The legal charges we make for dealing with NHS continuing healthcare funding claims.
An outline of our fixed legal charges for NHS continuing healthcare funding claims. Contact us for a free consultation about how we can help you obtain the funding you’re entitled to.
CHC Assessment Request Assistance
If you think that you or a loved one may be eligible for CHC continuing healthcare funding, then our specialist team can assist you in arranging an assessment.
Whilst you can initiate the process yourself by contacting professionals, such as nurses, GPs or the local authority, our specialist team can take the necessary steps on your behalf, making the process as smooth as possible.
Our team will write to the relevant body and request that a CHC assessment is carried out to determine whether you or your loved one is eligible for NHS CHC funding.
Should you wish to attend the assessment, the ICB will liaise with you to arrange a suitable time and date.
We offer this service for a fee of £175 + VAT.
See below for how we can further support you through the assessment process.
CHC Checklist Assistance
The CHC checklist is usually the first step to determine if you are eligible for NHS funding and acts as a screening tool for the full assessment. However, we are finding that this assessment stage is often being skipped, with cases proceeding straight to the full assessment stage.
Where the CHC checklist stage is carried out, our lawyers can have a consultation with you to discuss what the checklist is, how it is scored, and review each aspect of your case to better understand the care needs and how these are likely to be assessed.
Following the consultation, we will provide you with a document outlining the process and the key things to highlight during the assessment to make you feel more confident and prepared.
We offer this service for a fixed fee of £800 + VAT.
If you would like our specialists to deal with the checklist in person, this can be considered on a case-by-case basis. If we attend a meeting, then there will be a further fixed fee plus travel costs.
Full Assessment – Decision Support Tool Assistance
Following a positive checklist, a full assessment known as the Decision Support Tool (DST) will be carried out. During this process, the assessors will look at the same domains as the checklist in greater depth to determine whether there is a ‘primary health need’. Each need is then scored based upon the severity of the need.
Our specialist team can help you prepare for the full assessment. We offer a consultation where we will explain each part of the process to you, including each domain and how it is scored. We will discuss the needs so you can better understand how these will be looked at in accordance with the DST, helping you to feel more confident and prepared prior to the assessment. We will produce a written report of our findings so you can refer to this during your assessment. Of course, should you have any questions upon receiving your report, our specialists will be on hand to answer them.
We provide this service for a fixed cost of £950 + VAT.
Should you wish for our specialist lawyers to attend the DST process, this can be discussed on a case-by-case basis. This will incur a further fixed fee plus travel costs.
CHC Appeals
If you or your loved one has been found to be ineligible for NHS CHC funding at the full assessment stage, then you may wish to appeal the decision.
The ICB must be notified of an appeal within six months of the DST outcome.
There are 3 stages to the appeal process:
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Local Resolution Meeting
The first appeal stage involves having an informal conversation with the assessor who will explain how their decision was reached and help to clarify any issues or misunderstandings. You can raise any concerns you have as well as present information that you feel was not taken into consideration. If the original decision is upheld and you are unsatisfied with the outcome, you may move to the next stage.
2. Local Resolution Panel
A local resolution meeting will be convened, during which you will meet with an independent assessor who has not been previously involved in the case. The purpose of the meeting is to evaluate whether the Decision Support Tool (DST) comprehensively considered all care needs, assessed them accurately, and whether the assessment process was conducted appropriately. The potential outcomes of this meeting include overturning the original decision, conducting a reassessment, or upholding the initial decision.
3. Independent Review Panel
If you do not achieve the desired outcome during the local resolution panel, you may submit an application for an independent review by NHS England. Upon receiving your application, NHS England will determine whether it is necessary to convene a panel hearing. If a hearing is arranged, you will have the opportunity to attend and present your views. Attendance in person is not mandatory, and you may submit your views in writing. This is the final stage for submitting new information, making it crucial to ensure that all relevant information has been gathered, reviewed, and analysed beforehand. The panel can consist of several professionals, including a Chair, NHS representative, an NHS England Representative, Local Authority Representative, and a Clinical Advisor. Following the hearing, the Independent Review Panel (IRP) will issue a comprehensive report detailing its deliberations and recommendations, which will then be submitted to both NHS England and your local ICB.
How We Can Help with CHC Appeals
It is important that you contact us as soon as possible if you would like assistance with a CHC appeal, as you only have 6 months to inform the ICB of the request.
We will gather all relevant records to support your application, which will typically be from any care or nursing home, GP, and any recently attended hospitals. We will review a relevant 4-week period to produce documentary evidence which shows a Primary Health Need and draft the four key indicators.
We will cross-reference your case with the framework and legislative procedures, and any procedural failures will be identified. We will have a consultation with you to discuss any disputes arising from the DST and any aspect of the case you feel the records do not accurately reflect.
In addition, we will discuss the appeal process with you, advising you what to expect and answering any questions you may have.
We will make our submissions to the ICB and liaise to arrange a suitable time for the appeal hearing.
A member of our team will attend the appeal. You are welcome to attend yourself, but do not have to do so.
We offer our appeal assistance packages on a fixed fee basis, so you can budget for the costs.
- Stage One Appeal £6,400 + VAT.
- Stage Two Appeal £6,400 + VAT or £3,400 + VAT if we are also instructed to deal with Stage One
- Stage Three Appeal £6400 + VAT or £,400 +VAT if we were also instructed to deal with Stage One or Stage Two
Late Notice CHC Appeals
Depending on availability, our specialists may be able to represent you or your loved one at an appeal at short notice. However, short notice can limit the investigatory work we are able to carry out.
The Parliamentary Health Ombudsman
If the Independent Review Panel upholds the original decision, then you may be able to make a complaint to the Parliamentary and Health Service Ombudsman. Please contact our specialist team to discuss this further.
Retrospective Applications and Previously Unassessed Period of Care (PUPoC) Assistance
If you believe that you may have been eligible for NHS Continuing Healthcare (CHC) funding but were not assessed at the time, then it may be possible to recover care fees through a retrospective application, also referred to as a Previously Unassessed Period of Care (PUPoC).
Applications for retrospective CHC funding can be made in several situations, such as when you are currently receiving CHC funding but believe you should have been eligible earlier, or if no CHC funding assessment was carried out but it should have been.
Even if a loved one has passed away, you may still pursue an application, provided you have the legal authority to act on their behalf. If you don’t, then our team may be able to assist you with the necessary steps to establish this. It is important to note that retrospective applications are not permitted if a CHC assessment was previously conducted and the individual was found ineligible, unless there is evidence of procedural or clinical errors in the assessment. However, you may make a claim for any unassessed periods.
The process involves gathering and reviewing relevant records to establish evidence of eligibility. This includes assessing whether there was a “primary health need” during the period in question, as determined by the Decision Support Tool (DST) and the National Framework. The outcome of a retrospective application may result in full eligibility for the period, partial eligibility, or a determination of ineligibility.
Records are only held for a limited period, so it is advisable to act quickly to give you the best chance of making a successful application.
Our specialist team will help identify which organisations may hold relevant records and obtain these. They will then be meticulously reviewed, and relevant entries will be extracted and collated to evidence each need. We will write to the ICB, provide our documentation, clearly outlining how and why we believe you to be eligible for funding. Moving forward, we will liaise with the ICB on your behalf and manage your claim throughout, keeping you in the loop and up to date in each step.
Contact us for a free consultation
If you require further information about our fixed legal charges for NHS continuing healthcare funding claims, then please get in touch with our five-star rated team*. Our experienced lawyers are here to help you secure the funding you deserve. Contact us today for a free consultation.
Call 0333 888 0419 or email us at [email protected]
