Here at Just Caring Legal, we get many enquiries about the possibility of claiming back care fees for past periods when they or a relative were eligible for NHS Continuing Healthcare funding but didn’t receive it. The good news is that yes, it is possible, but it depends on the particular facts of the case. Claiming back care fees on behalf of someone who has died is also possible. The bad news is, you can no longer claim back care fees for periods of care in England before 31 March 2012. The Government set a deadline for claims up to this date back in 2013. The Welsh Government, meanwhile, has stipulated that retrospective NHS Continuing Healthcare claims could cover a period no longer than 12 months back from the date of application for review. Here are some brief answers to some of the other questions people often ask .
How is a retrospective claim for NHS Continuing Healthcare assessed?
Claims are assessed by a nurse reviewer, who should look thoroughly through all care notes, health reports and records from carers, GP, hospital clinicians and so on – plus any evidence the family provides. The assessor then compiles a needs portrayal document, This should be a comprehensive picture of the individual’s needs across the whole time period. The assessor will share this with the applicant, requesting confirmation of the content and inviting any comments they wish to add. There may well be a tight deadline for this feedback. Do not ignore it as it may delay your claim further. The reviewer will make a recommendation to the multidisciplinary panel of health and social care professionals, who should accept it unless there are exceptional circumstances.
How much of a priority is a retrospective claim for the CCG?
As well as going through this process for retrospective claims, the CCG also has to deal with current assessments for NHS Continuing Healthcare. According to the Parliamentary and Health Service Ombudsman, “We expect the NHS to prioritise current cases (where the person is still alive and needs ongoing care) over past cases where there is no longer a need for financial help with care needs.”
When will the backlog of retrospective claims be cleared?
When the Government announced it was setting a deadline for claims in England, CCGs received a flood of new claims dating back as far as 2004. NHS England has imposed a deadline of 31 March 2017 to clear the backlog. But many CCGs have struggled to handle the deluge of cases – most are complex and involve gathering historical evidence from a range of sources. The Ombudsman said: “We would expect NHS organisations to keep people informed about the progress of their claim.”
What if you are unhappy with the decision on your retrospective claim?
If you disagree with the decision the NHS makes about your retrospective claim for care fees, you may be able to challenge it. Any challenge should initially be through the CCG complaints and appeals process. After that, if you remain dissatisfied, you may be able to ask the Parliamentary and Health Service Ombudsman to look into your concerns. Here at Just Caring Legal we regularly help people with retrospective claims and appeals. Fill in our initial questionnaire and we will contact you immediately to provide bespoke advice and discuss your options.