Your CHC Appeals support thread

sarahjen

New member
May 8, 2023
5
0
Hi all - does anyone know of examples of successful appeals on the internet? or that they could share with me?

Huge thanks

Sarah
 

Dave63

Registered User
Apr 13, 2022
405
0
Hi Dave - thanks for your reply and good luck. Have you heard the appeal results? (sorry if you have said) And is there any chance that you wold be willing to share your appeal doc with me? - or know of any others that you could point me in the direction of? would be hugely useful as I've now done lots of reading / pulled lots of thoughts together and now working out how to best structure it! There is useful info on Care to be Different but their example appeal for the 4 indicators doesn't seem to totally tally with their advice - or with the info on the indicators.......which makes me think I'm stupid not to have got help with this! If you can help let me know and I can share my email. Hugest thanks and good luck. Sarah

Hi Sarah - No, not heard yet. The NHS exec have written to confirm that if mum is found eligible then all care home fees will be backdated to May 2021, which is when they received the original checklist assessment. So that's something I suppose.

The appeal submission was prepared by our solicitors and is 130 pages long. They're not normally that long but mums appeal is quite convoluted due to failures in proper process when evaluating mums needs and carrying out the first MDT.

Due to the submission containing a lot of personal and private information it probably wouldn't be appropriate to share the document I'm afraid.

You have six months from the date you received the outcome letter to confirm your intention to appeal. Once they receive that confirmation of intent that's when the clock starts ticking, however it'll take a while (months) for them to gather all the information from different sources needed for the LRM (Local resolution meeting). It may be worth speaking to one of the companies who deal with appeals and get some initial free advice about where you stand. Alternatively, the forums telephone helpline may be able to give you some pointers?

Dave
 

Dave63

Registered User
Apr 13, 2022
405
0
Finally, after a two and a half year battle, some good news. Mum has had her ratification for full funding approved by the LRM. They have also confirmed that all her care home fee's will be refunded, with interest, back to April 2021.

We're absolutely delighted obviously, but can't help feeling disappointed that it's taken so long due to the appalling gatekeeper mentality of the ICB.

It's also a tragedy that whilst all this was going on she had to sell her bungalow, which was her pride and joy and the reward for a lifetime of hard work, to cover her care costs. She'll never get that back and it nearly destroyed her when she had to sell it.
 

luggy

Registered User
Jan 25, 2023
205
0
Finally, after a two and a half year battle, some good news. Mum has had her ratification for full funding approved by the LRM. They have also confirmed that all her care home fee's will be refunded, with interest, back to April 2021.

We're absolutely delighted obviously, but can't help feeling disappointed that it's taken so long due to the appalling gatekeeper mentality of the ICB.

It's also a tragedy that whilst all this was going on she had to sell her bungalow, which was her pride and joy and the reward for a lifetime of hard work, to cover her care costs. She'll never get that back and it nearly destroyed her when she had to sell it.
Hi Dave63. That's wonderful news indeed but, as you have pointed out, it's a great shame that so many sacrifices had to be made unnecessarily.

You should be proud of what you have acheived for your mum.
 

Ruth32

Registered User
Oct 29, 2021
58
0
Finally, after a two and a half year battle, some good news. Mum has had her ratification for full funding approved by the LRM. They have also confirmed that all her care home fee's will be refunded, with interest, back to April 2021.

We're absolutely delighted obviously, but can't help feeling disappointed that it's taken so long due to the appalling gatekeeper mentality of the ICB.

It's also a tragedy that whilst all this was going on she had to sell her bungalow, which was her pride and joy and the reward for a lifetime of hard work, to cover her care costs. She'll never get that back and it nearly destroyed her when she had to sell it.
Wonderful news. Well done. Diabolical it has taken so long though. Understand re the disappointment regarding the house sale, we are in the process of selling my mums place, while we continue the battle with the CHC funding.
 

MarleysMum

Registered User
Sep 17, 2020
33
0
I’ve asked for advice here so just wanted to give an update.

Since I challenged in May for how the reassessment carried out in March was done, my Dad has been very poorly, even more so in the last 10 days. Last week the Nursing home chased the CHC re my Dads assessment and the meeting was booked for today. The CHC told me that he’d been flagged for a review but it had been missed.

I went there armed with a long list of questions and notes (thanks to the advice on here) but within the first five minutes the assessor told me she was authorising fast track. This was based on his nutrition ( he has severe dysphagia meaning often he can’t take anything orally and now has repeated chest infections) and how frail he is now.

The care home managers told me that they had agreed he should be fast tracked due to his recent deterioration. It will be reviewed in 12 weeks but she said if hes still with us, it’s virtually guaranteed it will be renewed as theres no way he’ll improve in that time. My sister in law is a manager in adult services and told me that in our area fast track is now only done if theres a life expectancy of 2-3 weeks. (Shes had no input so that’s not why it’s been approved).

