Your CHC Appeals support thread

Sammytessa1

New member
Oct 11, 2023
2
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Thanks Dave63. Rants are helpful! It all sounds very much like my experience. I hope you win your appeal.
Hi

I’m sorry to hear your experience and I hope you won your appeal. We are currently going through the CHC process and it’s been horrific. I cannot believe how the process is carried out and how they are not reviewed themselves . We had the assessor in mums DST that had never met mum and the other professionals had not seen her for a year,yet questioned us as if we were on trial and we are there for 24 hrs a day . It wouldn’t be allowed else where in the nhs, so why are they allowed to carry out this process in this way. My mum I feel for them became an insignificant object in a horrendous process. How is this allowed to happen ? The outcome will be what it will be, but the process should be carried out in a respectful , supportive manner and for us it wasn’t. It adds stress and anxiety to what should be precious quality time with a very special person. There needs to be change soon.
 

Dave63

Registered User
Apr 13, 2022
350
0
Hi

I’m sorry to hear your experience and I hope you won your appeal. We are currently going through the CHC process and it’s been horrific. I cannot believe how the process is carried out and how they are not reviewed themselves . We had the assessor in mums DST that had never met mum and the other professionals had not seen her for a year,yet questioned us as if we were on trial and we are there for 24 hrs a day . It wouldn’t be allowed else where in the nhs, so why are they allowed to carry out this process in this way. My mum I feel for them became an insignificant object in a horrendous process. How is this allowed to happen ? The outcome will be what it will be, but the process should be carried out in a respectful , supportive manner and for us it wasn’t. It adds stress and anxiety to what should be precious quality time with a very special person. There needs to be change soon.
We did win the appeal. However, that was at the end of May and to date the nursing home have yet to receive any payment of fees for the care package, and mum has not received a penny of the reimbursement due for the past 2.5 years for the fees she has had to pay.

Every request for an update goes unanswered, error after error and a very obvious lack of understanding of who they are supposed to be reimbursing or why they are reimbursing. The complete lack of communication across departments and the levels of dysfunction is absolutely staggering. If this is normal level of administration suffered by the rest of the NHS then no wonder it's on its knees.
 

luggy

Registered User
Jan 25, 2023
178
0
So, today's scheduled Local Resolution Meeting which was set 6 weeks ago, has been postponed by the ICB at the 11th hour, earlier this morning. Their excuse was that they couldn't find anyone to chair the meeting.

This will be yet another tactical manoeuvre, of which there is a long list. These manoeuvres are all being logged, should this appeal end up with NHS England.
 

Dave63

Registered User
Apr 13, 2022
350
0
Sorry to hear that @luggy.
It's not just the shambolic way they run their department which is frustrating, but also the inconvienience they cause to others who have set time aside to take part. My experience to date is that you can complain until you're blue in the face but nobody holds anyone else to account, whether it be ICB, NHS executive or Parliamentary Ombudsman.

Don't let the b**gers get you down, you'll get there in the end.
 

Palerider

Registered User
Aug 9, 2015
4,150
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56
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So, today's scheduled Local Resolution Meeting which was set 6 weeks ago, has been postponed by the ICB at the 11th hour, earlier this morning. Their excuse was that they couldn't find anyone to chair the meeting.

This will be yet another tactical manoeuvre, of which there is a long list. These manoeuvres are all being logged, should this appeal end up with NHS England.
It wouldn't surprise me if rather than they were unable to find anyone there was a refusal to chair the meeting bearing in mind the ICB is directly accountable for the decisions it makes -it seems a bit odd to arrange in advance and come the day suddenly there is no chair. I say this because the original ICB representative at our IRP suddenly decided not to appear (she was the manager) and another representative attended who couldn't defend the ICB's original position.
 

Dave63

Registered User
Apr 13, 2022
350
0
Two movements on the CHC front today.

Had an email from a CHC nurse assessor to advise she would be carrying out a review of mums needs on Sunday at 3pm via the phone with the nursing home. Sort of ironic that they haven't arranged payment of the care package for the past 5 months but are able to arrange a review of it. Also, an unusual day to do a review, but it turns out it's an outside company who are contracted to do reviews on behalf of the NHS, so it's probably an agency nurse working from home.

Also had an email from the ICB to apologise for the issues we've faced with mums reimbursement. They have informed me that due to MLCSU having organisational changes (I read that as not fit for purpose) all reimbursements are now being transferred directly to the ICB for them to process. The lady who emailed me has been very helpful and apologetic and answered my questions very promptly, so I'm a little more hopeful this will get resolved sooner rather than later. Famous last words!!
 
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luggy

Registered User
Jan 25, 2023
178
0
Two movements on the CHC front today.

