Appealing a Continuing Healthcare Decision

WellChild and Irwin Mitchell share a vision to help build stronger communities. We have teamed up to create a legal section for the WellChild Information Hub. This article on Appealing Continuing Healthcare Decsions is part of a series of legal articles aimed at families with children who have complex medical needs.

It explains how to appeal a decision, what to include in your appeal and tips on collecting evidence. To find out more about continuing healthcare and how to apply:

• Click here to see our article on Children and Young People’s Continuing Care
• Click here to see our article on Continuing Healthcare

How Do I Appeal a Continuing Healthcare Decision?

The decision letter from the ICB will provide you with the details on how to appeal and to who.

You firstly provide your intention to appeal and the ICB will normally provide you with a form to complete. However, you can provide your own appeal letter.

What Should I Include in the Appeal?

Supporting evidence is vital when appealing a decision as Continuing Healthcare decisions are evidence-based decisions. You should include as much evidence as possible.

What Does The Process Look Like?

Stage 1: The Local Resolution Meeting

The first stage of the appeal is the local resolution meeting with the ICB and assessors. These meetings are arranged differently depending on which ICB you are with.

Stage 2: Appeal to NHS England

If this meeting does not change the ICBs decision, The next step is to appeal to NHS England. You will need to use the details provided to you on the decision letter providing the outcome from the local resolution meeting.

Appealing If You Receive CHC Funding In The Community

These next few aspects are more complex than appealing a CHC eligibility decision and many different aspects would need to be considered. This is a brief outline of some of the things you should consider when having packages of care in the community.

We would suggest legal advice is sought in these occasions.

What is CHC Funding in the Community?

CHC funding can be provided in the community. If this is the case, the CHC funding will cover the:

• Nurses
• Heath Care Assistant carers required to meet the healthcare needs assessed in the DST

How Do You Challenge CHC Funding in the Community?

To challenge this, you will need to liaise with the CHC team for:

• How they would like this challenge to be made
• Deadlines for challenging the decision
• To whom to provide the challenge to.

You will need to then provide evidence and reasons why your hours need to be increased. These details change depending on the ICB involved.

Once you have gone through all the CHC appeals, you need to go to the Parliamentary and Health Service Ombudsman.

To appeal decisions around packages of care in the community is different which will require going through the appeal processes and then considering whether a Judicial Review challenge should be made. You can find more information here.

Further Information on Continuing Care

For more information about applying for continuing care and how it works, click below on our articles on Children and Young People’s Continuing Care and Continuing Healthcare:

The information in this article was correct at the time of publishing but may be subject to change

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