Beacon’s intimate knowledge of CHC system results in funding of £160,000 for Kate and her mother Gill

Posted on: November 22nd, 2023 by Amy

Kate’s mother Gill was assessed for NHS Continuing Healthcare (CHC) and found not eligible. In the months and years following this assessment, the ICB periodically reviewed Gill’s needs and on each occasion concluded there had been no significant change and that therefore there was no need to re-consider her for CHC funding.

With Beacon’s assistance, Kate appealed the original assessment decision and was successful at Independent Review (IR). However, the ICB stated they would only pay reimbursement up until the date of the first review. This constituted just 1 month of funding to be reimbursed.

Because each of the ICB’s reviews had concluded there had been no change in care needs since the original assessment, Beacon advised that reimbursement should actually continue through the reviews and be ongoing until any new CHC assessment found Gill to be no longer eligible. We advocated that Beacon discuss the case with NHS England to ascertain whether they agreed with us that the ICB (then CCG)’s position was unreasonable.

In addition to seeking advice from Beacon on this, Kate sought free advice from a legal firm specialising in Continuing Healthcare funding as to whether she should appeal this decision.

Many individuals choose to seek advice from a number of different legal and advocacy organisations before deciding how and with whom to proceed.

In this instance the solicitors Kate approached incorrectly treated the reviews as Full Assessments, and based on this advised that the ICB were correct to reimburse for just 1 month of funding. The solicitors advised Kate not to have Beacon discuss the matter with NHS England, but to instead accept the outcome and to consider appealing the reviews separately to secure further reimbursement.

When Kate came to Beacon for further advice, we were immediately able to identify that it would not have been possible to appeal these outcomes as they were reviews, not assessments. With Kate’s approval, we discussed the case with NHSE and were subsequently 100% successful in our approach, resulting in Kate and her mother receiving funding for 3 years (£160k), and the cancellation of a new scheduled assessment, meaning that funding was in place and ongoing from that date forward.

Kate says:

“I am so glad I put my trust in Beacon, even in the face of differing advice from a reputable legal firm. Their in-depth understanding of the NHS network and ability to navigate it were key in finally delivering a successful outcome.”

 

Date of upload: November 2023

NB: All calls to us are confidential, and we’ve changed the names of these clients to protect their anonymity.

Image courtesy of Elliot Manches via the Centre for Ageing Better age-positive image library

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