How to complain about an NHS assessment

How to complain about an NHS assessment

Following an NHS assessment for continuing healthcare or NHS-funded nursing care, you or your relative might be dissatisfied with the result. Here's what to do if this is the case.

Reasons for being unhappy with a decision might be because:

the NHS decides not to proceed with a full assessment of your relative’s eligibility for NHS Continuing Healthcare or NHS-Funded Nursing Care

after a full assessment, the NHS says that your relative doesn’t qualify for care, but you think that they should you have concerns about the process used to reach the decision.

Making a complaint to the NHS

If you are unhappy with the decision not to offer a full assessment to your relative, or feel the outcome of an assessment is not right, you can ask the Clinical Commissioning Group (CCG) - who decide who is eligible for NHS continuing healthcare - to reconsider its decision. You will need to write to the CCG within six month of receiving the assessment.

If the assessment has taken place:

1. Ask to see it and ask for an explanation as to the criteria on which the decision was based. 

2. If you can’t resolve the issue with the Clinical Commissioning Group, you need to escalate your challenge by requesting a referral to an Independent Review Panel (IRP), arranged by NHS England. 

3. If you are still dissatisfied with the decision of the IRP, then you should be given information on how to refer your relative’s case to the  Parliamentary and Health Service Ombudsman, who make final decisions on complaints about the NHS in England, including where there is a dispute about what happened.

4. For further advice about an NHS complaint:

In England and Wales, contact the NHS Complaints Advocacy

In Northern Ireland, contact the Patient and Client Council

In Scotland, appeal to the professional that made the decision and the appropriate NHS board. NHS Inform has contact details for the NHS boards and information on your rights when making a complaint. The Scottish Public Services Ombudsman also has information on making a complaint.

Be prepared

·         If you are considering appealing a decision or making a complaint, think about the following:

·         Have a strategy in place to conduct the appeal, including knowing what you want to achieve.

·         Be clear about the grounds for challenging a decision.

·         Try to be objective: when dealing with an emotional subject it’s hard to think with your head, not your heart, but a cool head and rational argument is likely to be more successful.

·         The NHS is not allowed to let budgetary considerations influence the decision. If you can find evidence of this, then you could be on to a winner – but this is notoriously difficult to prove.