I am Lauren Kennedy, Legal Advisor at Seatons Solicitors. If you or a family member or friend are thinking of applying for funding for care or have been refused care then give me a call for a free no-obligation chat.
To qualify for NHS continuing Healthcare Funding to fund a place in a nursing home or supported living in your own home, you need to establish that you have a Primary Health Need. In order to decide if you indeed have a Primary Health Need, the NHS will put the Applicant for funding through a series of assessments. It is not uncommon for the NHS to deny funding in cases where it should plainly be awarded.
Applying for funding can be a stressful process and it can seem like a bit of a battle trying to get the right decision.
At Seatons we are fairly uniquely placed in that we have not only lawyers on staff to ensure fair play and that the correct procedures are followed but we also have clinical staff who can advise on what should be the correct outcome by undertaking their own assessments of needs. We are a local law firm serving a national client base – because we are a law firm and not a claims management company we can also assist with any other legal matters that the application throws up.
So if you have been refused funding or have yet to embark on your application – give Seatons a call. We take our strapline of “The friendly Professionals” very seriously and we speak plain English. We will take the time to discuss your circumstances and offer a clear fixed fee service if you want to take the matter forward with us. There will be no pressure to sign up to our service and you will not be pestered forevermore with marketing calls.
We have included a few details of the process you may be embarking on to give you an idea of how funding needs are assessed.
The NHS Continuing Healthcare Checklist
This is the first stage of assessing whether you qualify for funding. If you pass this hurdle your claim proceeds to a more thorough assessment by someone from the NHS completing a form which is known as a Decision Support Tool. The NHS Continuing Healthcare Checklist is completed by a Social Worker or a District Nurse or if you are in hospital possibly a Discharge Planning Nurse. If one of these are involved in delivering care at the time you want to apply, then the best way to get the process started is to contact the District Nurse through your GP. It is possible that you may be told that it is not possible to get a Checklist done – or that you ‘don’t need one’ – we have come across both these responses – but you are entitled to have the Checklist completed to get the ball rolling.
The Decision Support Tool (DST) Stage
After having an NHS Continuing Healthcare Checklist undertaken – and if there is sufficient evidence of need, then the claim will proceed to the next step which involves measuring any need as against a set criteria. The criteria that are used are divided into 12 ‘Domains’ – these being:
“Behaviour, Cognition, Psychological and Emotional need, Mobility, Communication, Breathing, Medication, Altered States of Consciousness, Skin, Continence, Nutrition and Any Other Need”
The DST is completed by the Nurse Assessor from the NHS – all the available evidence from those involved in the care of the Applicant should be considered but it is common for some to be overlooked – and this can be crucial to the outcome. Seatons is uniquely placed in that we have our own Nurse assessor staff who will shadow assess and ensure that the evidence is given the correct weight.
Refusal to Fund
If you have been declined funding we can help you challenge the decision by lodging an appeal with the Local Dispute Resolution Panel where the matter can be reconsidered in light of submission on your behalf. The meeting should involve the Applicant for funding where it is possible for them to attend and/or the family members of any applicant.
Again Seatons’ medical and legal staff can get their heads together to review all the evidence to date and give your appeal the best chances of success by advocating at the Local Dispute resolution Meeting.
Appeal to Independent Review Panel
If the Local Dispute resolution Panel refuse to overturn the decision not to fund, then we can assist with the next stage of the appeal which is far more formal and lies with what is called the Independent Review Panel. This appeal is held at the HQ of NHS England and we strongly recommend that representation is sought. We can attend the hearing, provide medical staff and lawyers to make relevant submissions to get the decision not to fund overturned.
Other appeals lie with the Parliamentary Health Service Ombudsman and thereafter by way of Judicial Review which, again, we can assist with.
Many of us at Seatons have fought for funding for members of our own families and know how stressful it can be. We will support you all the way and with our medical and legal staff, we are a formidable team when it comes to challenging decisions not to fund.
GIVE US A CALL FOR A FREE NO OBLIGATION CHAT
Contact myself, Nicki or Adam on 01536 311690. Alternatively, you can fill in the online enquiry form on this page and we’ll get back to you straight away.
Seatons Interviewed On BBC Radio About Care Fee Funding