How Alice Macnair, Community Care Solicitor, won an NHS Continuing Healthcare (NHS CHC) appeal at the first stages for an Attorney client, securing an award of over £33,000 in backdated care fees.
Our client’s mother, Geraldine, had her NHS Continuing Healthcare funding withdrawn in early 2018, despite having very high level health and social care needs. She lived in a care home, and had dementia and multiple physical conditions which meant she could not communicate or mobilise at all. Her care was complex, due to her physical reaction when carers tried to help her move or administer personal care with washing and dressing. Geraldine had limited funds and was at risk of being moved to a new care home when she lost her funding.
The Clinical Commissioning Group (CCG) had advised the family that Geraldine’s NHC CHC would be withdrawn before the Decision Support Tool (DST) was even completed. They attended several long meetings putting forward strong arguments to no avail.
Alice formally appealed the decision to withdraw NHS CHC, arguing that the CCG had followed a flawed process. The CCG used a private company to carry out the DST, and Alice argued that the process they followed had been legally flawed, and that their Nursing Assessor had deliberately under-evaluated the level of Geraldine’s needs, with the aim of finding her ineligible.
Alongside the family member, Alice attended a new multi-disciplinary team meeting in early 2019, at which they CCG found Geraldine to be eligible for NHS CHC. Sadly, Geraldine passed away the following month. Rather than backdating the NHS Continuing Healthcare award as they should, the CCG followed a further flawed process, completing a new assessment without input from other professionals. They found her ineligible for the intervening period between 2018-2019, except for the one month between the meeting and Geraldine’s death. Alice lodged a formal complaint and appeal and attended a further multi-disciplinary local resolution meeting in early 2020.
Alice was successful in having the decision overturned. Alice obtained an NHS CHC award for Geraldine for the whole retrospective period. An award of NHS CHC must be enough to cover the whole cost of care and accommodation. This meant that Geraldine’s estate was entitled to reimbursement of the care fees that Geraldine had been wrongly forced to pay to the care home after NHS CHC was withdrawn. With the cost of care being around £1000 per week, this resulted in a back payment of around £30,000 to the family, with an additional month prior to Geraldine’s death reimbursed at £5,000.