Your CHC Appeals support thread

[whoknkows]

@Dave63 OMG what a mess and stressful too. I do hope this gets resolved urgently now.

A few years ago I worked for a company that sold publications and ran conferences for schools and care homes. Every month the bank statement would arrive with a number of payments received but no reference or invoice number, and I would start the laborious task of comparing potential invoices marked as unpaid with the amounts received and try and trace the correct school or care home so that they didn't get a threatening legal letter and late payment charge. Some schools outsourced their payments - one time a bill in the thousands remained marked as unpaid, I spoke to the outsource company, they had no intention of looking up the details whilst I was on the phone but I pointed out it was tax payers money and a school who had done nothing wrong was about to get a fine and go on a debtors list because she couldn't be bothered to look up an invoice number to confirm a payment. Some care homes organised payments twice because a chasing letter got sent and crossed over with payments that head office had made. Left and right hands rarely knowing what each other were doing.....

 

[Dave63]

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 get the sense that there are so many people across numerous departments who fail to communicate that it inevitably leads to a complete breakdown in getting things done efficiently. I don't think it's peculiar to the NHS, any large organisation which has managers managing managers who manage department heads who manage the people doing the work never works well.

It also became apparent from speaking with the people responsible for organising reimbursements that they have little, if any, knowledge of the guidelines set out in the National framework or the NHS Financial Redress guidance.

 

[nitram]

Ten tears ago when PCT was reconfiguring itself as CCG, I emailed the head office of the chain of homes asking for repayment of fees from date of CHC award plus two weeks in advance and got a cheque by return.

Given that self funding would be more than CHC and that the advance payment wasn't for delivered care I thought it best to have a go at the direct route and it worked.

 

[luggy]

Hi, I have now been given a date for the Local Resolution Meeting for mum's CHC appeal (31st October). I have got a legal firm acting for me who will represent me at the meeting, which will be via Teams. This is my first LRM, but I have previously represented mum without legal expert back up at 2 Checklists & Full Assessments, various reviews and also for my dad too, who has now passed away. So, I know what to expect.

For those of you who have already been in this position with legal expert representation at an LRM, how much involvement did you have at the meeting? I will have my own notes with me, as I have always done at previous assessments, and will be ready to interject if necessary. I'm just wondering how much input may be required from myself? Or should I leave it in the capable hands of the expert? After all, that's what they're being paid for

Thank you.

 

[Dave63]

Hi, I have now been given a date for the Local Resolution Meeting for mum's CHC appeal (31st October). I have got a legal firm acting for me who will represent me at the meeting, which will be via Teams. This is my first LRM, but I have previously represented mum without legal expert back up at 2 Checklists & Full Assessments, various reviews and also for my dad too, who has now passed away. So, I know what to expect.

For those of you who have already been in this position with legal expert representation at an LRM, how much involvement did you have at the meeting? I will have my own notes with me, as I have always done at previous assessments, and will be ready to interject if necessary. I'm just wondering how much input may be required from myself? Or should I leave it in the capable hands of the expert? After all, that's what they're being paid for

Thank you.

Hi Luggy

We also had representation at the LRM and for the most part we let her do all the heavy lifting in regard to presenting the evidence for each domain. They have a lot of experience with appeals and they know what does and does not need to be said with regard to proving a primary health need. You will be asked if there is anything you would like to contribute after each domain is discussed.

Anything regarding errors in process won't be discussed as they are dealt with seperately. The only thing that will be focused on is proving the primary health need and this is what your representative will be doing. A couple of days before mums LRM the representive called me to discuss how everything would work and was also able to answer any queries I had about how much involvement I should or would be expected to make.

I fooled myself into thinking I'd become a bit of an armchair expert on National Framework and the processes but I'm pretty certain that without the expert representative at the LRM we wouldn't have had a successful outcome. Which begs the question, how many people fall at this hurdle because they can't afford to pay for representation?

 

[luggy]

Hi Luggy

We also had representation at the LRM and for the most part we let her do all the heavy lifting in regard to presenting the evidence for each domain. They have a lot of experience with appeals and they know what does and does not need to be said with regard to proving a primary health need. You will be asked if there is anything you would like to contribute after each domain is discussed.

Anything regarding errors in process won't be discussed as they are dealt with seperately. The only thing that will be focused on is proving the primary health need and this is what your representative will be doing. A couple of days before mums LRM the representive called me to discuss how everything would work and was also able to answer any queries I had about how much involvement I should or would be expected to make.

