A battle for healthcare funding.
“It has been a long, arduous, frustrating struggle. There are many others who are being unlawfully denied NHS Continuing Healthcare Funding, feel impotent in the face of intransigence from the health service and are in despair. Hopefully my victory will inspire them.”
Don Keiller, a university lecturer, spoke to The Times after the NHS was forced to pay nearly £94,000 to his mother. His mother isa 90-year-old woman with dementia, who was wrongly denied funding for her care for two years.
Don, 60, fought long and hard to prove his mother was entitled to receive NHS Continuing HealthCare Funding (NHS CHC) to meet the full costs of her care. He showed that Cambridgeshire and Peterborough clinical commissioning group (CCG) repeatedly misrepresented the evidence to deny Vicki rightful access to these funds. NHS England is now looking into the case to see what lessons can be shared.
A common situation.
At Just Caring Legal, it is common to hear stories like Don’s. We are a specialist firm dedicated to recovering wrongly paid care fees. We help families who have been denied the NHS CHC funding their loved ones are entitled to.
Many people don’t realise that the full cost of care fees should be paid by the NHS where the person eligible for care has a ‘primary health need’. A large number of people also don’t realise that savings or owning your own home is irrelevant in this case.
The NHS is responsible for paying NHS CHC where the applicant has specific needs. These are described as ‘relating to the treatment, control or prevention of a disease, illness, injury or disability and the care and after care of a person with those needs’. The Court of Appeal case of ‘Coughlan’ clarified the law. Additionally, since 2007, there has also been a National Framework in place that provides further guidance on these cases.
Across the country.
Despite this, figures from the NHS’s own data provider reveal huge variations in how local CCGs are prepared to pay NHS CHC. There has been a downward trend in the numbers receiving the funding over the past few years. This is despite the reality of the UK’s rapidly ageing population.
In our experience, many CCGs are failing to apply the rules on NHS CHC correctly. As can be seen by Don’s case. They delay decisions, misapply the eligibility criteria and ignore evidence. In so doing, they avoid paying what is needed to meet severe and complex care needs.
Do you recognise your own struggles in Don’s story? Perhaps you have been told your loved one won’t qualify for CHC. Or, that an assessment has been carried out – without your knowledge or involvement. This may have found that your loved one is not eligible. Don too was told all of these things.
We have specialist experience in pursuing these complex cases. Just Caring Legal are a strong and persuasive voice for families. We construct robust legal arguments to challenge ineligibility decisions and recover the funding they are entitled to.