Why you might feel unhappy with an NHS assessment
- The NHS decides not to proceed with a full assessment of your loved one’s eligibility for NHS Continuing Healthcare or NHS-funded Nursing Care.
- After a full assessment, the NHS says that your loved one doesn’t qualify for care, but you think that they should.
- You have concerns about the process used to reach the decision.
Making a complaint to the NHS
If you’re unhappy with the decision not to offer a full assessment, or feel the outcome of an assessment isn’t right, you can ask the Clinical Commissioning Group (CCG) - which decides who is eligible for NHS Continuing Healthcare - to reconsider its decision. You’ll need to write to the CCG within six months of receiving the assessment.
Ask to see it and ask for an explanation as to the criteria on which the decision was based.
If you can’t resolve the issue with the Clinical Commissioning Group, you need to escalate your challenge by requesting a referral to an Independent Review Panel (IRP), arranged by NHS England.
If you’re still dissatisfied with the decision of the IRP, then you should be given information on how to refer the case to the Parliamentary and Health Service Ombudsman, which makes final decisions on complaints about the NHS in England, including where there is a dispute about what happened.
For further advice about an NHS complaint
- In England and Wales, contact the NHS Complaints Advocacy
- In Northern Ireland, contact the Patient and Client Council
- In Scotland, appeal to the professional that made the decision and the appropriate NHS board. NHS Inform has information on your rights when making a complaint. The Scottish Public Services Ombudsman also has information on making a complaint.
If you’re considering appealing a decision or making a complaint, you'll need to consider the following points.
- Have a strategy in place to conduct the appeal, including knowing what you want to achieve.
- Be clear about the grounds for challenging a decision.
- Try to be objective: when dealing with an emotional subject it’s hard to think with your head, not your heart, but a cool head and rational argument are likely to be more successful.
- The NHS is not allowed to let budgetary considerations influence the decision. If you can find evidence of this, then you could be on to a winner – but this is notoriously difficult to prove.
Getting help appealing against a Continuing Healthcare decision
Beacon is an independent NHS Continuing Healthcare information and advice service, commissioned by NHS England. Trained staff provide free advice for up to 90 minutes through their information and advice service.
If you or a loved one has been assessed as not eligible for NHS Continuing Healthcare and you want to consider appealing, Beacon has a paid-for service. You can read more about it on this page of their website.
I applied for my mum to have Continuing Healthcare, but the assessment was never completed. I then contacted my mum's MP. She has been fantastic and eventually I was granted help.
You might also want to let your local Healthwatch know about your issue. Healthwatch are the independent national champion for people who use health and social care services. They make sure that those running services, and the government, put people at the heart of care.
There is a local Healthwatch in every area of England and through these teams the organisation finds out what people want. This then enables them to advocate for services that meet local communities' needs. They also encourage people running services to involve people in making changes to care.
On the Healthwatch website you can link through to your local Healthwatch and report your experience of care in the NHS. No matter how big or small the issue, they want to hear about it.
If you feel unhappy with a local authority decision relating to care or an assessment, you have a right to challenge it.
We list the regulators, bodies and ombudsmen that can help you make a complaint or challenge a decision.
Under some circumstances the NHS will fund care for people with complex health needs. Read about the assessment process.