Had an email from a CHC nurse assessor to advise she would be carrying out a review of mums needs on Sunday at 3pm via the phone with the nursing home. Sort of ironic that they haven't arranged payment of the care package for the past 5 months but are able to arrange a review of it. Also, an unusual day to do a review, but it turns out it's an outside company who are contracted to do reviews on behalf of the NHS, so it's probably an agency nurse working from home.

Also had an email from the ICB to apologise for the issues we've faced with mums reimbursement. They have informed me that due to MLCSU having organisational changes (I read that as not fit for purpose) all reimbursements are now being transferred directly to the ICB for them to process. The lady who emailed me has been very helpful and apologetic and answered my question very promptly, so I'm a little more hopeful this will get resolved sooner rather than later. Famous last words!!
Keeping my fingers crossed for you @Dave63
 

Dave63

Registered User
Apr 13, 2022
350
0
Keeping my fingers crossed for you @Dave63
Thanks @luggy,

The review went really well. Two of the homes nurses sat in on it and I was armed with a copy of the national framework and mums previous DST and LRM report and determined to fight mums corner with both barrels. Fortunately, the nurses gave a master class in how to handle reviews and my input was fairly minimal. At the end of the review, which only took an hour, the nurse assessor confirmed no changes to mums domains and that chc would continue.
 

luggy

Registered User
Jan 25, 2023
178
0
Thanks @luggy,

The review went really well. Two of the homes nurses sat in on it and I was armed with a copy of the national framework and mums previous DST and LRM report and determined to fight mums corner with both barrels. Fortunately, the nurses gave a master class in how to handle reviews and my input was fairly minimal. At the end of the review, which only took an hour, the nurse assessor confirmed no changes to mums domains and that chc would continue.
I'm really pleased for you @Dave63 With any luck, you'll be onwards and upwards now.
 

luggy

Registered User
Jan 25, 2023
178
0
It's now been one month since our ICB cancelled the Local Resolution Meeting on the grounds that they didn't have anyone to 'chair' the meeting (for goodness sake, do they honestly think that I'm daft enough to believe that!?) There has been no word from the solicitor either, despite my sending them an email (a week ago) asking them to chase it up.

The ICB waited until the morning of the LRM, which was scheduled for 2pm that day, before cancelling it. I was all fully prepared and evidenced up to answer any questions put to me, and with an array of questions to ask them. I've been in Limboland ever since, with stacks of paperwork piled up on my living room floor in readiness for the re-scheduled LRM.

My next step is to phone the solicitor next week and strongly suggest that they chase up the ICB. I've paid them to represent mum and me at the LRM and we appear to have been put on the backburner.

Disgruntled doesn't even come close.

Rant over. I feel better for that.
 

luggy

Registered User
Jan 25, 2023
178
0
Following on from my previous post, it does appear that we have been put on the backburner by the solicitor representing our appeal. They have been sitting on their hands during this last month and have made no attempt to contact the ICB to reschedule the LRM.

As a matter of interest, how long has it taken others on this forum to reach the LRM stage following notification of appeal?

Mum's MDT took place in mid January '23 and we notified the ICB of our intention to appeal just within the 6 months at the beginning of July. By the end of July, the caseworker submitted the written evidence. On 15th Sept we were given notification of the LRM date - 31st Oct. On the morning that the meeting was due to be held, the ICB cancelled it. On the same day, the caseworker requested a new date. The ICB have not been in touch and the caseworker has not chased it up - until today, on my instruction. We were given 6 weeks notice of the original LRM date, so assuming we are given a similar period of notice this time, it will be at least the middle of January before the rescheduled date - and that's if the ICB responds before the end of this week.

The solicitors I'm using to advocate have been really good, but seem to have adopted a rather casual approach to this delay. The caseworker stated that ICB's have a huge backlog with appeals because of the cessation of the Covid 19 emergengy discharge funding - well, that happened in March '22, so I'm not sure that's a valid reason. It sounds as if the solicitors are the ones with a backlog, and are happy to let our case drift along so that they can catch up. Meanwhile, we've been pushed to the back of the queue.

I'm aware that these appeals can go on for a long time, but does it normally take this long just to get to the LRM stage?

Thank you.
 

Dave63

Registered User
Apr 13, 2022
350
0
Hi @luggy

Just had a quick look through my emails to get a timeline for our appeal to LRM.
  • 29 Mar 2022 - Outcome letter received
  • 16 Sept 2022 - Appeal lodged
  • 27 Apr 2023 - LRM
So the time between lodging the appeal and the LRM was 7 months. A lot of that time was spent gathering evidence by both the ICB and solicitors. I would have thought your ICB would have all the evidence needed as they had set a date for the cancelled LRM, so that shouldn't be a factor in setting a new date.

We were advocated for by Farley Dwek and the lady who handled mums case really knew her stuff and didn't give an inch to the ICB. The solicitors CHC nurse who represented us at the LRM knew her job inside out and very politely ran circles around the LRM panel.
 

Dirge

Registered User
Dec 20, 2022
34
0
My timeline is as follows:

24th Feb 2023 - Outcome letter
11th August 2023 - Appeal Lodged
21st November 2023 - LRM
 

luggy

Registered User
Jan 25, 2023
178
0
Hi @luggy

Just had a quick look through my emails to get a timeline for our appeal to LRM.
  • 29 Mar 2022 - Outcome letter received
  • 16 Sept 2022 - Appeal lodged
  • 27 Apr 2023 - LRM
So the time between lodging the appeal and the LRM was 7 months. A lot of that time was spent gathering evidence by both the ICB and solicitors. I would have thought your ICB would have all the evidence needed as they had set a date for the cancelled LRM, so that shouldn't be a factor in setting a new date.

We were advocated for by Farley Dwek and the lady who handled mums case really knew her stuff and didn't give an inch to the ICB. The solicitors CHC nurse who represented us at the LRM knew her job inside out and very politely ran circles around the LRM panel.
@Dave63 thanks for looking into your timeline. It sounds as though my timeline is similar currently, but likely to drag on. Our case is a little unusual, in as much as we're not disputing the scores applied in the domains as they were 1 severe, 6 highs and the remainder were moderates. We're focusing on the 4 key indicators, which were glossed over by the ICB. So, the evidence has always been there but ignored.

Our solicitor's have been good too, but I suspect that they must be very busy at the moment as they seem to be quite happy to wait for the ICB to reschedule and disinclined to chase them up when they don't.
 
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Dirge

Registered User
Dec 20, 2022
34
0
Thanks @Dirge within 9 months or so, which is good going. I hope it went well for you.
Thanks @luggy I think it was only 9 months because the appeal was outsourced to an external partner. Not really sure how it went as there were some records missing or incomplete from the CH which hampers the argument slightly.
 

canary

Registered User
Feb 25, 2014
24,699
0
South coast
they seem to be quite happy to wait for the ICB to reschedule and disinclined to chase them up when they don't
Mmmm..........
Is it possible that they dont think you will get it, so are disinclined to spend more time/money on it?
 

Dave63

Registered User
Apr 13, 2022
350
0
Our case is a little unusual, in as much as we're not disputing the scores applied in the domains as they were 1 severe, 6 highs and the remainder were moderates. We're focusing on the 4 key indicators, which were glossed over by the ICB. So, the evidence has always been there but ignored.
I think you're absolutely right to be focusing on the key indicators. The nurse FD use to represent you at the LRM will definitely be able to show how the combination of high scoring domains impact the key indicators which in turn will prove a primary health need.

Mums scores were not as high as yours but we were able to show how, collectively, they impacted her over all. Based solely on the domain scoring mums chances of a successful appeal were borderline, what swung it was showing how each domain when considered together showed her needs to be complex, intense and unpredictable.
 

luggy

Registered User
Jan 25, 2023
178
0
Mmmm..........
Is it possible that they dont think you will get it, so are disinclined to spend more time/money on it?
Hi @canary I don't believe that's the case. I wouldn't be pursuing it, if it were. Without going into the ins and outs of the copious amounts of evidence there is to support eligibility, our appeal is genuine. Plus, the solicitors have been paid in advance to represent me/mum at the LRM, so they would be failing in their duties if they decided to bin it! They are a reputable firm used, with success, by members on this forum.
 

luggy

Registered User
Jan 25, 2023
178
0
I think you're absolutely right to be focusing on the key indicators. The nurse FD use to represent you at the LRM will definitely be able to show how the combination of high scoring domains impact the key indicators which in turn will prove a primary health need.

Mums scores were not as high as yours but we were able to show how, collectively, they impacted her over all. Based solely on the domain scoring mums chances of a successful appeal were borderline, what swung it was showing how each domain when considered together showed her needs to be complex, intense and unpredictable.
@Dave63 FD have never mentioned to me that a nurse would be present at the LRM. FD's representative at the LRM was to be the lady who has been handling mum's case, although I know a nurse did an analysis of mum's DST and made recommendations. It all hinges on those 4 key indicators.

Anyway, thank you for sharing your experience and thoughts. I'm sure it will all come to pass eventually. Perhaps I'm too impatient - in my world, if an important meeting is cancelled, steps are usually taken to reschedule ASAP. I should know by now that the world of CHC makes the rules up as it goes along. What a shambolic lot these ICB's are.
 
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