Appeals Process

1. What is an Appeal?

An appeal is a request to reconsider a decision taken by an assessor within Calderdale Metropolitan Borough Council (CMBC) in relation to the outcome of an assessment, audit or review.

The aim of this document is to provide advice and guidance to help ensure that appeals are dealt with fairly, efficiently, effectively and within an open and transparent process.

2. Who can Appeal?

The council officer must ensure that the person or their representative know about the appeals process and how to appeal. An appeal may be made by the person who has been assessed, audited or reviewed; or the appeal may be made on the person’s behalf by someone else: a family member, a friend, or anyone who has the consent of the person (if they have capacity to consent), or who does so in their best interest (if they lack capacity under the Mental Capacity Act 2005). An appeal may also be made by an independent advocate for people who have substantial difficulty in being involved with assessments, audits, care planning or reviews.

3. What can be Appealed?

Assessment – An assessment under the Care Act 2014 is a process by which a local authority looks at a person’s or their carer’s care and support needs to determine if they are eligible for support. It considers a person’s specific needs, the impact on their wellbeing, and the outcomes they want to achieve in daily life.

The grounds for an appeal would be that the person or their representative feels that the assessment is not a true reflection of the persons needs or that they have been overlooked.

Eligibility – To be eligible for care and support under the Care Act 2014, a person’s needs must arise from a physical or mental impairment or illness, and they must be unable to achieve two or more specified outcomes, leading to a significant impact on their wellbeing.

The grounds for an appeal would be that the person or their representative feel that their care and support needs have not been fully recognised, if they are unable to achieve some of the outcomes stated in the Care Act 2014, or if the impact of their needs has not been fully taken into account.

Personal budget – A personal budget is an amount of money that is allocated to a person to meet their eligible needs identified with their assessment.

The grounds for appeal would be that the person or their representative feel that the personal budget is not sufficient to meet the persons needs and outcomes.

Support planning – A care and support plan is a detailed document setting out how a person’s needs and outcomes will be met, including what support will be provided, when and how it will be delivered, and who will provide it.

The grounds for an appeal would be that the person or their representative feels that the support does not meet the person’s needs and outcomes.

Review – Reviews are a statutory requirement to reflect on what is working and/or not working within a person’s support plan, consider any changes that may need to be made and ensure it is up to date and relevant to the persons needs and outcomes.

The grounds for an appeal would be that the outcome of the review isn’t accurate or reflective of the persons needs and outcomes.

Ordinary Residence – the place a person has chosen to live for a settled purpose, whether for a short or long duration.

The grounds for an appeal would be that the person or their representative does not agree with the decision made about their ordinary residence.

Financial Assessment and Care Charging– decisions about how much a person needs to pay towards their care and support (if anything) and collection of care charges.

The grounds for an appeal would be that the person or their representative does not agree with the decision made about their care charge or unpaid care charges.

Direct Payments – decisions about how direct payments are used or managed, including requests to use the funding more flexibly and requests to employ in exceptional circumstances,

• The spouse, civil partner, or person living as if their spouse or civil partner (no matter where they live)
• A close relative living in the same household, or that close relative’s spouse, civil partner, or person living as if their spouse or civil partner.

The grounds for an appeal would be that the person or their representative does not agree with the decision made regarding their request to use their direct payment more flexibly, to employ a close relative living in the same household or a spouse/civil partner, or any findings or actions taken in relation to the use or management of the direct payment.

In cases where a person or their representative’s appeal involves both an appeal and a complaint, the appeals element will be investigated under the council’s appeals process, while the complaints element will be investigated under the council’s complaints process.

4. How to Appeal Decisions

An appeal can be made orally, electronically or in writing. If an in-person discussion is required to make the appeal, this can be facilitated upon request.

4.1 Timescales

Any appeal must be lodged within 30 working days of the person receiving notification of the outcome of the assessment, audit or review undertaken by the council officer.

CMBC will have discretion to accept an appeal outside of 30 working days if circumstances have prevented the person or their representative from raising an appeal. However, an appeal will not be accepted if the issue or event being appealed against took place over 3 months previously.

