Your CHC Appeals support thread

[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.

My bad, sorry @luggy, just gone through my emails with FD and the lady who represented us at the LRM wasn't a nurse. She was however extremely experienced with LRM's and IRP's and it definitely showed during the meeting. I'm convinced that without her help we wouldn't have had a successful outcome.

Perhaps I'm too impatient

You are absolutely not being too impatient. Whatever the reason for the delays it's not your fault, it's not your mums fault, it's not FD's fault it's one hundred percent the fault of the ICB.

From just trying to get a checklist assessment to the date of appeal took us three years. There were multiple reasons for that and every single one was because of the ICB. At times it felt like we were dealing with the mafia.

 

[luggy]

My bad, sorry @luggy, just gone through my emails with FD and the lady who represented us at the LRM wasn't a nurse. She was however extremely experienced with LRM's and IRP's and it definitely showed during the meeting. I'm convinced that without her help we wouldn't have had a successful outcome.


You are absolutely not being too impatient. Whatever the reason for the delays it's not your fault, it's not your mums fault, it's not FD's fault it's one hundred percent the fault of the ICB.

From just trying to get a checklist assessment to the date of appeal took us three years. There were multiple reasons for that and every single one was because of the ICB. At times it felt like we were dealing with the mafia.

@Dave63 thanks for clarifying, and for the pep talk too. I like your analogy with the mafia - so appropriate. I shall hereafter refer to the ICB as the mafia.

Quick question - have you (or someone from FD) ever submitted a Subject Access Request to the CHC Team? I've submitted several SAR's during the last couple of years, especially when I was trying to fight the mafia(!) on my own, but it never occurred to me to send one to the CHC Team. Just a thought.

 

[Dave63]

Quick question - have you (or someone from FD) ever submitted a Subject Access Request to the CHC Team?

Not that I'm aware of.

 

[Dave63]

so appropriate. I shall hereafter refer to the ICB as the mafia.

Don't blame me if you wake up to horses head on the pillow

 

[luggy]

Don't blame me if you wake up to horses head on the pillow

😲😅

 

[Dirge]

Can I ask whether anybody has any knowledge/experience of appealing a CHC negative response to the NHS? I have gone though the ICB full process and am wondering whether there is any mileage in a further appeal or am I just wasting my time and should accept the outcome and move on?

 

[Norris]

Just received the response from our appeal to LRM today re my father in law… with the original decision being changed, so that CHC has now been awarded.

so I would say yes it is.

we ended up using one of the many advocate companies mentioned on the forum, for the appeal.This was because we felt the system was stacked against us and that it would level the playing field a little.

The advocate used all of the same examples we would have used, but their knowledge of the way to say things was invaluable.

would we have got the same result without using an advocate… possibly. Was our case stronger by using an advocate …. Most definitely

it has been a bitter sweet week though, not just the realisation of what this means, re the stage my father in law has reached, but we we’re also awarded CHC for my father on Wednesday, so been a bit like buses this week, this time under the fast track system, with the obvious implications this implies for his state of health.

 

[Dave63]

@Norris, that's excellent news about your father in law.
I'm sorry to hear your own father is poorly and although he's been awarded fast track it must feel like a double edged sword.

I'm sure you're already aware but the CHC financial redress rules mean that any fees paid by your father in law should now be refunded in full from a date which is 29 days after the original checklist assessment was received by the ICB.

 

[sdmhred]

I was going to ask about this - so if CHC awarded - fees backdated from 29 days after the initial checklist leading to full assessment? So if cashflow no problem then going with a lengthy process but using the time to get advocacy is of no disadvantage?

well done @Norris and all the best to your family and the funds which can be spent on a few treats for ur FIL to make the best of his time xx

 

[Dirge]

Just received the response from our appeal to LRM today re my father in law… with the original decision being changed, so that CHC has now been awarded.

so I would say yes it is.

we ended up using one of the many advocate companies mentioned on the forum, for the appeal.This was because we felt the system was stacked against us and that it would level the playing field a little.

The advocate used all of the same examples we would have used, but their knowledge of the way to say things was invaluable.

would we have got the same result without using an advocate… possibly. Was our case stronger by using an advocate …. Most definitely

it has been a bitter sweet week though, not just the realisation of what this means, re the stage my father in law has reached, but we we’re also awarded CHC for my father on Wednesday, so been a bit like buses this week, this time under the fast track system, with the obvious implications this implies for his state of health.

Thanks for your update @Norris , it's good to hear of these successes when you feel like you're banging your head against a brick wall.

 

[Dave63]

So if cashflow no problem then going with a lengthy process but using the time to get advocacy is of no disadvantage?

Assuming a positive outcome then that's correct. However, the flip side is getting a negative outcome and 'losing' the £1000's paid for advocacy.

 

[luggy]

Can I ask whether anybody has any knowledge/experience of appealing a CHC negative response to the NHS? I have gone though the ICB full process and am wondering whether there is any mileage in a further appeal or am I just wasting my time and should accept the outcome and move on?

Some of the advocacy companies mentioned on this forum will give an initial free consultation so that you can gauge whether or not it might be worth it. I'm assuming that your relative wasn't scored with 2 'severes' or 1 'priority' which would have made your relative eligible without question, so it really depends on what scores were given in the 12 domains on the DST but, more importantly, how the 12 domains interract with each other in the 4 Key Indicators of Nature, Intensity, Complexity and Unpredictability.

