We offer a wide range of services in relation to all stages of the NHS Continuing Healthcare eligibility process
Checklists, full MDT assessments, local and national appeals, reviews, withdrawals and refunds – Just Caring Legal has it covered
What is NHS Continuing Healthcare funding?
NHS Continuing Healthcare (CHC) is a fully funded package of care provided by the NHS outside of a hospital setting for individuals who have significant ongoing healthcare needs. The funding covers those but also any social care needs. It can be provided in a care home or at home, and it is available to everyone who needs it. It is not means-tested. Someone may need an NHS CHC assessment after they leave hospital, if it becomes clear they will need ongoing care. In this case, they will usually be assessed after discharge and a period of recovery. But they may need an assessment even if they are already in a care home or receiving care at home. It all depends on the extent, severity, complexity and unpredictability of their day-to-day needs.
Could I or my relative be eligible for NHS Continuing Healthcare?
Eligibility for NHS Continuing Healthcare does not depend on having a particular condition or diagnosis. To be eligible, you must have high level of care needs that arise from a ‘primary health need’. Sounds simple? Unfortunately, it is anything but. The problem is the concept of a ‘primary health need’ is not straightforward; there is no legal definition.
Since 2007, there has been a National Framework on NHS Continuing Healthcare in place, which provides standardised guidance that ICBs must follow in deciding whether there is a primary health need. However, there is still widespread uncertainty. As a result, many people are wrongly paying substantial care home bills, despite living with the devastating effects of health issues such as Alzheimer’s disease and other forms of dementia, Multiple Sclerosis, Parkinson’s disease, or the effects of stroke and cancer.
Challenging NHS Continuing Healthcare decisions can be perplexing, frustrating and distressing. It requires first-class knowledge of the complexities of the National Framework, a forensic eye for medico-legal detail, and hands-on experience of dealing with NHS Continuing Healthcare decision-makers. This is how Just Caring Legal can help. This is all we do.
As a solicitor’s firm specialising in NHS Continuing Healthcare cases, your Just Caring Legal solicitor can construct and deliver strong evidence-based arguments to ensure full and robust assessments and reassessments and challenge unfair and inadequate processes.
The first thing we need is information about you or your loved one’s care needs, health, situation and history. It is vital you help us with this as early as possible so we can accurately advise you on your chances of success and how to maximise these. This is why we have constructed our bespoke Free Evaluation Form, to gather as much information about your individual case as we can, as quickly as we can. As soon as you have completed and submitted it, we will contact you to discuss how we can best help you.
How can Just Caring Legal help with NHS CHC eligibility assessments?
In standard cases (which aren’t ‘fast-tracked’), there are two stages to an NHS Continuing Healthcare assessment.
‘Checklist’ stage – The Checklist is designed to decide quickly whether someone requires a full assessment and should be considered for eligibility for NHS Continuing Healthcare. If the Checklist is “positive” (2 or more domains scored A, 5 or more domains scored B, one A and 4 B, or one “priority” domain scored A), they are then entitled to a full assessment by a Multi-Disciplinary Team (MDT). However, there are often mistakes at the Checklist stage.
If you think an individual should have had a checklist but has been denied one, or that their checklist was inaccurate and they were wrongly denied a full assessment, Just Caring Legal can help.
- We can review the documentation to assess if there are grounds to challenge a historic negative checklist and apply retrospectively for an “unassessed period of care” and potentially a sizeable refund of care fees.
- We can carry out a full assessment of the paperwork ahead of a checklist to maximise your chances of success.
‘Decision Support Tool’ (DST) stage – This is a full, detailed assessment by a Multi-Disciplinary Team (MDT), usually a nurse trained in CHC assessments and a social worker. The DST sets out different levels of needs in relation to 12 care ‘domains’, basically assessing someone’s total care needs. This includes looking at behaviour, cognition, mobility, nutrition, and more. The MDT must agree on the level of need in each one, from No Needs to High, Severe or Priority depending on the domain.
Any statements about these needs must be backed up by evidence. This is likely to be in the form of daily care records, care plans, risk assessments, GP records and specialist assessments. It should also take into account any verbal evidence supplied by the carers and family members. It is vital to ensure as much clinical documentation as possible is gathered about the extent and severity of the care needs, the challenges involved in meeting these and whether the condition makes the care needs unpredictable. It is also vital to ensure that the care records fully reflect the amount of time, skill and attention carers put in to meeting the needs and managing any risks they pose to the individual themselves or others.
