Mrs P has a complex medical history, including bilateral strokes, posterior reversible encephalopathy syndrome (PRES), diabetic ketoacidosis (DKA), paralysis except for one arm, insulin-dependent diabetes, a stoma due to cancer, neuropathic pain, arthritis of the spine, and a history of breast cancer treated with hormone therapy. She has undergone multiple surgeries, including major bowel surgery in 2023, which led to complications and a heart attack. Mrs P’s condition requires 24/7 care, and home care is not an option due to the complexity of her needs, particularly at night.
The first Checklist, completed by the care home and without the presence of our advocate, resulted in Mrs P’s case being turned down for a Decision Support Tool (DST). Our advocate appealed the checklist, highlighting to the Integrated Care Board (ICB) and the care home how it had been scored incorrectly, making it appear as though Mrs P had recovered more than she actually had. The ICB agreed to a new Checklist with the presence of our advocate and our client, which resulted in a positive outcome.
Following the positive Checklist, a DST meeting was held with a full multi-disciplinary team (MDT). Unfortunately, the MDT determined that despite Mrs P’s complex and unpredictable health needs, Mrs P was not eligible for NHS continuing healthcare (CHC) funding. Both the advocate and the family strongly disputed this, leading to an appeal. The appeal meeting took several months to be arranged and during this period Mrs P’s condition continued to deteriorate, with ongoing issues such as seizures, severe leg swelling and confusion. She was hospitalised again in 2024.
The appeal meeting was eventually held in November 2024, during which the nurse assessor praised our advocate, stating that the representations were “well-reasoned and well-supported.” In early January 2025, we received notification that the CHC appeal had been successful, and the decision of the MDT was deemed “unsound.” This result provided much needed relief for our client and her family, and we were absolutely delighted for them.
We faced many issues along the way, and the journey from the Checklist to the successful appeal lasted over 18 months. However, we got there in the end, and justice prevailed.
Mrs W, Mrs P’s daughter, left us two reviews on Trustpilot as she utilised two of our services: our Full Package and Appeal Package.
If you find yourself needing some help and guidance through this difficult and complex process, please do not hesitate to get in touch with Danielle directly via email:
danielle.whitfield@simplycontinuinghealthcare.co.uk
We also provide lots of advice and guidance absolutely free of charge! To book a consultation, please contact Danielle.