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Case Study: Deputy Wins Appeal Against Funding Withdrawal & Recovers £156,000 of Care Fees

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How our expert Community Care Law team based in our Brighton office, helped a Deputy win an appeal against the withdrawal of a healthcare funding package and obtained a back payment of £156,000 in lost care fees.

The situation

Lynn, 65, has advanced Huntingdon’s disease and is unable to move or communicate.

In 2012, Lynn was awarded NHS Continuing Healthcare (CHC) due to the increasing complexity and intensity of her needs.

Her award was withdrawn in 2017 following a flawed review process. The funding for her £3,000 weekly care at home package ended, forcing Lynn to self-fund her care from her limited savings.

The Local Authority (LA) had failed to complete a social care assessment, resulting in a debt of £18,000 in care charges.

Lynn’s Deputy was unlawfully instructed by the Council to release equity from her property to continue paying for Lynn’s care at home.

What Martin Searle Solicitors did

Lynn’s Deputy contacted us when he was told NHS CHC had been withdrawn.

We lodged an appeal on behalf of Lynn, setting out the reasons why her assessment was procedurally flawed, and under-evaluated her needs across the different healthcare domains. We argued she still had a primary healthcare need due to the nature, intensity, complexity and unpredictability of her needs.

When it became clear that the LA was failing to properly assess Lynn’s needs, create a care plan or carry out a financial assessment, we challenged this on behalf of her Deputy. We obtained emergency funding from Social Services while they continued with their assessment and care planning process. We asked them to trigger a new NHS CHC assessment via their complex care team, pending the appeal resolution.

Social Services suggested that the weekly cost of care was too high, and that Lynn would need to sell her home in North West England to move into residential care. We represented Lynn at the local resolution meeting for her appeal and successfully presented needs-based arguments as to why Lynn must continue to be cared for at home.

The result

Lynn’s appeal and her new NHS CHC assessment was successful. Her £3,000 per week care at home funding was reinstated. The Clinical Commissioning Group accepted that Lynn would be more appropriately cared for in her own home. Her successful appeal secured a positive outcome for the backdated period, resulting in a large arrears payment of £156,000 to Lynn via her Deputy.

If you need expert advice regarding Community Care Law, our Health and Social Care solicitors team can help. Contact us today on 01273 609911, or email to find out more.

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