I fooled myself into thinking I'd become a bit of an armchair expert on National Framework and the processes but I'm pretty certain that without the expert representative at the LRM we wouldn't have had a successful outcome. Which begs the question, how many people fall at this hurdle because they can't afford to pay for representation?

Thanks @Dave63 for the sound advice. I will take a back seat as I don't want to put my foot in it! I'm also inclined to think I know more than I do at times!

 

[Dave63]

You couldn't make it up!!
Four months on and no reimbursement made and no payments made to the nursing home for the care package which should have started on 1st July. They have deposited £86k into the homes bank account with no explanation of what it's for or a breakdown of what it relates to.

They admitted it was an error and said they would reclaim the money but after four weeks they still haven't done so. Today an ICB credit controller called the home to say the care package money is on hold until the home repay the £86k. The home told him they would not do that based on just a phone call and that an invoice needs to be sent for the amount to pay back so they have a record of why the money has been paid. In what universe would anyone send £86k based on a phone call request? The homes administrator said it was obvious he was home working because she could hear a tv or radio in the background!!

The level of shear incompetence is so frustrating. It's like having to deal with people from a Benny Hill sketch - just not as funny.

 

[Ruth32]

@Dave63 Absolutely unbelievable and totally incompetent. I hope you receive it soon.

It does make you wonder what on earth is going on with some departments. I am having an issue with accessing my mums social service records (which I needed for the CHC appeal) It is now exactly 6 months after I put my request in and I have just been told my request hasn't been allocated to a worker yet. By law I was meant to have received this within 3 months of the request. The appeal has had to be sent off with details missing now. I am nearly giving up but have asked who I can complain too - I need to rant at someone !

 

[luggy]

You couldn't make it up!!
Four months on and no reimbursement made and no payments made to the nursing home for the care package which should have started on 1st July. They have deposited £86k into the homes bank account with no explanation of what it's for or a breakdown of what it relates to.

They admitted it was an error and said they would reclaim the money but after four weeks they still haven't done so. Today an ICB credit controller called the home to say the care package money is on hold until the home repay the £86k. The home told him they would not do that based on just a phone call and that an invoice needs to be sent for the amount to pay back so they have a record of why the money has been paid. In what universe would anyone send £86k based on a phone call request? The homes administrator said it was obvious he was home working because she could hear a tv or radio in the background!!

The level of shear incompetence is so frustrating. It's like having to deal with people from a Benny Hill sketch - just not as funny.

@Dave63 I'm so very sorry that you're having to deal with this. You've mentioned that you have had legal representation for your appeal - I'm assuming that this has finished now and they're unable to help with this unless you pay more money to them? I'm wondering if this isn't grounds for an NHS complaint? Or a letter to your MP, or the local press? Of course, that's all additional hassle and stress for you. I wish I could suggest something more helpful.

 

[luggy]

You couldn't make it up!!
Four months on and no reimbursement made and no payments made to the nursing home for the care package which should have started on 1st July. They have deposited £86k into the homes bank account with no explanation of what it's for or a breakdown of what it relates to.

They admitted it was an error and said they would reclaim the money but after four weeks they still haven't done so. Today an ICB credit controller called the home to say the care package money is on hold until the home repay the £86k. The home told him they would not do that based on just a phone call and that an invoice needs to be sent for the amount to pay back so they have a record of why the money has been paid. In what universe would anyone send £86k based on a phone call request? The homes administrator said it was obvious he was home working because she could hear a tv or radio in the background!!

The level of shear incompetence is so frustrating. It's like having to deal with people from a Benny Hill sketch - just not as funny.

.........and another thing @Dave63 this is an issue between the ICB and the care home which is of no fault of yours. As such, the ICB should not be waiting for the care home to repay the £86,000 - they should be reimbursing what is legally your mum's money without delay and the ICB & care home can squabble between themselves without detriment to you and your mum. Also, the £86,000 will have accrued a not inconsiderable amount of interest during the course of the last few months, which should be taken into account.

That's 2 things.

 

[Dave63]

@Dave63 I'm so very sorry that you're having to deal with this. You've mentioned that you have had legal representation for your appeal - I'm assuming that this has finished now and they're unable to help with this unless you pay more money to them? I'm wondering if this isn't grounds for an NHS complaint? Or a letter to your MP, or the local press? Of course, that's all additional hassle and stress for you. I wish I could suggest something more helpful.

