledge and experience with this so they'll be able to explain it better than me when you speak with them.

I know during an LRM that any failures in process are dealt with seperately, but I think (?) that an IRP deal with them as part of the review so you may get an opinion from them about the MDT issue.

 

Dave63

Registered User
Apr 13, 2022
480
0
Another thing which occurs to me @Ruth32 is if an MDT has scored any domains High or Severe, how do they then determine a persons needs as only ancillary to their accomodation? Surely those domain scores show a persons health needs are anything but ancillary. If they were ancillary then those domains would surely be scored as Low?

Again, I'm an armchair amateur so definitely something your legal advocates will be better placed to answer.
 

Dirge

Registered User
Dec 20, 2022
41
0
@Dirge,

Thanks for the reply, yes the ICB do seem to drag their feet a lot, this has been going on for over a year now ! I am surprised they are ignoring the NHS. Can I ask, are your appealing directly yourself or using an advocate ? And so does the NHS step in as judge as such and asks the reasoning from both sides ? My outcome also mentions

"It was agreed by the panel members that the care Mrs xxxxx required was no more than ancillary or incidental to that of the provision of accommodation and was not over and above what social care has a duty to provide under the Care Act 2014."

If this means she would just need her accommodation provided for, it is a load of rubbish as she was in an EMI unit, because she got thrown out of her last home because they couldn't cope with her, although they said they had a special unit for dementia guests and could cope with anything.
@Ruth32 I've just crossed into my third year since starting the process and yes I'm using an advocate, who to be fair have written a very comprehensive argument but the ICB have thus far rejected the evidence at the MDT and the subsequent appeal. I can't say what actions the NHS will take as we haven't got as far as the board as yet, my understanding is that both sides submit their "evidence" and the board will then convene a meeting where both sides argue the MDT scores and the nature, complexity, intensity and unpredictability assesments before the board makes an overall decision.
 

luggy

Registered User
Jan 25, 2023
224
0
@Ruth32 I do recall that when @Palerider posted on here a few months ago, after their success with the IRP, they posted the full IRP report on this forum. I read it and found it to be extremely helpful. I have tried searching for it again, but couldn't see it. It may have been removed, or it could just be that my woeful lack of skill with technology is letting me down again. It maybe worth a search?
 

Dave63

Registered User
Apr 13, 2022
480
0
@luggy I remember that as well but can't find it either. I did find a post from @Palerider with a copy/paste of the IRP outcome in the following post:

 

Louise7

Volunteer Host
Mar 25, 2016
4,934
0
The IRP report is in this thread @luggy - scroll down to message 1,079, posted on 5th Oct 2023:

 

luggy

Registered User
Jan 25, 2023
224
0
The IRP report is in this thread @luggy - scroll down to message 1,079, posted on 5th Oct 2023:

@Louise7 well done, thank you. @Ruth32 this may be helpful to you?