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Refunds, appeals and complaints

CCGs will normally make a decision about eligibility for NHS CHC within 28 days of getting a completed checklist or request for a full assessment, unless there are circumstances beyond its control.

If the CCG decides you’re eligible, but takes longer than 28 days to decide this and the delay is unjustifiable, they should refund any care costs from the 29th day until the date of their decision.

If your CCG decided that you weren’t eligible for NHS CHC, but then revised this decision after a dispute, it should refund your care costs for the period between their original decision and their revised decision.

Appeals

If you do not agree with the decision on your eligibility for NHS CHC, then you may appeal. Depending on the nature and extent of your appeal, this may either be resolved by meeting with the CCG. Alternatively your case could be taken to a local panel where a multi-professional health and social care team will review the domain weightings and the evidence, in order to make a recommendation for eligibility, which will then be considered by the CCG.

If the dispute cannot be agreed locally within the CCG, you may appeal the decision with NHS England. NHS England will review the decision, the process and the evidence through independent review process (IRP). If the decision made at IRP is not to your satisfactory, then you may complain to the Parliamentary and Health Service Ombudsman.

Complaints

If you have any complaints, please get in touch with our Quality and Patient Experience Team.

Lincolnshire CCG