NHS Continuing Healthcare Appeals: Local Resolution
This guide is to help you understand how you can challenge decisions about NHS Continuing Healthcare (CHC) that you do not agree with. We have also produced a more detailed guide which we can send you by post or email if you contact us.
NHS Midlands and Lancashire (NHS ML) manages Appeals on behalf of your Integrated Care Board (ICB). We will provide guidance and support to you, and we will try to resolve your appeal as soon as we can. If you have a question or concern about your case, you can contact us at any time.
Requests for an appeal should be made to:
or contact the team on tel: 0151 433 6987
What information will we collect?
We will collect and process data from a number of sources to ensure individuals appeals can be processed. As mentioned above, this will include requesting records from various places such as Care Homes, GP’s, Local Authorities, Hospitals, District Nurses and Mental Health teams. If they cannot provide records, we will let you know.
These records may include:
- Physical or mental health details
- Racial and ethnic origin
- Sexual orientation
- Details of care
- Religious or similar beliefs
- Sensitive information with regards to physical and mental health conditions
- Information pertaining to the referral, assessment, and care plans of the patient
- Financial information such as, Bank statements and Department of Work and Pensions (DWP) documents
- Family and relationship details
- The appellants proof of identity, authority to act, Power of Attorney
How will my information be used and shared?
Under the UK General Data Protection Regulation (UK GDPR) consent is not required for the processing of personal and healthcare data in the context of NHS Continuing Healthcare (CHC).
Information will be shared with relevant health and social care professionals who are involved in the CHC appeals process in order to determine whether any appeal should be upheld. All professionals involved in the process must maintain strict confidentiality regarding any information that is shared as part of any appeals process. Information may be shared at several points during the appeals process.
Information will not be shared with friends, family or other individuals not involved in the process without prior consent from the patient or appointed patient representative. Individuals have the right to withdraw consent to share information with friends/family/representatives at any time. A health professional will be able to advise you how withdrawal of consent may impact any appeal.
For further information regarding how your information is processed and how it is used within the NHS, please see NHS ML’s Privacy Policy: https://www.midlandsandlancashirecsu.nhs.uk/privacy-policy/
How do I access a copy of my information?
Should you wish a copy of any of your information then please initially speak to a member of the Appeals team who can advise. If they are unable to provide it easily, they will re-direct you to the appropriate department so you can make a ‘Subject Access Request’ or an ‘Access to Health Records Request’.
You can appeal against a decision you do not agree with for the following reasons:
- You disagree with the outcome of the Decision Support Tool (DST)
- The process used was not in line with the National Framework
- The assessment did not consider the right evidence
You must appeal within 6 months of the date on the letter telling you the outcome of your assessment. We can sometimes accept appeals later than this in exceptional circumstances.
When we receive your appeal, we will send you an acknowledgement within two working days. When an appeal is submitted by a patient’s representative, authority to act, proof of identity (ID) and an Authority to Release Records form will be required to commence the appeal. We will send you an application form and ask you for some supporting documents that we need to progress your appeal. We will ask you to return this to us within 14 days. When we have got this, we aim to complete your appeal within three months. If you do not send all of your supporting evidence to us with your completed forms, you will have six weeks to provide them.
The first stage of the appeal process is that a member of the appeals team will contact you to discuss your appeal and clarify things for you. When we have established the appeal can go ahead, we will request records from various places such as Care Homes, GP’s, Local Authorities, Hospitals, District Nurses and Mental Health teams. If they cannot provide records, we will let you know.
When your case is ready to proceed, we will contact you and invite you to a Local Resolution meeting (LRM). This could be a ‘virtual’ meeting, via computer or through a teleconference, or you could send us your points in writing rather than attend. Someone can represent you if you wish – legal representation is not required, however if you choose to employ someone to represent your case the NHS will not reimburse you this cost.
The LRM will discuss your reasons for requesting an appeal, understand the care domains you do not agree with and consider whether the process was properly followed. They will also make sure that all relevant information was taken into consideration during the CHC assessment. The LRM will try and address any questions but there are some things they cannot consider such as who delivered the care and how well it was managed, or the behaviour and knowledge of the professionals involved. This could possibly be looked at if you decide to make a complaint.
Your completed appeal application form and the completed Decision Support Tool (DST) will be the basis of the discussion at the LRM.
The LRM has an open session, you will be invited to this session to present your case, there is also a closed session. During the closed session the team will consider your case, make a funding recommendation, and complete a Local Resolution report.
The LRM recommendation will be verified by a Clinical Lead Nurse; final approval will be obtained from your ICB, and we will then send you the outcome. The possible decisions are to:
- Uphold the original decision
- Partially uphold the original decision
- Overturn the original decision.
The decision letter we send you will also include a summary of the discussion at the LRM and reasons for the decision. We aim to get this to you within two to three weeks.
If the individual was eligible for Continuing Healthcare Funding for all or part of the period under consideration, reimbursement arrangements will be made. In some instances, we will make the payment to the care home and they will reimburse you. If so, we will explain in the outcome letter we send you.
If your appeal is not successful and you remain dissatisfied, we will tell you how to contact NHS England to request an Independent Review of the LRM’s decision.
We understand that an appeal can be sensitive and emotional. We will always treat you with dignity and respect and we will try to make it as straightforward as possible. We also expect you will treat our staff fairly and reasonably throughout your appeal. We have an NHS ML charter which sets this out in more detail. Please contact us if you would like to receive a copy by post or email.
