By Rosalind Hughes, founder, Just Caring Legal
Like most of us, I’m feeling a bit deflated after Sunday’s disappointing defeat for Gareth and the boys. They fought so valiantly, showing courage, resilience and staying power against ever-lengthening odds. And it has made me a little philosophical. Because on reflection, I realise that those are the same qualities my clients require in their fight for the right to NHS Continuing Healthcare funding. The eligibility process for NHS Continuing Healthcare was not designed to be a battle. But sadly, that is what it has become. Clinical Commissioning Groups, who hold the purse strings, too often play fast and loose with the rules to deny funding to those who need and qualify for it.
In the face of a seemingly uncaring wall of bureaucracy, it takes guts to fight for NHS Continuing Healthcare
Just this week in a local dispute resolution meeting, the CCG representative who heard the case actually congratulated my clients on their courage. The family had stuck to their guns to appeal against a decision that their relative, Mr F, no longer required NHS Continuing Healthcare. The CCG had removed the funding even though Mr F clearly continued to present with a primary health need. This included cognitive and communication impairments, extremely challenging behaviour, a high risk of falls, intense nutritional requirements and a complex medication regime. Fortunately, we were able to convince the CCG that they had grossly under-assessed Mr F’s care needs. It took hours of evidence-gathering and Zoom meetings. And no, it shouldn’t be this hard to fight for the right to NHS Continuing Healthcare – but it often is.
The fight for the right to NHS Continuing Healthcare can be fraught with complexity
“In terms of complexity, the mental capacity required and the analysis skills needed, applying for NHS Continuing Healthcare (NHS CHC) funding was as complex as some of the nuclear deterrent policy I worked on.” So said Philip Mathias, a retired rear admiral of the royal navy who is spearheading a campaign for Judicial Review of the NHS CHC process. Mr Matthias faced a two-year “fight of his life” to get the NHS to pay CHC funding for his late mother, who suffered from severe dementia. He succeeded in the end. It’s a story similar to those we hear every day at Just Caring Legal.
But don’t be tempted to think it isn’t worth bothering to fight
Do you believe your relative has been wrongly assessed as ineligible for NHS Continuing Healthcare? Have they recently “failed” at either the checklist or the full assessment stage of the process? Or has the CCG decided following a review that they no longer qualify for the funding? Was your relative’s assessment carried out in line with the NHS Continuing Healthcare national framework? Did you as representatives get to be present when the Decision Support Tool was completed? Perhaps you feel the assessors downplayed or ignored evidence of complex and unpredictable care needs.
If so, it may be time to channel a little of that England team’s spirit. Because these are not small sums at stake. The care fee refunds we have won for clients can run into six figures. But you don’t have to do it all on your own. As Mr F’s family discovered, the right support at the right time can make all the difference. As specialists in NHS Continuing Healthcare, we can do as much or as little as you require. We will guide you through the system as smoothly as possible. We can be present at the appropriate meetings and speak on your behalf. And we can challenge officials on any underassessment of health needs, ensuring the assessment process is fully compliant. So why not call or email today and tell us your story. We will listen with care and compassion and give you a realistic assessment of your case. The initial conversation is free. So call today. Because as another leader nearly as great as Gareth once said: you have nothing to fear but fear itself.