How to challenge a decision

Appeal against a Continuing Healthcare decision

If you disagree with the outcome of either your screening Checklist or Full Assessment for NHS Continuing Healthcare, you have the right to challenge it. Here we explain how to appeal against a Continuing Healthcare decision.

Challenging the Checklist decision

If at the initial screening, or Checklist, stage you do not fulfil the criteria for a Full Assessment, you can ask the Integrated Care Board (ICB) to reconsider its decision.

If the decision remains the same, you have the right to access the NHS complaint procedure which consists of a written complaint to the ICB Complaint Manager and then the option to refer your complaint to the Parliamentary and Health Service Ombudsman.

Appealing a Full Assessment decision

If you have been through a Full Assessment for NHS Continuing Healthcare and you disagree with the outcome, you have the right to appeal.

Appeals can be quite stressful and can take many months to resolve. We advise you to take the time to understand why the assessment was unsuccessful before deciding whether or not to pursue an appeal.

Read our blog with more information to help you decide whether to appeal.

The NHS Continuing Healthcare appeal process

The process normally consists of three stages:

• Stage 1 is the local resolution procedure adopted by your ICB. It varies, but should involve an informal stage such as a meeting potentially followed by a panel review.
• Stage 2 is an Independent Review (IR) convened by NHS England which, if accepted, may lead to a formal review of the ICB’s decision by an independent panel of experienced health and social care professionals and a lay Chair. You will be invited to attend part of the panel hearing.
• Stage 3 is referral of your case to the Parliamentary and Health Service Ombudsman for a full independent investigation. Depending on this outcome there may be further stages involved.

Appeal timescales

You should be given six months to request local resolution (stage 1) from the date on your eligibility decision letter. In practice, we’ve found the deadlines given by ICBs range from two weeks to six months. However, national guidance states it should be six months, so it’s worth challenging your ICB on this point if you’re given less time.

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An important change to Independent Review timescales was made in Autumn 2019. You have six months to request an Independent Review, but you have just six weeks to submit all of your written evidence (including any supporting statements) after you have made that request. For those who wish to seek representation to help you through Independent Review, it is now vital that you get in touch with us – or your chosen representative – as soon as possible after receiving the local resolution decision, and before you notify NHS England of your wish to request an Independent Review.

After you have requested Independent Review, it should not normally take longer than three months to complete. In reality, however, it’s common for all of the appeal processes to take well over a year or require multiple panels before all available appeal options have been exhausted.

At Beacon we encourage ICBs to resolve appeals at the earliest opportunity to minimise the cost and stress to our clients.

A successful result

While appeals can be draining, a positive outcome can make a huge difference. Our perseverance in managing appeals has meant that some clients have been able to avoid selling their family home. For others, the simple recognition that a loved one should have been eligible was their biggest priority.

How we can help

Our blog gives more information to help you decide whether to appeal, and you can download our free Navigational Toolkit which contains a comprehensive guide to Continuing Healthcare appeals.

We can answer your questions on any aspect of appeals, through our Free Information & Advice service.

If you feel that you need representation or support from our casework team you might consider our Expert Analysis Service. This includes a comprehensive investigation into your assessment and decision to advise if you have sufficient grounds to appeal.

Alternatively, our Full Appeal Management Service leads you through the dispute resolution process from start to finish.