Appealing a NHS Continuing Healthcare decision

How do I appeal?

If you or your relative has had a NHS Continuing Healthcare (CHC) assessment and you do not agree with the eligibility outcome you have the right to appeal. Throughout the process we advocate your full involvement within this and would expect that you would have had any decision making fully explained to you. However, if you wish to appeal the decision, please contact the Continuing Healthcare Team at the address detailed on the decision letter. They will send you an appeal form and support you through the process. You will need to submit your appeal reasons within six months of receiving the Trust’s written decision letter.

Download appeal form

What will happen next?

The first stage is for the Lead Nurse to review your case and check that the process has been followed correctly and, where possible, to seek local resolution. This may involve either a meeting or a telephone discussion between the client/family/legal representative and Lead Nurse/Local Liaison and Resolution Officer. At this meeting we will endeavour to explain our process, answer any questions and document any additional information that you provide us with.

If it is agreed that a further assessment of your needs is required, your representative will be invited to attend to ensure that you are both fully involved in the process. We aim to complete stage 1 within 28 working days, although it may take a little longer if a further assessment is required.

Once stage one has been completed, if you remain dissatisfied with the outcome then you have the right to proceed to stage two of the appeals process (Local Review Panel). This panel will consist of a multidisciplinary team who have had no previous involvement in the Continuing Healthcare decision making process. You will be invited to attend the panel to explain why you wish to appeal the eligibility decision. We aim to send the decision letter and completed Decision Support Tool to you within twenty eight days of the panel date.

We hope that upon completion of these two stages that you will be satisfied with the decision making. However, if this is not the case you will have the right of appeal to NHS England. Full contact details will be provided with our decision letter.

Appealing on behalf of a family member or friend

You can appeal on behalf of a friend or relative, but in every case, whether someone is acting on behalf of a relative or friend, we will need to see evidence that you are the patient’s legal representative which can be in the form of written consent from the client or a relevant power of attorney.

The appeals form includes a consent to share information authority which enables us to request documentation from organisations such as care homes and GP surgeries to support an appeal.

Where can I find further information?

The multidisciplinary team will use the Department of Health National Framework for NHS – funded Continuing Healthcare 2012 and Decision Support Tool to inform their decision making of the client level of needs. These documents can be found on the Department of Health’s website at www.gov.uk.

Advocacy and support

If you require assistance or advice relating to the process, the following organisations can offer support:

  • Healthwatch
  • Age UK
  • SEAP – can provide you with support if you wish to make a complaint regarding the Continuing Healthcare process.

Where to find further information

If you have any questions, please contact the Continuing Healthcare team at the following address:

Cavanna House
Riviera Park
Nicholson Road
Torquay
TQ2 7TD

For any enquiries for Torbay areas please contact:

Tel: 01803 210738
Email: Continuing Healthcare Team

For any enquiries for Southern Devon areas please contact:

Tel: 01803 210630
Email: Continuing Healthcare Southern Team

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