So my feelings are very mixed. Finally he’s got what he deserves but only because he’s so very poorly. My dad has needed every aspect of his life and care managed for many months. He was classed end of life 6 months ago and prescribed anticipatory meds. Why do families that are already going through such upset have to continually fight for what’s right. I just pray for him to be at peace.

sorry for rambling on. My only advice is to keep fighting for what you know is right.
 

Dave63

Registered User
Apr 13, 2022
405
0
I’ve asked for advice here so just wanted to give an update.

Since I challenged in May for how the reassessment carried out in March was done, my Dad has been very poorly, even more so in the last 10 days. Last week the Nursing home chased the CHC re my Dads assessment and the meeting was booked for today. The CHC told me that he’d been flagged for a review but it had been missed.

I went there armed with a long list of questions and notes (thanks to the advice on here) but within the first five minutes the assessor told me she was authorising fast track. This was based on his nutrition ( he has severe dysphagia meaning often he can’t take anything orally and now has repeated chest infections) and how frail he is now.

The care home managers told me that they had agreed he should be fast tracked due to his recent deterioration. It will be reviewed in 12 weeks but she said if hes still with us, it’s virtually guaranteed it will be renewed as theres no way he’ll improve in that time. My sister in law is a manager in adult services and told me that in our area fast track is now only done if theres a life expectancy of 2-3 weeks. (Shes had no input so that’s not why it’s been approved).

So my feelings are very mixed. Finally he’s got what he deserves but only because he’s so very poorly. My dad has needed every aspect of his life and care managed for many months. He was classed end of life 6 months ago and prescribed anticipatory meds. Why do families that are already going through such upset have to continually fight for what’s right. I just pray for him to be at peace.

sorry for rambling on. My only advice is to keep fighting for what you know is right.
Hi @MarleysMum

It's such a double edged sword isn't it. On the one hand it's a relief to finally get what's deserved and on the other it's appalling what families are put through in order to get it.

Well done for fighting for your dad.
 

MarleysMum

Registered User
Sep 17, 2020
33
0
Hi @MarleysMum

It's such a double edged sword isn't it. On the one hand it's a relief to finally get what's deserved and on the other it's appalling what families are put through in order to get it.

Well done for fighting for your dad.
Thank you for your reply and the advice you have given on here. It certainly is and so unfair.
 

luggy

Registered User
Jan 25, 2023
205
0
Hi All.

The solicitor I've instructed to deal with mum's CHC ineligibility appeal, submitted their Appeal Submission on Monday. My ICB are insisting that before we have the Local Resolution Meeting, we must agree to have a two-way meaningful telephone discussion with one of their CHC clinicians. If the differences cannot be resolved on the telephone, we will be invited to attend a Local Resolution Meeting.

My solicitor had previously informed the ICB that we would be bypassing this initial process when it was offered a few weeks ago, and that we would like to proceed straight to the LRM, but the ICB are now insisting that we must jump through this hurdle beforehand.

Has anyone else come across this situation before? I'm curious to know whether or not my ICB are being obstructive, or whether it's a common issue.

My solicitor has yet to respond to this latest obstacle from my ICB.

Thank you.
 

Dave63

Registered User
Apr 13, 2022
405
0
Hi @luggy - Our solicitors had something similar prior to mums LRM. The following was included in their email to me.

Just to let you know, the ICB contacted me asking to arrange a clinical call with them. I queried this with them as this is not usual process and they have advised that it is to discuss the details of the appeal and to highlight the challenged domains. We have made this very clear in our initial appeal request letter and appeal form and I don’t feel there is any value in discussing this further until the ICB have obtained and reviewed the necessary records.

We tend to find that this is offered to families who do not have representation and this is purely used to explain the appeals process. I have therefore asked the ICB to obtain the records first but I have said that I am happy to discuss anything with them if they have any specific questions.
 

luggy

Registered User
Jan 25, 2023
205
0
Hi @luggy - Our solicitors had something similar prior to mums LRM. The following was included in their email to me.

Just to let you know, the ICB contacted me asking to arrange a clinical call with them. I queried this with them as this is not usual process and they have advised that it is to discuss the details of the appeal and to highlight the challenged domains. We have made this very clear in our initial appeal request letter and appeal form and I don’t feel there is any value in discussing this further until the ICB have obtained and reviewed the necessary records.

