Mike’s Story

We were instructed by ‘Mike’s’ family (for anonymity) in relation to his application for NHS Continuing Healthcare Funding (CHC).

Post-discharge from hospital Mike was assessed by his local NHS Integrated Care Board (ICB) for eligibility for CHC Funding. Mike was assessed by way of a Decision Support Tool (DST), with the Multi-Disciplinary Team (MDT) reconvening on two separate subsequent dates to review additional information and evidence.

Following review of that evidence, there was a split MDT recommendation as to overall eligibility. There was no evidence that the ICB had followed the correct process as documented in the National Framework in circumstances where the MDT are unable to agree eligibility. The ICB’s outcome letter simply stated that an “out of panel decision” of INeligibility had been made, but no detail provided as to who had made this decision. It later transpired during the Local Resolution Meeting, that this decision had been made by one individually acting unilaterally.

Farley Dwek Solicitors were instructed by Mike’s family to appeal the negative DST decision. Records were obtained from the Nursing Home and GP, and reviewed by one of our Independent Nurse Assessors. It was noted that Mike remained under the care of the Mental Health Team due to challenging behaviours, and there were ongoing frequent changes of medication to manage his symptoms, which were having little, if any, effect.

We provided a detailed Appeal Submission, amounting to 149 pages, challenging several levels of need in individual Care Domains and providing a detailed analysis of the four Key Characteristics, which gave a much more accurate picture of his overall needs.

The Local Resolution Meeting took place recently, at which the family were represented by one of Farley Dwek’s Senior Case Managers. We were subsequently advised by the ICB that the appeal had been upheld and Mike had been found eligible from the date of the DST on an ongoing basis!

We are delighted that Mike was found eligible for CHC and that this provided some much needed comfort and relief for the family, who were understandably concerned about the funding of ongoing care for their relative.

This is what his family said:

“My family and I cannot rate Farley Dwek Solicitors high enough for all their work in helping us with a successful appeal to grant my father CHC in his care home. As soon as I contacted them I felt listened to and supported and our solicitor Debbie was nothing short of incredible. Very knowledgeable in her field, always ready to offer insight and support and quick to respond to queries, we would have been lost without her! If you are looking for some advice and guidance on CHC’s look no further. Recommend without hesitation”. Emma