In recent reports to the BBC, over 100 families responsible for the care of severely disabled adults and children outside hospital settings have expressed concerns about the inadequacy of essential support provided by the NHS.

The BBC’s article published today, 14th February 2024 can be read here.

NHS Continuing Healthcare and its equivalent for under 18s, Children and Young people’s Continuing Healthcare, is the name given to the free, non-means tested care and support which the NHS is legally required to provide to people who need care, if, following a detailed assessment of their needs, it is decided that they have a Primary Health Need. These cases are decided by NHS Integrated Care Boards (ICBs).

The NHS asserts that support is tailored towards individual needs, guided by standardised protocols across England and Wales. However, the BBC has heard from 105 families who described serious concerns with how the two schemes are working – with most calling for reform.

• Disparities in access to NHS Continuing Healthcare: a Postcode Lottery
• NHS Continuing Healthcare Challenges, Reassessments and Overturned Decisions
• Navigating NHS Continuing Healthcare Appeals
• Expert NHS CHC Support and Guidance for Families: How can Ridley & Hall’s Continuing Healthcare Claims Solicitors Help

Disparities in access to NHS Continuing Healthcare: a Postcode Lottery

NHS data shows that in some parts of England more than 50% of adults who apply get support. In other areas, it’s fewer than 10%.

The story is even starker for under-18s – with eligibility rates ranging from 14% to 96% in 2022-23, according to data obtained from 33 of 42 NHS Integrated Care Boards (ICBs), who run the schemes.

The Department of Health and Social Care says there is always likely to be “variations in eligibility” in different parts of the country, because Continuing Healthcare (”CHC”) is delivered by individual ICBs “whose populations have differing health needs and age profiles”.

NHS Continuing Healthcare Challenges, Reassessments and Overturned Decisions

Since the NHS is publicly funded and the NHS pays for 100% of the care fees of those who are eligible for CHC, care is taken to regularly reassess those who are eligible.

These assessments can be sprung on individuals, who are then unable to prepare themselves for the upcoming assessment.

Some of the families say they were assessed as eligible for funding and then the decisions were reversed.  The withdrawal of funding isn’t always wrong – if needs have changed, this needs to be accounted for. However, in our experience as a law firm, assessors may be keen to withdraw funding, without considering evidence as a whole, by not applying the criteria correctly, or by relying on their own “professional judgment” in circumstances where that simply results in inconsistent decision-making.

Navigating NHS Continuing Healthcare Appeals

The BBC says they have seen evidence of assessments containing multiple factual and procedural errors, while numerous families have claimed medical records have been misrepresented or ignored. If you feel that an assessment for one of your loved ones was unjust, you can appeal the decision.

There is a 2 stage appeals process. The first step is a local Resolution Meeting (“LRM”) this is where you can argue your case to the people who originally made the decision as a result, success at this stage is highly unlikely. This is followed by an Independent Review Panel (“IRP”) where your case is put before a panel convened by NHS England and comprising assessors from other organisations.

Expert NHS CHC Support and Guidance for Families: How can Ridley & Hall’s Continuing Healthcare Claims Solicitors Help

One individual said to the BBC that “The constant battle you have [over care provision] is demoralising, and soul-destroying,”

Appealing a decision or even preparing for an assessment of a loved one can be incredibly daunting and frustrating.

Our care home fees expert and Partner at Ridley & Hall Solicitors, James Urquhart-Burton specialises in appealing Continuing Healthcare decisions. If you have a loved one who has care needs which you believe are intense, complex or unpredictable, James will be able to provide bespoke advice tailored to your loved one’s individual needs, with the benefit of his experience and in-depth knowledge of the relevant law and procedure. Call us now on our freephone 0800 8 60 62 65 or request a call back now. 

Rebecca Kershaw – Apprentice Solicitor