We tend to find that this is offered to families who do not have representation and this is purely used to explain the appeals process. I have therefore asked the ICB to obtain the records first but I have said that I am happy to discuss anything with them if they have any specific questions.
Thanks for replying Dave63. I'll have to wait and see what my solicitors response will be. I expect they've come across it before. May even be the same legal firm as yourself. Or even the same ICB!
 

whoknkows

Registered User
May 16, 2023
68
0
I haven't read all the posts, but it does seem confused and not always equitable. DH has just rang me to say his mother's respite in nursing home is officially ending and the social worker agrees she needs to stay in the nursing home. MiL doesn't have capacity and we don't have PoA so are not officially consulted, but they keep us informed. She has been paying based on respite care from income only, which basically took all her income less £20 ish per week. She has less than £23,000 in savings. We do have PoA on finances and I filled in the financial assessment details months ago. The fees get taken 5 weeks in arrears which confuses my spreadsheets - but she is still below the threshold.

The SW told DH that she is looking into getting some funding from the NHS, but DH has never bothered to read the info I send him or fully listen to what that may or may not mean. He needs to because of the complex ownership of her flat with shortish lease and held tenants in common with us. It currently has damp from a leaking roof, needs work in the communal hall and has problems with the lighting so an electrician friend will be asked to investigate. The flat could not easily be sold or rented in its current state and as part owners we don't want to sell and don't feel we can use MiLs small savings to put right all the problems, which even with our help, may not be enough to extend the lease. One estate agent confirmed it would be impossible for find a willing buyer for half a flat with a lease approaching the 82 year period that causes problems for sales and mortgages.

What I don't understand is what the SW meant? Did she mean she will look at CHC in which case do the family get to be involved without PoA. Or did she mean the nursing care allowance? MiL did not receive attendance allowance, but I ticked the box on the assessment form for it to be applied for. I will apply for council tax to be cancelled now.

I am assuming whether we end up with a self funding battle because of part ownership of a flat, the SW would prefer to get at least a chunk paid for by NHS. But will we will informed or involved especially if CHC is an option?

Lead nurse at the home calls MiL needs '24 hour care,'- she has an open wound and scheduled hospital visits to see what can be done, has had a rectal prolapse, is not mobile, has times of paranoia and hallucinations, and then can be calm for several days again, she eats well, is on medication currently to prevent infection, she takes 'blood thinners' for heart issues (she refused a pacemaker last year but now surgery would not be considered safe), history of depression, her records state kidney disease and pre diabetes, poor eyesight and hearing to be expected, and has had a number of non malignant skin cancers dealt with, but she talks clearly even if some of it is rubbish but has moments where she just 'disappears' and goes quiet, but is aware and afterwards says I went somewhere then.

If SW isn't thinking CHC should we ask her to? Or if finance department decide she isn't self funding, does it matter? I feel it is a bit of a waiting game, but not sure whether to try and get DH to be more proactive.
 

whoknkows

Registered User
May 16, 2023
68
0
Just reading more posts, so frustrating for so many and I assume if you go to appeal which can take months, in the interim the fees have to be paid? This seems like a nightmare if forcing a sale of property and in this current weird market likely a difficult sale for any, and for those who waited 2 years - but sold properties and are now waiting compensation, it certainly doesn't compensate for the stress, time and worry.
 

nitram

Registered User
Apr 6, 2011
30,282
0
Bury
@whoknkows
I'm unclear about details of your situation, you have posted in various threads about both your mother and mother in law and collation is time comsuming.

Am I correct in thinking that MIL lives in Scotland?
If so CHC is replaced by
and FNC is replaced by

All the links and information being posted refer to England and Wales.
 

whoknkows

Registered User
May 16, 2023
68
0
@nitram Sorry for taking up your time, I am posting about my MiL, my mother doesn't have dementia and I don't recall mentioning her. I took a while to get to grips with the format and where to look for answers, my fault, but when I was very low and stressed about all this I wasn't thinking straight. I am in essence the only person in my MiL family who does anything for her, I have PoA on her finances and organised all changes to bills, insurances etc. I feel isolated and obliged to try to help including where I can on important issues, but in all honesty this is a burden I didn't ask for. And particularly as I was the person who took her to 15 of her last hospital appointments where she was would insist they call me in, whether I wanted to be present or not. Her own family are disjointed with some not talking, none living near and some not seen her for 8 years still making no effort to get in touch with her or DH, even now 7 months after traumatic fall. I am the person who got some talking and contacted her good friend too.

I have to wonder if I was a son in law not a daughter in law, if all this would have fallen on my shoulders.

I have no direct contact with SS only my DH does, but he doesn't have time to investigate how everything works so I am trying to get to grips with the info and passing this on to DH who is contacted by SS and others, including a psychiatrist this week about DOLS (something he had never heard of) and he was involved in initial assessment via teams recently organised by SS as precursor to possible DST (again he had never heard of this). He is trusting the system for now and I am keeping a cautious eye on things, but I am not in direct contact with any of those involved and won't be.
 
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whoknkows

Registered User
May 16, 2023
68
0
@nitram - no she lives in England, (I have no links with Scotland). But thank you have printed and downloaded lots of useful info now from this source and others. I can only sit by and watch and wait and only act via DH if and when he is involved. I am stepping back now for my own peace of mind.
 