An official complaint was put in several weeks ago so I'll wait for that to run its course. Although the cynic in me says it's just the NHS marking it's own homework.

.........and another thing @Dave63 this is an issue between the ICB and the care home which is of no fault of yours. As such, the ICB should not be waiting for the care home to repay the £86,000 - they should be reimbursing what is legally your mum's money without delay and the ICB & care home can squabble between themselves without detriment to you and your mum. Also, the £86,000 will have accrued a not inconsiderable amount of interest during the course of the last few months, which should be taken into account.

That's 2 things.

The money placed in the homes account was apparently mums reimbursement with the instruction that the home had to transfer it to mum. Thing is it didn't even come close to covering what they actually owe. It's also not the homes responsibility to allocate money which has nothing to do with them. The home were quite rightly annoyed. Fortunately the homes management are brilliant and have been very patient throughout the whole thing. When I spoke with CHC they let slip that when the money is paid direct to the home they don't include the interest which would normally be paid and considering the interest is based on RPI that's a big chunk of money. Devious b**gers.

I've never come across anything which is so shambolic and incompetent in my life.

 

[luggy]

An official complaint was put in several weeks ago so I'll wait for that to run its course. Although the cynic in me says it's just the NHS marking it's own homework.


The money placed in the homes account was apparently mums reimbursement with the instruction that the home had to transfer it to mum. Thing is it didn't even come close to covering what they actually owe. It's also not the homes responsibility to allocate money which has nothing to do with them. The home were quite rightly annoyed. Fortunately the homes management are brilliant and have been very patient throughout the whole thing. When I spoke with CHC they let slip that when the money is paid direct to the home they don't include the interest which would normally be paid and considering the interest is based on RPI that's a big chunk of money. Devious b**gers.

I've never come across anything which is so shambolic and incompetent in my life.

This all sounds as if it is quite deliberate by the ICB, hiding behind incompetence. My dealings with my own ICB have given me cause to believe that they are dishonest. It's a national disgrace.

 

[Ruth32]

Just asking about peoples experiences regarding the time frame that they received a reply from the ICB/CHC after lodging a CHC Appeal. My mums was sent in 8 weeks ago and although it has been chased we have had no response.

 

[Dirge]

Just asking about peoples experiences regarding the time frame that they received a reply from the ICB/CHC after lodging a CHC Appeal. My mums was sent in 8 weeks ago and although it has been chased we have had no response.

My appeal was acknowleged within 2 weeks but was then passed to an external agency to review so my ICB may be working differently to others.

 

[Norris]

We had a response within a week..… but only For the ICB to say that they would hold the appeal meeting on the last day of the three month window… go figure

 

[Ruth32]

@Dirge @Norris Thanks for your responses. I have checked and the ICB has acknowledged receipt of the appeal but no other response. I didn't know there was a 3 month time limit. Do you know if this is just to respond with their views or to actually hold a meeting etc. Many thanks

 

[Dirge]

@Dirge @Norris Thanks for your responses. I have checked and the ICB has acknowledged receipt of the appeal but no other response. I didn't know there was a 3 month time limit. Do you know if this is just to respond with their views or to actually hold a meeting etc. Many thanks

@Ruth32 I'm afraid I don't know much about the time limit beyond the original CHC decision, I am using an advocacy service so have just left them to it, fully expecting them to pick up on any time restraints etc.

 

[Norris]

• The local CCG must deal with your request, complete a review and make a further eligibility decision within 3 months of receiving your initial request for review. If there’s a delay, the CCG must inform you in writing explaining why. It could be because they can’t access the relevant care records in time or they can’t pull together an appropriate multi-disciplinary team to carry out the review.

 

[Norris]

• The CCG has 5 days to acknowledge in writing that it has received your request – and it must also provide you with information on the Continuing Care appeal process

 

[Sammytessa1]

The CHC funding process is horrific and we found that as mums main carers and family members like many people have said it carried no weight of importance. It is a process that needs a complete review. We were all treated as second class citizens and mum was treated as just an insignificant subject in a process by the person carrying out the process . There needs to be change and not only change in the process, but some people carrying out the process need re training to remind them that there are people at the end of ‘the process’!!