Case studies & success stories

ICB Decision Appeal

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ICB Decision Appeal

This week’s success story concerns a patient who sustained a considerable pressure injury having been left in an unsuitable chair for too long by the nursing home. Staff had accepted his decisions to decline repositioning, notwithstanding Mental Capacity Assessments confirming he was unable to make informed choices about this care due to a severe cognitive impairment.

Despite the fist-sized, necrotic wound having been graded by the Tissue Viability Nurse only days earlier as a category FOUR ulcer, extending to the underlying tendons or bone, the Multi-Disciplinary Team (MDT) assessed only a ‘High’ level of need in the Skin domain. The stated rationale that the wound was “responding to treatment” confirmed a clear misapplication of the descriptors on the Decision Support Tool.

Problems with wound healing were further compounded by severe contractures, lack of sitting balance, lower limb spasticity and spasms.

The Nurse Assessor unilaterally reduced the assessed ‘Severe’ level of need in the Cognition domain to ‘High’ after the MDT, without discussing with the Social Worker, following a review of care plans, ignoring the Mental Capacity Assessments and Deprivation of Liberty Order.

Despite the unequivocal complexity of the patient’s needs, the ICB ratified the recommendation of the MDT that he did not meet the criteria for CHC funding.

Farley Dwek were instructed to appeal the decision on behalf of the family, obtaining detailed records and photographs by the Tissue Viability Nurse which contradicted much of the contents of the nursing home’s inaccurate documentation about the pressure ulcer. Detailed Written Submissions were provided to the NHS Integrated Care Board (ICB) in support of the appeal.

Following a brief Local Resolution Meeting, the ICB overturned the decision of ineligibility within 24-hours, correctly increasing the level of need in both the Skin and Cognition domains to ‘Severe’.

First Class Service. Kept us informed throughout, highly professional and I would not hesitate to use Farley Dwek in the future. Great service thank you.

CHC client

A sound investment! I had researched a number of firms offering assistance to help secure CHC funding for our Mum. I was very glad I chose Farley Dwek. Both my brother and I are retired solicitors and are able plough our way through regulatory material and legislation, However, neither of us had any experience in this area of law. I really appreciated Farley Dwek’s transparent and sensible advice. I would recommend doing the initial screening exercise with one of their nurses, we had the excellent Diane Jenkins for screening (and eventual support at the MDT).

CHC client

I cannot recommend FARLEY DWEK enough should you find yourself in this unfortunate situation. They ring you when they say they will, they write to you with updates and keep you informed all the way. I'd like to especially thank Ruth Pople and Jonathan Dwek who I regularly spoke to during the process.

Chris Gregg

My sister and I have received absolutely first class professional support, guidance and advice throughout an extended period of time, seeking CHC on behalf of our mother. Every member of the team, with whom we had various communications with, were professional, courteous, and clear. The process is a challenging one and without their guidance, support and expert knowledge we would not have achieved the successful outcome that we did. We cannot recommend them enough.

CHC client

The service I have received from Andrew Farley for a Continuing Healthcare Funding claim for my mother has been excellent. The initial contact with Andrew gave me a clear picture of the process, outlining timescales and explaining the stages that I would have to go through to achieve a successful outcome.

Mrs P

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