How Cate Searle, Health and Social Care solicitor, helped a client recover the full cost of her mother’s care at home package after a NHS Continuing Healthcare (NHS CHC) appeal.
Anna is Health & Welfare Deputy and Attorney for Finances for her mother, Ethel.
Ethel has advanced dementia and physical health problems. She had a live-in carer, but as her behaviour could be challenging, she also required a second carer for part of every day and sometimes at night.
This added to the weekly cost and Anna paid for half of the care costs, as Ethel could not afford them
Anna believed Ethel should qualify for NHS CHC to cover the full cost of her care at home and asked the NHS Clinical Commissioning Group (CCG) to carry out an assessment.
The CCG found that Ethel was ineligible for NHS CHC. Anna disagreed and appealed their decision. She attended a NHS Local Resolution Meeting. The CCG upheld their decision and told Anna that if she disagreed, she needed to apply to NHS England for an Independent Review Panel.
Anna recognised that she needed specialist Community Care Law advice to succeed at an Independent Review Panel. Ethel’s care agency recommended Cate.
Cate investigated by going back three years through Ethel’s care notes and concluded that Ethel had a primary healthcare need for two of the three years. She advised Anna to focus on these two-years to build the strongest case.
Cate prepared detailed written Grounds of Appeal for NHS England and attended an Independent Review Panel with Anna. The Panel accepted Cate’s arguments that Ethel had a primary healthcare need, backdating two years, and decided to award Ethel NHS CHC for care at home.
After this successful appeal, the CCG informed Anna they wouldn’t pay the full cost of Ethel’s care at home, as their Resource Allocation Policy stated they would only pay the equivalent cost of a nursing home plus 10%. This amounted to half of Ethel’s care at home costs.
Cate used the NHS complaints system to challenge the CCG’s Resource Allocation Policy. She argued it was in breach of Ethel’s Human Rights as it effectively forced her into a care home and that such a blanket policy is unlawful.
The NHS complaint was upheld in Ethel’s favour.
The CCG paid the full cost of care plus interest for the whole period that Ethel spent at home and was eligible for NHS CHC.
Anna, as Health & Welfare Deputy, later made a Best Interest decision to move Ethel into a nursing home as her physical health had deteriorated. NHS CHC fully fund the nursing home placement and Ethel continues to be eligible.