NHS Continuing Healthcare Appeals: Local Resolution

NHS Lancashire and South Cumbria Integrated Care Board’s (ICB) Continuing Healthcare (CHC) Local Resolution process is intended to ensure that where assessed individuals or their representatives have a reasonable belief that a decision of CHC eligibility may not be correct (following the completion of a Decision Support Tool (DST)), a local review will be undertaken. 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:

lscicb.triage@nhs.net

Level 3, Christ Church Precinct

County Hall

Fishergate Hill

Preston

PR1 8XB

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 inform the ICB of your request to appeal within 6 months of the date on the letter telling you the outcome of your assessment. Once you have made a request for an appeal, you will receive contact from the team and will be sent documents for completion (including consent and questionnaire).

The first stage of the appeal process is for a Clinical Nurse Reviewer to contact you to discuss the reasons for your appeal and answer any questions that you may have.  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.  Please note that 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. 

Your completed appeal questionnaire 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 and 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; and we will then send you the outcome. The possible outcomes 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 8 to 12 weeks.

If the individual was eligible for CHC 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. 

The ICB aims to complete appeals within 3 to 6 months.

 

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