The National Framework for NHS CHC advises that, where a full assessment has been undertaken of potential eligibility using the DST and a decision has been reached, if the individual is challenging that decision, this should be addressed through the local resolution procedure. Any challenge needs to be made with 6 months of being informed of the CCG’s decision of eligibility.
A request to review an eligibility decision can be made through an email, telephone call or post by an individual or their representative. A rationale for the Appeal should be provided by the appellant to include; where the National Framework has not been applied correctly or submission of evidence which was not considered in the decision making process. The NHS CHC team has 90 days to complete the Local Review process.
The WHCCG Local Appeals process consists of two stages:
Stage 1 Local Resolution Meeting- an informal face to face discussion with one of our clinical team, who will explore your concerns and work with you to discuss the process, any additional evidence you may have and clarify any questions you may have regarding the eligibility criteria.
Stage 2 A Summative Written Review of Eligibility-a formal written review of your case, collating both submitted clinical evidence underpinning your initial assessment, contextual verbal evidence discussed at the local review meeting and addressing any process issues arising.
To contact your CHC team for a local review:
NHS Continuing Healthcare and NHS-funded Nursing Care Team
5th floor, Civic Offices
Civic Way, Fareham
Hampshire, PO16 7AZ
T: 0300 123 4448
E: WHCCG.continuingcare@nhs.net