EPO Care

1)    We will ask for an Assessment of your Healthcare Needs from the PCT.

Sometimes the Primary Care Trust refuses this request or refuses a full assessment. It is important that this assessment is done as soon as possible, and preferably prior to any Social Services assessment of your finances. We will need to ask for your ‘needs checklist’ to see if a full assessment is necessary.

2)    We will check the assessment.

We will obtain the ‘decision support tool’ paperwork completed by your assessor, and check it with you, making sure that the document accurately summarises your medical and healthcare needs.

We will then present your views in writing to the Primary Care Trust Panel, who make the decision about your NHS funding, on your behalf. You or a relative may be invited to attend a panel review meeting or you may prefer to submit your views in writing. These views will then be considered along with the decision support tool and the multidisciplinary team’s recommendations.

3)    If that fails, and they refuse you funding, we will then ask the Primary Care Trust for a review. Sometimes the Trusts review the cases themselves, but sometimes they refer the requests to neighbouring Trusts. Primary Care Trusts are supposed to deal promptly with review requests. However, it can take months for the review to be done. However, where reviews are successful, funding decisions should be backdated to the date of the original funding application. Also, if you are challenging the withdrawal of existing continuing healthcare funding, the Primary Care Trust should continue to pay for your care pending the outcome of the review.

4)    If the Primary Care Trust review maintained its original decision, we can ask for the case to be referred to the Strategic Health Authority’s Independent Review Panel (IRP). You can also apply direct to the IRP if the local resolution stage is taking too long. The IRP has an advisory role and can only offer guidance on the validity of the PCT’s decision and whether the PCT correctly applied the National Framework. However, PCTs should accept IRP decisions in all but exceptional cases.

If all that fails, we will advise you on whether we consider court action to be appropriate

5)    We can ask for a complete re-assessment if your healthcare needs change.

6)    If the Primary Care Trust decides you do not qualify for fully funded care and you are faced with selling your home to pay fees, we will advise you if there is any way the value of your home could be ignored by the financial assessment made by Social Services who have a discretion to ignore the value of a home in assessing your ability to pay for care.