Just Caring Legal offers various bespoke options to help you at the DST stage of the process.
- We can review the records ahead of an assessment and provide our own pre-assessment of needs to be presented ahead of the meeting and discussed by the MDT.
- We can represent you in the meeting itself.
The whole process should be completed in no more than 28 calendar days, but wherever possible sooner than this. At Just Caring Legal we can guide you through this complex process.
The Fast Track Pathway Tool – This is a much quicker way to put NHS CHC in place specifically for those reaching the end of their lives. If an individual has a rapidly deteriorating condition which may be entering a terminal phase this tool is designed for use by ‘an appropriate clinician’ so that those who may be eligible can receive NHS Continuing Healthcare quickly.
Just Caring Legal can advise you on how to access this lifeline during what will undoubtedly be a very difficult time.
How can Just Caring Legal help appeal an ineligible outcome?
You usually have six months to appeal an ineligible outcome if you believe the ICB has not followed the National Framework. This is a local dispute resolution process carried out by the ICB itself. The appeal panel should look at the evidence anew as well as any further evidence you can provide to decide whether the MDT was correct in stating there was no “primary health need” at the time of the DST.
If after this process you believe the ICB has still failed to carry out a fair and accurate assessment of the needs, you can appeal to NHS England itself. The case should be looked at anew by an NHS Independent Review Panel (IRP). If you are still unhappy with the outcome, you may be able to appeal to the Parliamentary and Health Services Ombudsman.
Just Caring Legal has service options for appeals at all stages of the process.
- We can review your documents and give our professional opinion on whether you have sufficient grounds for appeal at any stage and your chances of success.
- We can draft appeals on your behalf.
- And we can provide professional representation at appeal meetings and panels.
How can Just Caring Legal help with reviews and withdrawals of NHS CHC?
NHS Continuing Healthcare packages will be subject to regular reviews – usually after the first three months and then at least annually. The focus of the review should be whether the care needs are still being met. But the ICB will also be looking closely at whether there are grounds for reassessing eligibility. We know from experience that ICBs will often carry out a full reassessment of needs, with a fresh DST, just because the needs appear more stable, even if this is purely because they are being well-managed. (Well-managed needs are still needs.) This can lead to unfair withdrawals of NHS CHC funding, where the ICB claims the needs have reduced, even though you know they have not and that the consequences of removing the care package could be catastrophic. So it is vital to prepare fully for an NHS CHC review and not assume it will be a mere formality.
Just Caring Legal can help at this stage of the process in a number of ways.
- We can give advice on how to prepare fully for an NHS CHC review – forewarned may be forearmed.
- If you are facing a full reassessment with a fresh DST, we can guide you through the entire process, just as we would for an initial application, to help you retain your funding package.
- If the worst has happened and your funding has been withdrawn, we can help you appeal using the full suite of service options just as we would for any other ineligible outcome.
Just Caring Legal - Service and Fee options
Fee Option 1: Full refund process on no-win-no-fee basis
Depending on your circumstances, a Just Caring Legal solicitor will carry out the full process of seeking to recover NHS Continuing Healthcare refunds from start to finish on your behalf with no initial fees to pay. This could be done on a Contingency Fee Agreement (a no win no fee basis). This means we will deduct an agreed percentage from the total sum we recover on your behalf. In the unlikely event that we recover nothing, there will be nothing to pay.
Fee Option 2: Possible one-off service options for a fixed fee
- Free initial telephone advice on NHS Continuing Healthcare.
- Review of papers and initial advice and/or drafting a formal complaint at Checklist stage.
- Review of documents at checklist stage and help to maximise your chances of successfully triggering to the DST stage.
- Review of documents with a view to preparing written representations in advance of the pre-panel/DST multi-disciplinary stage.
- Attending with you multi-disciplinary meetings, local disputes resolution meetings and Independent Review Panel meetings.
- One-off appeals to challenge ineligibility decisions (without a review of healthcare records). An additional fee will be added for review of the full healthcare records.
- Help and assistance with appeals where NHS Continuing Healthcare funding has been withdrawn.
- One-off appeals to the Independent Review Panel where local dispute resolutions stage has failed. An additional fee will be added for full review of medical records.
- A complaint to the Parliamentary and Health Service Ombudsman.
Get In Touch Now
We can make a real difference in helping you win your battle to secure NHS Continuing Healthcare funding. Do you think you have been wrongly paying care fees? Call today on 0191 556 1078 to find out how we can help you through this complex process and obtain more details of our services.