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smitty39

New member
Nov 26, 2021
2
0
Hi Ruth,

I always smell a rat when people seem to want to rush things through without following correct due process. My mum had her 3 month review in early December although in reality it was a 6 month review as it was 3 months late.

There was only myself , the assessor and a senior nurse from the home present. It was an “in person meeting” and the assessor got some time to see mum. To be honest I was expecting a difficult time since the original CHC decision was noted as being” marginal” which I felt might have been put in place to set us up for a fall at the 3 month review.

The senior nurse at the home confirmed that very little had changed since the full assessment and mum was confirmed as being eligible for CHC for another year by the assessor. Within 3 days I was sent a confirmation letter and a current written report over each of the domains , which detailed the original DST levels and comments and mums current needs and any recommendations to the nursing staff. I did notice however that the assessor marked mums behaviour back down to high from severe despite saying nothing had changed . There was even a contradiction saying that at the full assessment only the social worker gave a severe level , there was no mention of the dementia well being professional and unbelievably the notes also said the nursing home did not offer their opinion when presumably asked. It will not have gone unnoticed by the CCG that after the social workers severe marking for the behavior domain I was cut off of the teams meeting so as regards my presence and my tape recording cannot prove this is a deliberate lie or just incorrect. On rejoining the meeting I was told however that the general consensus of the panel was that mums behaviour level was severe and that is on tape. Best bit of all though is I have in writing on the original DST that other than the CHC assessor “ all other MDT panel members gave a severe level of need “. So alls well that ends well, I might not have it on tape but I’ve got it from the horses mouth in writing should I need that piece of evidence in the future.

Sorry if I have rambled on a bit about my mum’s 3 month review but it was only to show that you should be entitled to something in writing before being thrown into a rushed meeting. Study what you get and compare it the DST paperwork you got when your mum was successful at the full assessment as opposed to what they are saying at the 3 month stage.You might find a few things that compromise the soundness of the 3 month review, after all my mum got through the review but there were some glaring mistakes when summing up which makes me feel this might be the start of a process to get mum off of CHC in the not too distance future.

Regards rushing people, on mums first full assessment when she was still in hospital they gave me only a few days notice of an impending full assessment. I knew nothing of the CHC process back then and they knew it. Myself and mum had basically been setup to fail and they also knew that. I managed to get couple of weeks delay in order to accumulate evidence but it was nowhere near enough but at least it gave me some time to get a little familiar with the main points of the NF. On the day of the assessment none of the hospital nurses that had experience with mum were present , it was just myself , the assessor and a social worker that had never met mum. It didn’t smell right and indeed I later found per the NF it wasn’t right. I was even able to find out by a bit of stealth internet searching that the CCG assessor had only been in the job for a month.

After the rushed meeting I was told by the CCG that mum did not qualify for CHC which I was expecting and in reply they were told that I intended to declare the assessment null & void due to mispractice as per the National Framework which they were not expecting ! They did not try and defend their case and mum was subsequently given a 2nd full assessment that had to be abandoned for other reasons before finally getting CHC 3rd time lucky.

Whatever you do Ruth don’t be bullied, demand the paperwork, study it with a toothpick, tell them politely what you consider to be a reasonable time to prepare following receipt of that written confirmation. Learn as much about the NF as you possibly can and call them out at all times should you feel they might be in breach of it.

Wishing you the very best of luck !
I have never been asked to attend mum's assessments
 

Dave63

Registered User
Apr 13, 2022
405
0
It's now four months since full funding was agreed for mum and she hasn't received a penny of the reimbursement she is due. Nor have the nursing home received any payment of fees for the past three months despite being told they would begin the 1st of July.

Trying to speak with the people responsible is damn near impossible and out of eight email requests for information all eight have been ignored. I started the complaints process and two days later I received a call stating everything will be urgently sorted.

Two days later I received a call from the nursing home saying they'd had £75k deposited in their account with no indication of what it related to. CHC told me it had been paid in error and would be reclaimed. So far it's not been reclaimed and mum still hasn't received anything.

Not only is it worrying that huge amounts of public money is being paid out without any understanding of why or who that money is for but the level of incompetence by the department responsible for reimbursements is staggering.

There are times when you can forgive mistakes being made but this ICB has been on whole other level for the past three years.
 

luggy

Registered User
Jan 25, 2023
205
0
Good grief @Dave63 the level of incompetence there is shocking! Sadly, however, it doesn't come as a surprise - my ICB have been utterly incompetent and/or dishonest.

So, it seems the ICB have paid your mum's reimbursement to the care home? How on earth can they get that so wrong!?

I am so sorry that you're having to endure this, just when you thought that you had won your battle. What a lot of unnecessary hassle and added stress for you. I sincerely hope that this mess is sorted out soon.

Good luck.