Reviews, Complaints and Appeals
Eligibility for NHS Continuing Healthcare is not awarded for life and is reviewed at the three month point after the initial decision. After this point eligibility is reviewed annually.
We are responsible for the case management of individual Continuing Healthcare support packages, including monitoring the quality of care and arranging regular reviews. This can be through joint arrangements with Social Services where applicable.
If you do not agree with the decision on your eligibility for Continuing Healthcare, then you may appeal. Depending on the nature and extent of your appeal, this may either be resolved by meeting with you or taking your case to a local panel which is multi-professional and objective of the process that has been undertaken. The panel will review the domain weightings and the evidence, in order to make an eligibility decision or request more information regarding conditions and symptoms.
If the dispute cannot be agreed locally through panel within the CCG, you may appeal the decision with NHS England. NHS England will compile a panel that will review the decision, the process and the evidence as appropriate to the appeal. If the decision made at this panel is not satisfactory, then you may complain to the Parliamentary and Health Service Ombudsman.
NHS Continuing Healthcare Redress Guidance for CCGs published
Individuals can be reimbursed for care during periods they were eligible for, but did not receive, continuing healthcare support, this is known as a redress payment. Following a recent consultation, NHS England has published refreshed NHS Continuing Healthcare Redress Guidance for clinical commissioning groups (CCGs). The purpose of this guidance is to assist CCGs when settling claims around NHS Continuing Healthcare.
The document has been updated to reflect the principles that guide public bodies on providing remedies for injustice or hardship resulting from poor administration or service. It retains the aim of returning the individual to the financial position they would have been in had they been assessed as eligible and the need for redress identified.
Southampton City CCG will continue to consider individual cases as they do now, to ensure that all individuals receive financial redress if considered appropriate. If you think you are eligible for a redress payment please contact us in writing – The Continuing Healthcare Team, NHS Southampton Clinical Commissioning Group, Oakley Road, Millbrook, Southampton, SO16 4GX
For more information and to view the guidance please visit the NHS England website.
If you have any other complaints, please get in touch with our Patient Experience Team.