JANE’S STORY

Outcome at a glance

Jane kept her CHC funding, recovered backdated funding totalling over £48,000, and avoided the risk of having to fund her care fees independently.

Background

Jane had received CHC funding for five and a half years before a new assessment found her ineligible. She was concerned that the assessment did not accurately reflect her needs and wanted advice on how to challenge both the assessment and the decision to withdraw funding.

The Challenge 

Following Jane’s initial free 20-minute telephone discussion, our clinical advisor Judy Timson promptly arranged a full consultation with Jane.  Jane attended with support from her close friend and brother. Together, they reviewed the potential grounds for appealing the CHC decision. Jane was anxious about how she would afford her care if CHC funding stopped and had not received clear information from the Local Authority about what would happen to her package of care and how she would fund it.

Judy advised on next steps including requesting care records and medical records which would be required to evidence Jane’s primary health need. Judy gave Jane the information about how she could submit the appeal herself or the costs of instructing Moore & Tibbits to challenge the CHC assessment and outcome on her behalf.  

Following a thorough review of the records, past CHC assessments and outcomes, Judy wrote to the ICB with the grounds of Jane’s appeal. The ICB agreed to review Jane’s needs, and this review was attended by Judy. Judy's experience as a Registered General Nurse and knowledge of the continuing healthcare process meant that she was able to highlight relevant parts of the eligibility criteria as they applied to Jane’s circumstances.

A great result 

Following the review, it was found that Jane was eligible for CHC funding and the ICB agreed to backdate 33 weeks of CHC funding to Jane for the period where she was wrongly assessed as ineligible and had funded her own care fees. Jane received over £48,000 from the ICB and was thrilled with the outcome. Jane remains CHC funded to this date. 

If you are experiencing similar challenges, please get in touch to find out how we can support you and your family.