Case studies & success stories
Clinical Review Assessment Success Story
We helped with
Retrospective Review
This week’s success story concerns a patient who had been in receipt of CHC funding for some years, before this was unjustifiably withdrawn by the CCG.
We were contacted by the family after their local appeal to the CCG was unsuccessful. We conducted our own Clinical Review Assessment of the patient’s needs, and recommended immediate reassessment by the CCG, which was duly arranged. The CCG found the patient not eligible for CHC funding, despite its own Nurse Assessor having assessed one ‘severe’ and five’ high’ levels of need!! We appealed the CCG’s decision, making a robust written submission. The appeal was upheld on the basis of our submissions, with the CCG finally accepting the patient’s current eligibility for CHC funding.
In addition, as a separate matter, the CCG’s initial decision to withdraw CHC was appealed to NHS England. Upon receipt of the appeal, NHS England advised it could not consider the case, because the CCG had taken far too long to implement its decision to withdraw funding. The CCG was instructed to undertake a retrospective review from the date funding actually ceased until the date of the next current assessment.
We await the outcome of the retrospective review but having conducted our own Records Review of the evidence for this separate period, and given the recent confirmation of funding from the date of the current assessment, we feel confident this will be successful with a little more determination.