4.2 Appeals process 

Informal stage

1. Contact made with the council officer who made the decision within 30 working days of receiving notification of the outcome of the assessment, audit or review.
2. Grounds for the appeal and desired outcome must be clearly identified by the person or their representative.
3. The informal stage of the appeal process should be completed within 10 working days of receipt of the appeal.
4. The council officer looks at the decision again. This should be done with the person or their representative, in whatever way is most accessible to them and an advocate should be offered if appropriate. The council officer lets the person or their representative know the outcome of the reviewed decision.

If the person or their representative still disagrees with the decision, they are provided with the contact details for the Team Leader or the Team Manager of the team which undertook the assessment, audit or review to formally appeal the decision. The person or their representative should contact the Team Leader or the Team Manager orally, electronically or in writing. If an in-person discussion is required to appeal the decision, this can be facilitated upon request.

Stage 1 – Review by Team Leader or Team Manager

 Should the person or their representative remain dissatisfied, they can proceed to stage 1 of the Appeals Process.

1. Contact made with Team Leader or Team Manager within 10 working days of the receipt of the outcome of the informal review of the decision with the council officer.
2. Grounds for appeal and desired outcome must be clearly identified by the person or their representative.
3. Appeal acknowledged within 10 working days of receipt. This acknowledgement should provide the name of the Team Leader or Team Manager who will be dealing with the appeal.
4. Stage 1 of the appeal process should be completed within 15 working days of receipt of appeal. If the timescale is likely to exceed 15 working days, the Team Manager or Team Leader should contact the person or their representative at the earliest opportunity to advise of the new timescale. This should be no more than an extra 10 working days.
5. This could include a meeting with the person or their representative but must include a review of the relevant records and all the information provided by the person.
6. If appropriate the person or their representative should be offered an advocate.
7. Letter sent by Team Leader or Team Manager to the person or their representative outlining the outcome of the appeal. The decision should be communicated in a clear, accessible manner, that makes adjustments for any communication-related disabilities.
8. At the same time as the person or their representative is advised of the outcome of the appeal, they should be advised of the second stage in the appeals process, if they remain dissatisfied.

If the person or their representative still disagrees with the decision, they are provided with the contact details for the Senior Manager of the team which undertook the assessment, audit or review to formally appeal the decision. The person undertaking the appeal or their representative should contact the Senior Manager orally, electronically or in writing. If an in-person discussion is required to appeal the decision, this can be facilitated upon request.

Stage 2 – Review by Senior Manager

 Should the person or their representative remain dissatisfied, they can proceed to stage 2 of the Appeals Process.

1. Contact made with the Senior Manager of the team where the assessment, audit or review was carried out, within 10 working days of receipt of the outcome of Stage 1 of the process.
2. Grounds for appeal and an explanation of the continued dissatisfaction must be clearly identified by the person or their representative.
3. Appeal acknowledged within 10 working days of receipt. This acknowledgement should provide the name of the officer who will be dealing with the appeal.
4. Stage 2 of the appeal process should be completed within 15 working days of receipt of appeal. If the timescale is likely to exceed 15 working days, the Senior Manager should contact the person or their representative at the earliest opportunity to advise of the new timescale. This should be no more than an extra 10 working days.
5. This could include a meeting with the person or their representative but must include a review of the relevant records and all the information provided by the person.
6. If appropriate the person or their representative should be offered an advocate.
7. Letter drafted by the Senior Manager and sent to the relevant Assistant Director for oversight and quality assurance.
8. Following approval by the relevant Assistant Director, letter sent by the Senior Manager to the person or their representative outlining the outcome of the appeal. The decision should be communicated in a clear, accessible manner, that makes adjustments for any communication-related disabilities.
9. The outcome of Stage 2 of this process is final and conclusive of the process.

 Exceptions

There are some appeals where, although the overall process remains the same, the person responsible for responding to the appeal may differ. Therefore, although the policy will be followed, the person responsible for responding to the appeal will vary accordingly.

Certain decisions, such as some personal budget requests or direct payment requests to employ a close relative living in the same household or a spouse/civil partner are made by senior managers. As a result, appeals of these decisions will follow a condensed appeals process.

Any direct payment exceptional requests will always be considered in line with The Care and Support (Direct Payments) Regulations 2014.

5. Local Government and Social Care Ombudsman

 If the person or their representative is not satisfied with the outcome of the appeal, the Senior Manager will provide them with contact details of the Local Government and Social Care Ombudsman.