 

[Norris]

Agree

Assuming a positive outcome then that's correct. However, the flip side is getting a negative outcome and 'losing' the £1000's paid for advocacy.

yep no guarantees

we had had a couple of bad experiences at the checklist stage and then at the DST meeting… hence the reason for wanting someone to lean on. Also the area we are in comes in the bottom 5% of areas to award funding.

we took the view that if we were unsuccessful then the cost of the advocacy would have only gone in further care fees. So was worth the gamble.

as luggy says, the firm we used carried out an initial review of the case at no charge. So whilst no guarantees, they were able to confirm that our view of the domains and their interaction was on point and we weren’t barking up the wrong tree

Also we had approached the firm six months before hand and they had told us that they wouldn’t take us on at that point, as our case wasn’t strong enough. This also helped in the decision making process, as it gave us a degree of confidence that they weren’t just ambulance chasing

 

[Norris]

@Norris, that's excellent news about your father in law.
I'm sorry to hear your own father is poorly and although he's been awarded fast track it must feel like a double edged sword.

I'm sure you're already aware but the CHC financial redress rules mean that any fees paid by your father in law should now be refunded in full from a date which is 29 days after the original checklist assessment was received by the ICB.

I will update re the backdating in due course, as that issue isn’t clear cut

the reason for this is that a checklist wasnt carried out this time

the individual who was assigned the case said that it was obvious that my father in law would pass the checklist and moved straight to the DST…. They based their decision on a checklist that had been previously completed, that we failed on. That we had appealed and still got turned down on and that we were in the process of appealing to the ombudsman. So by implication they also saw an issue with the decision reached on the original checklist

so will see what they come back with re this

the ombudsman has confirmed that depending upon the outcome of the LRM they would ask the ICB to reopen the decision made on the original checklist… so we have that to fall back on if they refuse to reopen it straight away

 

[Norris]

I was going to ask about this - so if CHC awarded - fees backdated from 29 days after the initial checklist leading to full assessment? So if cashflow no problem then going with a lengthy process but using the time to get advocacy is of no disadvantage?

well done @Norris and all the best to your family and the funds which can be spent on a few treats for ur FIL to make the best of his time xx

Also you need to make a call as to your chances of getting a successful outcome, as if you Don’t win, but could have started a new checklist in the intervening period which would of received a positive outcome, you could end up out of money as a result of the delay in starting a new application

 

[sdmhred]

Thanks - its all such a minefield!

when is a new checklist triggered? Any time there is a significant change?

 

[Norris]

Thanks - its all such a minefield!

when is a new checklist triggered? Any time there is a significant change?

Exactly that

you can request a new checklist is completed at any stage. In the example above, there was a period of only six weeks between the failed checklist and our request for a follow up checklist.

 

[Dave63]

the individual who was assigned the case said that it was obvious that my father in law would pass the checklist and moved straight to the DST…. They based their decision on a checklist that had been previously completed, that we failed on. That we had appealed and still got turned down on and that we were in the process of appealing to the ombudsman. So by implication they also saw an issue with the decision reached on the original checklist

Para 121 of the National Framework allows for skipping the checklist stage and going straight to DST so you would assume (always a dangerous thing when dealing with ICB's) that the start date of redress would be from the date of referral as opposed to receipt of a checklist? Also, if the referral was based on a previously completed checklist I agree that that should either be the start date of redress or at the least looked at retrospectively.

Slightly off topic, but it's ironic that legal fees can't be included in redress due to the ombudsmans view that the NHS has a robust complaints and appeals process which negates the need for legal representation. Then you look at cases like yours and think 'hmmm, I'm not so sure'.

 

[Dirge]

Some of the advocacy companies mentioned on this forum will give an initial free consultation so that you can gauge whether or not it might be worth it. I'm assuming that your relative wasn't scored with 2 'severes' or 1 'priority' which would have made your relative eligible without question, so it really depends on what scores were given in the 12 domains on the DST but, more importantly, how the 12 domains interract with each other in the 4 Key Indicators of Nature, Intensity, Complexity and Unpredictability.

@luggy . I'm currently using an advocacy company but with 2 negative outcomes already I need to decide whether a direct appeal to NHS has mileage. Relative had 1 severe, 3 Highs and others are mainly moderate however we have challenged 3 of the moderates as being higher. It seems that the ICB and LRP have cherry picked the comments they wish to use in the Key Indicators and omitted others which would be beneficial to the case. There are also procedural issues from not following the framework but I've read that these wont be taken into account by the NHS.

 

[luggy]

@luggy . I'm currently using an advocacy company but with 2 negative outcomes already I need to decide whether a direct appeal to NHS has mileage. Relative had 1 severe, 3 Highs and others are mainly moderate however we have challenged 3 of the moderates as being higher. It seems that the ICB and LRP have cherry picked the comments they wish to use in the Key Indicators and omitted others which would be beneficial to the case. There are also procedural issues from not following the framework but I've read that these wont be taken into account by the NHS.

Ah, I see. It seems that you are already part way through the appeal process, with advocacy, and are debating whether or not to take it to NHS England (IRP). I didn't pick up on that in your original post - my mistake.

I haven't reached the LRM stage yet - that's set for 1st Feb (it should have been 31/10/23, but the ICB cancelled it that same morning). My mum was found to be ineligible at the DST, with 1 severe, 6 high's, 3 moderate's and 2 no needs, and with a complete disregard for the 4 Key Indicators. We have also suffered at the hands of numerous abuses of process.

It's tricky to advise on whether you should proceed to the next step, but I know of at least one person on this forum who was successful at the IRP, and if we're unsuccessful at the LRM, it's my intention to take it to the IRP, pending advice from our advocate. The finances and levels of stress will take a fair amount of battering, so I know it's not an easy decision to make.

Best of luck.