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Monday, 9 January 2017

Challenging local authority and NHS assessments

Challenging local authority and NHS assessments

If you or your relative are unhappy with a decision made by the local authority or NHS relating to their care needs, you may decide to challenge the decision. We explain how to challenge a local authority needs assessment or financial assessment, or an NHS decision that is affecting your relative.

On this page, we give information about:

1. Reasons why you might want to make a challenge
2. Making a complaint
3. Tips for making a successful complaint
4. Taking the matter to an ombudsman: your final option

Reasons why you might want to challenge a decision

If you, or your relative, have had a care assessment, financial assessment or carer’s assessment and are unhappy with:

·         its content
·         the way it was conducted
·         or the outcomes

you have a right to appeal or complain. Possible reasons for dissatisfaction include:
·         Your relative has not seen the assessment or has not had a chance to comment or sign.
·         The assessment didn't cover all of your relative’s needs. There should be a record of all presenting needs, not just those classed as ‘eligible’.
·         Your relative is unhappy with the decision following a financial assessment and can’t afford what the council is asking for.
·         The local authority didn't offer any feasible options for meeting non-eligible needs. Local authorities are supposed to signpost people to other services that could meet non-eligible needs.
·         You don’t agree with the judgements about which needs were ‘eligible’.
·         You don't agree with the way your relative's needs are described.
·         The assessment failed to offer clear outcomes (the difference the service is meant to make to your relative’s life) or the outcomes are not appropriate or not of your choice.
·         The choice of service suggested by the care plan won't meet your relative’s eligible needs/won't deliver the intended outcome.
·         The amount of service offered will not meet your relative’s eligible needs.
·         There have been unacceptable delays in carrying out the assessment or making decisions.
·         Poor customer service or rude staff.

Making a complaint

If you want to challenge a local authority decision, you should first complain to the relevant local authority itself.

All councils are legally obliged to have a formal complaints procedure in place. They should publish information to make it clear to users that they are entitled to a review; explain how to request a review; and explain how to make a complaint.

This information should be available on all local authority websites and given to you or your relative at the time of the assessment.

Tips for making a successful complaint

·         Make it clear that your letter or email is a formal complaint by stating this at the top.
·         Include all relevant facts (plus dates, times and names).
·         Attach copies of all relevant documents.
·         Keep your complaint as brief and to the point as possible.
·         Say what you would like to happen - for example, you would like an apology or a review.
·         Be polite.
·         Keep a copy for your own records.

Take the matter to an ombudsman: your final option

If you are not satisfied with the local authority’s response and you believe the fault is down to a service or administrative error, your final option is to take the matter to an ombudsman. 

Once the ombudsman has decided whether it can legally deal with your complaint, it will then have up to 12 months to provide you with a resolution.

Contact the appropriate national ombudsman as follows:

In England: Local Government Ombudsman

In Northern Ireland: Northern Ireland Ombudsman
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