How Paula Jones, Associate Solicitor, secured a NHS Continuing Healthcare Direct Payment Personal Health Budget worth £98,000 per year where the Clinical Commissioning Group had refused to agree a Direct Payment.
Emily’s son Roger, aged 22, has very complex needs requiring 1:1 specialist care, 24 hours a day. The Clinical Commissioning Group (CCG) carried out an assessment of Roger’s needs and found him eligible for NHS Continuing Healthcare (NHS CHC) funding, but refused to agree his Personal Health Budget figure (PHB) or agree to Direct Payments.
Due to the dispute with the CCG, Emily was providing all of her son’s care and support herself, despite the CCG’s recognition of his complex and intense healthcare needs.
Emily had tried to resolve this by corresponding with the CCG for over a year but the CCG refused Direct Payments for Roger on the basis that Emily had not yet identified the exact care provider that she would be using from a pool of four that she had shortlisted
Paula identified that the CCG had micro-managed the Personal Health Budget process to the extent that it did not provide the flexibility, control or choice required under government guidance.
Paula wrote to the CCG, on Emily’s behalf, to try and set up a roundtable meeting to resolve the many complex issues. However, the CCG remained intransigent and Paula had no option but to write threatening to Judicially Review the CCG.
This threat of a Judicial Review public law challenge lead to the CCG finally agreed to implement Roger’s PHB and Direct Payment. This enabled Emily to hire carers and support for her son to supplement the unpaid support that she provided.
The CCG refused to backdate Roger’s Direct Payment, and failed to apologise for or rectify the many issues that had arisen as a result of their conduct during the case.
Paula is continuing to assist Emily to pursue a complaint to the Parliamentary and Health Services Ombudsman in relation to the CCG’s refusal to backdate the payments and the many other outstanding issues.
The CCG has agreed to a current Direct Payment for Roger in the region of £98,000 per annum, allowing Emily to manage and have control over the way in which her son’s support needs are met.