To ask the Secretary of State for Health and Social Care, whether there is a formal process in place for patients who receive Continuing Health Care funding to challenge a decision of Decision Support Tools that move them from funded health care into social care.
The National Framework for NHS Continuing Healthcare and National Health Service-funded nursing care sets out the process to be followed if an individual wishes to challenge an NHS Continuing Healthcare eligibility decision following the completion of a Decision Support Tool or Fast Track Pathway Tool.
There are two stages involved in the challenge to eligibility decisions, firstly a local review process at the clinical commissioning group level, and secondly a request to NHS England, which may then refer the matter to an independent review panel.
When a case is referred to NHS England’s independent review panel, it will consider the case and make recommendations to the relevant clinical commissioning group. The role of the panel is advisory, but its recommendations should be accepted by clinical commissioning groups in all but exceptional circumstances. If the original eligibility decision is upheld and an individual is still unhappy with the decision, they can contact the Parliamentary and Health Service Ombudsman.