What happens to funding during a dispute

Benefits, finances and funding
1

I feel like I’m losing my mind here. Every day I’m being told something different by people who should know the system far better than me

As per my previous thread my Dad has had his funding withdrawn following a review, much to the surprise of everyone involved in his car.

We’ve had basically zero information, there was a letter sent to the care home saying funding was stopping on 21st of the month and that’s it. We’ve lodged an appeal but haven’t even had acknowledgement of that.

Last week the home manager said not to worry as while the dispute was ongoing the current funding arrangements would continue. Today she has said she’s not sure that’s true and we may need to pay.

I’m looking at a document from the Department of Health and Social care titled, National Framework for NHS Continuing Healthcare and NHS- funded Nursing Care and in a section headed Guidance on responsibilities when a decision on NHS Continuing Healthcare eligibility is awaited or is disputed it states

This guidance sets out the approach to be taken by ICBs and local authorities (LAs) in three situations:

  1. (a) where there is a need for health or care and support to be provided to an individual during the period in which a decision on eligibility for NHS Continuing Healthcare is awaited, in a case that does not involve hospital discharge; or
  2. (b) where an ICB has unjustifiably taken longer than 28 calendar days to reach a decision on eligibility for NHS Continuing Healthcare; or
  3. (c) where, as a result of an individual disputing an NHS Continuing Healthcare eligibility decision, the ICB has revised its decision.

a) Where care needs to be provided whilst a decision on NHS continuing healthcare is awaited, in a case that does not involve hospital discharge

  1. A person only becomes eligible for NHS continuing healthcare once a decision on eligibility has been made by an ICB, informed by a completed Decision Support Tool or Fast Track Pathway Tool. Prior to that decision being made, any existing arrangements for the provision and funding of care should continue, unless there is an urgent need for adjustment.

  2. If, at the time of referral for an NHS Continuing Healthcare assessment, the individual is already receiving ongoing care and support funded by an ICB, or a local authority, or both, those arrangements should continue until the ICB makes its decision on eligibility for NHS Continuing Healthcare, subject to any urgent adjustments needed to meet the changed needs of the individual. In considering such adjustments, local authorities and ICBs should have regard to the limitations of their statutory powers.

that to me says that when the outcome of a disputed decision is awaited the current funding arrangements remain in place, does anyone have any experience of this?

2 Likes
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Go and see someone who understands the documents like someone in citizen advice, age UK, lawyer or someone who works with money for advice. It is a minefield and you need someone who understands the forms as it is easy to get lost or con from not understanding the form’s.

1 Like
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Call Citizens Advice this morning pronto. They can help navigate everything.

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I’m not able to access my paperwork right now, but I know that the Care Act says that assessed needs must be met. Even if a client refuses to pay, Social Services must step in. They can then ultimately sue through the Courts to reclaim their money. The next step has to be Social Services doing their own assessment AND A CARERS ASSESSMENT for you. Stress the urgency. I would then try to step back and tell the ICB to fight it out with SSD! Tell the home too. You are not personally liable for anything. If dad has under £23,000 his contribution would be minimal. I would also copy the rules you have posted here and send a letter by Special Delivery to the Head of the ICB asking why staff are ignoring their statutory duties. I would also suggest that they should not be dealing with any further cases until they have satisfactorily completed a course of further training!