Continuing Care Assessment Appeals
This is the third article in a series looking at care package
funding. The first two explored how to navigate the care funding
maze (specifically 'means tested' Social Care versus free NHS Care)
and prepare for a NHS Continuing Care Assessment. In this article I
discuss the process for appealing a decision.
Continuing care assessments are covered in The Continuing Care
(National Health Service Responsibilities) Directions 2004. Article
4(3) of the 2004 Directions states;
Where a person, or someone acting on a persons behalf
a) is dissatisfied about
i. the procedure followed by the Primary Care Trust or an NHS trust in reaching a decision about the persons need for continuing care; or
ii. the application by a Primary Care Trust or an NHS trust of the criteria referred to in direction 2(2)(a) in relation to such a decision and
b) has been unable to resolve the matter
informally
he may apply in writing to the appropriate Strategic Health Authority for a review of the decision.
(Direction 2(2)(a) requires the Strategic Health Authority to
establish a set of eligibility criteria for the provision of NHS
funded continuing care)
In other words, if a person is not satisfied with the outcome of a
Continuing Care Assessment they can request a review of the
decision. Specifically anyone who is dissatisfied about the
procedure followed by the PCT, or the application of the criteria,
that cannot be resolved informally, may apply for a review.
Upon receipt of a written request for review, Article 4(4) of the
2004 Directions require the Strategic Health Authority to notify
the standing chairman of the review panel. Having taken account of
any advice from the review panel, the Strategic Health Authority
must give notice in writing of its decision and the reasons for it
to the applicant. Except in exceptional circumstances such notice
must be given within two weeks of the receipt by the
Authority.
If the review is unsuccessful (i.e. refused) the person can then
approach the Health Service Ombudsman. (Note however that the
Ombudsman will normally expect complainants to have tried to
resolve their concerns through the NHS complaints procedure before
they consider taking the case on).
In summary, if you are not satisfied with the outcome of a
Continuing Care Assessment you are entitled, after trying to
resolve this informally, to request a formal review by your
Strategic Health Authority.
References and Resources
The Continuing Care (National Health Service Responsibilities)
Directions 2004 are available at;
www.dh.gov.uk/en/publicationsandstatistics/publications/publicationslegislation/DH_4077239
A list of the 10 Strategic Health Authorities is available at;