Increasingly we are encountering instances where individuals have engaged fully in the NHS Continuing Healthcare assessment process and secured a recommendation at the multidisciplinary team (MDT) meeting that their relative is entitled to continuing healthcare funding. However, the ICB responsible for implementing the funding has then sought to overturn the decision without any real basis to do so.
Why has my continuing healthcare funding been denied?
The National Framework for continuing healthcare funding makes it clear that the ICB may not overturn the recommendation of the multidisciplinary team following a Decision Support Tool assessment unless there are ‘exceptional circumstances’.
These exceptional circumstances must be clearly articulated and should not ever be made by one person acting unilaterally.
Examples where exceptional circumstances would be applicable:
- The DST is not completed fully ‘for example where there is no recommendation’
- There are significant gaps in evidence to support the recommendation
- There is an obvious mismatch between the evidence provided, and the recommendation made
- The recommendation would result in either authority acting unlawfully.
As such there are a clear set of limited areas whereby the ICB may overturn the decision of the MDT or the recommendation of the MDT.
Can a refused continuing healthcare funding claim be overturned?
We have successfully challenged instances where the ICB stated there is insufficient evidence to support the recommendations made. By submitting a fully prepared case, with evidence of primary health needs taken from care records, the scoring for each domain can be justified. We have argued that the process has been correctly adhered to and the recommendation for funding has been implemented.
Unsure if you or a loved one qualifies?
If you think you or a loved one may be eligible for CHC funding, don’t delay. We’re here to guide you through every step.
Submit an enquiry to get started.
