“The evidence shows that over the past few years many thousands of old, ill and vulnerable people will have been denied healthcare funding to which they were legally entitled, a total figure probably well in excess of a £billion… This is possibly one of the biggest financial scandals in the history of the NHS.”
These are the words of Rear Admiral Philip Mathias, taken from an open letter he sent recently to the Secretary of State for Health and Social Care. Mr Mathias is an esteemed veteran of our Royal Navy; he is also fresh from the frontline of an exhausting two year battle with the NHS to secure care funding for his vulnerable elderly mother. It is a battle waged by thousands of anguished families every year.
What is the NHS CHC scandal?
NHS Clinical Commissioning Groups (CCGs) have a duty to arrange and fund NHS Continuing Healthcare for eligible individuals, regardless of whether they are in a residential or nursing facility or at home. The funding is designed to cover all daily care requirements that arise as the result of a “primary health need”.
What qualifies as a primary health need, however, is not written in stone. It doesn’t depend on a particular disease or diagnosis, for example. Instead it is decided case by case on the evidence by a multidisciplinary team of health and care professionals, supported by a dedicated “decision tool”. This is where the problems so often start.
“A blatant attempt to understate her condition”
In the case of Mr Mathias’ mother Joy, the “tickbox system ruled that her dementia-related behavioural problems did not suggest a strong enough ‘primary healthcare need’ to be eligible,” Mr Mathias said in a recent interview in the Daily Telegraph.
“Yet her care home records detail 170 incidents of serious aggression and violent assaults, including biting, punching and kicking staff, damaging property, throwing fire extinguishers and threatening a carer with a knife.
“For the CCG to then claim she only had some ‘incidents of challenging behaviour’ was, in my view, a blatant attempt to understate her condition in order to avoid categorising her behaviour as ‘severe’, which would have meant they had to recommend her for funding,” Mr Mathias said.
Joy Mathias died just hours after NHS officials finally agreed to pay for the care they should have been funding all along – her son received back pay totalling £200,000.
Do you have your own story from the NHS CHC frontline?
If so, we want to hear it. Because we may well be able to help.
Just Caring Legal is a solicitors’ firm specialising in NHS Continuing Healthcare Funding. Challenging faulty decisions like that of Joy Mathias is what we do every day of the week.
Call us today on 0191 556 1078 or email us at email@example.com to arrange an initial discussion of your case. Our expertise will maximise your chances of securing the money you need to meet your vulnerable relative’s care needs.