Moore and Tibibts have a 100% success rate on appeals in relation to NHS continuing healthcare funding.

If you have been through a full assessment (a DST) for NHS continuing healthcare funding and you disagree with the decision, you have a right to appeal.

Key Timescales

You have six months from the date of your decision letter to lodge an appeal however, it is important to check the deadline in your letter.  We have found some ICBs have given deadlines ranging from two weeks to six months.  The national guidance however, states that it should be six months so anything less should be challenged.

Process:

Reviewing the decision

It is important early on to establish whether you are likely to be successful at the appeal.  Our nurse, Judy Timson who previously worked as a continuing healthcare assessor and appeals nurse in the NHS has extensive expertise in this area and will:

• Review and analyse the DST which is being appealed and where appropriate consider previous DST(s);
• Identify any errors, flaws and omissions in the DST and any failings to apply the criteria correctly;
• Meet the person and review care records to collate and submit evidence in support of the appeal;
• Provide you with a full appeal report, setting out the strengths and weaknesses and the merits of appealing the decision not to grant full CHC funding.

We will advise you on the likelihood of success at this stage so that you do not incur further costs if we do not think you will be successful.

Pursuing the appeal

If you would like to continue with the appeal, we will:

• Liaise with the ICB and provide formal notification and submission of the grounds of appeal;
• Attend the local resolution meeting (LRM) to discuss the appeal.   We will discuss our concerns and grounds for appeal with a senior assessor who will review your case.  They may decide to do a re-assessment or uphold the decision.
• If the outcome of the LRM is to uphold the original decision, the ICB will then prepare a written response to the appeal (the Needs Portrayal document (NPD) – for further info, click here). Following scrutiny of the NPD, we will then prepare written submissions in response.  The ICB will consider these and then make a final decision in respect of the appeal.

Next Steps

If you are successful, we will seek to recover the outstanding care fees that are due together with interest.

In the unlikely event that the appeal is unsuccessful, we will advise on the next steps which is an Independent Review organised by NHS England.