Help with Appeals

Many families have already worked through the funding process themselves, without the need for any assistance. Many are successful, but others are not so fortunate and find themselves frustrated by the NHS appeals process.

If you need help with an Appeal, we may be able to help. The first stage is for us to assess your relative’s eligibility through our Clinical Review Service.

If you proceed with our Clinical Review Service, we will send one of our experienced specialist nurses to meet both you and your relative to carry out an independent assessment of their care needs, face to face.

Following the assessment meeting, our nurse will produce a detailed report which we will send to you, setting out our nurse’s assessment of you relative’s care needs. This report follows the same format as the Decision Support Tool (DST) used by the NHS in determining a patient’s eligibility for NHS Continuing Healthcare Funding.

The report will help you to understand, whether in our view, there is any realistic prospect of arguing that your relative should potentially qualify for NHS Continuing Healthcare Funding, and therefore to continue to Appeal.

If our nurse’s report concludes that your relative may not qualify for funding at the moment, you will be able to use the report as a baseline and for comparison purposes, when monitoring important changes in your relative’s condition, in case they meet the funding criteria at any future re-assessment. Furthermore, the report will also give you the reassurance of knowing that the matter has been assessed objectively by a skilled nurse who has a wealth of experience in this specialised field.

The Clinical Review Service is offered on a fixed price basis and includes: all administration costs, the time and travel costs for our nurse to visit you and your relative in their care environment, the assessment of your relative’s care needs based on a discussion with you/your relative, a review of available GP/care records (if appropriate), a written report, and a further telephone discussion with you based on that report. Of course, our nurse will also be able to answer any detailed questions you may have about all aspects of the assessment process.

If, after the Clinical Review Service, our nurse believes that you have a strong case, we can help you with your Appeal and we may be able to offer our Appeal Service on a fixed fee basis. Our fees are payable whether your appeal is successful or not. In some cases, we may be able to offer to work on a Contingency Fee Agreement basis*, sometimes known as “No Win, No Fee”. That means, if we are unable to secure funding for your relative, then you will pay us nothing.

For appeals on retrospective reclaims, we also charge a fixed fee which is payable whether your appeal is successful or not. However, as above, in some cases we may be able to offer to work on a no win, no fee basis under Contingency Fee Agreement*. That means, if we are unable to secure funding for your relative, then you will pay us nothing.

If we are successful with regard to both a current appeal and retrospective appeal, we will agree an overall percentage reduction to account for this, and are happy to discuss this on a case-by-case basis.

* – Subject to terms and conditions