Appealing a NHS Continuing Healthcare decision

How do I appeal?

If you or your relative has been found ineligible for NHS Continuing Healthcare funding, you can appeal against the decision by contacting the Continuing Healthcare Team. The Appeals Co-ordinator will support you through the process. It is recommended that you read all the correspondence and take the time to understand why the assessment indicated a non-eligible decision before deciding whether to appeal or not.

Please note, the appeal should relate only to the period covered within the Decision Support Tool.

A request to appeal a decision can be made by phone or in writing to the Continuing Healthcare Team. Your appeal reasons need to be provided to the CHC Team within six months of receiving the written decision letter.

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

Torbay and South Devon Continuing Healthcare Team
Sherborne House
Kingsteignton Road
Newton Abbot
TQ12 2PF

Tel: 01626 357820
Email: Continuing Healthcare Team

What will happen next?

Stage 1 – Local Resolution Meeting (LRM)

You and/or your representative will be invited to attend a Local Resolution Meeting with the Lead Nurse for Continuing Healthcare, Appeals Co-ordinator and where possible, the Nurse Assessor who conducted the assessment. If you and/or your representative are unable to attend in person there is an option to hold a teleconference call instead.

You and/or your representative will be able to provide any additional evidence that you would like to be considered. A summary of the meeting will be taken and a copy will be sent to you and/or your representative.

If new evidence is provided, the Lead Nurse may ask the nurse assessor to further review the decision and produce a report. A copy of the outcome will be sent to you and/or your representative. The Lead Nurse will also review the case and check that the correct process has been followed and, where possible, seek resolution.

If following the LRM there is no resolution and you and/or your representative remain dissatisfied, a request can be made to proceed to stage 2. Contact should be made with the team within 28 days of the LRM.

Stage 2 – Local Review Panel (LRP)

This panel will consist of a multidisciplinary team who have had no previous involvement in the Continuing Healthcare decision making process. You and/or your representative will be invited to attend the panel to explain the rationale of why the ineligibility decision is being appealed.

We aim to conduct the LRP within 3 months of the LRM. At the start of the meeting the Chair will introduce the members of the panel and set out how the meeting will be structured.

We aim to send the decision letter and completed Decision Support Tool to you within four/six weeks of the LRP.

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.

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: