A family recovered around £65,000 in previously paid care fees after our team supported them through the ICB appeal process and a local resolution meeting, resulting in full NHS Continuing Healthcare funding being awarded.
The family approached Compass CHC after a Decision Support Tool (DST) assessment had been completed independently and they were considering appealing the ineligible outcome. We acted quickly to initiate the appeal with the Integrated Care Board (ICB), ensuring the case was properly evidenced and presented from the outset.
We requested and reviewed extensive care records, prepared a detailed letter of representation, and supported the family at the local resolution meeting. The Advocate demonstrated that the scoring for Communication, and Behaviour and Drug Therapies and Medication domains should be High. The panel agreed the patient needed timely and skilled interventions to manage psychological and behavioural needs, as well as support with medication compliance.
The panel concluded the primary health need criteria was met and awarded full NHS Continuing Healthcare funding. This means the individual is now receiving the right level of care, fully funded by the NHS, and the family has been reimbursed for 20 months of care fees they should not have had to pay.
Ewa Krzyskowska, Advocacy Director comments:
“Too many families are left navigating the CHC process without clear guidance, while facing immense emotional and financial pressure. This outcome shows the difference thorough evidence-gathering and strong representation can make – securing the right package of care and recovering fees that should never have been paid.”
Key outcomes
- Full CHC funding awarded following an ICB appeal and local resolution meeting
- 20 months of care fees backdated
- Approximately £65,000 recovered for the family
- Ongoing care now fully funded by the NHS.
Learn more: How do I appeal an NHS Continuing Healthcare funding decision?
If you are funding care privately and are unsure whether NHS Continuing Healthcare may apply, we can help you understand your options and support you through the assessment and appeal process. Contact us to discuss your situation confidentially.
