Challenging Care Needs Assessment

Should you qualify for Care Needs, the Local Authority will advise you as to what services it can provide to you directly or arrange for you and this is known as your Care Plan and can recommend either services to enable you to stay at home or that your needs require residential care.

I did not qualify – what now?

  • Should your needs not be great enough to qualify for a Care Plan. The Local Authority should still provide you with information as to what help and assistance is available locally (through charities or local businesses) to help with your needs.
  • You can apply for a re assessment should you feel your care needs or financial circumstances have changed

Reviewing your Care Plan

You have a legal right to review your care plan at any time should you feel that your care and wellbeing needs or your financial situation has changed.

A review should occur by default the Local Authority review you care plan every year even if nothing has changed.

Furthermore, should you not agree with their decision, you have the right to challenge the decision.

What if I don’t agree with the Care Plan?

You may want to challenge the decision reached because you are unhappy with the findings, the way it was carried out or the final outcome.

  • Ask the Local authority to full explain their decision to you in writing as to how they came to their decision.
  • If you still don’t agree with the decision, you can inform the Local Authority that you think the decision is unfair.
  • If you are still unhappy, you should use the Local Authorities Complaint Procedure to progress your claim.
  • You can further seek advice from Citizens Advice, Local Councillor or Local Support groups who may be able to assist.
  • If you are still unhappy, you can ask for an independent Local Authority or Trust to carry out an independent review of your case.
  • As a final option you can take you matter the ombudsman for review.
  • Should the person in care have lost capacity, you can specifically apply to the court of protection to make decisions on behalf of the person including best interest decisions, living arrangement decisions or safeguarding decisions.
  • Remember, you can still ask for a reassessment at any time should you feel your care needs or financial circumstances have changed

Challenging Care Fee Funding Assessments or Social Care Services

Following the Mean Test regarding your funding are your care needs, you may be unhappy with the decision and you have a right to challenge it and appeal the decision.

As with all assessments, you have the right to a re assessment at anytime should you feel that your financial circumstances have changed.

There a re many reasons why you could wish to appeal the decision but they could include that you believe that you can’t afford what the council is asking for or disagree that your needs are covered by their care plan or the assessment has failed to offer suitable outcomes.

If you want to challenge or appeal a decisions you should;

  • the Local authority to full explain their decision to you in writing as to how they came to their decision.
  • If you still don’t agree with the decision, you can inform the Local Authority that you think the decision is unfair.
  • If you are unhappy, you should use the Local Authorities Complaint Procedure to progress your claim.
  • If you are self funding you can also contact the Independent Healthcare Advisory Service (IHAS) regarding your complaint. You can further seek advice from Citizens Advice, Local Councillor or Local Support groups who may be able to assist.
  • If you are still unhappy, you can ask for an independent Local Authority or Trust to carry out an independent review of your case.
  • As a final option you can take you matter the ombudsman for review.
  • Should you still not be happy with the outcome after the Ombudsman has reviewed your situation you can complain to the Local Government Monitoring Office or
  • Should you not be happy, you can make an application to the High Court for Judicial Review to decide whether the Local Authority has acted unlawfully.
  • Remember, you can still ask for a reassessment at any time should you feel your care needs or financial circumstances have changed

Other Avenues for complaint

  • Write to your local MP / Councillor
  • Contact your local healthwatch service
  • Make a complaint under the Mental Health Act 2005
  • Issue a court application relating to a breach of the Human Rights Act.

Challenging NHS Continuing Health Care Funding

Following your NHS Continuing Care Funding Assessment and findings, should you not be happy with the outcome you can take the following steps;

  • Request a review of your assessment by the Local Clinical Commission Group or Health and Social Care Trust. You must write to the CCG within 6 months of receiving the assessment
  • If the assessment has already occurred, you can request to view the assessment and ask for a full explanation as to its contents and how the decision was reached.
  • If you are still unhappy the CCG should provide you with advice and information how to refer your complaint to the Health Service Ombudsman.

Retrospective Review

Should you believe that your relative (who has died) was wrongly paying care home fees, you can bring a retrospective review to try and recoup incorrectly paid care home fees.

Complaint about the Mental Health Act.

If you are unhappy with he way in which the Mental Health Act has been used you can complain.

  • You should firstly company to the service provider.
  • If you aren’t happy with the response you can ask the Care Quality Commission to investigate your complaint.

Support in Making Complaints.

  • NHS Complaints Advisory Service
  • Patient Advice and Liason Service
  • Patients Association
  • Relative and Residents Association (Care Home Complaints)
  • Citizens Advice
  • Heathwatch Network.
  • Solicitors