Your CHC Appeals support thread

[Ruth32]

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]

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.

NHS England IRP Decisions - Your 15 Step Guide

Understanding NHS England IRP Decisions in this 15 step guide. Often the Care Commissioning Group (CCG) will review...

caretobedifferent.co.uk

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.

NHS England IRP Decisions - Your 15 Step Guide

Understanding NHS England IRP Decisions in this 15 step guide. Often the Care Commissioning Group (CCG) will review...

caretobedifferent.co.uk

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.

NHS England IRP Decisions - Your 15 Step Guide

Understanding NHS England IRP Decisions in this 15 step guide. Often the Care Commissioning Group (CCG) will review...

caretobedifferent.co.uk

@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]

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.

Care Act 2014

An Act to make provision to reform the law relating to care and support for adults and the law relating to support for carers; to make provision about safeguarding adults from abuse or neglect; to make provision about care standards; to establish and make provision about Health Education...

www.legislation.gov.uk

 

[Dave63]

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]

@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]

@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]

@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:

CHC: Finally after 18 months of legal quibbling...

Well the requested 21 days extra has now passed and there is still no response from the regional CHC IRP. On Monday I will be looking at the next steps as clearly this is now a breach of their own guidance. Nothing on this dementia journey has been easy and frankly I am weary of services that...

forum.alzheimers.org.uk

 

[Louise7]

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

CHC (Continuing Healthcare) support thread

No idea I'm afraid as mum is yet to have hers. However, there does appear to be a pattern with reviews being used to withdraw funding due to the person suddenly becoming miraculously better in an originally higher scored domain. The guidance is very clear in that the review should only be used...

forum.alzheimers.org.uk

 

[luggy]

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

CHC (Continuing Healthcare) support thread

No idea I'm afraid as mum is yet to have hers. However, there does appear to be a pattern with reviews being used to withdraw funding due to the person suddenly becoming miraculously better in an originally higher scored domain. The guidance is very clear in that the review should only be used...

forum.alzheimers.org.uk

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

 

[sdmhred]

Long story here…..but I find out after mum has died that her CHC application was declined (no surprise there)….but wait for it - they sent the outcome letter to the wrong address so i find out 6 weeks later..…..

I won’t be appealing the CHC although she was eligible….but I will be complaining and requesting damages for a big breach of confidentiality!

 

[luggy]

Long story here…..but I find out after mum has died that her CHC application was declined (no surprise there)….but wait for it - they sent the outcome letter to the wrong address so i find out 6 weeks later..…..

I won’t be appealing the CHC although she was eligible….but I will be complaining and requesting damages for a big breach of confidentiality!

Good grief! Their incompetence is baffling. I'm so sorry to hear that your mum has passed away and, on top of that, you're having to deal with this too xx

 

[Dave63]

Long story here…..but I find out after mum has died that her CHC application was declined (no surprise there)….but wait for it - they sent the outcome letter to the wrong address so i find out 6 weeks later..…..

I won’t be appealing the CHC although she was eligible….but I will be complaining and requesting damages for a big breach of confidentiality!

So sorry to hear your mum has passed @sdmhred

The levels of dysfunction and incompetence by CHC teams seems to know no bounds. It was only after a bit of digging during my frustrations with them that I discovered that the administration of the process was contracted out to third party companies. For my region it was so dysfunctional that the CCG took back control and our issues were resolved very swiftly thereafter.

 

[sdmhred]

Thanks both. They seem quite open to admit it too without even realising what they have done 🤷‍♀️🤷‍♀️
Thanks for the advice on this thread. we would have good grounds to appeal but i am not up for it in the circumstances. I have learned a lot though and will be able to pass onto others.