Sheila will try to answer as many of your English Social Care questions as possible, giving priority to frequently asked questions and questions regarding current events and trends.
How do I appeal a funding decision?
Due to the great level of care provided at our care home , we recently had one of our residents taken off the fast-track path and assessed as requiring nursing by the county nurse-assessor. However, the funding panel ignored this assessment and agreed to only pay at the residential rate. When trying to appeal this we were informed that there was no formal appeal process. There could be no clearer indication that this county put a greater importance on their budgets than they do on care. What can we do about this? Our matron is currently recording all nursing care provided to this resident.
Thank you for your question which of course is extremely serious.
What you need to consider along with the family of the service user is that the person at the heart of this decision, the service user, is the person that should be appealing the decision not to fund the nursing care.
Although you will be assisting the person and their family it is the service user that is being denied nursing care and therefore all appeals and complaints should be made by them or their next of kin.
There is more than one way of looking at how to deal with this:
1. I think that a letter should be sent to the Service Director and/or your local Councillor raising the issue and see what their response is.
2. Your Council does not appear to have an appeals process for Adult Social Care decisions but it seems to expect that these issues will be dealt with as a complaint and you can read about that process on their website by putting Social care complaints into the County Council website's search engine.
If neither of these approaches work then there are two other options I think:
1. Write to the person's MP.
2. Consider whether or not by denying the appropriate funding to the service user that this has become a safeguarding issue.
Your final course of action is to contact the Local Government Ombudsman but you have to have gone through any appeals or complaints processes before you can do that.
I know that many other providers of Adult Social Care will be in the same position that you are in and that many, many people continue to receive care that is not being appropriately funded through the goodwill of the social care provider.
What would you like to ask Sheila?
Sheila Scott OBE from National Care Association (NCA). Care is Sheila’s life; she possesses a strong command of the issues facing the care sector informed by her long career as a nursing professional, the owner and manager of a care business and as a leader in the care sector.
Sheila will try to answer as many of your questions as possible, giving priority to frequently asked questions and questions regarding current events and trends.
Please note that Sheila can not offer answers to matters requiring legal advice. If your matter concerns a specific service provider, please contact the CQC.