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How to Appeal

NHS Funding

If you're unsuccessful in applying for NHS funding you can challenge a decision and appeal. This must be backed by evidence to support why you feel that the decision reached was flawed. You must submit an appeal, in writing, to the local NHS CCG who undertook the assessment.  These details should be provided to you in the outcome letter you receive that sets out the negative funding decision following the assessment. You must list all your reasons – with evidence - for disagreeing with the decision to deny funding.

The basis for appealing a decision can be either that the procedural process was not correctly followed, and / or the evidence was incorrectly weighed against the levels of need awarded and the wrong decision was reached based on this evidence ie the patient’s needs are complex, intense and /or unpredictable in their nature and as such are primarily health needs. Should the Local Dispute Resolution process uphold the ‘ineligible’ decision, the next step is to request an Independent Review Panel to be convened at regional level. If the Independent Review also find you ineligible for funding, you can request NHS England undertake an appeal and convene an independent appeal panel.  If you remain dissatisfied with the outcome following NHS England level you may approach the Parliamentary and Health Service Ombudsman for a case review and /or a full independent investigation.

Once you receive the letter informing you of the CCG’s decision you have 6 months from the date of the letter to initiate an appeal and request a review of the decision. The CCG has a further 3 months from the date of your request to undertake this appraisal and complete the local review stage. This process can take up to a year to complete, the time it takes varies dependent on geographical location.

When the local review stage has been completed, you have a further 6 months from the day you are notified to request an Independent Review Panel (IRP).

Within 3 months of your request for a review, NHS England should convene the Independent Review Panel. At the IRP, 3 decision makers must work together to decide on the outcome of your appeal. The panel should be headed by an independent Chair and should also include a health and a social care professional who must not be from the same CCG who made the initial decision

 

Be aware that in our experience some CCGs are keen to send people down the complaints process and refer to the PHSO as a means of 'offloading' your case. Both can take years to reach a decision and offer a resolution. Our advice is follow the appeals process to its conclusion first

 

Local Authority/ council

If you're turned down for funding or you're unhappy with the council's decision you can challenge it : 

  • if they refuse to pay for care services

  • if you're unhappy with the service you've been offered

  • if you don't think they’re paying enough towards your care

Always complain directly to your local council they should have a formal complaints procedure on their website. If you're not satisfied with the outcome of your complaint you can refer to the Local Government and Social Care Ombudsman.

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Click here for the Parliamentary and Health Service Ombudsman

Click here for the Local Government and Social Care Ombudsman