Dispute Resolution

If you disagree with the outcome of either your screening Checklist or full assessment there is a dispute resolution process available to you. If at the Checklist stage you do not fulfil the criteria for a full assessment, you can ask the Clinical Commissioning Group to reconsider its decision. If the decision remains the same, you have the right to access the NHS complaint procedure which consists of a written complaint to the CCG complaint manager and then the option to refer your complaint to the Parliamentary and Health Service Ombudsman.

If you have received a full continuing healthcare assessment and disagree with the outcome, you have the right to appeal. The appeal process normally consists of three stages. The first stage of appeal is through the CCG’s local resolution procedure which may vary depending on where you live but often involves a meeting with the CCG continuing healthcare team or a panel review. The second stage is an Independent Review Panel convened by the NHS England. This is a formal review of the CCG’s decision by a panel of experienced health and social care professionals who are independent of the CCG that carried out the initial assessment. You will be invited to attend part of the panel hearing. The third stage is to refer your case to the Parliamentary and Health Service Ombudsman for a full independent investigation. Depending on this outcome there may be further stages involved. The first two stages should not normally take longer than 3 months each to complete however in reality it is not uncommon for appeals to take well over a year or require multiple panels before all available appeal options have been exhausted. NHS England are keen to ensure that disputes are resolved at a local level wherever possible and at Beacon, we encourage CCGs to resolve appeals at the earliest opportunity to minimise the costs and stress to our clients of having to pursue an appeal for months or years.

At Beacon our aim is for everyone to receive an accurate, detailed and fair assessment and we understand that sometimes it takes several attempts to achieve this. For some families, our perseverance through appeals has meant the difference of hundreds of thousands of pounds. For others, successful funding has meant not having to sell the family home, while in some cases, it was simply the recognition that their relative or friend should have been eligible in the first place.

If you or your relative/friend are assessed as ineligible for NHS continuing healthcare following a full assessment of need, we strongly suggest reading all correspondence from your local CCG and taking the time to understand why the assessment was unsuccessful before deciding whether or not to pursue the dispute resolution process. The experienced caseworkers at Beacon can assist you to understand how the outcome was reached and provide a comprehensive analysis of the assessment, identifying any inaccuracies or potential avenues for appeal. We understand that the key to winning an appeal is often to show how an individual has changed as a result of their disability, accident or illness, and so we take the time to get to know the person behind the assessment rather than only relying on written records. We take care not to mislead people and will not advise you to appeal unless we genuinely believe you have a case.