Tips and advice for success at your CHC review

Introduction

Once CHC funding has been awarded, the ICB must conduct a review of the care arrangements within 3 months, to ensure these remain appropriate.

If nothing has changed, CHC simply continues. Reviews will be undertaken annually thereafter to ensure that the care package in place is still needed and, if so, that it still meets that patient’s needs.

If the review identifies significant changes in the patient’s needs – either at three or twelve months – a full assessment using the Decision Support Tool will be undertaken, meaning CHC may be withdrawn.

These reviews naturally cause families anxiety and stress because there is always a possibility that CHC could be withdrawn, leaving their relative to fund their own care. If they have assets and savings in excess of £23,250, they will have to self-fund their care which could equate to several thousands of pounds a month – in some complex cases, this could be an eye-watering £10,000 a month!

This blog will explain how ICBs arrange these reviews, how patients and their families can prepare, and highlight key tips and pitfalls to avoid.

How an ICB Arranges a Three or Twelve-Month CHC Review

ICBs oversee NHS CHC funding and are responsible for ensuring that eligible patients receive the appropriate care. The 3- and 12-month review is designed to evaluate whether the patient’s condition and needs have changed. If so, this may mean their funding status will also change.

The Review Process

1. Initial Notification and Planning: The ICB should notify the patient and/or their family/representative of the upcoming review and invite them to participate. However, this does not always happen, with some families only discovering a review has taken place when they are informed of an upcoming reassessment!
2. The Review: The reviewer arranges a meeting with the patient’s care provider and representatives, either in person or virtually (usually, Microsoft Teams). If a Decision Support Tool (DST) has been completed, the Reviewer should make comparison with that assessment to see whether needs have changed. If the patient was Fast-Tracked for CHC, the Reviewer should consider whether their condition has stabilised or if they are still rapidly deteriorating.
3. Outcome: The Reviewer makes a recommendation to the ICB as to whether needs have changed significantly since the award of CHC. If not, funding simply continues; otherwise, a full MDT is arranged to reassess the patient’s eligibility for CHC.
4. Multidisciplinary Team (MDT) Assessment: The ICB convenes an MDT meeting, where health and social care professionals reassess the patient’s needs using the DST, making a new determination as to their eligibility for CHC funding.
5. Communication of Outcome: The ICB informs the patient and their representatives of the decision, outlining the next steps funding their care.

How to Prepare for Your Relative’s Review

Preparation is absolutely key to ensuring that the review process is robust and accurately reflects your relative’s needs.

Take nothing for granted! Don’t be complacent and assume that your relative’s needs are such that they must surely (or automatically) quality for ongoing CHC, or that the fact nothing has changed means CHC funding will continue.

Here’s how to prepare effectively:

1. Don’t be Fobbed Off!

CHC Practitioners will often downplay the importance of the review, telling families it is just a formality and there is no reason to attend. Don’t accept this! Insist you want to participate fully in the review. If the review goes ahead without your knowledge and involvement, complain to the ICB. You have a right to attend and participate!

2. Get a Copy of the Previous DST

The focus of the review should be on whether anything significant has changed since the most recently completed DST. It does not matter if the Reviewer does not believe your relative is eligible; if nothing has changed, there are no grounds for reassessment. Make sure you familiarise yourself with the content of the DST, the levels of need and the rationale for eligibility.

3. Keep Comprehensive Records

Maintain a daily care diary yourself detailing your relative’s condition, symptoms, required interventions, and how their needs have evolved since receiving CHC funding (or the last 12-monthly review).

4. Gather Medical Evidence

Compile all relevant medical reports, GP notes, and care records, to present a clear picture of your relative’s ongoing needs to support your position.

5. Engage with Healthcare Professionals

Speak with carers, nurses, and other healthcare professionals involved in your relative’s care to gain their insights on any changes they have observed.

6. Understand the CHC Criteria

Familiarise yourself with the National Framework for NHS Continuing Healthcare to understand how eligibility is assessed and ensure that your relative’s needs are clearly presented in a coherent manner.

7. Prepare for the Meeting

Write down key concerns, questions, and examples of how your relative’s condition impacts their daily life, to ensure nothing is overlooked during the review. You know your relative best and can fill in any gaps or misunderstanding in the Reviewer’s knowledge of their needs.

Preparation, Preparation, Preparation! Never Take MDT Outcomes For Granted

8. Have an Advocate

Consider seeking assistance from an advocate or CHC specialist who can support you in the process and ensure your relative’s case is presented effectively. Farley Dwek have many years of experience representing families at reviews and offer their Review Support Service.

Tips for a Successful Review

• Be Proactive: Contact the ICB in advance to confirm the review date and ask about the process.
• Be Prepared: Obtain and familiarise yourself with the most recently completed DST. Concentrate on whether anything significant has changed.
• Stay Objective and Evidence-Based: Present factual information backed by medical records and daily care logs.
• Emphasise Unmet Needs: Clearly articulate any gaps in care and how they affect your relative’s well-being.
• Challenge Decisions if Necessary: If you disagree with the outcome of the review, request a reconsideration immediately. Write to the ICB clearly setting out why the decision to reassess is flawed, with reference to relevant evidence in support. You will need to demonstrate that your relative’s needs have not changed (and CHC should continue)

Pitfalls to Avoid

• Failing to Prepare: Lack of documentation and evidence can weaken the case for continued CHC funding.
• Not Attending the Review: Absence from the meeting means missing the chance to advocate for your relative’s needs. Who knows what may be said or done if you aren’t in attendance? Don’t forget that you can always appoint a (professional) representative to go with you or be your advocate.
• Underreporting Symptoms: Be honest and thorough about your relative’s difficulties and care needs to avoid underestimating and downplaying their requirements.
• Accepting the First Decision Without Question: If funding is withdrawn or changed, explore appeal options if you believe the decision does not reflect your relative’s needs.

Dissatisfied with your MDT outcome? Consider these potential grounds for appeal…

Confused? Read This Before You Start Your Retrospective Appeal for CHC Funding…

Conclusion

The 3-month review following award of CHC funding, or subsequent annual review, is a crucial step in ensuring that your relative receives appropriate ongoing care.

Understanding the ICB’s role, preparing thoroughly, and actively participating in the review process can make a significant difference in securing continued care and support. By staying informed and advocating effectively, you can help ensure the best possible outcome for your relative.

For help with your review contact us on 0161 979 0430; or send your enquiry to us at: enquiries@caretobedifferent.co.uk

For more reading around the subject, here are some more blogs from our archives:

June’s feature on flawed CHC assessments and the importance of good record keeping

Can The MDT Panel Refuse To Proceed If I Have An Advocate?

Never count your chickens… Why MDT assessments are still a cause for concern!